William Chatterton transcript

Written by Christopher Kelly

March 4, 2016

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive Podcast. My name is Christopher Kelly and today I've got not one but two guests for you today. The first is my 12-year-old nephew, William Chatterton. Hi, William.

William:    Hi.

Christopher:    And the other is one of my more regular guests, Dr. Tommy Wood. Hi, Tommy.

Tommy:    Hi.

Christopher:    We've got kind of an interesting project to do here today. Wills is doing something for school and we thought this list of questions that he had for Tommy would make a rather interesting podcast so maybe you can let me know after the show whether it was interesting for you or not. Certainly, the list of questions is very interesting for me. We're going to talk about how diet can affect your cellular health.

    Cells, I think, are super duper interesting. The levels of organization in physiology, it reminds me somewhat of computer science. The most basic level, there are atoms and molecules and macromolecules, and then just above that there is the cell and the cell is the first thing that can sustain life. The interesting thing about the cell is that that's what we are. We are just a hundred trillion cells, a big bag of cells so when something goes wrong and you walk into the doctor's office, you may be complaining about a migraine or fatigue but at some level what you really care about is the cell.

    I'm hoping that the questions that we're going to answer today will be relevant for you if you're suffering from a problem or if you're trying to improve performance. I think that cellular function and cellular health and how it relates to diet is a really important topic. So what do you think? Should we just dive straight into the first question?

William:    Yeah. Sure. The first question that we have here today is: can your diet affect the starting health of new cells that are constantly growing?

Tommy:    Yeah. Yes. Yes, it can.

Christopher:    Next question. No. Just kidding. Perhaps you'd like to elaborate further, Tommy.

William:    We're constantly growing cells regardless of our age. If you think about when the baby starts in the womb, you basically have to create everything from scratch but even now we know that even as you're older that there are cells all the way throughout the body which you replenish over time. The gut is replenished very frequently. There's a very, very rapid turnover, what we call it, of cells in the gut. There are certain areas of the brain where even as we get older we can make new cells. So we're constantly having to do this. At the same time, we're also breaking down also in getting rid of old junk. Various things we do in the diet can also help us do that.

But if you are trying to create new cells, you obviously want all the building blocks that you use to make those cells. That's going to be various types of fats, proteins, carbohydrates, all those things you talked about, and you want those to be made in the way that you intended, right?

You and I, Chris, have talked a lot about things like we want measured markers of something like DNA damage.

Christopher:    Uh-hmm.

Tommy:    DNA is obviously the main message that's used to tell the cell what it's making basically. That's the code that tells us what's going to be in that cell and how it's going to work. In order for that to happen you need the DNA to work properly and for that to happen then you need all the sub-parts of DNA but you also need to make sure that DNA doesn't get damaged.

    There're many ways that DNA can get damaged in terms of we talk about information, oxidative stress, those kind of things that can come in particularly from the diet so, say, if a diet is very high in fats or oils that we have heated to a high degree to fry things in, then we know that they can cause damage to the DNA and then you're not going to get the cell to make the proteins you want so it's not going to function properly.

    On a different scale, you might say there are various other things that you need for sub-parts of the cells, say, the mitochondria, to work properly. You need to get those from the diet so another thing might be DHEA which is an omega-3 fat which we know is very important for the membranes, particularly in the mitochondria so they function properly. If you don't get enough of that, then you get a huge host of downstream effects.

    Basically, a larger part of it comes down to you are what you eat, right? So if you want to make healthy functioning cells, you need to eat and provide all things in order to make those cells.

Christopher:    Okay. That's interesting. There are certain types of fats then that you think cause oxidative stress. How do we identify those and avoid them?

[0:05:00]

Tommy:    The fat story is really interesting and has multiple different facets to it but the simplest way to think about it is the fact that the – we talk about how saturated a fat is or isn't so we have saturated fats and that's basically where you have the length of your fat is made up of carbon molecules and they are attached to lots of hydrogens and various other things depending on the fats. If there's no extra space we call them, no extra space for bonds or no double bonds in that fat, they're not saturated. What's good about that is there's no space for that fat to become damaged.

But if you have an unsaturated fat – and that's a fat that has one or more double bonds in it, and those bonds are basically somewhere where there's a possibility that something can come in and break that open and that can create something called a "free radical" which is basically an unpaired electron which then goes and attacks things. That's part of what we call "oxidative stress."

If you have an unsaturated fat, the more unsaturated it is, usually the less stable it is. Then if it's less stable, then you don't want to do things to it that damage it like heat it up. One thing we have been told recently is that unsaturated fats, polyunsaturated fats are very good for us and they tend to come from vegetable oils if you're taking them in high quantities. The first thing we do is we heat them up to 350 degrees and then drop stuff in them to deep fry it.

Christopher:    Yikes.

Tommy:    You can measure the breakdown products of these fats. We know that the higher the temperature and the longer you're heating for, the more damaged they become. What's interesting is that fats that are in vegetable oils, the omega-6 fats, also when they're in the body, whether they're damaged or not in the first place, when they're being carried around in the proteins that go around in the blood, they're not very well protected so they're also more likely to then become damaged in some way and then cause problems.

    That's slightly different from the omega-3 fats which we hear a lot about in conjunction with seafood. They are also polyunsaturated but there are actually some proteins that protect them slightly better so then once they're in the body they are less likely to become damaged than something compared to like an omega-6 fat that you might find from vegetable oils.

    If one of the first steps you want to do is try and remove a fat that's going to potentially be harmful in some way, stop by removing all those very highly processed oils. If you are going to use them, don't heat them up but ideally you want to probably remove as much of them as possible. I mean, if you really want to boil it down is don't eat deep-fried stuff. Yeah. That gets you a really good path on the way forwards.

    Did everything I say make sense, Wills?

William:    It did. Indeed.

Christopher:    Can you understand that? It's not that hard to understand, is it? This concept of saturated fat? It doesn't confuse people. I know there was a drive to say things like "white solid fat" because "unsaturated" and "saturated" were too big a word for people to understand but I think we get it.

William:    Yes. I know we've already covered this quite a lot, Tommy, but how direct do you believe that the link between cell health and your diet is?

Tommy:    I think it's incredibly direct. Now, if we're going to talk about things that are important for cell health, then food is absolutely up there, one of the most, if not the most, important part of the health of your cells.

    However, this is something that I try and talk about a lot is that there are lots of other things that are also important in terms of your exposure to light at the right or wrong time of day, stress, making sure you sleep properly, making sure you're part of the right kind of group, social group, family group. All of that affects how our genes express and how our cells function.

    Some people want to say it sounds crazy, that if you get a little bit stressed they're not going to affect the health of your cells, but the downstream effects of long-term high levels of stress really is reduced function of your cells. So food is incredibly important but if people focus just on food, then they kind of miss some of the other really important stuff.

Christopher:    That can be really important, right? That can make or break people. I mean, certainly that was the first thing that I discovered and I know it's the first thing that a lot of other people discover is the food part. It makes a huge difference but it's a bit more complicated than that, right? There're other things that can affect cellular health too. You can have the best diet in the world but if you're incredibly stressed out because something bad's happening to you, perhaps you're in a toxic relationship or perhaps you're completely isolated from a social group or not sleeping well, then that can have just as big as impact as the diet can.

[0:10:29]

Tommy:    Yeah. That has good and bad sides to it because everybody wants just one thing that they can fix and that solves all their problems. You might say, oh, well, you don't, you're not part of like a good social group and therefore you're doomed and then you're like, well, how on earth will I make all these new friends? That's difficult.

But equally on the other side you could spend hours of your day worrying about every single thing that goes in your mouth, or maybe you just go and give your mom a hug –

Christopher:    Aw.

Tommy:    -- and that has a similar effect. I am now just going slightly further up north in Norway where my stepdad and my mum have a house and the first thing I do is give my mum a hug and I've done my cells a huge load of good.

Christopher:    Every parent listening to this interview is hoping that their kid turns out like you, Tommy. Like, I want him to be a doctor and I want him to help people and then I want him to earn a Ph.D. and then I want him to win a Nobel Prize and take down the whole of the medical establishment and show how wrong they are. It seems reasonable expectation, don't you think?

Tommy:    Oh. Well, yeah. I got most of them so far. We're making progress.

Christopher:    You're about three-quarters of the way there I would say.

Tommy:    Yeah. Yeah, right. Done the easy stuff.

William:    The question that we have is: what is the most nutrient-dense meal that you could eat for an increased cell health?

Tommy:    Yeah, I was thinking about this. Probably the most nutrient-dense meal I can think of might not taste very good because it would probably be some kind of combination of small fatty fish so you've got lots of DHEA and also micronutrients like selenium and iodine and things like that. Maybe if you had a very small fish like a sardine then you'd get some of like the skin and bones and stuff in there and there's lots of collagen and good stuff in there. So maybe some cooked small fish then maybe something like some eggs with some egg yolks or some liver and then a good amount of some really dark green leafy vegetables, and preferably some grown out in the wild because we know that plants that are forced to go and grow out in the wild have more of those things that stimulate our body to have sort of beneficial adaptations and so they're probably better than what you might buy in the supermarket.

But supermarket bought kale or spinach or red cabbage, all those things would be good as well. So some of those animal foods and then some of those sort of like plant foods to go with them, that's what I think. But fish plus liver, maybe not everybody's favorite combination.

Christopher:    I'm not sure I am happy either but you can too. I definitely have had a salad with some cooked greens in it, and then a can of sardines and then some liver pate. Julie makes liver pate quite often and so I'm pretty close to getting all of those things.

Tommy:    How's the new surf and turf?

Christopher:    Exactly. New surf and turf. Excellent. That's a really good answer. How about you, Tommy? Do you ever eat anything like that?

Tommy:    Do I? I eat a lot of those things but I never had them in one meal. Yeah.

Christopher:    Okay.

Tommy:    If I had to go for one single meal, I've never done that. But I'm not particularly squeamish about mixing foods or eating certain foods at certain times of day so if somebody put that in front of me, I'll definitely eat it.

Christopher:    Yeah. I'm the same actually. It's really helpful, isn't it, to not be: oh, well, I couldn't possibly eat that for breakfast or I can't eat that for lunch? That's really limiting and getting away from those constraints I think is really helpful.

Tommy:    Yeah. When you're trying to sort of overhaul what you eat and you have this fixed image that breakfast has to be cereal or toast or often has to be sweet in some way –

Christopher:    Right.

Tommy:    Then that kind of really limits you in terms of the different things that you can eat instead.

Christopher:    Yeah. People get over that really quickly. It's nothing too much to worry about. Okay. Well, on to the next question then, Wills.

William:    My next question is: how do you think the ketogenic diet would affect the cells? So more high-fat foods as you mentioned earlier.

Tommy:    There's obviously both for you, Wills, and anybody who isn't certain at home is obviously various different steps that you can take there. Adding fat into the diet doesn't necessarily make it ketogenic but there can often be some benefit there and often, at the same time, you'll be reducing your carbohydrate intake. It usually is what you're swapping out in order to add more fat.

[0:15:14]

    That can kind of increase and increase and increase until the point where your carbohydrate – and usually they have to reduce protein and take a little bit such that some of the fats that you eat as well as maybe some of the fats that are released from stores in the body are turned into ketones. That's what we call a "ketogenic diet."

    There're multiple facets to a ketogenic diet. There's definitely a huge amount of research suggesting that probably for everybody and certain people with some kind of diseases that more or less time eating a ketogenic diet or being in ketosis is a good thing.

    The ways that that happens I think is firstly off, when you go on a ketogenic diet, it's often very similar to something like what Chris eats which is very low in refined carbohydrate, some proteins, some animal foods and lots of fat and also lots of vegetables. Not everybody does it but I think that that's always going to be a benefit, and what you've done is you've immediately removed all the crap, right? You've gotten rid of those vegetable oils we talked about, you've gotten rid of the donuts and the pancakes and the bread and all those things that we know can cause problems with hormone signaling, incident signaling particularly in probably, say, in combination with somebody who has also got all those other lifestyle that we talked about that they're doing those things wrong as well then those big swings and blood sugar can affect the way the proteins in our body work and all those kinds of things. So we've taken those things out.

Also, if you're in ketosis, then what you see is in the short term very interestingly is you'd probably get an increase in oxidative stress, particularly in the mitochondria which are like the powerhouse of the cell. We call them – because that's what they make – ATP. That's the energy currency for our cells.

In the short term, maybe in the first one or two weeks, when you're in ketosis you have an increase of oxidative stress. Everybody has always taught that oxidative stress is a bad thing. We talked about those free radicals. They can go and damage stuff. But, actually, [0:17:40] [Indiscernible] species also act as signaling molecules in the cells. They kind of tell the cell to do different things. You need some but you then – it's like the Goldilocks effect so none is bad, just enough is good, and then too much is bad again. What happens is that that increases and then the cell adapts to it and then you actually get an increase in lots of things that make your mitochondria function that allow you to then adapt or absorb oxidative stress from other places.

The way the ketogenic diet works is probably on multiple facets and probably even ones that I haven't mentioned all that we don't know about yet but it usually comes from both improving the quality of the diet and then ketones can do all kinds of things like downgrade inflammation or inhibit inflammation and then boost the way the mitochondria work, make them more efficient which is creating a healthy population of mitochondria that are all very similar and all function together is probably the goal of all of the stuff we're trying to do in order to become healthier.

Christopher:    So you're saying that in the beginning, the ketogenic diet may cause more oxidative stress but later on, once you become adapted to the diet, there may be less.

Tommy:    Yes. That's what we see from animal studies certainly when we put them on a ketogenic diet in the short term. You'll see some people say ketogenic diet is bad for you because you get an increase in oxidative stress. In the short term, that seems to be true, at least for most of the animal studies. But then there's an adaptation. You get an up-regulation of lots of genes to do with antioxidant handling so more glutathione, more ability to then absorb those stresses and an improvement in mitochondrial function. If you consider oxidative stress to be purely a bad thing, then the ketogenic diet might turn out to be overall bad, but in reality it's probably a stressor in the short term that gives your body a beneficial adaptation later on.

Christopher:    Just to kind of ask that same question, just tell me what to do. What should I do? Do you think everybody should be eating a ketogenic diet or do you think that's about it?

Tommy:    I don't think everybody should be eating the ketogenic diet, and certainly not all the time.

[0:20:02]

    There are some other things that happen. Your electrolytes, so your sodium and your potassium and other things like selenium, they become harder to hold on to. People can become deficient in those things on a ketogenic diet. If you have problems with other hormonal signaling things, then the extra stress of the diet can be a problem. But I think if we're all going to have a scenario where we're functioning optimally, we should spend a period of time in ketosis either through just complete fasting or restricting carbohydrate, and then also spend more time eating high levels of carbohydrate.

If we really want to take it one step further, we might want to do it in line with how we found foods in nature previously. The way people like to think about that is in the winter, you're probably eating meat, animals, whatever. You might hunt whatever was hibernating in the cave next door and you manage to kill while it was sleeping or whatever. In the summer, then you've got more access to carbohydrates because fruit grows on the trees and berries on the ground and things like that.

The best way to do it is to time that with the seasons. We talk about seasonal food but then everybody just buys what's in season in a country on the other side of the world. The optimal thing will be to time all those things together and that will kind of tie together a lot of the problems that we think people are having.

Christopher:    Excellent. Did you have any other questions, Wills, about the ketogenic diet? Are you sold on it? Are you going to start eating a very high fat, low carbohydrate, moderate protein diet anytime soon?

William:    Well, in my household, we do tend to eat quite a high fat diet. We don't eat gluten and we have less dairy than everybody else so almost but not quite.

Tommy:    That's fine, Wills. I'm sure you guys are doing it just right.

Christopher:    I think so too. Oh. Why don't we move on to the next question then, Wills?

William:    More than half of past major events in how we have changed in how we ate, our next question is: what happened to our food on diets between the Paleolithic era and what you might call today the "food pyramid"?

Tommy:    Yeah. This is something that is still a very hot topic of debate. Actually, there's a talk, there's a lecture here in Oslo by somebody next week that I'm going to go to. The title of the talk is something like – it was basically rubbishing people who were talking about the food that we eat is we have all been using that to inform how we should eat now and they've decided that that's a whole bunch of nonsense. I'm going to go and see what they've got to say.

    This is still something that's hotly debated. A lot of it has to do with, say, carbohydrates so how many carbohydrates you have access to and when we started to eat them. This particularly ties into when we started using fire and when you have fire then you can cook things, and when you can cook things there are more things that you can eat.

    A part of the thought process is that the reason we evolved the way we did is because when we started to get access to fire, then we could cook food and get so much more out of it than we could before. A large part of that is again DHEA that I talked about earlier. We think that some of it came maybe from people who live near the sea, could get access to fish. But we also know from some research that people have done more recently is that if a tribe didn't live anywhere near the sea, they managed to get their DHEA other ways and the way they did that is from the brains of animals. If they didn't have access to big animals, then they'd go down to the villages of the people who did have access to fish and they'd eat their brains because their brains would be full of DHEA.

Christopher:    Oh, my lord.

Tommy:    That was definitely very important, and cooking meat was probably part of that because it helped us digest it and get the most out of what we were eating.  

    The typical storyline is that around 10,000 years ago, we became agriculturalists so we started farming basically. We learned how to grow and cultivate seeds and grasses like wheat.

[0:25:02]

    In a lot of places, immediately after we did that, health – if you look at one region of…

    

    You can take any region in the world where you have a fossil record that has people before and after the onset of the agricultural revolution we call it, or people just basically starting farming and then basing most of their diet off what they could grow. That was often wheat and large volumes of carbohydrates from that one source.

    Often, when you see that and you have that direct comparison and you see the people got shorter, slightly shorter, and they seem to have worse – you can see it from their teeth. They have worse dental health and some other problems and they maybe had more infections and things like that.

    We can't say that that was definitely the course. I think part of it is not just the fact that wheat is evil necessarily and nobody should eat it, but it's the fact that when you only –

Christopher:    Can I just interrupt you there and say that wheat is evil and nobody should eat it.

Tommy:    Fine. That's something – yeah.

Christopher:    I'm just joking.

Tommy:    Plenty of people believe that. I think for a lot of people and probably more people than some people say that you just shouldn't eat wheat. Well, there's no benefit from it. I don't think there's any benefit from it but how evil it is for everybody is a matter of debate. We'll put it that way. I mean, you gain very little from it. Probably nothing and it may even be harmful for a good proportion of people.

    But I think where the real problem is is that when you learn how to cultivate wheat and you used to spend all your time scratching in the mud for tubers and foraging berries and going out and hunting whatever animal it was you hunted, all of a sudden the food just turns up right in front of you, right? So then all you eat is that. I think then that becomes a problem. So whether the wheat on its own was a big problem or whether it – you completely change the way that people approach food and then I think that becomes a big part of the issue.

As we sort of went from the Paleolithic into the Neolithic era, then we know that people started farming and we had a lot of crops. A lot of them were sort of grains or were grain-based.

Much more recently, talking about the food pyramid, in 1980 was when we had the first dietary guidelines in the U.S. The base of the pyramid was again grains. There's a huge amount of debate about why this was but part of it was because you had what was still a relatively poor country. In the run up to the formalized food guidelines and people being advised to eat things, grains were said to be the staple because it was something that the government could easily subsidize and could then be provided cheaply to a very large population. It was based on convenience rather than for optimal health.

There were some other things like people thought that saturated fats were bad and that kind of lent itself to people moving towards that kind of diet. At the same time, obviously, since the 1980s, since those dietary guidelines came into play, we've had around that time – and maybe ten years before – people were, because of the saturated fat story we were talking a lot more about, polyunsaturated fats because if you eat a lot of vegetable oils, your cholesterol comes down. We thought that cholesterol was bad and caused heart disease, therefore polyunsaturated fats are good for you. That was the way it was sold.

But because for a number of different reasons we talked about earlier, vegetable oils, polyunsaturated fats can be bad. I really think that kind of killer combination of a high processed carbohydrate intake plus vegetable oils and plus more and more refined sugar which is part of that sort of carbs deal, and at the same time we're not eating all that good stuff that we talked about from animals, those nutrient-dense foods, we don't eat those, we don't really eat any plants, we don't eat any vegetables…

There's been a huge shift from those foods that we used to have to go out and really work hard to get to this sort of really detrimental mix of nothing. It's not really useful to you in any way other than the fact that it is calories. I think it's 70% to 80% of the calories in the western world come from wheat, corn, and soya. That's what we eat, that kind of beige processed food. As soon as you think about that, you realize why we're in so much trouble.

[0:30:18]

    

William:    Just another question here. Do you think that the food pyramid would be changed soon or…

Tommy:    There's a huge number of people who are working really hard to try and get that done. There's a big movement in the U.S. and there's a movement that is just dying to be put together by some good friends of mine in the U.K. They're trying to do something similar.

    I think it's incredibly important but it's not necessarily important because it won't change the way people eat. I don't really believe that people eat according to the food pyramid but I believe that the food pyramid is used to create the foods that we then eat because then you can say that this is high in healthy whole grains and healthy vegetable oils because that's what the food pyramid says.

    I don't know anybody who looks at the food pyramid and says, "Well, do you know what? I haven't had my base today of grains. Therefore, I can't move up to the next step" or level of the pyramid. I don't really think anybody thinks like that but it all kind of informs the food that is created and then put in front of us.

    I think it is really important but there are a large number of people who are also working really hard from the other side. There's a number of reasons that almost all large countries, specifically in the western world, heavily subsidize their farming. That is largely crops and then also dairy.

There will always be a huge pushback from any kind of industry that is heavily subsidized by the government. If you then want to say: if the government guidelines changed overnight to say that people shouldn't eat grains, there will be complete and utter uproar from every level – from the farmer himself because obviously his income is going to be slashed and that's an incredibly important thing that we must take into consideration. I don't want this guy to starve. But then there's also all those people who make the food that you can make out of wheat and corn and soy which is most of the food that we eat today.

There're a huge number of vested interests and then also a number of nutritionists who have decided that things are the way that they are and they should be and should stay and that they're the expert and you have to listen to them and anybody who doesn't listen to them is full of shit. While they're in positions of power, their kind of hubris is going to stop us being able to make any changes.

The long answer to your question is: people are trying but I'm not sure it's going to happen any time soon. But in the U.S., they recently changed the guidelines to reduce the wordings around saturated fat, taking away that things just that it's bad for us and we should be really cutting it out or really reducing it in our diets. They've also removed dietary cholesterol. Things like eggs have a good amount of cholesterol in. They've removed the caution there that eating those might be bad for you. So, baby steps.

William:    Just recently – well, maybe a week ago – on your website, you released a couple of talks from Iceland. Some of the answers and questions were based around the Terry Wahls diet.

Tommy:    Yup.

William:    What is your personal opinion on that?

Tommy:    Okay. We're talking particularly about one talk I gave about multiple sclerosis which is Terry Wahls' area of interest. It's also the area that I came into this whole scene with.

    Terry Wahls has kind of become – she has essentially dramatically improved her health and reversed her multiple sclerosis largely through diet and also some other things like she had to do some electrical stimulation of her muscles to kind of get her strength back so that she could get out of her wheelchair.

    I'm a huge, huge fan of her diet. The reason why is when I talk about multiple sclerosis, I talk about what we did. I have a family of chemical engineers. My stepbrother has MS, and my stepfather is a chemical engineer. All he knows how to do is make models of problems to try and solve the problem, right? That's what chemical engineers do, probably better than anybody else in the world. They're problem solvers. That's what they're taught to do.

[0:35:17]

We basically built this huge model of multiple sclerosis to try and find out what the causes were. One of the things that's really important is diet. That comes in two parts: take out the things that are bad and putting in the things that are good. What that ends up looking like is very similar to a Paleo style diet.

People with MS almost always have an inappropriate reaction to grains, particularly gluten; and dairy, particularly casein protein but also some other proteins and dairy. But you also just have, say, mitochondria that really aren't working properly so you need to give them all the things that they need to work properly. What ends up looking like is a lot like a Paleo diet and then there are other things that you can do. You can take out some other problems foods.

I know that Terry Wahls' approach toward the end moves towards some periods in ketosis because that's really important for brain health and brain function is getting some ketones to the brain if in the diseased state. The reason why I'm a big fan of her approach is because it's very similar to what we found but we did it in two very different ways at very similar times. If two groups of people get the same answer to the same problem using different methods, I really think that sort of bolsters the evidence behind it.

So I always mention her work at the end of my talks because we give very, very similar advice and I think it's really important to show people that lots of people have asked this question and if you come up with the same answer then I think that really increases, say, the credibility or the likelihood that what we found is right.

William:    Yeah. Yeah.

Christopher:    Do you mind if I jump in here, Wills? I'm going to steal your next question because I can't help myself. Do you think that Terry Wahls did any of this work for herself or do you think she just highlighted other people's research and ideas?

Tommy:    Yes. When I read this question before, I thought it's such a good question. I think it's so, so important in this whole kind of area. In reality, there's the quote that there's nothing new under the sun, right? Every idea that you have, somebody else has had already. They may have not acted on that idea but that idea has already come and gone.

    I really fight this in myself all the time because I've had this really, really good idea and I don't want to tell anybody about it because then they might steal it and do something with it. I think that's just a very natural human reaction but I also probably have other ideas somebody else has had; they just haven't applied it in some way or maybe I had this idea but I actually heard it from somebody else then forgot about it and then thought I came up with it by myself.

    The important thing is that, yes. Terry Wahls has taken a huge amount of research and used it and is then applying it to other people. But if all those ideas weren't being used in the way that she is now using them or they hadn't been properly applied -- she's the first person who's applying all these different principles in patients with multiple sclerosis in clinical trials. She tinkered with all this and used it on herself so she learned from other people, she had gathered other people's ideas, she used her own self as a guinea pig, and then is now applying it to other people.

    So, yes, I think every person who's in the health field and most other fields has taken ideas from other people and just built upon them. I think it really depends on how you look at the question. Did she have any super novel research that she did by herself? No, not really. But she's achieving incredible things by putting together a program based on all these ideas that kind of answer the question as a whole. So yes and no.

Christopher:    She's not the only one, right? I had tremendous results eating according to the Autoimmune Paleo Protocol which I don't believe was invented, but certainly was popularized, by Sarah Ballantyne or The Paleo Mom. It's just the same thing all over again. Did she start this stuff from scratch? No, but she did a tremendous amount of work and produced an excellent book that popularized the diet and, in doing so, she's helped a tremendous number of people.

Tommy:    Yeah, absolutely.

William:    So what do you think is the most helpful piece of simple advice that you could give about customizing the Terry Wahls Protocol personally for people's everyday lives?

Tommy:    Okay. If we're applying the Terry Wahls approach to everybody, say, not just people with multiple sclerosis?

[0:40:04]

William:    Yeah, yeah.

Tommy:    Okay. What this would look like generally is a very high plant, high fat, fairly low carbohydrate Paleo style diet so no grains, no legumes, no dairy. Terry Wahls is really big on vegetables so she says you should have a third of your vegetables should be dark green leafy vegetables, a third should be colorful vegetables, and a third should be sulfur-based vegetables or cruciferous vegetables for lots of various different reasons and lots of them are to do with cellular function.  

    But if you are just the average person who is then trying to find something that's sustainable for a longer period of time, there's a possibility that it can be restrictive. I think it's only restrictive if you think of it as restrictive. Actually, you can find a way to make it as varied and as exciting as you want but that just takes a little bit of work on the front end.

    But that doesn't necessarily mean that everybody needs to eat like that. I think the best way to start is to start with a basic diet and then reintroduce things. People might want to reintroduce some dairy. If they're on an Autoimmune style diet, an Autoimmune Paleo Diet then that excludes eggs. Maybe they want to start by reintroducing eggs, particularly egg yolks. Let's start with egg yolks and then egg whites. People are more likely to be sensitive to the whites than yolks. Then give yourself some time, bring it back in, and see how you feel. If you ever don't feel quite right after bringing your food back in, then maybe that's something that you shouldn't eat anymore. It's probably just not doing you that much good.

    I think the best way to do it is to – particularly when people start out with health problems and not just multiple sclerosis. But I'd always recommend – and I know that's what Chris does too – is you just start with the basic exclusion diet and then you tinker from there. You pick something, maybe something that's less likely to be problematic. A lot people might have problems with large quantities of grains so maybe you introduce that later than something like eggs or dairy. You just try it and see how you go.

    The problem is that it's a simple answer. The answer is eliminate and then reintroduce stuff and see how you feel, right? Some pretty simple answer but you can take a fair amount of time that requires you to kind of know your body and kind of see how it affects you.

    The answer is simple but everybody needs to realize that it's going to take some time to figure it out -- which is fine. I think we have a lot of problems because we're completely disconnected from the food that goes in our mouths so maybe spending a bit more time thinking about it is a good thing. Spending too much time thinking about it is a bad thing so, again, you can go too far but I don't think most people go far enough.

Christopher:    Yeah. I can tell you, Wills, what I see people achieve in practice. This is the way that I did it and this is the way I'd recommend anyone listening do it. Say you've got a problem, a specific problem that you're trying to address. Well, our scientific or maybe unscientific intuition is just to remove things one at a time. But the problem with that, it just takes too long and that there're too many interfering factors. What I think works better is just to be really strict for a period of, say, 30 or even 60 days. Just eliminate everything.  

    The Wahls Protocol gives in detail the list of foods which are likely to be problematic, the things that you should or shouldn't eat. So you stick to that, you're super strict for a period of two months, and then you get to this place where you're like, "You know what? I feel awesome." And then you can start reintroducing things one at a time. At that point, it's much easier to figure out which particular foods might be a problem for you.

    For example, I was speaking to someone recently who never thought they had a problem with nuts until they eliminated the food for two months and then tried reintroducing them. At that point, they were feeling so good and they had such an exquisitely sensitive sense of how they were feeling that they knew that the nuts just didn't agree with them for whatever reason. Maybe they just felt a little bit more tired or had a bit of brain fog or something like that. They didn't really like nuts that much anyway and so now they just don't really eat them anymore. I don't think anything bad is going to happen by them eliminating nuts for an extended period. I think you understand kind of that you have to go through this process of total elimination and then reintroduction afterwards.

    The next question is – and I'm going to ask it – are there any other diets apart from the Wahls Protocol that could produce the same result?

Tommy:    Yes, there are. There are diets that have been used very successfully according to the research done by the people that looked into them. The main one that I know that I don't know, Wills, that you maybe had seen it, and Chris and I, you and I have talked about it is the diet put together by a physician called Roy Swank: the Swank Diet.

[0:45:13]

    If you look at all the research, actually, historically, the most successful diet for multiple sclerosis is his diet. He did work on the most patients and gave [0:45:27] [Indiscernible] diet, followed them up. Compared to, say, Terry Wahls, who started very recently and doesn't have that much data yet, it's the best published diet for multiple sclerosis.

    The problem is – we've got a problem – is that it's a very low fat and fairly low animal product diet. It's much closer to something like a very low fat vegan or vegetarian diet. The things like dairy are okay as long as they're very low fat because part of the theory there was the saturated fat was causing part of the problems. There are many issues with this.

    We saw a benefit in these patients. Basically, the stricter you were with the diet, the better you did. This was back in the time when it wasn't randomized controlled trials. Everybody went on the diet. When you go on any diet, you always improve the quality of your diet, which is important; you are actively engaging in your own treatment which always has a positive effect. We had no control group and we do lots of things that confounded.

    When we think about maybe some of the processes underlying multiple sclerosis including problems with cellular function, then I think the way that Terry Wahls approached it is much more intuitive to me in terms of actually fixing those problems than something like the Swank Diet. People have been doing some research on the Swank Diet recently. I'm not sure if they've published any papers. I certainly haven't seen any. But I've seen some preliminary results and they weren't particularly impressive.

    If we look at the data that's out there, the true published data on diets that help multiple sclerosis, the Swank Diet is the best published and supposedly the most successful. It obviously does have some benefits. I truly believe that he saw an improvement in his patients. Why that's the case, I'm not sure, and whether that's the best diet possible for multiple sclerosis patients, I don't think that that's true.

Christopher:    So you think there might be some confounding factors here then, that Swank was getting the patients to do something in addition to the diet?

Tommy:    No. I think the diet had some benefits. It was a much improved – it's still an improved diet quality over what people were probably eating before. Almost any diet that works, usually you remove a bunch of stuff that probably isn't very good for you. That was still the case in the Swank Diet because it's still largely a whole foods based program and I think there's some benefit there.

    But whenever anybody does anything to try and improve the health and with any kind of diet study, you can't have a blinded – your patients can't be blinded. They know what they're eating. You can't prevent that. It's not like some anonymous pill that you can give them a placebo or give them the drug. You can't do that.

    So that's one of the real problems is that these people, they were all seeing – they see Roy Swank, he tells them he's got this great diet, it's going to help them, and it does help them. Part of that is because they're engaged in the process. Part of that is that they have improved the quality of their diet. There are lots of other potential things that could be going on but I think it did have benefit. I believe that if people with multiple sclerosis went from eating a standard western diet and started eating the Swank Diet, I'm certain it would help them. But I don't necessarily think that it's the best possible choice.

Christopher:    Right, right. That makes sense. Well, the next question is a really good one. Why don't you go ahead and ask it, Wills?

William:    If the Terry Wahls or Swank Diet was so successful slowing or even curing multiple sclerosis – and I know there're other diets that can treat certain medical issues -- then should doctors recommend dietary subscriptions more?

Tommy:    Yes, they should. I absolutely think they should. But, unfortunately, at the moment that comes with a number of caveats. The first one is that doctors aren't taught anything about nutrition. We hear that in the – we'll call them the "alternative health communities" which is the low carbohydrate community or the Paleo community, which they are, the alternative health communities. I spend a lot of time there but I'm also a traditionally-trained doctor.

[0:50:12]

    Traditionally-trained doctors get a real bad time in those groups. We're constantly told how we know nothing about nutrition and how we're all useless and all this kind of stuff. Part of that problem is we're just not really taught about any of this stuff. Equally part of why we're not taught about any of this stuff is because at the moment, this kind of era, we'll call it an "era" of what we call evidence-based medicine which is that everything that we have to do as a doctor has to be fully backed by ten randomized controlled trials of a thousand people each and the treatment you're giving is the best one possible.

    The problem is that when it comes to dietary stuff, it's just never going to happen. We have very short-term studies that you can do very intensely but they're very expensive, not very many people and you don't know how that lasts for a long period of time. Or you can look at what people eat over a long period of time and look at their health but that doesn't really tell you anything about whether it was the diet that caused those problems or preventive diseases, just kind of gives you some ideas.

    The studies that the medical community wants in order to have the evidence to prescribe different diets to people with different diseases, I don't think they're ever going to happen. Nobody has the money for those studies. They're just not going to happen.

    I do think that these diets and different diets for different conditions do help people and you see it very frequently. The patient in front of you, there's always a confounding factor and it comes down to they're taking active engagement in their health, there's no control group. Could we do lots of other things at the same time that might be helping them? Somebody will always say that the evidence isn't good enough, and I think that's really going to hold us back from being able to truly prescribe diets to people.

Christopher:    Yeah, I know. I think that's a really important topic. In a way, it's like a double-edged sword, isn't it? The evidence-based medicine? It's such a powerful tool but, in this respect, it might actually be holding everyone back.

Tommy:    Yeah. Absolutely. I think it's really important. When you're trying to bring a new, say, drug to the scene, there's lots of funny statistical stuff that you can do to kind of make a drug scene better. Nowadays, when you bring in a new drug to the market, it's usually to replace another drug that's going off patent or often to replace another drug that's going off patent so you're not making any money from it anymore.

    What you do in a clinical trial is you look for something called "non-inferiority" which basically means that your new drug isn't any worse than your old drug rather than showing superiority which means that your new drug is better than your old drug. But if you have a new drug and you showed non-inferiority, that doesn't mean it's even the same as. It means that based on the statistics you have, it's probably not worse. That's what we were saying. But then you have this new drug and you have the advertisement that goes into it. You send it to the doctors and it becomes a new thing.

    In that kind of world, if you're bringing drugs to medical treatment, I think it is very important to have randomized controlled trials. It needs to be really rigorously tested. You need to make sure it's safe to get to lots of people.

    So then I think it's really important. You're right. But when it comes to more complex things like diet and lifestyle, you just can't control that stuff because it's a person at the end of the day. You can control a pill they take in the morning with their breakfast but what they do for the other like 23 hours, 59 minutes, and 59 seconds of the day, it's impossible.

Christopher:    Right. So there's no way to isolate the variable that you're interested in in the same way as you can do with some novel molecule.

Tommy:    Exactly.

William:    My next question was: why don't doctors prescribe certain foods to their patients as some are known to have medicinal properties? But I think we've already covered that enough so I'll move on the next which is: what can you recommend for any small changes to an everyday diet and lifestyle?

Tommy:    I think this is something that I've mentioned sort of throughout and Chris has mentioned throughout. We can probably just summarize it very nicely. Just eat real food. I know that for some people that becomes very complicated because maybe they don't have the time to cook or they're not used to cooking as is more and more common. But in reality, it's just going out, even if it's going to your local grocery store and just picking actual ingredients – vegetables, fish, meat, eggs. It could be nuts, anything like that, single ingredient stuff and just turning it into food.

[0:55:16]

    Simply by doing that, you remove all of the stuff that we talked about earlier. You don't even then need to worry about gluten and dairy and strict Paleo and all that stuff. I don't think most people need to worry about that. I think if you just start by going and finding real food and even better if you can go to a local farmers' market and talk to the guy that reared the sheep that was killed and then gave to you. I think connecting with that local environment is really good but some people don't have access or the money for that and that's fine too.

So just eating real food and then getting enough sleep, spending time with people you love and who love you and not worrying about the things you can't control like I'm moving every day. Walk a lot, occasionally lift some heavy stuff. Right. If you do all of that, I really don't think there's anything…

All of those steps require a lot of input from you. I won't pretend that it's easy but if you do all those things and you do a lot of outdoors as well – I think that's really important. Getting the right light at the right time is very important.

So if we do all that stuff, then I think that that's really the key to everything. Does that help? Is that far too complicated?

Christopher:    No, no. It's not that complicated. The "just eat real food" message is pretty simple to understand. I think it's an important one.

    Well, this has been great. I quite enjoyed this. Did we answer all your questions satisfactorily, Wills?

William:    Yes, you did. Really well. Thank you.

Christopher:    When I say "we," I mean did Tommy answer your question satisfactorily? I think the answer is yes.

William:    Yeah.

Christopher:    Thank you so much, Tommy.

William:    Yes. Thank you.

Tommy:    It's a huge pleasure. It's been a lot of fun. I'm honored to be part of it so thank you.

[0:57:05]    End of Audio

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