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00:00Karan Rajan, former NHS surgeon, author, social media superstar, welcome to Well Enough.
00:07Thank you very much for having me.
00:08I also wanted to include in that intro, although we did talk about it off camera, that you're the king of misinformation takedowns.
00:14So I kind of want to open with that and discuss this with you.
00:17When did you start stitching these videos together?
00:19Because now you have millions of followers, millions of eyes on you and your videos, they make sense of very complex topics in a really accessible way, which I love.
00:30But the reason I found you is because I used to watch these videos where you would take down misinformation and wellness grifters and people talking nonsense.
00:37So how did you start doing that and why did you feel that you had a responsibility to do that?
00:42Well, I've been on social media for a while, since 2010, but more about the misinformation and health giving content has been more so since 2019, 2020, because we saw a real peak in the rise of misinformation, health misinformation in 2020, coincided with the COVID pandemic, lockdown, vaccines, etc.
01:02And the misinformation around COVID was just the tip of the iceberg.
01:08And if you went a few layers beneath that, there was nonsense and wrong health information about gut health, sleep supplements, brain health, and way more child development, you name it.
01:20Any area of medicine or health or science, there was some wrongdoer giving some false information.
01:26And I wanted to use the knowledge I'd accrued and ability to look at research and counter that as much as I could.
01:32So to arm people with the right tools.
01:34I want to do maybe a bit of myth busting with you now, if that's okay, because I have come across a lot of different TikTok trends, a lot of different, you know, suggestions on how we should all be living, how we can all feel healthier in my role as a wellness editor.
01:49And some of them are an instant eye roll.
01:51And I just think total nonsense.
01:53Absolutely not.
01:54Others are more nuanced and they, you know, they could convince you.
01:57So I've got a couple here and they're of personal interest to me as well.
02:02Intermittent fasting.
02:03So I have read that for women, this is not necessarily the be all and end all.
02:09It can mess with your hormones.
02:11But I've also seen people saying, no, it doesn't really, you know, it doesn't really work like that.
02:16It depends on who you are, your body composition, your metabolism.
02:20It's not about gender.
02:21I would love to know what you think about this, because there are a lot of kind of biohacking bros online that say intermittent fasting is the one.
02:29Other people say, if you're a woman, it might wreck your hormones.
02:31Is that true?
02:32So with a lot of caveats, which we can get into, there is no, you know, intermittent fasting is not a panacea for health or wellness.
02:42And it truly does depend on how, you know, your activity levels, your background, your medication history, all these sort of things stack up.
02:50And actually, there is no significant benefit in prolonged fasting.
02:56So prolonged hours of fasting beyond the fasting that you can get overnight and short periods of fast that you can do during the day for gut health.
03:06And there's different buckets of what you're trying to achieve with the fasting.
03:09There could be weight loss, there could be, you know, relieving some GI symptoms, there could be gut health, microbiome, gut barrier health.
03:19And so there are different buckets of what you're trying to achieve.
03:22And so if you're trying to achieve weight loss, we know that at a very reductionist level, calorie deficit will allow that weight loss.
03:31And intermittent fasting is a conduit by which you can easily stick to a calorie deficit.
03:36So if you skip breakfast and then only break your fast at lunchtime, you've essentially skipped one meal.
03:43So it becomes easier to divide your calories across two meals instead of three meals.
03:48And you're more likely to sustain a calorie deficit if you're doing intermittent fasting like that.
03:52Now, for gut health specifically, there's some research suggesting that, you know, with some extended fasting, you could improve gut barrier integrity, reduce intestinal hyperpermeability or leaky gut, and increase the levels of Acomansia mucinophila, which is one of the beneficial bacteria which strengthens the gut lining and eats the mucus away and clears up debris in the cells.
04:17But again, to get those benefits, the gut benefits of fasting, if you fast overnight, you just need to bring forward your eating window the previous night and maybe bring forward your breaking of the fast.
04:28So, you know, don't eat dinner after 7 p.m., which I think a lot of people can stick to, which is also good for gut health if you don't eat too late tonight.
04:36And then if you have breakfast, say, 9, 10 a.m., that's around a 14, 15 hour fast.
04:42And that is still giving you the same benefits as a more extended fast, but it's just overnight instead.
04:48So you're not feeling hungry suddenly during the day.
04:51If you're very active during the day, you are pregnant, you're having heavy periods, you're a child, you're elderly, you're on a bunch of medications, then it becomes counterintuitive to do that prolonged fasting during the day.
05:05And if you have specific medical conditions, if you're diabetic, if you've got other issues, hormonal issues, metabolic issues, nutrient absorption issues, in those cases, something like a fast doesn't make sense.
05:18And so actually, you know, the long wind answer is you don't need to do any fancy fast or protocol to have good health.
05:26Wow. OK, this is great information.
05:28And I want to go back to what you were just saying about leaky gut.
05:33This is also a term I've had thrown around a lot.
05:35How I healed my leaky gut.
05:37Do you have leaky gut?
05:39What is a leaky gut?
05:40Is that a thing?
05:41Yeah.
05:41So the reason I use the phrase leaky gut is not because it's a diagnosis of its own, but it's a colloquialism for IBS type symptoms or some vague GI symptoms someone might get.
05:54If they've got some low grade inflammation in the gut or if there is some microbiome dysbiosis or disturbances, which could, again, provoke some specific set of GI symptoms.
06:04And it's not a blanket thing that someone can have leaky gut.
06:07Leaky gut is not a diagnosis.
06:09It's not classified as a diagnosis, but it can signify some underlying symptoms which could point to a specific GI condition.
06:16Like a lot of people who have IBS symptoms could have leaky gut symptoms that could be things like bloating, pain, constipation, diarrhea, excessive flatulence, maybe some acid reflux, a bunch of different things.
06:31And we sometimes as patients or medical practitioners or health practitioners don't know how to categorize those symptoms in a thing and then say, oh, that's leaky gut.
06:40But actually, maybe, you know, it should not be a clinical full stop.
06:45It should actually be the start of a conversation and better questioning rather than the end of the conversation.
06:49OK, you've got these symptoms.
06:51What could it be?
06:52Could it be a GI condition?
06:53Could it be IBS or a certain subtype of IBS?
06:56Could it be inflammatory bowel disease?
06:57Could it be a chronic gynecological condition with GI symptoms?
07:01So actually, that's what it is.
07:02And so leaky gut on its own, if it's really impacting someone's life and life limiting,
07:07then it should be a stepping stone to then a deeper line of inquiry as to actually what is causing that.
07:13Let's get to the bottom of what that diagnosis is.
07:16So I think it's great as well that you've stressed the question mark over that because I see videos where people say, if you have leaky gut, this is what is happening.
07:25And, you know, they're explaining how maybe something in your gut barrier is compromised and things are leaking into your bloodstream and that's your diagnosis.
07:33You can't get a diagnosis from an influencer on Instagram.
07:35So I like that you've explained that in terms of what it could be and how the term can be applied.
07:41I hope that you're enjoying this episode with Dr. Karan Rajan.
07:44If you are, please subscribe to our channel and like this video.
07:47So glucose spikes.
07:49I see a lot of videos with influencers saying, you want to prevent glucose spikes.
07:54Don't do this because it will spike your glucose.
07:56People wearing, you know, CGMs, continuous glucose monitors, because they want to stabilize their glucose.
08:02Now, from my understanding, glucose spikes after you eat and that's quite normal.
08:09But is there something bad about glucose spiking to a particular level?
08:12Is there a reason influencers are saying, let's try and control it and stabilize it?
08:17What's your take on that?
08:18Yeah, as you very well pointed out and correctly, you can get a lot of stresses on the body, physiological stresses on the body, which can cause a glucose spike, which is completely normal.
08:28Right. If you eat a meal, if you exercise, if you're stressed, the moment you wake up, there are so many different things in your body that can cause a glucose spike that is physiologically normal.
08:39And even CGMs, which people use to monitor those glucose spikes, they can have some inaccuracies because it is measuring the glucose from interstitial fluid rather than the blood all the time.
08:53And so I think what's important to take into account is that these can be useful tools.
08:59Definitely, if you've got glucose regulation issue, insulin sensitivity issue, prediabetes, diabetes, etc.
09:05If you're an athlete looking to manage your glucose load, you know, you're a high level athlete can also be beneficial because actually you're looking for those 0.1% gains and you're looking for that level of data.
09:17If you're just an interested person and you want to know how your body responds to different stresses, different interventions, different supplements and different lifestyle factors.
09:28Again, useful data points. I am never going to sway anyone away from collecting data.
09:34And this is where I've changed my opinion on that. And I believe that everyone should take as much data as they can.
09:40However, I've also seen the negative sides of obsessing over metrics when you shouldn't obsess over them.
09:47So if you overly obsess over sleep data from a ring or a watch that can provoke orthosomnia, where actually it counterintuitively worsens your sleep because you're looking, oh, I've not got enough to sleep and it can cause that sleep anxiety.
10:00Similarly, with glucose spikes, I've seen patients in clinic over the years where they've tried to increase their fat intake to cause a blunting of their glucose spikes.
10:08And the increased fat intake has caused cardiovascular issues, high lipid levels, high LDL cholesterol level, which is the bad cholesterol and an increased risk and incidence of gallstones because they've got an increased amount of cholesterol on their diet.
10:22So I've seen how it can go both ways. Right.
10:26So if you're cautious about it and know that, hey, I've just eaten this meal of rice and beans, which is a healthy, balanced meal, but that's increased my glucose levels and glucose spike.
10:38I'm now not going to worry myself and then eat, you know, a high fat meal to blunt that spike.
10:45And it's all about just having the understanding of the science and being balanced about it.
10:49So I'm all for it, but also just be cautious not to fear monger yourself about it.
10:54Absolutely. And I do agree with you on trackers.
10:56I wrote a piece about sleep maxing and how the idea that we need to optimize our sleep might cause more anxiety.
11:03I can see that we're both double tracking.
11:04So I do think that, you know, trackers are great and actually they've really helped my health personally.
11:10I have tracking to thank for many of the interventions that I've made for my own health.
11:14But I admit, you know, I did get a bit OTT with my own sleep, which caused me to write that article.
11:19So I think it's worth pointing out that we can possibly overdo it in terms of worrying too much.
11:24Yeah, I will say that. So I've been wearing this sleep ring for a while and I briefly divorced from it for the last four months because a lot of traveling, I knew I was going to be under a lot of stress.
11:37I knew that my sleep would be affected. And so it was not going to tell me anything I didn't know already.
11:42And it causes you to feel bad, right?
11:44Yeah, exactly. And so I recently started again because I've got somewhat of a routine and that's correlating with improved sleep day on day.
11:51And so I think these tracking wearables are a means to an end.
11:56Their whole purpose should be so that at the end of it, you don't need them, right?
12:00I don't plan on wearing this ring for the rest of my life.
12:03I don't need it. And I'm going to cancel my membership within the next year.
12:06However, like this watch, I wear it as a step tracker, which I will use every day and also as just like a watch and to receive, you know, messages, emails, messages, as well as just being an actual clock where I can look at it.
12:19I don't actually use this to track any sleep stuff or anything like that. It's just steps and time.
12:24Yeah, I think if you've got a good handle on it and you know how to control your relationship with it, great.
12:30My fear is that, like you say, things can get out of hand and it shouldn't be forever.
12:35Did it actually make me wonder when you said that, though, will I be wearing mine forever? At what point will I stop?
12:40It's quite an interesting thing to consider.
12:42I have seen so much about cortisol. Cortisol face, cortisol belly. Is your cortisol out of control?
12:48The reason that you're feeling bizarre as a woman and, you know, you can't control your anxiety is cortisol.
12:54We have made this hormone the devil, but it's not necessarily bad for us, is it?
13:00And, you know, is cortisol belly a thing? Maybe you can explain that for us.
13:04I mean, in specific conditions, when you have pathologically raised cortisol and that can be due to, you know, a lack of homeostasis and balance in the body
13:15or even sometimes cortisol secreting tumours. You can have that as well.
13:20And you can get Cushing's syndrome where you've got raised cortisol and that can cause excess visceral fat deposition.
13:27That would be technically like cortisol belly, I guess.
13:31So pathologically, you can get medically raised cortisol, which is not good and you need to be monitored for it.
13:36And that would be a specific medical diagnosis. That's a disease state.
13:40And that can be caused by a variety of things, as I mentioned.
13:42However, cortisol on its own, I think we like to vilify certain specific things like weight or glucose or cortisol or adrenaline.
13:53I mean, all of these things should be looked at as a spectrum, as part of a package.
13:57And we need cortisol for normal physiological function, to sleep, to wake up, to regulate our energy levels, to regulate fatigue.
14:07So it's essential. If we didn't have any cortisol, we'd die.
14:10And so it needs to be looked at in that lens.
14:14And so it is much easier to, say, avoid this, detox that, fix this, rather than having the balance and nuance.
14:23Like, well, it depends if...
14:25So actually, again, if someone is, you know, making something out to be worse than it actually is,
14:33you need to be looking at, are they selling something, are they trying to sell a course,
14:38are they trying to benefit in some way from making a problem so they can sell you a solution?
14:43This is the hill that I will die on because I do genuinely believe that so many companies are trying to make us believe that we are broken
14:50and that we need to be fixed and purified and flattened out.
14:54And that's why they want to encourage us to, you know, fix the blood glucose spikes, fix the cortisol, you know, fix all of this.
15:03But actually, a lot of the time, like you say, our bodies are really good with homeostasis.
15:07And a lot of the time, we don't need fixing.
15:08And I also think we live in this era where, I talk about this a lot, wellness washing has become a thing.
15:15And everything needs to be some kind of protocol that you absolutely need.
15:19Otherwise, you're not going to survive.
15:20You're not going to make it.
15:22And actually, I think that's slightly unnecessary and worrying.
15:25And it's now affecting people who are as young as primary age.
15:28And that, to me, is a real point of concern.
15:31Yeah, we've got a lot of protocols for everything.
15:33You've got an intermittent fasting protocol.
15:35You've got a gut health protocol, gut health resets.
15:37And it can be overwhelming.
15:40And I think a lot of the time, it just boils down to very basic foundational things.
15:46Sleep, fiber, hydration, movement, social contact, you know, just balanced nutrition, dietary patterns over time.
15:55And those aren't sexy things.
15:57We've known about these things for ages, you know, for decades.
16:00But they're not sexy.
16:01Not everyone knows what these habits are.
16:03I mean, you say we've known about them for a while.
16:05But I think that our health literacy in this country is not as good as it could be.
16:10There are a lot of people that really rely on videos like the ones that you make for this basic information that they just never got from anywhere else.
16:16You're obviously a gut health expert.
16:18And gut health is a really complex concern for lots of people.
16:23They don't understand what promotes good gut health.
16:25They don't know what good gut health looks like.
16:27It's really difficult to know, you know, oh, I should be eating more beans.
16:31People load up on loads of beans and then they feel awful.
16:34You know, how can we make sense of this?
16:36Are there any kind of hard and fast rules that you can recommend?
16:38Yeah, I mean, ultimately, there's a lot of noise out there about probiotics and this and that.
16:46And ultimately, it comes down to probiotics are guests and fiber is the rent.
16:52So most people don't have a problem with a lack of probiotics or a lack of good bacteria.
16:58They have a problem with a lack of fiber and feeding the innate endogenous microbes they already have.
17:06So it's not a bacterial number issue.
17:10It is a starvation issue and us not feeding them enough.
17:14And so our inner garden is starved, you know, as the analogy is.
17:18And I think, you know, most people could start with the most basic thing.
17:22And it's actually relatively cheap, is eating more dietary fiber.
17:26And not only the number, but the quality and diversity of that fiber.
17:30As a starting point, that is the best place you can start.
17:35And then you start to work about other things.
17:37So fiber, then you add polyphenols.
17:40Then you just learn what are sources of high fiber, snacks of high fiber.
17:45Learn how to cook.
17:47Learn how sleep is involved with your gut and circadian timing as well.
17:51So I think, you know, there's like a pyramid on which you can base your life and build your gut foundations.
17:59But ultimately, the base of that pyramid, the biggest lever you can pull is just fiber.
18:04And I would challenge most people to, you know, tell me that increasing your fiber intake over three months has not made an impact on your life.
18:16You need to give it time.
18:17If you do it for a week or two weeks, and then you say, oh, I'm more bloated, you will be.
18:22Because your gut bacteria are enjoying the feast you're providing them and churning out more gas.
18:27And they're trying to become more efficient at processing that fiber.
18:30And it takes time to settle.
18:31So actually do it for three months.
18:33Increase your fiber intake steadily, slowly, three months.
18:36And tell me you don't feel a difference.
18:38We had a nutritionist on the podcast in season one who specializes in hormone support, helping women with PCOS and other related issues.
18:46And she said that her number one go-to for women struggling with those kinds of issues is beans.
18:51So that's really interesting.
18:53I do think that there is, there's this kind of hack culture whereby someone might bypass beans and just go straight for a fiber powder or a fiber supplement.
19:03Is that going to be the same, worse, better?
19:07It can be all of the above, right?
19:10And it really depends what you're doing, what you're using it for.
19:13So there's so many use cases for, you know, a fiber product or a fiber supplement.
19:19And it really depends on your lifestyle.
19:22So my dietary intake of fiber is around 50, 60 grams a day.
19:27But I've built that over several years to get to that point.
19:29And I still take a fiber supplement in the morning with my coffee because it gives me this kind of insurance, like a multivitamin for my gut.
19:36And it gives me a baseline because if I am traveling, if I am skipping meals, if I'm going out to eat, if I'm slightly stressed and I don't make something,
19:44or sometimes I just want to have more fiber without the meal prep or the calories, I reach for that.
19:49And so I think there's lots of use cases.
19:51But even beyond that, for certain people who are on GLP-1s, for example, right?
19:57If you're on GLP-1 medication, your appetite's going to shrink.
20:01And often the first thing that's going to be cut out is fiber.
20:03And so if you've got a reduction of fiber and the GLP-1 slows your gut motility, it's a recipe for constipation.
20:11So those people, more than anyone, probably could use fiber supplements because they don't have the appetite to eat maybe a tin of beans, but they still need fiber.
20:19So in that case, fiber supplements could be a game changer for them.
20:23And similarly, if you're trying to bridge the gap between improving your nutrition, which is not going to be an overnight thing,
20:29a fiber supplement could be a bridge to that.
20:31And so there are so many use cases for it.
20:33So yes to fiber supplements, but also you could have a varied diet and not need a fiber supplement also.
20:39So you can make a case for it and it purely depends.
20:41So the only caveat I would give is that there are different qualities of fiber supplement, right?
20:47So early on, like in 2018, I remember trying lots of different fiber supplements.
20:53And one of the ones I tried, which really did a number on me, was inulin powder.
20:58Bloats you quite a lot, right?
20:59Yeah.
20:59It's a rapidly fermenting fiber and it really causes a lot of bloating.
21:04And especially if you've got sensitive guts, that can worsen it even more.
21:07And that can really put you off fiber altogether.
21:09Yeah, I learned that firsthand with inulin.
21:11Yeah.
21:11So that is what you have to take into account about the quality dosing.
21:16Is it low FODMAP?
21:17Is it this?
21:18So again, with any supplement, you need to do the due diligence and research and that has to come from within.
21:24So interesting because, yeah, obviously, I get sent a lot of supplements to try.
21:30And as part of my job, I'm really, really interested in these kind of women's health support supplements.
21:34And then you think, OK, is it menno washing?
21:37Is it legit?
21:38But a lot of these kind of women's health supplements, they contain really key ingredients.
21:43And some of them I found to be incredibly effective.
21:45But others, I noticed they do often contain a lot of these kinds of ingredients like inulin.
21:50And personally, I found that they didn't really agree with me.
21:52But eating quite a fiber-rich diet of whole foods does work for me.
21:57So I guess it's case-by-case basis, isn't it?
21:59100%.
21:59And, you know, it's about diversity in everything that you buy, everything you try.
22:04And there's no one thing which will help for everything.
22:07And if, again, if someone is taking like a supplement or a fiber supplement or whatever they're trying,
22:13that's never going to replace a diet.
22:15That's always going to be a bridge or an addition or an adjunct or, as the word implies, a supplement to dietary factors.
22:22And even, you know, diet on its own is not going to change someone's trajectory alone.
22:28You need those other foundational buckets as well.
22:30The sleep that directly impacts diet.
22:33If you don't sleep well, you're going to feel more hungry and you're going to reach for those hyper-calorific, hyper-palatable foods,
22:38which may be ultra-processed and deficient in fiber and high in fat, sugar and salt.
22:43So there's all these things.
22:44Like we need to look at the body as a collection of systems, not one discrete part which needs fixing.
22:50You were talking about GLP-1s.
22:51We're taught to restrict.
22:53But you've made a case for not restricting but adding more, always adding more.
22:57And I really like that approach.
22:59And it's not something that I come across that often because all I see on Instagram and TikTok is people telling me to cut things out or to swap for a supplement.
23:08And you've just explained that a supplement, you know, cannot be an alternative for a decent diet or all these pillars.
23:14It's, you know, what can we do?
23:15Say if we, because I speak to a lot of women who are struggling with postpartum hair loss, speak to a lot of women who are struggling with brittle nails, who are struggling with breakouts, bloating.
23:24There are a lot of these issues.
23:25Yeah, ultimately, especially for women, it comes down to like, actually, sometimes more is better.
23:31You know, whether it's more calories, more fiber, more nutrients, more polyphenols, more protein.
23:37You know, at certain life stages, requirements for various nutrients goes up.
23:41So if you're pregnant, my wife's pregnant at the moment, fiber intake, dietary fiber requirements are higher because, you know, you've literally got this thing squishing your insides, putting you at higher risk of constipation.
23:54So you need more fiber and your guts and potentially some dysbiosis.
23:58You're also needing the building blocks to feed, you know, a living entity.
24:04So you need more protein.
24:05The dietary protein should go up to roughly 1.2 grams per kilo per day.
24:09So actually more at various life stages, even menopause, same thing happens.
24:14The gut motility slows down.
24:16There's some dysbiosis.
24:17There's more tissue breakdown.
24:20So protein fiber goes up.
24:21So actually more is supportive for hormones, for normal homeostatic mechanisms.
24:27And it's actually looking holistically at those basic things you need.
24:31And, you know, to tie in together the sort of gut and sleep and other things,
24:34we know that the gut is the sort of core pillar which links other things as the gut skin axis.
24:41If your gut is, you know, in a state of shambles, you can have a higher risk of breakouts of inflammatory skin conditions, acne, psoriasis, eczema.
24:50So if you find that your skin is breaking out, there's also a high probability that maybe your gut isn't as well calibrated as you think, right?
24:58And anyone who's had breakouts of acne will be able to link certain points when their gut is kind of, you know, doing somersaults and a higher risk of breakouts.
25:07Similarly to gut and brain, you know, often there's this fog, brain fog, lethargy, low energy and low clarity and irritability you might get.
25:19That can be directly linked to gut.
25:21We know the gut and brain is linked.
25:22You know, you get nervous before an interview, before an exam, before a physical event.
25:27And you might notice some gut symptoms as well.
25:31Gut immune axis.
25:32So, again, you might be at a higher risk of infections and colds and flus when your gut isn't quite well calibrated and tight enough.
25:41Should we shift the way that we're looking after our guts during cold and flu season then?
25:45Or would that not necessarily help us?
25:47Again, it's about supporting it with things it needs.
25:50So, you know, none of these things are going to guarantee you don't get infection, but fermented foods, fiber, polyphenols, diversity, all of those things can just aid microbial diversity,
25:59which can then support your immune system because we know that the gut lining is one of the most underrated parts of your immune system that no one even thinks is part of your immune system.
26:09I also think that there are a lot of myths about, you know, like we talked about adding things in, but also eliminating things.
26:17And one of them is detoxing.
26:19And I wanted to ask you about that because I see gut detox, liver detox all the time on social media.
26:24I wonder if we can dig into that because, you know, is there a point where you should ever detox your gut?
26:30Is there a time when that might make sense?
26:34And also, are you confusing detoxing your gut with something like a juice cleanse that someone's trying to sell you?
26:38Because that, I would assume, is not good for your stomach.
26:41Yeah, I wouldn't know in what sense or scenario a detox would be an appropriate therapy for anyone.
26:49Like, you know, I'm open to being educated by someone where they could classify a detox as genuinely beneficial.
26:56But I think that just may be hyping or exaggerating simple protocols that we have.
27:02Like, for example, you know, one thing which can be highly beneficial to someone who's experiencing bloating can be to avoid grazing or snacking constantly throughout the day.
27:12Because every time you eat, you don't allow the migrating motor complex, which is the wave of peristalsis in your body, in your intestines, to clean up the debris and dead cells and microbes.
27:26So when you stop eating, the MMC, the migrating motor complex, activates.
27:31It's like this internal biological rumba that you have that sweeps up all the debris and dirt in your body.
27:37And if you clean up all the dirt and debris, there's less stuff there which can ferment, right?
27:43And this fermentation can cause gas and bloating.
27:45So if you're constantly grazing, you might have a higher risk of bloating because of that, because you're not allowing the MMC to be activated.
27:51So that is a hack or a protocol or, you know, if you really stretch the term, that's a detox in a sense.
27:58If you go to Austria and you go to one of these clinics where they put you on bone broth for a few days, is that essentially?
28:04I mean, they call it a detox, but is that essentially what's happening?
28:08You know, I think you can paint a detox in so many different ways.
28:11If it's just another evidence-based tool where maybe there's some calorie reduction and it's causing some weight loss and you get some benefit from that,
28:18or there's some period of intermittent fasting, or you're loaded with certain supplements which you were deficient in,
28:24and actually just taking you from a deficient state to a normal state and you classify that as a detox, sure, detoxes work in that specific case.
28:32Yeah, and I guess I'm also, I often come across things like, oh, you need to take milk thistle and you need to take apple cider vinegar because it's going to flush out toxins.
28:42Is flushing out toxins a thing when we talk about ingredients like that?
28:45I mean, they are, they're not clinical.
28:48They come from nature.
28:49So, you know, we know that a lot of plant-based medicine can be quite good for us, but is that going to flush out toxins?
28:54Yeah, I don't understand the term flush out toxins because actually the most powerful organ to flush out toxins, you know, is the liver.
29:02Yeah.
29:03Has over 500 rolls in the body and that metabolizes so many things which actually we don't know are harmful,
29:08but the liver is just, you know, quietly humming away doing its job.
29:11So the best thing we could do to flush out toxins would actually be to support liver health.
29:16And the best way to support liver health would be to increase your intake of antioxidants and polyphenols, which you can get from, you know, food.
29:24That's a very good point.
29:25Well made.
29:26I do, I find all of this kind of thing so interesting.
29:28And often I just really want to ask the question, is this true?
29:32Because.
29:33It's usually no.
29:34If you have to ask that question, it's usually a no.
29:35There's so much information that we get bombarded with.
29:38But yeah, the terms like, you know, flushing out toxins and detox, I get that we live in more toxic times than we ever have.
29:44You know, we've got microplastics coursing around our bodies.
29:46But I do also get quite suspicious when I see people trying to sell things like detoxes.
29:52What about red and green flags?
29:54You know, is there a way to spot someone that might be selling a, you know, a liver detox MLM versus someone who's giving you good advice?
30:02Yeah, I mean, it's hard nowadays because confidence is often conflated with something that is accurate or something which could be legitimate because people will actually gravitate to those who sound confident.
30:19Generally, science is circumspect.
30:22It is entrenched in maybes, possibilities, couldbes, canbes, risk of, all of these very nuanced terms.
30:34And it's very balanced for that reason, because science can always be disproven.
30:38It could be wrong in a few years.
30:40You know, there's all this kind of gray around it.
30:43And a true scientist will never say yes or no.
30:46They'll always be, I don't know, maybe, could be.
30:48And often if someone is leaning on binary outcomes, black and whites and hyperboles and really polarized terms, like this will fix this, this will cure this.
31:02For me, that is, there's a high index of suspicion to be like, this is likely to be misinformation.
31:09But then also using that as a springboard to do your own research.
31:12You know, none of the videos I produce online, I want anyone to take verbatim and immediately go, okay, I will do that.
31:21I just want to share interesting things with you.
31:24Go use that as a stepping stone to do your own research and come to your own conclusion and do some more deep dives into that topic, hopefully.
31:34And I've just sparked interest in fasting or hormones or pregnancy or nutrition or fiber.
31:40And that's just like, you know, a little sweetener for you to, you know, go and look into it a bit more.
31:45So, and also someone who then is trying, who stands out in a sea of one opinion.
31:53If everyone is saying one thing and someone is saying another thing, again, that's another flag.
31:58I'm not saying that they're wrong based on just that because we don't want to be sheep and just follow one thing.
32:02But again, if multiple people who you trust or who seem trustworthy are saying one thing, but some person is saying another thing, again.
32:10But nowadays, it's not just one person saying another thing.
32:12We have a million people saying a million different things.
32:15So it's very hard.
32:16And ultimately, it is, comes down to you.
32:19You need to go and fact check and cross-reference yourself.
32:21Absolutely.
32:22I mean, I always see it with carnivore diet and carnivore diet really gets under my skin because, you know, forget everything you know about what you've ever been told.
32:30Well, the food pyramid is nonsense and, you know, I did this and I felt great.
32:33And I always think, well, yeah, you felt great because you cut out ultra-processed food, sugar, all the things that, you know, were making you feel bad.
32:41But you're not going to feel great long term on this diet.
32:43It's not that good for you.
32:45And, you know, I've fallen out with the carnivore influences before.
32:48It's fine.
32:50I'll stick my head above the parapet there.
32:51But I find things like that and, you know, these kind of overblown huge statements where people say, forget everything you know about this.
32:58This is the way forward.
32:59I just think, sounds like a cult.
33:02Yeah.
33:02I, we don't have long term studies on the health effects of carnivore meat only diets.
33:09But it stands to reason that given how important fiber is for microbiome health, it doesn't make sense that most humans would do better on a carnivore only diet long term.
33:22I've tried the keto slash carnivore diet when I was in my early 20s and I felt good.
33:28I lost weight rapidly and I felt more alert and full of energy for a couple of weeks.
33:35But then a quickly constipation, bloating and general fatigue over the next few weeks.
33:41And I continue to lose weight.
33:43That also plateaued off for a few months.
33:44But, yeah, it just, it's, it wasn't the way for me.
33:48And, you know, that was a very dark period in my history or nutritional history.
33:52I've done all the diets over the years.
33:54And, you know, it's all about adding things in and just being balanced.
33:57Like, you know, a Krispy Kreme doesn't make or break your, you know, entire dietary pyramid or life.
34:05And, you know, I think your gut microbiome and your health internally is agnostic to individual foods.
34:12It doesn't care about the passport of individual ingredients.
34:14It looks at the trajectory and patterns over time.
34:17Yeah, I mean, I went down that rabbit hole too.
34:19There was a time I was obsessed with keto many years ago, but I have since become wiser.
34:26A very, very large percentage of women are now looking to social media for help because they're not necessarily feeling that they are being served by medical professionals.
34:35And I remember you did a brilliant video about how to advocate for yourself when speaking to a doctor.
34:40I think the reason we see so many of these kind of women's health coaches and these kind of intermediaries are because women struggle with not feeling heard.
34:51We know the gender pain gap is real, that women aren't necessarily being taken seriously when they go to a doctor with symptoms.
34:57And, you know, that becomes even worse when we're talking about women of color.
35:00You know, those rates of not being believed increase, which is, you know, unthinkable, but it is the reality.
35:06So I really want to ask you a bit more about that video and also about how, as both a medical professional and an influencer in your own right, you know, how do we help women in these scenarios?
35:16Because they are coming to social media now looking for answers.
35:19If you want to advocate for yourself, you first need to reframe that being persistent is not being demanding or difficult.
35:28You're advocating for your health.
35:31And so that is a simple clinical fact and a clinical need.
35:35And historically, women have been socialized to downplay pain, to accept vague reassurance and to delay care.
35:46And all of that is a perfect storm to being mistreated, misdiagnosed, underdiagnosed, or overdiagnosed with the wrong thing.
35:54Someone can be overdiagnosed with something like IBS, where it's actually something like SIBO, you know, small intestinal bacterial overgrowth or inflammatory bowel disease.
36:05And someone could be underdiagnosed with endometriosis and in fact labeled as irritable bowel syndrome or acid reflux or something like that.
36:13So, you know, I think in terms of advocacy, one thing I would always advocate for is actually going to an appointment with someone else if you can.
36:23Because number one, you have an independent adjudicator there that can limit any unconscious bias that in the heat of the moment can help you to recall useful information and can also advocate on your behalf as well.
36:38I think that's a really useful tool because, again, it's not like a confrontation between patient and doctor, but it's always useful to have someone there, to be someone independent who's also on your side, on your court.
36:52And secondly, I would say to document things and to really use specifics.
36:59So instead of saying things like, you know, this has really been troubling me for a while, get really hyper-specific and data-driven.
37:08This has been impacting my sleep for six months and I find it worse when this happens.
37:14It's improved by this or I can't go to the gym because this is impacting this and really getting hyper-specific and documenting how long, when it happens, you know, exacerbating factors, relieving factors.
37:30If you are data-driven, data is undeniable.
37:34You know, it's inevitable that if you go with data, that cannot be dismissed.
37:37Not that anything should be dismissed, but it really helps your case and also gives a burden of results to a doctor that they have to then look at that, analyze that, and then go down a certain route.
37:51And actually, asking for second opinions, being vocal, again, is not being rude or confrontational.
37:57If, for example, a doctor, a common response may be, oh, it could be stress, it could be anxiety, it could be this.
38:05Yeah, maybe it is in some cases.
38:06You know, the anecdote you told me, a doctor told you to walk more.
38:09That might sound dismissive and you walked more and it did help.
38:12So, yeah, in some cases, it may be psychological, but we shouldn't psychologize everything.
38:18So a reframe could be, I appreciate that my symptoms could be related to stress, but I also wanted to explore other physical symptoms.
38:25What are some potential diagnoses that you're looking at or what could certain blood tests reflect or what are certain blood tests we could do to see if, you know, this can be ruled in or ruled out?
38:36What do you think about the utility of these scans?
38:40Can I get a referral to this specialist?
38:43What do you think about that?
38:44If they refuse that, you can ask, could you just maybe document that in my record that I have requested this referral?
38:50All of those things are not confrontational.
38:53They're not aggressive.
38:53They're just you advocating for yourself.
38:55At the end of the day, you're just trying to be heard.
38:59You're trying your symptoms to get out there.
39:01And if you need to use these reframes, which are very polite and just very matter of fact, then so be it.
39:07And, you know, there's a list of things that you could do.
39:09And when you come to the table with certain specific things, it triggers the doctor to go down a certain algorithm.
39:18And I can say this as being on both sides, being an advocate for my own health and family's health and being a doctor as well.
39:24If I say to a doctor, I've been experiencing this for six weeks every single day, that's going to trigger a different algorithm in my head as a doctor than if I said six days, for example, or didn't give a numerical value.
39:37Because is that acute?
39:38Is that chronic?
39:40So all of these things matter.
39:41Data matters.
39:42And also, I love the fact that you were, you know, talking about pushing for more testing or, you know, more analysis or thinking about things in terms of specifics, because there's a lot of onus put on the individual at the moment.
39:54The idea that, you know, we should be tracking, we should be looking after our self-care, we should be doing this, that, the other.
39:59And, you know, if someone is genuinely really unwell, you know, they've got a chronic illness, you know, a wellness protocol, yeah, it might help them.
40:09But ultimately, they, you know, they need that professional care.
40:12And I think often we can sweep people like that under the rug by assuming that wellness will fix everything.
40:18You know, some people really need clinical care.
40:20So I think being able to understand how to push for that and how to advocate for yourself is so important.
40:25So you bringing those tips is super essential.
40:28Thank you for doing it.
40:29I always ask my guests for their one wellness non-negotiable and their tip for feeling well enough.
40:34The whole idea of this podcast is that we can help people get to a phase where they feel they are doing enough for themselves.
40:40And it doesn't have to be perfect.
40:42And it certainly doesn't have to be super complicated.
40:44So what would your one tip be?
40:46When it comes to health, I mean, I'm very, very biased because it's a personal and professional passion of mine.
40:52But, you know, a lot of people are genuinely fiber deficient.
40:56And without fear mongering people, that is the cheapest and easiest thing that you could literally do today.
41:04And unbeknownst to you, start feeling and having benefits within 24 to 48 hours.
41:11We have research suggesting that if you have a high fiber intake today, your microbiome will experience changes within 24 to 48 hours.
41:19So literally what you eat today will determine your gut health in one or two days time.
41:24And I think that's quite powerful to have that immediate impact.
41:27And even though you might not see or feel it, it's actually happening on a microscopic level.
41:31So whether it is literally going out and researching what are high fiber foods.
41:37Most people, if you ask, if you stop someone on the street, I guarantee you the average person would be able to easily rattle off three high protein foods.
41:45Salmon, eggs, chicken.
41:47Boom, done.
41:47But if you ask them to name three high fiber foods, they would struggle.
41:51They would pause.
41:52They would think.
41:53Maybe they would say beans.
41:54But then they would struggle after that.
41:55And so I want to arm people with the knowledge of a battery of things that they could have.
42:01Popcorn's high in fiber.
42:03Dark chocolate's high in fiber.
42:04Edamame's high in fiber.
42:05Chia seeds.
42:06Nuts.
42:07So many random things which you don't think about high in fiber, which are.
42:11So that would be the number one tip.
42:13Go and have a read of what is high in fiber and slowly aim for getting over 30 grams a day.
42:19Forget the 30 gram limit.
42:21That's a baseline.
42:21You need to get above that bar.
42:23Dr. Karim Rajan, thank you for all of your tips and for joining me on Well Enough.
42:27Thank you so much for having me.
42:28Thank you so much for having me.
42:29Thank you so much for having me.
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