Dr Fede Amati

0:00What if a marginal gain unlocked greater performance? What if an insight in data could change everything? At Aramco, our focus on detail helps us deliver reliable energy to millions across the world. Because margins aren't marginal. They're where we can truly push the limits of what's possible. Aramco, an integrated energy and chemicals company. Learn more at aramco.com.

0:36Hello and welcome to The Midpoint and it is a very warm welcome back to the wonderful medical scientist and clinical nutritionist Dr Federica Amati. She's back with a timely new book The Appetite Reset and the core of the book is the idea that hunger is not a test of willpower, it is indeed a biological function. And this of course comes out as the use of GLP-1s are ever more mainstream, ever more popular, and the conversation around their long-term use and how to get off them without piling on the weight is also getting louder. She looks at why jabs alone are not enough and why you should be preparing before you even start using them.

1:11And of course, if you don't want to use a GLP-1, the book is for you because it aims to help you reduce food noise, something people talk about when they find it really difficult to lose weight and how you can improve that idea of being fully sated there is lots to talk about you've also sent in a load of brilliant questions so I'm going to put those to her too so let's go meet Dr Federica Amati. Federica Amati it's so great to have you back on the midpoint and you have this new book The Appetite Reset and I'm intrigued to know when you realised this book was necessary with the the conversation and the noise around GLP1s.

1:47Yeah I think it was around sort of autumn last year actually so quite recently but the conversation had really picked up I was asked to contribute to a documentary for the BBC sort of two three years ago when it first started and a lot of the predictions we made then started coming through about how people were going to come off it and potentially be in worse shape than when they started and all of these stories started to come up you know lean mass loss and side effects and I just thought actually I have quite a lot of patients that I've looked after with my clinical team well-founded health they're a group of doctors and we work together and it's exactly how you should take these drugs right so with all the care and even then it's complicated and each patient's very different and so I just thought actually this is a you know I always try to make my books useful Gabby so that people can actually take something from them and improve their lives and I thought this would be quite useful because we know that the stat that did it for me was that 99 % of people are accessing these drugs outside of a healthcare setting 99 % depending on which estimates some say over 95 but it's definitely sort of in the 90s so they're not getting any support before they go on them during their usage maybe ticking a box on a website or something and then coming off which is obviously hugely important yes and so we and now we know that you know 50 to 60 percent of people come off within a year and this is for people whose prescriptions are due to obesity or type 2 diabetes so this is for the people who are taking the drugs as intended even they're coming sort of stopping within a year so there's a real need to help support people through this time and as I started writing the book which was really designed to be a companion to anyone who is thinking about taking the drugs or on them or coming off them I started to realize actually the science of appetite is fascinating and it's not always explained or taught even at medical school so I as you know I teach medical students about nutrition and I was like we don't actually teach that much about how appetite regulation works the hormones involved how you know how it all functions so in the end the first half of the book is actually just the physiology of hunger and appetite which is why it's relevant to somebody who isn't going on GLP ones or thinking of going on them because yeah they can almost if they understand what appetite is and how it works you're hoping that they then can control that with their diet yes The hope is that if we have a better understanding and appreciation of how the system is set up, and it is actually set up for us to succeed, like biology is trying to help us out here, then we can A, appreciate it better, realise that we are in a situation where the environment we live in is stacked against us.

4:30But there's things we can do to help ourselves out of that. And then also, if you're somebody who actually biologically needs more support. And so when you start to understand that in some people, the brain responds differently to the same signals, then the medication becomes a really good option. But we still need the support, the lifestyle medicine intervention alongside the medication. Otherwise, you're just getting half a prescription and it really isn't setting anyone up for success. so I'm hoping that the book will help more of us appreciate how amazing our appetite system is how brilliant the biology inside us already is and then also make sure we take these medicines seriously don't treat them as a silver bullet that works for everybody they really don't right that like every other medicine there's side effects and there's potential that it won't work if our body and our brain are set up to understand that appetite is something that you sate and then And, you know, later in the day when you need to eat something, your brain, your body tells you.

5:31What happens to people who talk of food noise, who just don't seem to be able to control that appetite? You know, so food noise is super interesting because it's essentially something that's a result of these medications. Is suddenly so many patients have described food noise quietening, switching off food noise, that there is now medical consensus as to what food noise is. Before these medications, it wasn't a thing, which I find fascinating. So now there's the for the first time, like literally last year, a group has published what's considered to be the first description of it and the first way that we can categorize food noise.

6:10So it's a really important point to say that food noise isn't just thinking about food or being a foodie. Food noise is disruptive. It's in the way of your normal daily function. It's unwanted, obtrusive thoughts about food, food planning. is it healthy is it not healthy how many calories so it's something that now we know is present in a lot of people who have obesity and with these drugs it just quietens um and it's very it has very strong parallels with eating disorders so people who have eating disorders also have this rumination about food and so this has given us a whole new window into human psychology and how it works and the question you asked is like how did we get to a point where so many people suffer with food noise if we're naturally supposed to not have it exactly and it's this this imbalance this mismatch between our biology and the food environment we live in the obesogenic environment which is often called so we live in an environment which constantly stimulates us to seek food and actually we have an abundance of food so it's really odd because our body is like constantly receiving information to snack eat buy this purchase that try this eat this prepare this but we have an abundance of food all the time every corner store petrol stations places where you didn't used to have food do you know what i mean and now it's available everywhere and the food we have available to us most commonly is nutrient lacking so it's energy dense plenty of calories in it often plenty of sugar but there's no nutrients and so this my biology is like hang on a minute so we've got all the stimulus this queue external cues to purchase and buy and eat food then we have loads of food available we eat it and we're getting energy but we're not actually getting the nutrients that help our biology to switch on and say oh look we've got nutrients here you can you can feel satiated and that's because again we now know this a lot more thanks to these drugs and the research that's gone around around them that there are specific cells in our gut that are nutrient sensing so they only switch on when they actually have nutrients touching them if you will and those nutrients are complex carbohydrates so the kind of carbohydrates actually reach further down in your tract not just get absorbed in the stomach or the mouth or very high up in this more intestine healthy fats and proteins right we actually need these nutrients to reach these some of them are called l cells there's these nutrient sensing enter endocrine like there are lots of words cells that essentially when they sense the nutrients they then release grp1 pyy gip all these satiety signals and so that the answer is like we have this environment where our entire biology is looking for this food that we see keep seeing everywhere the nutrients aren't really there to send the signals to to signal our brain that we're satiated and at the same time we've got this constant preoccupation also thanks to diet culture there's also sort of a cultural preoccupation with food and so then we now have a sort of pathological psychological state where people are so preoccupied with food and it is so obtrusive in their mind that it actually stops them from performing at their best in the rest of their lives which is fascinating but also super sad and these drugs are actually switched off this noise So you can be born without this noise and the noise can develop through obviously eating the food that you described, which is not nutrient rich.

9:44Maybe it's high calorie, maybe it's high sugar. But over a period of time, your appetite will effectively be dictated to. Yes, it's like a real mismatch. It's like a reverse of hacking in a positive way, isn't it? You've kind of hacked your genes in a negative way. Anti-hacking. And so what you've just touched on is, like, I always think about newborns as the ultimate simple hunger signals. So they newborn babies and babies have just have homeostatic hunger, as we call it. So they just cry and scream when their energy levels are dipping and their internal hunger cues are saying, hey, we need more energy because we're running out.

10:22Babies don't care about food advertising. They don't respond to you saying, oh, my goodness, can you do you recognize this dessert or this cookie? They don't have any emotional relationship to food yet. And so when you think of babies, that is pure homeostatic hunger. They are eating in response to a decline in nutrient availability. That's how we're born. And then through life, we start to pick up hedonic hunger signals, which are things like the yellow arches. Oh, my gosh, does that mean you might get a happy meal or, you know, on a Friday at home? we have ice cream and so therefore so you start to have these emotional connections and cue response based on brands often um and based on things that we learn so learned behaviors and the hedonic hunger is often what external cues adverts play on so they they advertisers know this they know that we respond to these things and so that's a lot of the time you might you might not be hungry at all you've just had lunch but you then see an advert or a sign on the street for i'll give you an example i happened to the other day i walked past the shop and it said like tiramisu ice cream and i was like yes that's a bit of me so i literally i had just had lunch walked into the shop and i was like i'll have some of that and that's hedonic hunger right that's got nothing to do with your biological childhood somewhere does it that's tiramisu is your yeah is your go-to dessert i would be if i saw coffee ice i love coffee ice cream so i would be i can avoid all ice cream forevermore i'm not that bothered about if i see coffee ice cream something it must go back to some period of my life where i loved coffee ice cream yeah and it sucks me in and so then you're like i need i'm gonna have it and you're not at all hungry i'm going to go have some coffee ice cream exactly and so there's these there's this differentiation in the types of hunger but the food noise is really this mismatch between the way our biology is set up you know we obviously evolved over thousands of years to actually survive in fairly scarce food resources but the resources we had were incredibly fiber rich and very rich in nutrients and bioactive compounds in the foods we ate so tubers and roots and berries and leaves and all these things and so the way that our when you look at our appetite regulation system it's really set up to succeed with those kinds of nutrients because there's a delayed signaling from each part of the gut but the food that we often eat doesn't actually activate the entire way down because it doesn't reach the colon so if you take an example of a meal that's i don't know something like a white bread sandwich um with very minimal amounts of say chicken in it and nothing else like so that sort of chicken mayo sandwich right when you eat that you might activate you might see the sandwich you might interact with it for a minute before eating it a lot of people just wolf food down straight away so there's okay let's do the interaction then so is that an important thing because i i think we might have discussed this before i've definitely mentioned on the podcast that i was trying to explain to my husband that even if he hangs around me while i'm cooking yes that helps his enzymes get ready to eat yeah exactly so um and he's like what do you mean as well it's just the smells and the sensations and feeling the food and everything so the interaction with the food if we're on the go food and you haven't cooked it yourself or made it yourself it's still important to have that relationship i mean yeah it would be helpful let's let's do it let's hello sandwich how are you let's flip to a healthy let's flip it to a healthy way because then you'll see the gaps with modern food environment right so the best possible thing would be that you you get your groceries you get them all out and you chop them so you've got the peppers the sweet potatoes the onions you start chopping them up so visually you're seeing the colors you're seeing the foods you start chopping you start getting some smells right the the act of preparing your meal is actually the first step in satiety signaling so your brain is thinking right there is food coming we're going to be eating some food and it starts to tell your stomach to increase its gastric juices start getting ready for that salivation in the mouth right you'll start you'll get a little bit what's the word well it's not drooling it's um it's when you're like you when you're just you're releasing your saliva yeah but there's a word there's a phrase for it it'll come to me it'll come to me later and so that starts like increasing and your pancreas gets primed to releasing insulin because we want to absorb the nutrients as efficiently as possible right so that all happens before you've taken your first bite now if you cut that out entirely and you're somebody who's drinking your lunch at your desk you've just you've just given yourself you've just shortcut one of the main things that are part of what's happening then say you are drinking your lunch at your desk if you're drinking your lunch at your desk you don't have any of that priming so what's coming to the nutrients so the stomach hasn't increased its gastric juices for example so you're a bit less efficient at breaking the stuff the food down your stomach will just leave you without leaving the goodness it just won't yeah it just won't you won't have the same amount of breakdown and the insulin priming won't have happened as well so you won't start absorbing nutrients as quickly you know it's all things that when you look at population level data the populations who spend time preparing their foods and sharing it at a table have better health outcomes they're associated with overall improvements and markers of health the mediterranean diet one of the key components of the mediterranean diet is conviviality which is this idea of preparing your meals and sharing them it's literally a part of the diet um because we know it's so important so that's it's called the cephalic uh stage of appetite regulation it's this interaction with food seeing smelling and thinking about preparation then you get to eating it and when it reaches your stomach our stomach is like a balloon and as it stretches they're stretch receptors and those stretch receptors are nerves that literally travel through the vagus nerve to your brain and they tell your brain hey there's food in the stomach we've got we've got something here and that's what i would describe as fullness so when your stretch receptors are activated to a certain point your stomach is full and you get that it's temporary but it means you've got enough food in your stomach but it's temporary then as your stomach empties into your small intestine you have some of these nutrient sensing cells are there and they're really important for telling the pancreas get the insulin out there's things coming they're very sensitive to the protein the fat to carbohydrates and they're the first time that you see this grp1 pyy gip these peptides that are satiating there they suppress your hunger so they compete with ghrelin which is like a hunger hormone to say actually look at this we've got some food we can tone down the hunger we can stop seeking food it's great so this all happens within 40 to 60 minutes of eating so if you have a meal that at least reaches your top of your small intestine that could be your sandwich with your chicken then you will feel like you've eaten something in the first hour however if the food is really highly processed very low in fiber and lacking in nutrients then it kind of ends there most of the nutrients have been absorbed very high up in the tract your small intestine is actually not as small it's really long and a really large number of these nutrient sensing satiety cells live at the end of the small intestine and so we really want to eat foods that can carry nutrients all the way through the small intestine right towards the end the foods that do this are foods that have really good structure and they have high fiber because fiber traps some of these nutrients in and they don't get sort of to reach the nutrient sensing cells until later in the tract so fiber is very important for satiety and as we get to the end of the small intestine to the colon we get to the colonic phase and this is where you know some people say oh i had this meal and i'm full three hours later because if you've eaten a meal that's really high in fiber has really good quality fats in it and you're you're like three to four hours later it's making its way through your colon there's nutrient sensing cells there right and they are responding to the nutrients in the food but they're crucially responding to the breakdown products of the fiber fermentation from your gut microbiome so the microbes break down the fiber and they produce short-chain fatty acids so the nutrient sensing cells are also sensitive to these fatty acids so the more short-chain fatty acids your gut produces the more these nutrient sensing cells are then activated in the colon three to four hours later to say hey we've still got some nutrients this is great and so you can see how if you have a very nourishing meal that's nutrient dense and high in fiber what if a marginal gain unlocked greater performance what if an insight in data could change everything at aramco our focus on detail helps us deliver reliable energy to millions across the world.

19:03Because margins aren't marginal. They're where we can truly push the limits of what's possible. Aramco, an integrated energy and chemicals company. Learn more at aramco.com.

19:19Actually, you're going to feel pretty satiated for hours. Yeah. We've talked fiber on the podcast before how important it is because it seemed to have been the forgotten entity for a while, didn't it? People focusing so heavily on protein. If you want to add some extra fibre into a meal very quickly, are we talking beans, pulses, lentils? Yeah, beans, pulses, nuts and seeds. Whole grains are the unspung heroes. How would you add whole grain to your evening meal? So you might buy some barley and cook it exactly the same way as rice. Or nowadays you can get the pouches of spelt, you know, the microwavable pouches.

19:56So if you're someone who doesn't really want to try cooking something new, you can get micro-ribble pouch spelt of quinoa which is whole grain, it's actually a pseudo grain but you're allowed and you can also introduce oats again, so oats are a really good whole grain we just want to go for the jumbo rolled ones or the ones that are actually still cut, so that's the whole grain, it hasn't been rolled out. And is barley gluten free? Barley isn't gluten free, buckwheat is quinoa is frica I believe is also gluten-free so there are gluten-free grains you can get okay so so you can just use use those like you would use rice effectively yes you can use the same as you can add them to stews to soups you can put them in stir fries or so it's the same way as you would rice i would say that for texture plate reasons like um quinoa is a hard swap for me because it's very different texture but barley and buckwheat for the gluten-free option work well you can make a buckwheat risotto for example um and it's just you know i'm passionate about the whole grains the other group of foods is whole fruits both whole grains and whole fruits have been quite demonized with the kind of fear of sugars glucose but actually but they have so much more to them than their their starch right and we know from population level data that the dietary factors that are driving most deaths that's a strong statement but it's what it shows what the data shows is a diet low in whole grains by a country mile is the biggest one and a diet low in whole fruits is so diet low in whole grains diet low in whole fruits diet low in nuts and seeds is up there at the top so fruits are controversial aren't they and actually one of the questions that came through to you was about smoothies yeah and so when you say whole fruits you mean eating the apple rather than juicing the apple yes so eating the apple eating the banana eating the kiwi keep the skin on to as many things obviously not bananas but like kiwis and apples and pears keep the skin on um whole fruit kiwi skin oh i do yeah but you know the golden kiwis the skin's a bit less fluffy so it's a bit less of an aggressive way to do it like you're eating a brush um yeah okay so obviously bananas you can't keep the skin on but any fruit that you can yes but you where you can keep it on and eating whole fruit like it's so good for you i'll give you a really cool very new study came out last year um i think it was in denmark they took a group of patients that had early like pre-diabetes so type c diabetes but not so serious that it needed to be medicalized yet and they put them on a mediterranean dietary intervention where 50 of the calories came from whole fruit that's a lot okay and nine out of ten patients improved their glycemic control so their blood glucose improved six out of eight of the patients in that trial could stop their medication wow so whenever and everyone's like i'm just good that's incredible whole fruit when you think about whole fruit you mustn't just think about the sugars there's vitamins there's fibers there's these bioactive plant chemicals in them there is so much more to fruit than the sugar it comes in sugar is like a side product is there are there any fruits that perhaps they'd be the last ones that you would incorporate if you were looking at the sugars or looking at the nutritional breakdown Well, it's actually even more complex than that.

23:17So because it's not so straightforward as saying, oh, this one's bad, this one's good. I mean, it's true. Berries have the most research as being super helpful. They're very rich in these bioactive molecules that are antioxidant, polyphenols and things like this. And they're higher in fiber. So berries, maybe they're like the most efficient fruit choice. But actually, we know that a variety of fruit is the best way to go because each fruits have different fibers and different compounds. in them and so the combination feed different populations in your gut and they have different micronutrients so you're best off just getting a variety and you listen in the uk apples pears kiwis bananas grapes and berries are like a nice thing roster fruits are coming back they need to honestly we've suffered from cutting them out and and the effects you know what i'm always fascinated by is the effect that fruit has on blood pressure so we know blood pressure is a real problem hypertension high blood pressure is the number one risk factor for cardiovascular disease and you know cardiovascular disease heart disease is still the number one killer and a whole introducing whole fruit adding whole fruit to the diet measurably lowers your blood pressure so i have a lot of patients and a lot of friends actually who have worried about fruit they're like oh i only eat one portion of fruit a day i'm really careful i'm scared of the sugar and I'm like, you are literally doing yourself a disservice.

24:39Please eat more fruit. Two to three servings a day. I mean, and if you look at this latest trial. I have a lot of berries, but I've been, I suppose, subliminally drawn away from the fruit bond. The other day I had an apple. And I was like, this is lovely. Delicious. Yeah, an apple for ages. And then immediately thought, oh, but all that sugar. Have I just taken loads of sugar that I shouldn't have? No, you're taking on so many beneficial compounds that are literally going to help you live longer. Okay. Eat the fruit. An apple a day. I mean, the old, yeah. Yeah. Exactly. Shall we get into some of the questions that you've answered quite a lot, actually, already with your brilliant answers.

25:13But some from our lovely listeners pertain to things like collagen. Is that something that can be absorbed externally? Do we need to take it? This is quite, I mean, it's not that trendy, but it is something that is at the moment a conversation. I get asked about it a lot still. Yeah. So I feel like I've been asked about this one for at least three years. but it still comes up a lot and another thing that comes up a lot is women will say to me i am targeted i get the adverts for all the time so the evidence is really clear topical collagen does nothing it's a huge molecule it doesn't cross the skin barrier as it shouldn't because your skin's supposed to protect you from things crossing it so a collagen cream is just an expensive moisturizer the things that are actually doing the work are the other ingredients in the cream so probably not a good way to spend your money hydrolyzed collagen in some trials has shown benefits but they're quite marginal and the problem with collagen trials and there's a lot of debate about this but the problem with the collagen trials is that a lot of the collagen preparations have other ingredients in them so it's usually collagen and vitamin c or like collagen and creatine and vitamin c there's something in there and so it's hard to untangle what's the collagen and what's the rest of the mixture.

26:27So you've got to look at pure collagen then to get some kind of results. Yes, and the pure collagen, honestly, the evidence is stronger for joint pain than it is for skin health, if we're talking about skin here. What I always say to people I work with is, listen, if you've noticed a difference in your skin and buying the collagen isn't impairing you from buying more whole fruits, more fresh vegetables, then it's okay, like go for it. but mostly the evidence is telling us it's not going to be that measurable an effect on your skin. You mentioned joint pain, that's quite significant. The joint pain results I think are more compelling than the skin results.

27:06But you're best off eating more fruits and veg and looking after your skin as opposed to just buying very expensive collagen supplements. Quite a lot of questions about eating on the go. What would you recommend to eat well on the go? What would you recommend to buy from a mini supermarket for lunch? You talked before about garages who sell food. I'm saying it in inverted commas because there's not much of it that I would like to put in my mouth. But what can you do if it's unavoidable that you're going to be on the go? So I, two things, when I'm out all day, have a really good breakfast. So like really hit all that satiety signaling potential you can.

27:42That just helps set you up for the day and you're less likely to feel really hungry. And bring snacks with you. So like bringing a healthy snack is such a flex. so if you've got some nuts you've got some fresh fruit bananas and apples travel very well so do satsumas um and if you can plan where you might eat so if you have some sort of idea where you'll be that's great if you end up stuck in like a tesco express or sainsbury's local then actually kind of ignore the meal deal you can get a decent combination of ingredients usually for under 10 pounds and normally the way i think about this is get yourself a tin of fish ideally like an oily fish if you can stump if you like it so mackerel or sardines then get yourself like a bag of leafy vegetables some sort of salad or if not a punnet of cherry tomatoes so some of some veggies um get some mixed seeds or some mixed nuts as well and then if you want to and if you can one of those patches of the quinoa or some just oat crackers some good complex carbohydrates and then you can add things like olives or some sauerkraut so like some just for flavor and topping and then as long as you have somewhere where you can put them in a in a bowl if you've got an office you can put them in a bowl yeah then actually you can make a fairly balanced meal with some basic ingredients and for a good price everything you've described there and i'm not saying that you know we're kind of going to offer advice about how you share your lunch but you could easily two people could kind of share that couldn't they and or you could make it and then keep the rest for tomorrow in a fridge if a lot of offices have fridges now yeah um so you could package it away for the next day and so you have you have it and it's honestly more affordable much more nutritious and will keep you associated for longer than a meal deal are there any high street cafe not the brands i'm talking about yeah i don't i don't want to name any names and put them in your head but there are any that are better than the others there are but they come with a price tag right so the ones i like attis beautiful they do a really good job there's also what's the one that makes the beat salad projects you know but these are really quite expensive you're looking i have I have to say the portions are generous, but you're not going to get a lunch for much less than 20 pounds.

29:48So it really depends on your budget. And this is a big problem with our food environment in general. It's quite, you have to put in an extra bit of work to access healthy food on a tighter budget. A lot of people then think, oh, well, I'll go and get my lunch, as you say, in liquid form. And they go to one of those high street places where there's lots of different drinks available. You can add lots of different things into it. Oh, are they? I kind of know. They're a no. They're a no. So we talked about the four stages of appetite. If you're drinking your lunch, listen, occasionally getting a smoothie might be like the best option.

30:20But if you're buying like a bottled lunch situation from a petrol station or supermarket, you're bypassing cephalic region. You're not activating stretch receptors in your stomach because it's not enough volume in there. You are activating the top part of your small intestine where the carbohydrates, sugars and proteins will be absorbed straight away because they're already blended and hydrolyzed. your lower part of the small intestine might get some dregs le colon's getting nothing so it's really not working with your biology and and and i worry about there's no evidence for this so i might be wrong but i do worry about the speed of absorption from your small intestine to your liver when everything is in liquid form like that's not how we are supposed to be absorbing our nutrients um so i'm really not a fan of drinking your lunch at your desk um there are I was just thinking actually there's also like the Farmer J.

31:09They're really good. Yeah, they are excellent. But are they pretty much London based? Yeah, these are all expensive London brands. Yeah, they're amazing. They are. Farmer J's are amazing. But they are expensive and they are pretty much themselves. And that's why I think you have to plan a bit. Bring things with you if you can. And if not, go to the supermarket and think ingredients instead of ready meal. Good advice. Is it better to have two meals a day if you're aiming for weight loss? this is the fasting kind of question yes um the short answer is not really so and actually for women especially perimenopause menopause where we need to be much more conscious of nutrient density and really working with our bodies to make sure it gets everything it needs it's reducing meal times it makes it harder to get enough nutrient density so i would say it's less about the number of meals you have it's more about the time window within which you eat them so if you're eating your three meals a day within a good 10 hour window so you're giving your body a 12 to 14 hour overnight fast if your goal is weight loss by the way otherwise if your goal isn't weight loss 12 hours overnight fast is perfect it seems to work well it seems to also improve your sort of metabolic function but it's all marginal dietary quality is the big factor so making sure you're eating the best possible dietary pattern is going to move the needle the most but if you're trying to structure your eating which is a really good idea with weight loss then it's less about the number of meals you have and more about keeping them at regular timings right even if you've had a different sleep pattern that night you'd still say if you're having breakfast at eight o 'clock have breakfast at eight o 'clock yeah try to keep things constant yeah sleep ideally you keep your sleep window constant as well yeah well the best sleep expert we've had on the podcast over the last few years the thing that she said you should focus on is your wake-up time as opposed to worrying about you're going to bedtime and that helps to regulate sleep so that would also buy into that holistic view of your body and its metabolic function.

33:06It's circadian clocks, it's all rhythm based and the more we respect the rhythm the more the rhythm can sustain itself as being predictable and efficient. You see this flattening of circadian rhythms over time with age and a lot of the sleep dysfunctions and metabolic dysfunctions pair up with this flattening. so we really should have said the best advice rather than the best as if i was grading them all i was grading them all i just remember coming away thinking that seems like it's a good piece of advice isn't it because you then don't beat yourself up if you go to bed a bit later but actually if you and don't you find anyway that if you go to bed late you still wake up around the same time and i say that about my kids if my mum puts them to bed she's like well i put them to bed a bit later i was like we'll do nothing for their wake-up time they'll just be tired well done you yeah um i want to talk to you a little bit it's a slightly off topic but about education and you know what you do is educate you educate students but you also educate us what more do you think public health policy and the government should be doing to make the kinds of things you're talking about now more accessible and easy for people because as you're talking i'm just thinking of i mean my walk from here to the place i've come from when i work on these podcasts is another studio and i pass i'd say 25 eateries none of which i want to go into right so how can we how can we make good healthy food more accessible for people yeah so i think here i always like to point to countries that are doing a better job because actually there are countries that are doing better job than us so we can look at what they've done the policies they have in place and it spans quite a lot of things so like there's different touch points there's licensing the number of licenses you give out for fast food outlets on streets pretty simple camden who does that well uh so we japan and sort of singapore and brazil so a lot of countries do that quite well uh that i think france also has a policy in place where you have a limit on the number of fast food outlets basically that you're allowed to have totally that it feels like that yes yeah you do not see yeah so there's there's also so there's the kind of actual urban planning how many of these outlets are allowed are they allowed to advertise so interestingly singapore you're not allowed to put like a big billboard um unless you're selling healthy food so the healthy food outlets are the ones that are allowed to advertise the unhealthy food outlets can't so it's a bit like putting cigarettes behind the counter type thing right um then there's education system so there's if you think about institutions if you start with institutions usually have a big impact that means improving the food in schools improving food education in schools i mean japan has zero foods prepared off-site all food is prepared in schools right um italy france spain have massively protective laws around what's served to children especially in early life and then what's actually taught in school so bring back teaching kids how to prep food how to grow food what it is i love teaching children in schools i just do it when i can like in my free time i give lectures and they are so open to it kids are amazing they love it um so there's schools there's hospitals so actually improving hospital food massively improves outcomes for the patients now at the moment in the uk if you go into the hospital you're likely you're more likely to come up with more malnutrition when you came in that's so you're getting worse this is why we try to dismiss patients so literally like institutions schools hospitals prisons if you start with big institutions and changing what food is served to them you could massively improve outcomes with a long-term effect right so that's like institutional then there's a policy level how accessible is food and supporting farmers so supporting the way that food is grown and distributed in the country so that vegetables are accessible, fruits.

36:39So you're taking out the middleman a bit. You have to sort of reduce the monopoly that supermarkets have in how they're allowed to price and distribute fresh produce. Are you worried about what's happened with the price of fertiliser, for example, and oil, obviously, with farmers? They're talking about just not even bothering this autumn with crops because they can't afford to grow them. Are you worried that there's been a lack of, it would seem, policy kind of to help the farmers in this country there's a huge lack of foresight with these things and actually henry dimblebee did an amazing job with his plan which set out a lot of changes for the farmers to become more self-sufficient and be able to thrive not just literally skate by so there have been really good policy options built by people who are experts i'm definitely not a farming policy expert but there are really good full systems solutions that haven't been taken So now we're looking at even more increases in food prices.

37:34I mean, food prices have increased drastically since the pandemic. And we're looking at another big increase this winter. And we know that access to food, healthy food is a big block for the majority of the households that suffer the most metabolic dysfunction. So these diet related chronic conditions are disproportionately found in populations that have less access, that have reduced excess income. and it's going to be an even bigger divide if food prices continue to grow so we need to really like we what i really it's hard because not working at policy level it's about giving people the incentive to be like hang on a minute this is not okay with me i'm going to use my power to vote to write to my mp to do whatever it is that's in your power fill out the forms online where you can complain basically um and also find ways where you can support your local farmers where you can buy produce from them start to look outside and see what's available support perhaps or if you're trying to support families that have less access how can you support food banks for example donating fresh produce there's lots of things that we can do as individuals and if we all come together and push for the same change actually it does then force change but certainly top down has been pretty slow with these changes which is why so much of my time is spent hopefully educating giving tools that everyone can use in their daily lives because yeah otherwise it's a good time to remind isn't it as food prices are going to increase that vegetables in cans you know beans and legumes in cans and frozen vegetables are a good way of getting those nutrients at a lower cost absolutely so frozen veg tinned canned also if you buy dried legumes they're like incredibly cheap dried whole grains it takes a bit longer to prep but it's really soaking them overnight in water it's not too much more than that um but you know it's it's really trying to buy bulk as well of a lot of these products will make them a lot cheaper so nuts and seeds are super nutritious the price can go hard quite high for those so if you buy like mixed nuts and mixed seeds in bulk the price is drastically reduced um and so it's just also to your point knowing that it doesn't have to be a fancy brand it doesn't have to be sort of super fresh from the shelf you can actually frozen vegetables especially in berries can often be more nutritious than the ones on the shelves because they're frozen on the field immediately yeah and so all the nutrients are preserved um so there's lots of things like that which make it a bit more accessible and hopefully take some of the stress away it doesn't have to be like you'd have to pick it from your own field or anything yeah it's always wonderful to chat to you and um and we covered such a wide range of topics there but i think the start of our conversation really did focus on your new book the appetite reset and it was so informative thank you for that and thoroughly recommend any of your books they should all be on everyone's shelves so um good luck with this one and um i'll probably see you next year yeah i hope so thank you so much thank you

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