DR FEDERICA AMATI: THE DANGEROUS LINK BEHIND ALCOHOL AND BREAST CANCER

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2:25and I'm going to kick myself for bringing it up is the secret. Of what? Of the music. Oh.

2:38What was that? Got a little bit nervous there. I got a bit nervous. But there's a little secret that we're keeping for you but we're going to let you know very soon about it. I want to say a big thank you to everyone who is a returning listener of Great Company and everyone who is a new listener. Welcome to the show. The point of the show is to bring back connection and just great company. The show has no gimmicks. And at the top of the show, Jemima and I, who Jemima is my producer, we talk about the things that I have done wrong and right, and what I can change and not change, and we talk about our guest.

3:12And today's guest is Dr. Federica Amati, who is the head nutritionist and head of science communications at Zoe. Zoe is a nutrition science company that everyone is talking about. And I'm so excited for her today. Yeah, it's a bit of a different episode. You were really excited. You really wanted to do an expert. Why did you? Yeah, why were you? I tell you the reason why is that this podcast is about great company, right? So anyone typically can come on the show. I love chatting to different celebrities in their own right, actors, artists, musicians, whatever it may be. But also at the same time, I think I'm in my sort of era, I suppose, of wanting to gain a lot of knowledge.

3:56And one of the things that I'm really interested in at the moment is my own health. I think for a long time, I haven't put my health first. I probably drank too much in my 20s. And like all of us, you know, I've had my stresses. And I know that when I'm eating healthy and being healthy, I feel so much better. And I want to know the science behind that. Yeah, I feel like it's definitely something that's more in like the public consensus at the moment. Well, my big thing was, is when I had a real batch of, I don't know, anxiety, and it was just before lockdown, I listened to a podcast where they explained that the gut and the mind were connected.

4:33And a lot of your dopamine and a lot of your endorphins and all that happy stuff within your body comes from the gut. I know I have a bad gut. And hopefully, Dr. Frederica Ramati today is going to explain everything around gut, everything around nutrition, what I should, shouldn't be eating, what can make me feel better, what can make me feel worse. Just for Jamie. And not just for me. Make me feel better. Make all of us feel better. Well, I think that's the point. I think that's why you're the producer, right? Don't be too specific with your gut issues. Okay. But this is where anyone listening to this can take advice.

5:08Oh my gosh. I am ready and poised with my pen and pencil and paper. How much do you have? Just a pen and pencil. Nothing to write on. Anything to report back from me that I did wrong last episode? No, I thought you were great. And I think, but I think this one's going to be a new challenge. Why? Because, well, Dynamo, we were taught, it was, you know, we had some real depth of his life story. Whereas with Dr. Federica, we're not, we're not asking her life story. We're using her as an expert to find out what she's, you know, she's going to be educating us in a different way. And that's not to say that we aren't learning things from all our guests, but this is quite a different.

5:45So today there's more being a pupil. We're more going to learn things. Yeah, you're going to school today. I honestly cannot wait for this I am so excited I want to know about UPFs Ultra processed foods Yep and also Do you know what I heard recently? What? Apparently we consume A credit card's worth of plastic every week Yeah I did know that Isn't that disgusting? Okay listen I think we've rambled enough I'm so excited I've got so many questions Okay here we go Get ready for this episode With Dr Federica Amati On Great Company

6:21Hi, I'm Dr. Federica Amati and I am great company. Doctor? You don't have to call me that. I feel like I should. Okay. Federica Amati, I have so many questions. I mean, it's frightening and my ADHD brain is literally... So for the listeners, can you explain exactly who you are and what you do? Yeah, of course. So I'm Dr. Federica Amati and I am the head nutritionist at Zoe, the nutrition science company. I'm a lecturer in nutrition at Imperial College School of Medicine and I'm also a research fellow at King's College London. So I am a educator and I'm also a researcher of science. And I've also written two books, one of which came out last year and is on nutrition for the menopause.

7:12and then my newest book, which I'm really excited about, which is called Everybody Should Know This. And that really is a book about nutrition through the life course, because often we're told that food can serve us in the same way throughout our lives. And it's quite unusual to hear anybody talk about the fact that our needs change. So what we need to thrive in our childhood is different to what we need to thrive in our 20s. And it's different again in our midlife. If you had to highlight yourself that the misconceptions that we think in, especially in nutrition, what are the misconceptions that suddenly when you had studied this and learned, you were like, oh my God, that is a light bulb moment for me.

7:54Yeah. I mean, my first light bulb moment was really realizing just how much of an impact nutrition could have. Just fundamentally, like how it can... On what though? On what? On disease, on just any outcome, name it. So reducing the risk of cancer, improving your sleep, improving your fertility, reducing your risk of heart disease, reducing your risk. So what blows my mind? Are you serious? Yeah, yeah. It's that important? Yes. So if you look at the top killers that we have, right, you can boil it down to like four main things. Heart disease. Heart disease, type 2 diabetes, like metabolic diseases, right?

8:32Which is? Type 2 diabetes, obesity. I mean, cancer is kind of on the metabolic disease pathway. So let's make cancer three, but they're very interconnected. But if you look at the risk factors for those, right, it's poor diet, lack of movement, smoking. Now, smoking can't be that. It can't be that. No, no, like honestly, 80%. So there's lots of different people who have done modelling work to see how much of it can be attributed to said exposure. So how many diseases could we prevent? How many chronic diseases? We have to be clear that there are infectious diseases in the world as well. And that's a different topic.

9:15But in terms of chronic disease, which is what most of us will die of in the UK. What does chronic mean? Chronic diseases are non-communicable, so non-infectious diseases like cancer, like type 2 diabetes. They are diseases that take time to develop. And infectious diseases like malaria. Yeah, exactly. Infectious diseases are spread by a pathogen, by something that means you catch it, basically. So chronic diseases now are the number one killers all over the world, actually. So there's been like a big shift in epidemiology where even in countries which are low economic income countries, chronic diseases are taking over as a case from infectious diseases.

9:53And when you look at chronic diseases, one of the estimates is that 80 % of the cases could be prevented with lifestyle modification. 80%, which is like a lot, right? So how do we not know this? Well, nutrition education is not a priority. Because it's not sexy. Well, I think it's, do you know what? I don't know if That sexiness. I hope it is. But no, I think it's because our understanding of that power is more recent. I'm not going to say recent, but the past 50 years, 40 to 50 years is when it's really emerged as like, OK, we should probably do something about this because we could prevent so much disease.

10:3780%. Yeah. I don't want to jump ahead because I think, but why has there been a shift in chronic diseases? Why has there been a shift with more people having these obesity, whatever it is? Why is that happening? So there's a few things. First of all, we're surviving longer thanks to medicine. So we're no longer dying of flu as much. We don't die of bacterial infections because we have antibiotics. So there's been a massive shift in, especially in children dying. So we have like, thankfully, childhood mortality is right down. So when we work out like the average age that people are going to live, we take into account all mortality, including childhood mortality.

11:17And that's really gone down. So people are living longer because they're surviving past childhood. We're not dying of common infectious diseases. We're not dying of like stubbing our toe and getting, you know, an infection or all those things used to kill us. Right. And so there's one side is that. And the other side is that we now live in an environment which doesn't support long-term health. So our food environment, there was a big panic after the Second World War, where we thought that we weren't going to have enough food to feed the populations of the world. So scientists got to work to make sure that we could provide more food to the populations.

11:55And we now have in the US, an average, I'm not sure what the UK number is, I think it's pretty close, 4 ,000 calories per day, per person are available in the food environment, right? So we've overshot the mark. And what is our typical daily average we need? um it's really hard i think it's not helpful to think about average calorie calories are such a weird thing i get that but you know say say we go with the 1800 to 2000 so we're providing twice as much energy as anyone needs in the food environment so we've ever shot that and then we couple that with the fact that you know the work environment has changed we don't we don't move around during the day as much because a lot of us have jobs that require us to be quite sedentary either at a desk or driving things, or we're just generally not moving our bodies as much because a lot has been automated.

12:45So when you combine those two things, and then you also have like a new types of stress that are part of our world now, which are perceived stresses. So things like deadlines and emails and social media, these are things that are a perceived threat that our body gets stressed about, but that we don't have a physical consequence to. So, you know, going back like a long time ago, if you saw a threat, you would run away from it. Totally. No, completely. Whereas now it's like kind of pervasive and it's hard to remove ourselves from that stress. I completely agree. It's social media, email, social, it's that instant.

13:27Everyone's available. And so when you wake up in the morning now, you don't stretch, you don't yawn, you don't open your eyes slowly and you get out of bed and you walk downstairs and you make your coffee or whatever you're doing you wake up and you're alert boom straight away and that causes real issues and we can't and there's that amazing book which I haven't read but I've always been told about it which is Why Zebras Don't Have Ulcers Oh it's such a good book you must read it I know it's one of my faves okay so I need to read and the whole concept is is that a zebra goes to the watering hole it gets chased by the lion or the lioness it runs away it's nearly eaten but then goes back to the same watering hole because it will just live in the present.

14:04We're humans, we can't do that. Yeah, and it's also this idea that essentially, you know, the way we've evolved is to react to stress with a short-term response. So you have a stressor, you react, and then you go back to normal. Whereas nowadays, stress is a bit more chronic stress. And so then you have this, what in the book is referred to as like chronic inflammation, which is a result of the chronic stress. But also when we look at the increased lifespan, we haven't actually been very good at increasing the number of healthy life years. So even though we're living like 10 or 15 years longer than we would.

14:39We're living sick. Yeah. And that's where we know we could change that bit. So we want to live a long time. Of course we do. But no one wants to live 10 to 15 years in poor health, right? So it's how do we allow the healthy life years to catch up with the longevity that medicine gives us. And whilst medicine will help us get to 100, we need our lifestyles to help us get to 100 healthily. And understanding that our environment isn't set up for it right now is part of the key, because as soon as we realise that, then we can make choices differently. And that's where I think the UK is really behind compared to the rest of the world.

15:26So some countries like Singapore have really changed some of the societal structures to help. In what ways? Yeah, well, they've done some really cool stuff. I ask so many questions, it's frightening. Honestly, I'm worried. I'm always worried about the time. I want to spend all day with you. This is fascinating. Okay, go. So just a couple of things. I'll give you some examples. And actually, the Blue Zones documentary that Dan Buettner has put on Netflix covers this in one of the last episodes as one of the examples. So they've done things like making healthy food more accessible and more signposted.

16:03So if you're providing a healthy lunch option, you are allowed to have bigger advertising and you're allowed to make more of a shout about it to attract people, for example. They've also created these really cool interconnected living quarters for the elderly so that if they end up living alone, they'll be living in a structure that supports them and allows them to be sociable. We really don't look after our elderly people here in the UK. it's shocking. The loneliness is crazy. The loneliness epidemic is horrible. And even just like the sidewalks are often really dangerous to walk if you're unsteady or if you're in a wheelchair, there's not enough space.

16:37So we're missing a trick there. Majority of our population is going to be older very soon. Our population structure is such that I think the majority of the population is going to be over 65 by 2030 or 2035. And there's this archaic view that we have that as soon as you hit your 60s, 70s, well, that means you're old now. It's just not the case. It's not the case at all. So it's like we have to change our attitude, I think. And again, other countries do better with this. Integrating older people into family units. If we only treat people when they're ill and they come to hospital with something that's already broken, there's only so much we can do to get them back to full health, especially if they're older.

17:18So frailty is a real issue in the elderly. And if somebody is quite frail, they could have like a common cold and end up in hospital for two weeks because their sort of resilience is lower. So instead of waiting till they get to that point, let's act earlier and reduce frailty because then we have less, there's less of a chance that a simple cold will result in like a serious hospitalisation. And then domino effect on the NHS will be unbelievable that we aren't just going into hospital for these situations that could be prevented. Yeah.

17:53In terms of chronic disease, I get it. Smoking, not good. Alcohol, sure. Not good. I want to ask about alcohol. I want to get into that. The other thing, not moving, not exercising. We understand. Those are the sort of ones. They're the big hitters. Sure. What are the hidden ones that we don't really know? And what are the unhealthy food habits that we're not sure about as well? Okay. I think they're the big hitters, but how many people still smoke? I would say a lot. Quite a lot. And vaping. not safe like is it better than smoking cigarettes sure should we do it no so so like it seems obvious but people still walk around smoking and vaping and so even though that's like the one well everyone knows that one it's like yeah but you know actually one of my friends have you ever smoked in the past i did see my boyfriend smoked yes see there we go did i know what i know now no not so much and also like i'm not defending this at all actually um but since then the smoking ban has come in since then it feels like public health understanding of how bad smoking is has improved and it's true also that younger people are smoking less now so that statistically it's it's it's a trend which is great and drinking less alcohol and drinking less alcohol as well um but you know if you look at so dr helen o 'neill she's wonderful she runs hurtility which is a love her she's a dream so her her research that she did women actively trying to conceive smoking was quite high percentage you know so it's like we know it but we don't know enough we can still repeat it don't smoke um and with alcohol drinking similarly it's one of the only things that we ingest which is a class one carcinogen what does that mean so it's it's labeled it's understood as directly causing cancer by itself very few things that we ingest are class one carcinogens right a handful in fact.

19:45Alcohol is one of them. The second one is processed meat. So, you know, salamis, pastramis, those kinds of meats. The third one is betel nut, which is very hard. I've never seen it. I've never come across it in the UK, but it's a carcinogen. And the fourth one is Chinese saltfish. Again, I have not come across it, but it's a carcinogen. Those four things are the only things when you look at this quite terrifying graphic, which is put out by the WHO Cancer Research Group. Those are the only four ingestible things that cause cancer directly by themselves. And yet, alcohol is pervasive. It's everywhere.

20:20That is. And we advertise it too. It's not just that it's available. We actually have alcohol adverts encouraging us to drink it. Now, you know, on the flip side of that, research shows that having a glass of red wine with your meal could be protective and some of the centenarians of the world. Do you believe that? Yeah, I do. Because the reason I believe that is because our body is very good at helping us stay alive. And I do believe that having a glass of red wine, but you know, a glass of red wine, no one drinks that. It's like this much. I think a glass of red wine with your family sitting down in the context of a Mediterranean diet brings us together and is such a minor part of the other greatness that's part of that lifestyle that it probably just helps people come together and have a moment of like, cheers, great.

21:14So the binge drinking culture we have in the UK is literally killing us. Yeah, it's directly contributing to the cancers that we see. So especially liver and gastrointestinal tract, so esophagus, mouth, stomach and colon cancer directly. And also one that I think is really not spoken about enough is in postmenopausal women, drinking alcohol is one of the biggest risk factors for breast cancer. Why? So, well, it's, again, it's a carcinogen. The exact mechanism as to why specifically breast cancer is something that I haven't, I don't know why exactly that. Like, so I know that there's a relationship there and there's a very obvious causative link.

21:58If we had to like understand at cellular level, why specifically breast cancer, I don't know, I'd have to think about it for a minute, but it's such a, it's a well-established relationship. and a lot of women post-menopausally actually interestingly come to me and say I can't I don't tolerate alcohol anymore I don't know why I can't drink and I used to drink quite a lot so in some in some people like it's almost like their body rejects it which is good because the relationship it has with increasing risk each unit of alcohol increases breast cancer risk by a measurable amount in all the data analysis so I think you know if people I do get asked about alcohol drinking by the press because people love reading about it.

22:40And do I drink? Do I have an occasional glass of red wine? Yeah, I do. I do when we have family around for dinner or maybe we're celebrating a birthday. But genuinely, that's the only time I will drink alcohol. And I think when it's in a social context where it's part of the social gathering, not the point of the social gathering because if you're going out for drinks you're going out for the drink and then who's there's there kind of thing it's just different so i think that there is such a thing as maybe drinking in a way that isn't going to be too detrimental to health but for those people who don't like drinking like there's no benefit to drinking right so if you can not if you can live without drinking alcohol you're probably better off not drinking alcohol and and okay and and And also with alcohol as well, it's not only the sort of effects that it has physically or mentally as well.

23:37It shatters us. And Jamie, if you look at, so David Nutt, another legend, Professor David Nutt, who got thrown out of parliament for saying that ecstasy was safer than alcohol. He was right. He did this beautiful study where he plotted the harm to health and the harm to society of each drug. And you have all the different drugs and you get, you know, right at the bottom, which is not harmful to anyone is like mushrooms just harmless you know people who take mushrooms don't really harm themselves they don't really harm anyone else um and then you could go up and heroin and cocaine pretty harmful to self a little bit harmful to society right then you go to alcohol and it's off the scale it actually means alcohol is so harmful to society that it's the only reason that that access is so big it's just up there somewhere like completely off the scale Why?

24:27Because it makes you aggressive? It makes you aggressive. Like the amount of alcohol-related incidents, driving, aggression, rape, I mean, name it. Alcohol is not a good drug for society. But is that because it's accessible? I mean, probably partly, right? But still, that doesn't... But I think it's also just because alcohol does tend to cause aggression generally. More generally, it's a bit more of an aggressive drug. Can I ask you a big question? Do you think there's a synergy between this pandemic of mental health, anxiety, depression, all these different things? It's like a lava going through towns and cities throughout our country.

25:02Do you think there's a correlation between our diet? Yes, 100%. Yeah, really? Of course. So like, I think it's really important that we think of human beings as a whole thing. So our mental health is not detached from our physical health. Our mental health and our physical health depends on our environment. So we know that our environment is not supporting our health. So it's kind of no surprise that whilst our physical health is worsening, our mental health will also worsen because we are one thing. So you can't separate people into systems, right? If I said to you, you know, Jimmy, I've got really terrible backache.

25:43Well, that backache will be impacting my sleep. It will be impacting my mood because I'm not sleeping and I'm in pain. It will impact how much I'm able to move, which will then impact other things. We don't live in systems. We live as whole people. And in the same way that our physical health is suffering, our environment isn't set up for us to thrive. Our mental health is obviously going to suffer too. You're right. We separate everything. Yeah, and it's pointless. We think, oh, it's my brain. I'm feeling depressed. No, it's everything. Everything's connected. It's everything. So I did a lot of the patients that I looked at in my PhD, they were mental health service users.

26:23And when you looked, I tried to predict, how could you predict patient outcomes? Like, what is it about the people coming into the services that could help us understand whether they're likely to recover or not? That was my question. and the answers were various, but one of them is basically you can't take context away. So if somebody comes into a mental health service and they have no access to housing and they can't get nutritious food every day and they have lived a trauma, then we can give the best cognitive behaviour therapy there is, but then they'll improve, but they're not going to be undepressed.

27:04They're not going to suddenly go below threshold. because we've delivered a good service. There's context. Context is always king, right? So whilst we try to understand how to improve people's health and mental health is huge and it's such an important topic, we have to understand that we need to treat people as a whole. So patient-centered care, that's actually what my master's dissertation was in for public health. Patient-centered care predicts how well people will recover from an illness or feel better. because when you address the entire person as a whole, they're much more likely to be able to feel better and to improve their health on the whole picture, not just one thing.

27:48So of course, I'm not suggesting that if you cut your wrist, then yeah, you just treat the cut. But when we're talking about these issues that impact our quality of life, like mental health does, it's not only does diet impact the likelihood of us having mental health issues but if you suffer with mental health you're also going to make different dietary choices because cooking up a delicious meal that's really nutritious when you have severe depression is super hard because you don't have any energy you don't want to get out of bed let alone cook up a feast so yes um so there's this really on one of the seminal trials on this is called the smiles trial and it was run by professor felice jacker in australia and it took her ages to even get funding to recruit the patients for this because no one believed it would work.

28:38She wanted to see what happened if you had a group of patients with resistant depression. So these are patients who've had CBT, they've also got sometimes pharmacotherapy, so drugs. And she wanted to see if she could make a difference by changing their diets. And they ran the trial and it was randomized. So she didn't know when she got the data and they analyzed it they didn't know which group was which and when she first ran it she thought they'd switched the groups by mistake because it was such a change get out of here seriously so she found that in her in this trial and i think it's been repeated now uh replicated rather she found that giving a mediterranean dietary intervention so um but very she also did an affordability study with this so she showed that the diet that she recommended these patients was actually more affordable than the diet that we were on to start with, right?

29:29So it was actually cheaper to eat this way. So the Mediterranean dietary intervention with a little bit of red meat, because a lot of these patients would be 12 deficient. She found that she could reduce severity of depression symptoms by up to 30%. Wow. And these people were resistant. So they had like really resistant depression. So we know that we can improve mental health symptoms. And we also know that there's lots of beautiful reviews done on things like Mediterranean diet and likelihood of developing depression and likelihood of developing anxiety. And if you have a Mediterranean dietary pattern, then you're less likely to develop these conditions.

30:08So we know that it can help protect against mental health issues. Now, having transient mental health problems is part of being human. So I think we also need to, you know, it's normal to have periods where you have issues with your mental health but it's the resilience it's the being able to recover it's the it's for it not to become a chronic mental health condition that's what we want and um and yeah diet has absolutely plays a part not only in prevention but also actually in curing it and making sure people can live a healthy life i mean do people with severe mental health conditions like schizophrenia their life expectancy is 20 years less than people without that's not because schizophrenia is killing them that's not what it is it's because their metabolic health their diet their physical activity their social isolation is such that they lose 20 years of life that is wild yeah so we you know the two things go hand in hand and we can't you can't if someone is suffering it you need to treat the whole person not just symptom.

31:16I heard a rumor that if you change your diet, it can help you find a mate. It can help you with sex. Is this true? Yeah. I mean, it's interesting the way we select our mates. I mean, it sounds really rudimentary when you put it like that, because I think now we're quite cerebral in how we date nowadays, but there is like this fundamental attraction that you get when you meet someone that you're attracted to. And it's that kind of intangible, I don't know why I find you attractive, but you are. And that's really our bodies. That's not our brain. That's like, that's not our, it's not us being reasonable.

31:54It's that reproduction is designed so that we mate with somebody who's compatible on an immunological level. So immunology plays a huge part in fertility and in successful pregnancy. If you're not immunologically compatible with your partner, you just have higher risks of things like infertility and miscarriage and all sorts. Well, because immune systems need to be compatible to create a new baby. So when a woman is pregnant, pregnancy is essentially growing a foreign body in your body. And so if your immune system rejects that, it's not going to be very successful. So that's going quite deep.

32:33That is fascinating. Yeah, it is. and I think it's really important. I never thought you were. You're growing something foreign in your body. Yeah. And the placenta is a whole new organ, right? That is dictated by both sperm and the egg itself. So compatibility on a sort of chemical level is actually really important. And what people, what our microbiome does and not just our microbiome, but certainly like our health status and how our immune system is functioning sends out certain signals. So if your gut microbiome is really, really healthy and your immune system is like primed to work really well, everything's in balance, you're very resilient, you'll send out different signals than if you're immunologically compromised.

33:19Or say, for example, if your immune compatibility with a mate isn't great, the two of you won't find each other as attractive in theory. and that's really through smell we think the majority of it is through smell so pheromones are these like mystical chemicals that everyone likes to bottle up and sell for like 200 pounds but they do they have a part to play in mate selection and we also think that the gut microbiome so there's like a gut skin axis so some gut microbes will translocate to different areas of your body including your armpits and then how those got how those microbes how those skin microbes break down your sweat changes the odor you have so how you smell to your mate will will change according so it's really interesting listen it's like it's kind of like fun science I call it but but it's um it's really interesting to think that you will sort of attract slightly different and you will be attracted to slightly different people subconsciously so this is the subconscious attraction i'm sure we've all had it where you kind of meet someone and they're not necessarily who you would think you'd be attracted to in your head but then you're like for some reason i'm attracted to you i think my wife with me she's like i don't really like i'm not sure why evolutionarily like you know we are primed in some sense to be attracted to people who are just immunologically compatible for us and now whether we act on that or not i think that's where that's our like free will comes in or whatever but there is like an animal instinct level and sex and diet it can help with sex well i think yes i think remembering that our sex hormones are really closely linked to our health so again evolution is very clever if you're not particularly healthy so if you're not metabolically super healthy um it will down like down regulation of your sex hormones tends to take place um and that makes sense because in the wild millions of years ago if you weren't particularly healthy it's not a good idea to put the fate of the next generation of the next like genetic generation in your hands.

35:23So there's a downregulation of sex hormones, which reduces your sex drive essentially. And that's, you know, that's just a consequence. It's the same if you have a very poor diet. If somebody is really undernourished, you know, their periods will stop. If they're female, their periods will stop and their hormone levels will go right down. So really a repression of the sex hormones. So yeah, of course, like your dietary status, the nutritional status does impact how well your reproductive system works and therefore how much your sex hormones drive you towards having more sex. Why is fertility declining?

35:57Well, there's a few reasons or hypotheses. There's the later age. So we do have a bracket of high fertility and for the sort of general population when you look at statistically average is between the age of 19 and 25. That's our peak fertility. And it feels so young. Yeah, it does now. Right. But we evolved to have children at that age over millions of years. It's been a long time. Been a long time. And evolution and biology haven't really kept up with our modern lifestyles. So the fact that we now on average now, I think the childbearing age is actually 30 or 31. So recently in the past few years, it's moved up into the 30s.

36:43Wow. So that's the average age for the first child for females in the UK now. And that's a really big jump to go to, considering that we're most fertile at like 22. That's like eight years later to have the first. So that's definitely a factor. So the fact that we're having families later. And I think there's lots of reasons why people are having families later. Is that because we're living longer as well? Yes. I mean, I think the fact that we're living longer gives us this idea that we have longer to do it in, to have children in and to have a family in. But actually, I think it's also the fact that we don't have, we don't live in a way that supports families anymore.

37:22So we often live far away from our parents and our grandparents and our, you know, siblings. We're raising kids in these single households, family, single household families, like these nuclear families. And that's not, again, that's not how we evolved. If you go and look at primates or actually even if you look at people who still live in indigenous communities, children are raised by the village, literally. So it's quite unusual to have these family units where just the two parents are the primary caregivers most of the time. It's really stressful because it's a lot to do. So being older also means that parents are more likely to have more financial stability.

38:02They're more likely to feel like they can tackle parenthood. and obviously in the well not obviously but in the uk the government doesn't really support new parents you don't have access to free child care for the first two years of life and then if you do try and access um sort of child care money or some sort of support both parents have to be working um or the mother has to be working or the father so whatever parent has a child but how can you possibly hold down a full-time job and therefore qualify if you have a newborn so it doesn't really make sense so that the way society is structured here in the uk yeah doesn't support new families you can look to denmark or sweden you know they do a much better job germany there's much more affordable child care and much longer maternity leave and also paternity i mean paternity leave here is like two weeks nothing that's two weeks do you know what guys get it hard they do no they do though because men who do want to actually partake some some some companies now offer shared parental leave.

39:04So you can actually share the sort of six months. But most of the time men have to go back to the office within two weeks. And in a lot of companies, that's frowned upon actually. Like they legally have to give the two weeks, but they don't really want to. I'm putting it out there. Father's Day is not a great day either. It's not a great day. It's not a great day. Why? No one gives a shit about it. Like they actually don't. No, come on. Mummy's Day, Mother's Day is Mummy's Day. Jamie's now requesting yeah yeah yeah mummy's day those are that's a big day father's day is not so big oat milk should we drink it yeah it's fine yeah if you also listen substitute milk is the same rule for all of them right if you don't want to drink dairy if you don't want to drink cow's milk whether it's for environmental reasons or taste whatever there are some really good substitutes and you can make your own at home as well if you don't want to buy them So oat milk is a good substitute because it's very environmentally friendly.

40:06You know, it's the same rule for any of them. If they've got loads of added ingredients in. So if there's like emulsifiers, sweeteners, sugars, colorants, stabilizers, then maybe choose a brand that has less stuff in it. However, if you're also trying to find a brand that will provide iodine, B12 and calcium, for example, maybe you're following a vegan diet, then it is worth having the fortified ones because they can be a really good source of those micronutrients which are harder to get in a vegan diet. So it's a bit nuanced but it's not that complicated. It's just pick one that you like the taste of that you can afford and that doesn't have too many additives.

40:43If you want to make your own at home I think the simplest one to make is cashew nut milk because you just soak some cashews and then you blend them and then you use that. So if in doubt if you're allergic to nuts then I think oat milk's a good one. Soy milk is actually great in terms of nutritional nutritional qualities it's like it's got good protein content good fat good sugar it's quite similar to cow's milk it adds well to you know coffee and tea you can foam it and phytoestrogens which are contained in soy are good for health so win-win um it just depends what you like are we consuming uh plastic every week yes we're breathing it as well and we're touching it so there is a sort of body of research that points to endocrine disrupting chemicals in our environment as being a major driver of infertility and plastics is definitely one of those so bpas and pfa pfoas for example so these forever chemicals so we should not be drinking out of plastic bottles we should try and avoid that as much as possible at the risk of like becoming a bit overwhelmed yeah i know i know i think that there's a couple of times in life where i would really recommend being more careful and that's if you're trying to conceive so if you're trying to have a baby whether you're a guy or a girl or whatever it does impact the quality of your sperm and the quality of your eggs and the likelihood of fertility so if you're one of those people or if you're pregnant especially in the first trimester try and avoid where possible drinking or eating from plastic so you know if you use tupperware maybe try and use like a glass one or a steel one.

42:21Don't heat plastic in the microwave. That does not great. And then one of the simplest ways to avoid like a big amount of exposure is try not to redecorate the house or the nursery while you're pregnant in the first trimester. Really? Yeah, because so our floors, our carpets, our sofas and beds, everything has flame retardant and flame retardant chemicals are endocrine disruptors. So actually just trying to not do that in the first trimester of pregnancy is helpful and you know yeah if it's not if it's not going to be a huge mental load for you to try and not use plastic utensils plastic cups plastic bottles and plastic containers for food then that's great but but i'm just a bit mindful of not scaring people too much it's just one of the things in our environment to think about and as we've touched on like have it being really anxious or really stressed is also not good for our health so just pick pick what you can address and start with that.

43:21We know if you're going to pick between eating some, you know, vegetables that have been maybe wrapped in plastic and not eating the vegetables, you're better off eating the vegetables. Okay, they're going to have a better health impact on you than avoiding that plastic at that time. So it's just about balance and not getting too stuck in the weeds with some of this stuff because it can be overwhelming and we don't want people to, you know, just give up. Up.

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45:07Credit to the people.

45:14Talk to me about UPFs. Yeah, ultra-processed foods. Ultra-processed foods. Why is that so terrible for us? And what is that? Salamis, chicken nuggets? Yeah, so processed meats is one group of foods which are harmful because they're carcinogenic. So they have this cancer-causing effect. and it is really the pastramis the salamis the sort of cheaper hams and sausages and meats that you get that have been processed and to be made into something like spam you know those kinds of you know processed meats ultra processed foods is a relatively new category for food and ultra processed foods are foods that are industrially made that you could not make at home yourself that have chemicals added to them to make them taste good and feel good in your mouth so things like emulsifiers or like extracted fats, then sweeteners.

46:07There's all these, you just wouldn't be able to buy them in the supermarket and add them to your food yourself, right? And they're called ultra processed foods because of this, because of the industrialization and the fact you couldn't make them. Now, processed foods are things like tinned beans and sweet corn and frozen berries. They're not a problem. So sometimes people write about processed foods being bad for us but they're not bad for us in fact having frozen and tinned vegetables and fruits is one of the ways people can get a healthier diet so it's really important that they're much more affordable it's cheaper and it's yeah completely so whole grains like dried whole grains are wonderful bread is a processed food right because you have to do something you have to put the flour and the water together and like bake it it's processed yogurt is a processed food it's milk that's been churned.

46:58So processing is not an issue. Processing is something's been done to it. Yeah, exactly. Ultra processed foods. Now, there's lots of science now that has shown that they are correlated with poorer health. There's only a couple of clinical trials that have shown how this might be happening. So the problem with science and things like this is that whilst there's lots of studies now that show an association. So the more ultra processed foods you eat, the more likely you are to suffer with depression, the more likely you are to suffer with obesity, the more likely you are to suffer with non-alcoholic fatty liver disease.

47:35And what all these diseases have had associations with ultra processed food consumption. But for us to be a hundred percent sure, like what it is that it's doing this, how is it happening? Then you need the clinical trials with a control to see like, Is it the ultra processed foods themselves that are doing this or is it something else? And this is where the debate is really heated at the moment. So Chris Van Taleken has written a brilliant book called Ultra Process People where he talks about the science and breaks it down. And he's kind of in the he's sort of saying that all ultra processed foods need a health warning kind of thing.

48:11And then there's a bit of gray area. and then there's some scientists who firmly believe that ultra processed foods are important for feeding the population and making it accessible because it's cheap right and so we haven't landed on exactly how this is going to pan out like where do you lie well so i i think we have to be realistic right the uk has the highest ultra processed food consumption in europe we are Matched, I think, only by the US globally. Yeah. So it's not a great thing. We're not in a good place. In the UK, it's like 65 % of the calories consumed come from ultra processed foods.

48:53That is not good. And in children, it's up to 72%. So we're in a really bad place. Is this laziness? No. It's not. It's not individual laziness. You see, this is the problem. The issue is that... You said that very strongly. Very strongly. It's not about individual agency. Sure. Okay. Because if you're a person who lives in an environment where ultra processed foods are what is being served you 90 % of the time, you will eat from what is available to you. Because it's your environment, right? Yeah. So not only do the majority of our supermarket shelves contain ultra-processed foods in a way that actually finding fresh fruit and vegetables or where's the nuts in your local supermarket?

49:38The nuts and the seeds, the beans and the lentils are like in the middle aisle on the bottom shelf. They're there if you look for them. They are hardly highlighted or brought to attention, right? Right. So until we have some, there was a Tortoise Media did a big report where they sort of showed that some companies in the UK only produce ultra processed foods. That's it. They don't make any other food. So we have entire companies that only make those. And then we don't have any kind of restriction on how many of them can be sold. If we look again to Europe, Italy, very proud, has the lowest. So we have 14 % of our calories come from ultra processed foods.

50:17That is amazing. It is, but it's possible, right? Like we're richer as a country, GDP wise, UK is richer. So it's nothing to do with that, right? It's just to do with making a conscious decision that we need to make minimally processed foods or processed foods, the majority of the food environment. But it's expensive. No, why is it expensive? I thought the issue was... We throw away so much food here in the UK. Like you don't need to look too far to see that farmers aren't happy with the way the food environment is at the moment. But, you know, we have, we grow plenty of fruits and vegetables in the UK.

50:49You can freeze, can, tin, dry them. We can easily feed people better than we are now. It's just that profit wise, right? If you're eating a minimally processed diet, and there's science to show this, you get fuller quicker because there's more fiber, because you have to chew your food. So you can't sell as much food if you're full because you're not going to eat it. So there's a real conflict of interest between to make a nation healthier, you want them to eat and feel satiated. But if you want to sell more food, they need to be hungry. Now, ultra processed foods are very palatable, hyper palatable.

51:35So they're very delicious to eat. They're not filling. They have hardly any fiber in them. So you eat more and more and more. You eat more of them. you absorb the energy and the nutrients from them much quicker because they're so soft and smushy that our body can just absorb it. And you don't get the same signals. So, you know, now GLP-1 agonists like Ozenpicka, like all the rage, we make GLP-1 in our gut. It's one of the appetite suppressing hormones that we make when we feel full. But if we don't have any fiber in our diets, like 90 % of people don't reach the minimum dietary requirement for fiber every day, 90 % that's the only nutrient deficiency we should be talking about nobody needs more protein in the UK okay we don't need to be eating protein bars for god's sake fiber is the one that literally nine out of ten people don't get enough of what is fiber what is fiber fiber is the undigestible part of plants that makes up the structure of the plants normally so when you look at a celery sick, it's crunchy and hard, and the fiber offers us that food matrix, that food structure.

52:43Now, we humans don't make the enzymes needed to break fiber down. That's why we have evolved over millions of years to have a very long gut, very long colon that houses trillions of gut bacteria that do break down the fiber. So when we eat fiber, it goes straight through, as in, But slowly and keeping us feeling full, it goes through our stomach, through the small intestine, all the way down to the gut. And when it gets to the gut, our gut microbes have a party and they break the fibre down for us. And actually they create hundreds of chemicals as a result of that digestion process. So they metabolise the fibre and the metabolites they create, which is sometimes called postbiotics, they range from short chain fatty acids to enzymes to hormones.

53:35So we make vitamin K, for example, and B12 in our gut. And they then go out to do different things for us, either by affecting our immune system. So the 80 to 90 % of our immune system cells lie around the gut. And the gut bacteria have like a communication system with the immune cells, telling them what's going on. and they also go into our circulation so the vitamins for example but also some of the hormones and some of the neurotransmitters that we make in the gut they can also travel up through they can affect or impact the vagus nerve signaling so vagus nerve is this really huge nerve that goes from our brain down to our guts into the enteric nervous system which is the second brain so this big collection of nerve cells that sit in our gut.

54:25And the vagus nerve has a direct impact on our behaviour, our mood, our stress levels. This is proven. It's bi-directional. Oh yeah, yeah, yeah. It's a whole field. Yeah. It's bi-directional. And actually we used to think that the majority of the messaging went from the brain to the gut. But now we know that about 80 % is from the gut to the brain. this is a huge area just for me and i just think for so many people the gut i've always i haven't been told but in recent years i've been told that the gut can regulate your mood massively so lots of reasons potentially why we feel anxious depressed why we can't sleep why we have these different problems can be too down to the how healthy our gut is yeah that can be also down to our diet exactly that's the point right so the thing is is our diet affects our gut massively.

55:14So what we eat directly influences what gut bacteria we have. So the population of gut bacteria depends what you feed them. If you don't feed the good guys, they will die. And then other guys will come. Your gut microbiome is an ecosystem. So just like any other ecosystem, depending what's available to it, it will change. Now, once you understand that, then it makes sense that the diet impacts our mood. So the gut microbiome is crucial. Gut health is crucial for our mood and our sleep because diet is crucial for our mood and our sleep. It's just that gut is one of the mediating factors. So our diet impacts our mood and it impacts our sleep in lots of ways, including metabolic health, circadian rhythm, lots of other things, but also through the gut microbiome.

56:01And I think people, it's great that people are engaged with gut health now because changing your gut microbiome and changing that ecosystem is something that we can do. We have that power with our food choices. And so if that helps people engage with improving their diet, that's awesome. Before we end this, we end with eight questions. Some of them we've given a spin, some of them we couldn't. So we just left with it. Number one, what is a saying or phrase that you'd want people to come away with from this interview? Food is your single best tool to improve your health. Love that. Best compliment someone can give about a gut?

56:43Very regular. Number three, what's the scariest thing about the gut slash people's knowledge? The scariest thing about the gut, I mean, one of the scariest things I think to this day is what people do sometimes. So I found out recently that Wim Hof used to sit on public fountains to give himself a colonic irrigation. That's why he has a massive scar, because it just punctured one day. So what people do to their gut scares me a bit. I mean, he's a bit wild, I know. But I think, you know, we are resilient human beings, but I would really hope, I just, sometimes it worries me that people do things like coffee enemas or colonic irrigation or cleansers.

57:28Clonic irrigation is not a good idea. So, clonic irrigation is like if you had a beautiful English country garden and you decided to flood it on purpose. Why? What is it? Why are we doing that? Why are we doing that? So, there's lots of, and I, you know, I think, and also like gut cleansers where they, where you are stimulating, like, really, really aggressively stimulating your gut. I think we should just stop that. So, that's quite scary. And I think what's something that's actually really exciting, but also quite worrying and not worrying it's something that's exciting but we need to see how we can use it usefully is the fact that gut microbiome interacts with the drugs we take so pharmaceuticals and gut microbiome interactions are a field of research that's really interesting it looks as you know many drugs like paracetamol ssris interact directly statins interact directly with our gut microbiome and our gut microbiome also dictates how effective they are so at least in part so i think that's something that i think will become more of a topic and something that we need to consider more closely because many people take a lot of prescription medications and we're not really um we don't really yet understand exactly how that's impacting the gut microbiome or the efficacy of the drugs when was last time you cried and why oh i cried um just what day is a day Friday.

58:54I cried just this week because it was the seventh anniversary of my dad's passing. So yeah, so I cried because of that, for sure. And I just read a passage about him in my audiobook on the anniversary of his death. Yeah. So it was quite a weird moment. How did he die? He had colon cancer. Yeah. Do you think you could have prevented it? Yeah. Well, I don't think I single-handedly could, but I wish I knew then what I know now, because I think I don't, I don't think I have that kind of power to prevent it, but I certainly think I could have maybe, maybe, maybe had a bit more of a, um, a bit more of an understanding and I may have been able to help in some way.

59:38Um, even, you know, even during his cancer treatment and stuff, but it's, he's definitely one of the reasons why I do what I do. Like it just motivates me because I think his cancer could have been prevented had we had we known how to amazing reason to do it as well yeah he's amazing he and he was always my biggest fan like honestly that man he thought I was awesome from a very young age so yeah I think hopefully he's proud now because he always wanted me to sort of he always kind of secretly wanted me to like do tv and podcasts and write books. And when I was young, I was like, Dad, no, I don't want to do any of that.

1:00:18I want to be a scientist. And here I am. So, yeah. That is amazing. Is there some things with the gut that's irreversible that we do to it? Yeah. So there is, the gut is pretty resilient, but there are some things that will damage it and it's hard to reverse. So diverticular disease is actually quite common. So diverticuli are quite common. They are sort of these pockets that form after the age of about 50 normally. You know when you blow up a balloon too many times and then it sort of gets a bit stretched? It's like that for your gut. And they're becoming really common because we sit a lot and constipation is very common.

1:00:57And so this straining and pressure on our gut causes this stretching and these pockets to form, which can either go completely unnoticed or they can become inflamed and cause quite serious complications and inflammation, sometimes have to remove parts of the colon or can be life-threatening. You can't reverse that kind of structural damage to the gut. However, I do know people who have had to have resections. They've had to have part of their bowels removed because of this. And they have then gone on to rebuild their diet and have good gut health after. And there's lots of people who live with stomas or ileostomy so where they have had to essentially have part of their gut removed or their gut removed and then have a bag outside you know in in many of those people they won't be able to necessarily reconnect the gut to the small intestine if especially if they've had it all removed so there are there are medical situations in which you can't necessarily repair the gut or all that sort of bring that back so um it does happen and but there's also stories where people have had colon cancer removed or as I said diverticular disease or diverticulitis that has caused resections and they're able to rebuild a healthy gut and continue with a healthy life.

1:02:17What's something that people are embarrassed to admit with gut health? Nowadays I mean to me I get told all sorts. People are quite happy to tell me about their bowel habits. I'm so open to it. It's good it's so good that it's not a thing anymore because is it's such an important marker of health. So if you're speaking to a doctor and you tell your doctor that you haven't been to the loo for five days, that's a big red flag for gut health. So I think it's really important that we are open about our bowel habits and how we feel and changes in bowel habits. What does a healthy poo look like? A healthy poo.

1:02:50Healthy poo. A healthy poo. If you look at the Bristol stool chart, they have really good pictures of what a healthy poo looks like. But we're essentially looking for a well-formed solid sausage that's easy to pass. that's basically yeah yeah pretty much and in my terminology you call that houdini where it just leaves no mark i like that um but yes i think uh i think people are still people are still a bit embarrassed about about bloating and flatulence i find so i think often people don't realize that bloating is almost almost always caused by constipation of some of some form wow um and and then holding farts in and so like not letting it out is a huge contributor to bloating.

1:03:35I would recommend, you know, whatever makes you feel comfortable, go to the loo, do it whatever you need, but it's not, it can actually be unhealthy. If you're always holding it in, it's really not great for us. Producer Jemima calls it a ninja poo. I like that. Turn offs. What foods should we be eating to find us a mate? okay um so nourishing your gut microbiome so the foods that your gut microbes love are high fiber so any plant mushrooms nuts seeds whole grains herbs and spices leafy greens fruits and veg um all of those are great fermented foods so kefir sauerkraut and kimchi they're really good because they have lots of live microbes that can go in and add to the party in the gut.

1:04:25So those are the kind of two main food groups that we should be focusing on. These, just all the plants you can get and some fermented foods. Last one. What do you like most about your job? What do I like most about my job? Oh, I love my job. It's hard because I love teaching and I always cry when I get the student feedback because it just brings me joy. I also love working one-on-one with my patients. Like I, it's so great. Some of them have been my clients for years and the satisfaction of helping people with their diets is just huge. And I also love my work with Zoe because what Zoe is doing, you know, it's such a mission driven company where we actually want to improve the health of millions.

1:05:07And that's quite an ambitious goal. But we now reach over a million people through our podcast and our social media. So for me, like I have, I work a lot. I love my job. And I love all aspects of what I do. I also have to say, I have loved writing my books. Any person who reads it and says, if one person says, that was really useful for me, I've changed this, or I feel better about this. That's it. That's like, that's 100 % satisfaction for me. If my, since a young age, my driver has been to try and help people to, and it sounds so cheesy as I say it, but really like if I can just help one person improve something about their health, I'm done.

1:05:51So that's why I've got very high job satisfaction, which is great. I'm so lucky to be where I am. I know that. So I'm trying to do the best I can whilst I have the work, like whilst I do the work I do. Federica, thank you so much. That was fascinating everywhere. I really appreciate it. Oh, thank you for having me. Thank you. I have honestly learnt that is a wild episode so much so much that I need to now well thankfully the episodes get out so people can just listen to it but like was I okay quickly I know I'm just cutting you off there was that alright you were unbelievable don't do that to the guests I will not but no you were lovely you were great I learnt so much favourite thing you learnt so actually some of the bad stuff So the thing about women, after menopause, every unit of alcohol they drink increases their chance of breast cancer.

1:06:50That is mad and terrifying. It's mad. Yeah. I just, the fact that we know, it's proven that UPFs give us cancer. Mad. Mad. And how many we have in this country. Yeah. What was the percentage? Hugely high percentage. It's like one of the biggest in the world. It's mad. and also oh there's just so many things I could honestly keep going forever on things I've learnt if you want to know more or hear more about Dr. Frederica Ramati she has a book out Everybody Should Know This such a good title great title we'll put a link in the description in the show description everything's always in the show description by the way so go and check it out and we spend a lot of time writing those show descriptions too so do read it thank you producer Jemima I really want to say a big thank you to everyone who listened to the episode as always you can find us on social media at great company podcast.

1:07:42If you want to send us a message, or you want to watch any of the clips or watch us on YouTube, you can great company podcast on YouTube as well. And if you could possibly do us a massive favor and press that subscribe button. Follow, follow. You have to say follow Jamie, stop getting it wrong. Wow. Press that follow button or subscribe button, wherever you're listening to this podcast means the absolute world to us. It really, I cannot stress enough how much it helps us. So that would be amazing. Jemima, thank you. Thank you, Jamie. Thank you, listener. Oh, we did the same thing. Just want to say everything at the same time.

1:08:21Thank you, listener. Oh, we did it. You said. Thank you, listener. Thank you for listening to Great Company Podcast.

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