How Much Protein Do You Really Need for Longevity? | Evidence-Based Guide with Dr. Rupy Aujla

34:18You want to be using your ideal weight. So whatever the kilogram amount that you times that 1.2 by or 1.6, you want to be using the ideal body weight. Similarly, if you are underweight as well, you'll be using your ideal body weight. So that's the first part of the equation. Then let's say we'll use myself because I can do the math a little bit in my head. I'm around 75 kilos. I'm trying to opt for 1.6 grams. That's my ideal body weight. Ergo, I need to be consuming around 120 grams of protein per day, which is 40 grams of protein split across three different meals for argument's sake, as that's the typical eating pattern.

34:52What does 40 grams of protein look like in a typical meal? All right, So let's take, and I have a picture, a number of different pictures in the book, because I want people to be good estimators or guesstimators of protein when they make their breakfast. So if I think about... Let me get it out. Yeah, sure. Look, are you impressed what I brought your book with me? I'm very impressed that you got it. Yeah, yeah. That's the page there. If you're on YouTube or listening, maybe it's on Spotify, they now have our full videos up. You'll be able to see. So, okay, talk us through this. So for this morning's breakfast, for me, I had 150 grams of Greek yogurt.

35:29So that was a good couple of heaped tablespoons. I know from this diagram that Greek yogurt is around 10 grams of protein by 100 grams. Full fat. Full fat, always full fat. And it's strained. So any strained yogurt is going to be high in protein because you're getting rid of some of the water and the sort of technique sort of concentrates those proteins so 150 grams i'm looking at about 12 grams of protein there i enriched this with some peanut butter peanut butter is i love peanut butter like crunchy 100 no added salt no added palm oil none of that no added sugar none of that stuff by just adding a couple of tablespoons of that we're enriching that yogurt and we're boosting that yogurt by around seven or eight grams of protein.

36:17So that's 20 grams in total. I'm going to add a handful of mixed nuts to that. So that's again, around eight grams or so, depending on how big your hand is. And then I'm also going to have that with some berries. And on the side, I had some of my doctor's kitchen bread with a bit of hummus as well. So it was a bit of a mix and match situation this morning. And that got me close to, I'd say, 35 grams of protein, just from those elements so that for me is like a healthy high protein breakfast it's got nuts and seeds they're anti-inflammatory i've got some berries in there i've got my protein i've got my base that's like an i an ideal way of of eating let's say i haven't had lunch yet but um my lunch is gonna be some some like a do you know farmer farmer jays yeah i love farmer jays it's so good it's just like so easy i feel like you should have created that i know i really feel like i should have i i like and when it came out i was so jealous i was like farmer j's name sucks but in all honesty like it's really good so you know if anyone's in london you you know what i mean they have these field trays you can see everything and they have like they portion it out don't they portion it out and so if i go to farmer j's i know i want i tend to eat plant-based when i'm out so i will go for the tempeh option if you look at tempeh in the book per 100 grams it's around 25 grams of protein which is uh really might not even heard of tempeh yeah well tempeh is a fermented soybean product and the benefit and i talk about this in the book as well the benefit of fermenting your uh legumes is that it increases the availability of those proteins it makes it slightly more gut healthy as well because you've got some of those parabiotic benefits of the of the microbes uh it tastes delicious as well and it's easier to digest so that you know 200 grams of that that's going to give you around 30 grams of protein as a minimum um and then i'm going to be having it with like grains and like some greens and stuff all those different elements like your grains and your greens they also have protein in as well not very much and i put that in the apart from quinoa yeah because quinoa is actually more of a protein food to the carbohydrate food which is different to rice yeah yeah i mean it's a pseudo grain so it's not not strictly a grain it's a seed which is why it's got like a weird sort of look to it when you when you cook it but But you're right.

38:35Yeah. Quinoa is like slightly higher in protein. And then even your green. So when you have like a cup of greens, like 100 grams, that's around anywhere between two or three grams of protein in that alone. A lot of people realize that. So every little bit adds up. And this is where you can actually quite easily achieve a healthy high protein meal with some of these different elements as well. And I have this sort of like thing. I don't think I wrote about in the book, but you want to start with your core protein. So that could be chicken or fish or tempeh or tofu. These are high quality proteins.

39:08Eggs, another really good high quality protein, about six grams per average egg cooked. Then you want to have a plant-based partner. So that could be your legumes. It could be lentils, because as you'll realize when you read the book, lentils and chickpeas when they're cooked are relatively low in protein. They're not a core protein source. So they average between 6 and 8 grams per 100 gram of cooked bean. And even at the higher one, like black beans and pinto, we're looking at 8 to 9 grams. So A, it's not complete protein, and B, it's not enough total protein either. So you want to have a core protein, plant-based partner, and a topper.

39:49And the topper could be nutritional yeast. It could be hemp seeds, one of my favorite seeds. They're about 30 grams of protein per 100 grams. it could be mixed nuts it could be uh peanut it could be whatever you want but if you have this formula every single meal time that's how you're going to easily get to your protein goal and then like you know dinner i mean last night my wife came back from uh holiday and i cooked her it was like an arabiata sauce um with uh i think we put aubergine in it i put chickpeas in it some chicken that i'd made i spatch cooked some chicken at the weekend so i just shaved a bit of that and then i added some uh protein through that and then added some moringa leaves have you ever used moringa leaves fresh oh man so there's like a a turkish store nearby to us we live in north london and moringa fresh is like a really bitter version of rocket and when you put it into a sauce with tomatoes and other acidic it kind of mellows the flavor and is absolutely delicious but if you don't want to be that bougie you can just use spinach i mean at one point kale wasn't i know yeah it's having a moment and it's costing more than anything else yeah yeah yeah i'm a big fan of cavallonero as well yeah that's how like i like i want people to visualize what it means to eat a high protein meal in a healthy way because we've been led to believe that high protein has to be chicken chicken chicken chicken chicken like chicken for breakfast lunch dinner and dessert like it like it doesn't have to look like that that's bland is boring you know it's it's uh this idea of high protein having to be about muscle food and muscle growth and whilst that's very important to preserve particularly as it pertains to the longevity sphere it does not need to look that mundane and bland and as as a foodie i would never create a book that was just about you know just the single protein source you just mentioned there a terminology that's really interesting it's a buzzword and i'm i i believe in you know i believe i'm all for health span medicine you know things that are going to help improve our quality of life get us to live you know enjoy our quality of life longer longevity is a term that i'm finding a little bit harder to relate to now just because of this fear that it's gone in but protein is having its moment in the longevity circles so we now understand like how much protein we should be having around 1.2 grams, potentially up to 1.6.

42:19You've just explained so well how we can kind of distribute that through our day in terms of food and food quality and nourishment, because they also contain great like polyphenols in there and fibrous foods. They all are a great mix and blend. But why is protein so connected to this longevity space that is just booming and booming and booming? Yeah, I think it's because we've realized the pragmatic approach to increasing health span is having a muscle-centric view of healthy aging. And I even struggle with that because I don't think it's all about muscles, as I said earlier. I think it's also about bone health, immune health, skin health, etc.

43:04And for that, we need protein. It's the building block. Exactly. So just stepping back a bit, the reason why I'm so passionate about this subject is because proteins are literally the building blocks of life. So when you consume protein, whether it's coming from tempeh or edamame or nuts and seeds, you break it down into the corresponding amino acids of which there are nine essential, 20 odd that are non-essential. But it's a bit of weird terminology, depending on who you are, so there are like 22 or something, some say like more or less. That aside, we break it down as these corresponding immunos, and then they are repackaged into whether it's part of your organ, whether it's an immune cell, whether it's a bone cell.

43:46These are all parts of the same protein Lego-like blocks. And so when we get older, the ability of us to actually package and build these same molecules is impaired for a number of different reasons. a lot of people say mitochondrial health so that's the sort of uh energy organelles yeah they actually have a role in like immune health and self-signaling as well but yeah they're sort of colloquially known as the power the battery cells of our uh cells um and then when you think about this from the perspective of what kills older people what knocks them for six it is frailty it's falls it's literally falls and why do people fall it's because of a blend of poor stability poor proprioception so that the ability of us to think of our body in space and also the musculature that will enable us to be solid and the reason why is because a we're not very good at exercising and and b we're very sedentary i'd say but b there is a sitting on a sofa yeah i know yeah i always i always think about myself when i'm doing a podcast and i talk about this concept but importantly there is a natural degradation of our muscles as we age over time and that's just unfortunately inevitable it's not to said that you can't reverse that with exercise in particular and protein but it is generally what happens if you don't do anything about it when you're in your 20s and 30s you look at dumbbell and you you can build muscle when you're older than that you have to work a lot harder but i also think that the reason why this is so important because obviously we have such a variety of listeners on the show from people from 20s to you know up to 60s is that you have to start young you know getting your body attuned to this now and getting the signaling going and on all of these exercises and building that muscle growth helps the prevention right rather than getting to 50 and thinking okay now i need to start weight training or thinking about protein we really need to be thinking about this when we're 20 i think an analogy is our pensions right so in a perfect world everyone would have started an isa account and not spent any penny of their isa and contributed the max amount every single year from age 18 and that's their isa and their pension as well also please do that so i know it's so good and i wish i did this like you know for myself as well but this is the the correct analogy to be using because in the same way investing in our pension is great for our financial health investing in our muscle health and our stability and our core strength this is great for our overall health as we get older as well so and for the reasons that we discussed earlier it gets harder to consume enough protein when you're older your threshold is a lot higher to increase your your muscles and your bone health so you need to start early as possible and the evidence is is clear that you know if you are less frail you're less likely to have the fall you're less likely to experience the risks of of having fall and it's just it's a really really good problem so the best medicine is to try and prevent that as much as possible and one of the ways in which we do that is by getting enough protein but also exercise and i think exercise is probably the biggest lever even though i know i've just written a book about high protein i think i say in the book it's like i don't want to like convince you otherwise exercise is the best but protein is a very close second well they're two co-partners right i'm glad to that because i i mean this is not a sob story but i lost my grandmother in covid to a fall um and you know you kind of think i think about her and i go wow she was so switched on her mind was there you know she had so many amazing more years in herself but the thing that killed her was her hip when she went out too quickly to try and get the post and that made me think about all of these different combinations of how I should be living now which is really important because I think a lot of us think about chronic disease and inflammation and that's the next question you know around inflammation but I do think that we don't ever think about just taking our health for granted and having a fall and that could be the end it literally could be yeah yeah it's it's so sad but it's so common so let's go to um anti-inflammatory foods okay yeah because i think this is let's take it up a level um if we can anti-inflammatory foods so it's interesting i actually got a text yesterday from a really good friend saying hi babe how are you my my husband's mother-in-law has just been also i don't want this to also all feel like this is for people that are 60 plus but this is why i want me to think about it now my mother-in-law's just been diagnosed with arthritis and she's got it in her hands what anti-inflammatory and foods are good and i was literally had your book open on the anti-inflammatory index and i was like well this is obviously something that people want to know about um i'm sure you are that person on speed dial for any of your friends when something happens in the family and your people are going or can i ask for advice so you know inflammation it's the you know it's it's such a big topic that's spoken about is like it's the lead of any chronic disease um and there's so many factors that can influence our inflammation from stress exercise also influences our inflammation um but also food and also environment and you know products that we're using things around the home but people might not have heard of the anti-inflammatory kind of index so i want to talk about anti-inflammatory foods and the dietary inflammatory index and so there's a really interesting study where I just want to touch upon before we get into what that is which was an analysis of 128 ,612 people from the UK Biobank participants aged 60 plus.

49:53Now it basically shows something very interesting which looked at higher plant protein and fiber intakes which were associated with significantly lower crp levels which are your inflammatory markers whereas higher animal protein was linked to higher cpr levels which is very interesting because i always find that a really interesting marker for people yeah obviously people with inflammatory bowel disease can have very high levels of of this when they're going into attack so can you start first of all explaining what this is yeah and why it's important and what foods are contained in it because from that it's more plant-based foods yeah yeah and you'd you'd imagine that wouldn't you like the results of that to me and you are probably not that surprising increasing plant protein uh increasing fiber oh lo and behold reduces inflammation across the the majority of people um but i think this whole idea of inflammation is i want to reframe it slightly for folks because I think people think of inflammation as universally a bad thing and actually inflammation is so so important for our body it's the reason why me and you can have this conversation in the middle of London surrounded by environmental pollutants from the exhaust fumes surrounded by viruses surrounded by all these different unfortunate pathogens and still thrive and not come down to a florid sepsis or like a generalized infection.

51:21So the way I like to get people to conceptualize inflammation is it's kind of like your internal campfire. And your internal campfire, if you imagine like we go away to the British countryside or something and we set up camp and we do what every good sort of like camping holiday does. Get sticks and put campfire on and get some marshmallows going. A campfire is a wonderful thing. It provides beautiful light, it provides warmth, it could keep predators out, we can cook our food on it. It's great, but if our campfire was to go unwieldy, it was to get out of control, we might overcook our pasta, if we're eating pasta.

52:06Well, the Italians would be so upset. we might like we might burn ourselves it could become so unruly that it burns the entire campsite down this is sort of like the language of your immune system it's getting this balance correctly on the one side we need inflammation on the other side too much inflammation can be a bad thing and so whilst it has a role in fighting pathogens and signaling as part of your immune system when that becomes completely out of whack this is where issues arise and we know that people with excess inflammation and there are multiple ways in which we can measure inflammation in the body although I think the way we measure it currently today is quite crude so we use things like CRP or high sensitivity CRP in research we use things like interleukins like IL-6 you might see there's and papers if you read them online.

53:00We know that people with raised inflammation have higher risks of metabolic disease. We know it's associated with obesity. We know that it's even associated with mental health issues as well. High inflammation that can come from diet or sedentary behavior. Autoimmune. Autoimmune conditions as well. All these different things. So we know that as a foundation, we want to be bringing our inflammation levels in balance. And the reason why our inflammation levels high is a because of diet so lack of fiber feeding our gut microbes ensuring that or not having enough of the polyphenols in our diet can you explain what they are very quickly so polyphenols are colorful uh pigments that you find in different fruits and vegetables but also beige ones as well i think we forget about mushrooms and onions you know those have like novel plant chemicals that are great.

53:50There are literally something around seven or eight thousand phytochemicals that have been identified, many of which are not studied. Some of which you might have come across like resveratrol because everyone loves to talk about resveratrol because it's in red wine. But it's also been like dried grapes and peanuts and all that kind of stuff or quercetin that you find in alien vegetables, onions. But there are literally thousands and we haven't actually like fully crossed how important all of them are they are together my perspective is you want to hedge bets and just try and get as many different polyphenols in your diet as possible the other things that can raise inflammation apart from the absence of some of those elements in the diet are things like sedentary behavior like what we're doing right now so do we have to like do star jumps in between i know like i feel like yeah i mean i'm very twitchy so i do like shift around But yeah, like the way I like people to think of sensory behavior, particularly if you work in an obvious based environment, is like your inflammation level creeps up the longer you are in this position.

54:52So it just like goes up every hour, just like. And what you want to do is discharge. And it's very uncertific, but you want to discharge some of this inflammation by getting up, going outside, maybe doing some lunges, star jumps, if you like. This sort of brings it back down into level because exercise as a net effect is actually anti-inflammatory. In the short term, it's pro, but in the long term, it's anti-inflammatory. The other things that probably doesn't get enough airtime, stress, poor sleep, loneliness. These are all things that are - They're all massive factors. Yeah, big, big factors.

55:27But going back to the index of the anti-inflammatory foods, so you mentioned some polyphenols. So basically most plant-based foods, right? Right, that would be like some of the highest, because I bet people listen to this going, oh, what about turmeric? I thought that was an anti-inflammatory food. And so there's been a few buzzwords on what anti-inflammatory foods is. But for anyone maybe struggling with high amounts of inflammation, maybe that's an autoimmune condition, maybe that is, it could be a mixture of things. And as you said, it's also very linked to mental health. What should they be looking in this index of foods that's going to lower the inflammation or support it?

56:02So aside from like, you know, trying to address the pro-inflammatory factors. Diet is one of those big levers. I would say probably secondary to exercise again, but diet is a really, really big lever. Why didn't you write a book on exercise? I know, I know. I'd have to do a lot more research. So the way to think about anti-inflammatory foods is group them into categories. And this is largely based on the DII, so the Dietary Inflammation Index, something that we actually used when we created our anti-inflammatory category on the Dr's Kitchen app as well. So every recipe broadly is anti-inflammatory.

56:33And we did the math on that as well, which is a lot of math. So herbs and spices, really easy ways to get strong anti-inflammatory foods into your diet. So if you look at the OREC scores, the antioxidant scores, the DII scores, these all score the highest, i.e. they are the most anti-inflammatory. So things like turmeric, clove, cinnamon, kitchen counter herbs, oregano, basil, marjoram, these are just as impressive in terms of the anti-inflammatory effects. A lot of them are down to their unique polyphenols but because we don't consume them in significant quantities whilst they are the most powerful they overall will contribute some but not the majority I would say of the anti-inflammatory benefit of your entire diet fats really really important so extra virgin olive oil as an example is again very anti-inflammatory you also have things like nuts and seeds that's why like a handful of nuts and seeds I think is great for everyone every single day it's been shown in the pretty med studies been shown in multiple different studies to be net beneficial for your heart as well and it's polyunsaturated fats just want to mention that rather than like trans fats yeah yeah i mean trans fats generally we luckily we don't have too much of that in our diet if any at all but yeah mainly poly and monounsaturated fatty acids also they contain things like vitamin e which we know can contribute to healthy heart healthy brain anti-inflammatory again and then also the um the types of nuts all have their different sort of varying ratios of fats as well so again like i just take a uh a spread betting approach i don't just focus on one nut like pistachios i focus on sunflower seeds and hemp seeds and tahini nut butters all that kind of stuff so you want to try and get a good healthy collection of fats also from things like fatty fish so salmon sardines herring the smaller the better anchovies i absolutely love i know that's a bit i put them on my omelette oh i put them everywhere yeah i put them into like curries and stews yeah maybe not my bath sometimes i eat straight from the can to be honest but uh or the or the glass jar but yeah so the these are really really good quality fats these fatty acids that contribute to resolve ends and anti-inflammatory action so you want to be getting like oily fish and then berries so the colorful fruits i have a penchant for berries because they tend to be high in some of these powerful anti-inflammatory chemicals and the cyanins and and the like i get them fresh where i can but also frozen is also a good strategy particularly for things like blackcurrants bilberries these are all like really high in anthocyanins in fact blackcurrants i believe the highest in anthocyanins maybe secondary to haska so they're yeah so they're a type of uh phytochemical or plant chemical that are responsible for the the deep purple blue color that you get in in berries so blueberries and black currants and the have you heard of something called the haskba berry yeah i have yeah many years ago yeah a company that started yes yeah yeah yeah yeah so they they have a product i don't know the company personally but like they have a product where they've they're freeze-dried and powdered these berries that are hard to get in the uk i think they're grown in canada yeah um but those i think are the highest in anthocyanins so i mean it's not like a top trump's game here like you're not just trying to always go for the top ones again it's about diversity it's even things like aubergines yeah exactly they're high in it exactly yeah so you know you want to try and get it from as many different sources possible because what uh one like an onion might be lacking in terms of andesignins or other pigments a white onion will certainly make it up in other ways maybe that's quercetin or alice or whatever it might be so the best approach is just trying to get from multiple different sources and the other thing is fiber and the reason why fiber is anti-inflammatory is because you are supporting these microbes many of whom are working to reduce inflammation in your body as well, nourishing the gut cells with their metabolites.

1:00:42So they work away, they digest the food, they create these fatty acids, and they nourish the colonocytes, the lining of your cells. They reduce the permeability of your gut. That in turn reduces the overactivation of your immune system that reduces inflammation as a net effect. So if you're doing these things across the board, you're getting herbs and spices you're getting oily fish you're getting extra virgin olive oil you're getting berries you're getting good quality fats you're getting enough fiber like getting a really good dose of this anti-inflammatory medicine and i have this thing called bbgs i don't know if you've come across it before but beans berries greens seeds and nuts every single day you want to try and get one of each of these every single day it doesn't need to be all the same meal but like handful of berries, handful of beans or legumes, lentils, whatever you like.

1:01:37Greens, I try and get greens every meal, even breakfast, but you know, a couple of portions cooked and seeds and nuts a handful every day. If you hit your BBGs every single day, it's one of the most potent anti-inflammatory medicines I think you can, you can take. I'm going to put this in a context and you can tell me if I'm wrong, but I feel like I'm not. It sounds like the Mediterranean diet. I'm just trying to keep it as simplified as possible for people, right? Where, you know, the Mediterranean diet is probably one of the most well studied diets out there, right? When it comes to nutrition and health, whether that even be for things like mental health, and look at the Spiles trial by Philly Stracker, all the way kind of across the board, Mediterranean diet seems to be kind of one of the most supported and studied areas for your health overall.

1:02:26And so what I'm hearing is a lot of the Mediterranean diet foods are in this anti-inflammatory index totally yeah yeah if you look at the Mediterranean diet as a whole through the lens of the DII it is anti-inflammatory if you look at like um even the most I know food pyramids and and plates are like uh out of fashion at the moment if you remove some of the refined products that they have on the plate I would say that's net anti-inflammatory you know the modified mediterranean diet like the mind diet for dementia and and brain health again anti-inflammatory so there are common themes throughout different diets that have been studied that are like you know generally healthy plant focused whole removing on refined products and using good quality fats yeah so what i want to come on to now which i know is a bit of a spin because you've just spoken about anti-inflammatory foods which is predominantly mediterranean based it sounds like we've spoken in depth about protein about why it's important for the lifespan and how we can again diversify protein throughout the day and the different types of sources you're laughing because you know i'm about to bring up but i was like reading today's interview and thinking what else is really on topic right now and i'm just gonna throw in an iv drip random i know but so in context right because everything that we're talking about i don't want it to sound like it sounds simple because it's not because when we actually break down like you know we've really got to like rethink our habits and how we're going to structure these in the day and prep time and you know making sure that we reduce the friction in all these areas to create a healthy foundation of a diet in everyone's busy lives it's easier said than done but the interesting thing is i was on this again like a longevity type of panel last week and everyone was asking about this topic it was kind of like one of the biggest things so i've just written a big article on it for substack and i thought actually might be really interesting to talk about this today so and then you said actually it's been asked a few a few times so nad it's a supplement that so many people are now trying to take intravenously within their yeah taking it as an iv drip one i wanted to ask your thoughts on that as a medical doctor or people are taking it in supplement forps which is less absorbable but we can kind of like get into that in the beginning first of all like can you explain what nad is for people that are listening that don't know what it is and what are your thoughts on kind of the hype around it at the moment yeah so i looked into nad when i had someone on the podcast a few years talking about it and it was still quite new to me then and honestly it's still quite new to me now but from what i've seen i'm not convinced that it's a good uh spend of your time or your money because these drips do take a while as well to like um to to take so what is nad so nad is nicotinamide adenine dinucleotide that's it okay or abbreviated as nad plus yes um and it's really interesting as a molecule because it is a cofactor in the energy generation within the cell the mitochondria so it 100 has a role and the interest in the longevity space is the amounts of this molecule appear to decline over time as we age which is why a lot of people are taking versions of nad or the precursor called NMN, which is the mono, not the dilucleotide, but the mononucleotide of that in an attempt to reasonably increase NAD in the cell.

1:06:11The issue is, whilst we might have seen some of these effects in rodent models and animal models, there's real lacking human trial evidence. And for anyone that knows anything about pharmaceutical drug trials, just because you've seen it in an animal model does not mean that it's going to be the same in the human. In fact, the vast majority of drugs have been completely pulled or not even made it to pass the first phase of human trials because they just didn't work. So that's the first thing I think people need to wrap their head around. When you see an animal study or you see someone promoting it based on an animal study.

1:06:52Red flag straight away. It should just be, that's interesting. It's cool. I love some of these animal-based studies, but it does not translate into an evidence-based action to take in the human world. So when you look at the issues around NAD boosters or NMN, A, like you alluded to, there's the form factor. So supplements, oral intake tends to be completely digested and there's nothing that goes into your bloodstream. So people had the smart idea of, okay, well, let's do an IV drip. IV drip sort of bypasses that metabolism and that metabolic pathway. But again, there's no evidence that it actually gets into the place where you want it in the cell.

1:07:40And in fact, we don't actually know a lot about that conduit between the mitochondria, so these organelles in your cell, and the cytoplasm, which is the space around the cell, we actually don't know a lot about that relationship as in and of itself. So the fact that people can say, oh, okay, well, we're going to take this and it's going to somehow get from your bloodstream into your mitochondria and it's going to have this magnificent benefit on longevity, I think is a real, real fast stretch today. I'm happy to have my mind changed when some human trial evidence comes, but I have not seen anything remotely close to the hype that has been generated around this to qualify for me taking time out of my day to sit and have an IV drip for an hour or two hours, where actually, if you want the best bang for your buck, if you're interested in mitochondrial health, which people should be, go and do exercise, do a HIIT train, do a zone two training, do anything that increases my tachondrial biogenesis that we can actually measure from biopsies and stuff.

1:08:52That's where I put my money. Do maybe some cold exposure if you want as well. Maybe there's certain benefits of that. I'm much more convinced of that evidence than I am for the NMN supplementation evidence. The other things I would say, which again, doesn't get talked about enough, I would invest in therapy like if i had the like choice between spending 100 pounds or 200 pounds on an iv supplement a couple of times we don't know what the dosing is either like that's the thing like yeah like i've got no idea how much we should be taking whether it should be a daily thing whether it's a weekly thing i've got no idea um so i would i would rather spend my money having two sessions of therapy every single month like i think it's going to have a much better impact on longevity or health span than any of these supplements so i'm really really bearish on nad boosters in total as you can probably tell but happy to be convinced uh otherwise yeah it's interesting i was just bringing up what i had written about and i said exactly the same thing and that's why i started writing about this because i was on that panel but also i'd had an nad drip because I always find it interesting.

1:10:02I want to go and trial things. And I actually had it taken out of me because it made my heart, because obviously it's energy, right? So you do feel quite flustered. That's one of the side effects. But my heart was interesting. You were talking about 200 beats a minute. I don't know what mine was. Probably wasn't anywhere near that. But I was getting really flustered, hot, overwhelmed. My heart was going really, really fast. I thought I was going to pass out. And I was like, this needs to come out of me. This does not feel like this is doing what it that's good for me and i wanted to read a bit more into it and you know i i wanted to look at the other clinical trials after that because i was thinking what have i just done to my body and they were short they are they're not long-term trials i think that's also what we've got to think about right these are short trials that have been done then they don't have meaningful clinical outcomes yet and i think a lot of these places are from quite luxurious places that are giving giving these treatments out with people that can spend that money and when we're thinking about it like I was actually going well what's the what's the risks versus the benefits and the theoretical concern is that yes NAD supports cell growth um DNA repair like those things we do know but some researchers are exploring whether excessive NAD hence why dosage is really important IV drips you're getting an excessive amount in the IV drip right could even fuel cancer cell proliferation like and I think about this in synergy with nutrients I'm not saying that this is what all IV drips do that give nutrients and there's sometimes when people are very deficient in certain things they do need it medically but I'm talking about like not medically right I'm talking about going into clinics and just asking for certain drips to get these huge infusions for me when I was taught in biochemistry and nutritional science it was all about nutrients and vitamins and minerals that all work together in something called synergy you know they all kind of are co-factors of one another and when you swamp your body with one huge thing and none of the others you're automatically going to be putting them out of balance yeah and i don't think we think about it with these things and so when i'm looking at you know if someone's deficient then of course we need to be topping them up because they're deficient they don't have enough in their body.

1:12:16But right now this is so early. They're like, are we testing for how much is in their body? Are we testing it versus what the dosages are? And so, you know, when I kind of see that it could be, you know, linked to cancer cell proliferation, my ears tweak up a bit. Yeah. And so I do think it's an important topic to like bring up. And also when I was looking at it, I was like, well, you know, where does it come in food? And it is like, if we look at the ways that we can support it through diet, and I put it through here, we can look at it through like, like green vegetables, fish, mushrooms, edamame, all of these can help as the precursors to NAD.

1:12:52So again, focusing again on the things that we know aren't going to be detrimental, I think are really, really key. I think it's a really important point you made about dose, because we know from the large trials looking at multivitamins or high dose vitamins, and even vitamins that you just buy off the shelf from your local health food store, when taken at an excessive dose consistently for the wrong person who might have precancerous lesions completely unbeknownst to to that individual i mean we not to scare everyone but you know we have cancer cells around our body circulating every second of every day and our immune system is just like a targeted SWAT team going around our body and like removing any malfunctioning dysfunctional cells if we start giving molecules that could be amping up the defenses it's almost like arming a bunch of terrorists in our body and it's a bit of a stark analogy there but like it's not what you want to be doing and as a one-off like probably not gonna do any harm no you've got to worry about it but if this is something that you do like all the time yeah once a month or a couple of times a week i mean the honest answer is i have no idea i mean why do i think anyone does i don't think anyone could sit there and give a full explanation that they know exactly what's going to happen to do it every single week because the research isn't there yeah exactly yeah and i think these packages that are being sold i hope they've got a lot of insurance because if a year down the line someone suddenly has a a cancer lesion that's found on a on a screening and you do a history you're like what have you been doing for the last like couple of years like oh well i excise i look after my diet and I've been doing these NAD plus IV drips, I would be very fearful to be the individual that is selling those because, I mean, they're unlicensed.

1:14:45And I think someone's trying to make it a pharmaceutical product in the US. Whether or not that is coming from a commercial perspective or whether it's because they generally think it should be a pharmaceutical product, I'm not too sure but the research today I would say it's probably a not a good spend of your money and be yeah they're expensive yeah completely unknown so it brings me back to my a question I want to make sure that we finish with which is you know we've spoken about the food we've spoken about like evidence-based ways to increase protein and anti-inflammatory foods and to maybe bypass the NAD drips try if you want but the jury is out on clinical evidence I see all the time nutritional myths come up sometimes I think should I just go into myth busting and then I'm like no I'm not going to do that but I was like when you're sitting here today I'd love to ask you which I haven't asked yet and I was wondering what you were going to say but what's one of the biggest nutritional myths that you're seeing online right now going around that you're just like we need to cancel that out that's not true and it's harmful probably that we're eating a protein i'll probably get some comments about that but probably that i would say i i think like we're not being respectful of the state of affairs by continually repeating this um outdated idea that we eat enough protein we don't need to worry about protein i take i take the complete opposite opinion and like i said to caveat this i'm not saying we need to eat more animal-based proteins i think we probably eat enough of that if you look at the consumption rates in the us and the uk as well on average we're consuming enough of that but where we should be leaning into more of is plant-based proteins and the benefit of that is you're not only getting the protein which is super important but you're also getting the fiber and the other the isoflavones the phytonutrients that we've been talking about that are so useful so that's probably the one thing i would say and it's almost like turning the lens on ourselves somewhat because it's very easy to point fingers at keto and carnivore and you know seed oils and all this kind of stuff it's really really easy to just blame blame blame but actually i think a true reflection and a true sort of um way of of weeding out misinformation if you like is actually turning the lens of ourselves because we're not perfect we're we're fallible and you know i've probably got things wrong as well i have got things wrong many many times in the past and one of the things i got wrong was protein and i was just you know slinging out the same response about protein and it was it was incorrect yeah well that just means that you're not reductionist which is great um because science is always evolving and you've got to evolve with it otherwise you just stay in a lane And actually, the one thing I think a good scientist is, is always being able to say, oh, well, I didn't realize that now I've changed my mind on this thing.

1:17:49Yeah, when the data change, we change your mind. You have to be flexible. We spoke about earlier the spotlight effect on the Substack 5 questions, which I'd really love people to go because that was really like who Rupi is and so much wisdom that you've learned from back in 2003, really, when you first started med school. And so I wanted to kind of end with like, what is the one piece of advice that you would give to people listening now and listening today? Like whether it's health or a piece of wisdom or something that for you, I think health is all encompassing. It's not just the food that you put on the plate.

1:18:24It's not just the amount of hours you get in bed. Health is also so much about mindset, emotion, resilience. It's all kind of weaved together. So for people kind of listening to this right now, what's the one piece of advice that you'd like to leave them with? I think it's important to know your knees. So when I say knees, I'm talking about N-E-E-S. So know which aspect of your lifestyle that you need to put extra effort in. So that's nutrition. Is it emotional health? Is it exercise? Is it sleep? I think we were talking about 80-20 or 90-10 earlier. Just knowing where you need to put a little bit more effort in is a nice framing practice.

1:19:04and I know for me, my nutrition is great. My exercise is okay. My emotional health is great. Sleep is really, really poor for me at the moment. And so that's what I'm putting more emphasis on. But for someone else, it might be completely different. They might sleep like a log. They might have real refreshing, energetic sleep. And then the nutrition is all over the place. So knowing your knees, knowing where you want to put your chips, where you want to put some extra energy it's just a good practice to ensure that you're putting your energy in the in the right direction i love that you explained that because at one point i thought you meant your actual needs no no and i was like what is what is in the needs i didn't know about this talk to me about biomechanics at one point your needs are also very important but no i think it's really interesting i think we can look at these needs a lot when it comes to work i think a lot of people can you know do their plan of the year or the end of year review or like their quarterly review or whatever that is and they can go where do we need more emphasis and where have we kind of fallen short this month and so like often we don't do it for ourselves and we put ourselves last and so actually like spreading that knowledge to your own personal life is really important and I've now started you know I used to always make although Oliver Berkman told me to not make lists because he was like they're not helpful but I do make a list of things I have to kind of achieve in the week but now I also make a personal list and before it was just work focused and it was just like these are things that I need to hit these are things that I need to do this is how I'm going to distribute my time and then I looked at my diary and I was thinking wow this is really where you prioritize everything there was no personal needs in there ever and so now in the beginning of the week i make my work list i still do everything i need to hit but i make my personal yeah my personal list yeah and it's been a real for me i don't say hardship because it's not been hardship but it's been a real kind of mindset change in the fact that i'm allowed to do that and not feel guilty i think i used to always put my personal needs at the very end of the day when i get in at 10 o 'clock and i think well what have i not done yet but actually now i distribute it because i think your diary reflects really where you put most of your time and energy absolutely yeah yeah and we forget to look at it like it's important to just look back at the previous week and just see where your energy was sucked and where you actually need to put more emphasis in and i think like just your knees or knowing your knees is a good sort of framing exercise for for me at least anyway yeah it's good because it's flexible that's the biggest thing right it's flexi so rupi you've been an amazing guest thank you we spoke about so much from the personal side on the five questions to everything on the importance of I guess lifespan and health span right now the question I ask to everyone which you might know if you've listened um is what does live well be well mean to you for me it means living in harmony with what my body is telling me and I think being intuitive about where I need to put extra energy um for me that's how i i live well because the answers are in us and i think if we take the time to listen as i was mentioning on the exercise that i did with the silent retreat um the answers come up and you can be your own expert and know exactly where you need to put your energy that's a self-trust isn't it yeah that comes with wisdom and lots of learning Ruthie thank you I can't I mean I have obviously shown this book if you've been watching on YouTube listening where we put our videos but this is such an amazing book thank you um you really do put the kind of practicality into making things a little bit easier but also just delicious like the thing that I have always connected food to is nutritious and delicious and I think when we can think about the word healthy it's so often related to just being boring and my dad still even though i cook for him all the time because you don't want me to live off and i'm like no but that also is not healthy yeah yeah you know and so you do create such delicious vibrant thank you gorgeous and it's an amazing one so everyone should go and buy this thank you i appreciate that um you're from a former nutritionist it's something that i've already got my top five in there nice and uh and yeah i'm gonna be i'm gonna make sure i actually like realize what my proceed is the the kind of imposter syndrome is going oh my god what was mine everyone should know the number yeah thank you thank you sir i appreciate it