Which chocolate is the healthiest? | Spencer Hyman and Prof. Sarah Berry

26:23But I was most struck by the fact that some of them were able to wean off these medications, which was striking. Can you help us to understand how this change in what you're eating could suddenly stop your joints being inflamed and in pain? Because, you know, the link is not obvious. I think it's complex and multifactorial. Simply speaking, I will say we know a lot of our dietary components like sugar, a lot of these saturated fat, processed foods, drives inflammation in various ways. I think one of the primary ways is through how it affects our gut microbiome. I think that we end up assaulting our important gut barrier with loading it with all this sugar and fat and these emulsifiers and food colors and other processed things that are really insulting the gut barrier.

27:24And that is leading to this systemic inflammation. A lot of the cytokines, these proteins, inflammatory proteins I talked about earlier, like TNF, like IL-6, these go up with poor diet. And I mentioned to you earlier, those are the things that we target with our drugs. And so these things are all related concepts. And so by simply improving our diet, improving our gut health, decreasing the dysbiosis that we experience, I think that that is leading to these improvements in our joints. You're very focused on measuring this sort of level of inflammation in the body of your patients. You've talked about that quite a lot.

28:05You're saying that if I go and eat like a typical Western diet, you know, all the hamburgers and all the rest of it, I come back in a year's time, you're going to actually be able to see that in the inflammation, like in my bloodstream with these markers? Yes. It's so fascinating. I don't know if you've ever gotten phlebotomized. People draw your blood. I definitely have. But if you get your blood drawn after you eat a big hamburger or a big fried meal or something, I mean, it is striking. Blood normally is nice and deep red and pure. And there's not, you know, if you spin it down, you look at the serum layer.

28:47It's a nice, clear layer. literally minutes after you eat that hamburger full of saturated fat and whatever else is in it that serum layer becomes cloudy and it's like all these lipid particles that end up going straight to your liver causing inflammation that stuff is coursing through your blood and it's considered you know a hazard your your your immune system reacts to that and that's part of the issue is that we're getting this dramatic response to saturated fat. It's quite striking. That's quite a crazy picture, your paintings. You're saying like, you can tell if I've just eaten a hamburger, you don't even need to do the blood test.

29:28You can just look at my blood if you pull it out of my arm. And that you feel is not good. That is not sort of a normal situation. That's fascinating. So how profound a change were these participants having to go through in order to get this benefit? Were you having to go from like literally, you know, your normal diet, which has got plenty of meat, and of course you eat some French fries, and like nobody's perfect to like this perfect sort of vegan diet where all you eat is like rabbit food. Like is that what was required in order to have this impact? So dietary adherence, I think, was variable.

30:06I think they did see better, you know, improvements with those who were able to move towards more whole food plant-based eating patterns. I think that so the intervention did include a lot of dietary counseling and a lot of kind of hand-holding. But I will tell you, there is a preponderance of data that supports the whole food plant-based diet in terms of improved health outcomes. And I would say, I would not call it rabbit food. I think that there's lots of yummy, delicious, you know, as Christopher would say, Christopher Gardner would say, unapologetically delicious food. There's a lot that can be done in terms of plant-based, plant-forward, or I should say plant-centric eating.

30:49But it's so clear to me, the data supporting that dietary pattern with positive outcomes. I guess what I was wondering is, do you need to be perfect in order to get that benefit? Because obviously you're talking about a trial and I've spoken to other podcast guests who talk about, like, you can do a trial and you can get people to do something quite extreme for, you know, a month or a couple of months, but it's sort of not sustainable. And the question then is if you're not perfect at this. So let's say somebody's listening to this and like, I don't want to be in a position where I never get to eat any red meat again.

31:25From your view as a clinician and a scientist, like, do you need to be perfect on this to get this benefit on arthritis? You don't need to be perfect. Nobody's perfect. Let me tell you some anecdotes that I think are really striking. So I've actually had some very good luck coaching my patients towards more whole food, more plant-centric diets. A lot of them have improved. And then what happens is they have a slip up and they, you know, gorge on sugar or they gorge on a steak and they will literally feel it in their joints quickly. And it's striking. So at this point, once they've made the change, you're saying that they can literally feel like later in the day or something, the impact on their body of that particular food.

32:11It's so fascinating. I've learned so much from my patients. I think some of them, like, you know, when they're really able to kind of get themselves to a really nice kind of homeostatic balanced point, their joints are doing well. And then they slip up and they find trigger foods. It can literally happen in some patients. I mean, within hours or a day or, you know, short periods of time, they can suddenly feel their joints light up. And I think what's so exciting is that the joints, you know, you don't feel your cholesterol going up. You don't feel your glucose, well, you have CGMs, but you don't feel your hemoglobin A1C rising up, right, for diabetes.

32:48But people feel their joints. And it's really incredible. In my patients who have come with me on this journey towards eating for health, I'm a huge believer in food is medicine. And those have done these end-of-one experiments, and then they have found, you know, certain trigger foods. So, yes, you don't have to be perfect, but it's so fascinating how food can reinforce what might be driving your underlying inflammation in a very tangible way, which I think is really striking. I think that's amazing idea that you could actually eat a particular food and just feel it in your joints that it feels bad.

33:27Because I think one of the things that is, I think, very hard about food is that for most of us, you know, we're surrounded with this environment with all this delicious ultra processed food everywhere that's been designed by very clever scientists, right, that you can't stop eating it. And mainly, you're not really aware of how it's making you feel. But it sounds like you're saying that if you're at the point where you are living with arthritis, in a way you're sort of more sensitized. Clearly, our ancestors were quite happy to occasionally eat honey and fruits and the red meat whenever they could get it.

34:02And so it wasn't causing them any problem. And here you're talking about these patients who can sort of feel the negative impact immediately. what's going on here that they're having this different experience than our ancestors would have had? First of all, I think our ancestors probably had better gut health. And so, you know, I think one thing that's so complicated is that when you have poor gut health, I think that's setting you up for an immune system that's primed to respond to different proteins, different antigens. And like I said, the ones that are in the joint, there are T cells that may end up going to the joint.

34:39And so whether the food that we eat is basically triggering those T cells to get activated, whether it's basically because you've got this leaky gut, breach of this gut epithelial barrier, and your immune system, which is, by the way, the gut has the biggest immune system, and whether then those T cells are getting educated to then, they're getting activated and reactivated upon introduction of some of these trigger foods. I mean, that I think is a mechanism that is most likely to explain this gut joint connection. That's really interesting. So you're saying the microbiome you think is playing this very important role in how the food is then leading to inflammation.

35:22Do we know whether there's a positive impact here as well? Have they looked at the microbiome in this study, for example, or elsewhere and understood whether you know, by shifting this food, people living with arthritis are actually able to improve the microbiome and that's leading to these improvements? Yes, I think it's the microbiome is a bit of a complex galaxy. I think that there's no one perfect microbiome. But I think one theme that keeps coming through in every study is that diversity of the microbiome is super important. And if we feed our microbiome good foods, we take care of it by eating, again, high fiber, lots of plants, good foods, then the good bugs will proliferate and predominate.

36:08And I think that the problem with our industrialized society and our diets is that we really have, unfortunately, a decrease in our gut microbiome diversity, which is a huge problem. And so definitely studies have shown that patients with rheumatoid arthritis and a lot of other inflammatory diseases have a decrease in their microbial diversity in their gut. and then just trying to figure out what are the good bugs. I think there are several different candidates, but it really is the composite mixture of bugs that leads to a good gut microbiome. There's not a one-size-fits-all. Now, I know we focus a lot on arthritis, but I think sort of taking us through this story with inflammation, I think you've already explained how much this is touching sort of almost all the other diseases, right, that are likely to affect us.

36:55But one you haven't mentioned is something that I understand you're also involved in researching, which is that you're part of a multidisciplinary group that's looking at cancer at Stanford. Is that right? Absolutely, yes. Is there any connection between this sort of chronic inflammation that we're talking about and cancer? Definitely. And I think these are incredibly complex topics. But one thing that has come to light recently in the past less than a decade is we are learning how important the immune system is in terms of cancer control. And so what's happened is the Nobel Prize was awarded in 2018 for the advent of what are called immune checkpoint inhibitors.

37:35And to try to kind of distill this down, basically the immune checkpoint inhibitors are these molecules, these antibodies that take the brakes off the immune system. So they inhibit the inhibitors of our immune system. And in doing so, it allows for this very robust immune response to occur. and hopefully it means it's going to stimulate some of those T cells to go attack our cancer cells, right? Our bodies are constantly surveilling for cancer. We're probably developing little aberrant cells right here as we're sitting, as we speak, and because we hope our immune systems are good, we're clearing those cancer cells.

38:14But you can imagine when you have aberrant inflammation, your immune system may be somewhat compromised in clearing those cells. And so we're learning that, for example, cancer is becoming more and more common, and we're seeing it in younger and younger people. And so there's probably a role for the immune system. Again, our gut microbiome, these are so many complicated concepts to try to tie together. But I'll just go back to the checkpoint inhibitor example because I think it's really interesting. So immunotherapy is really helping to stimulate our immune systems to kill our cancers. Unfortunately, our immune systems then can get so activated, they can end up attacking different organs of our body as well, including our joints, our skin, our lungs, other places.

39:01And one thing that we've learned is that diet plays a really important role in the immunotherapy response. So scientists at MD Anderson have shown some really beautiful data. When they looked at patients with melanoma, which is a type of skin cancer, who were receiving this immunotherapy, they found that the patients who had the most robust response to clear their cancer were the ones who were on high fiber diets. And they're finding that the patients who had the most diverse microbiomes, right, those were the patients who ended up having a more effective anti-tumor response. And I think other data, we're learning that similarly, I think, you know, our gut microbiomes are really important in mediating and tuning our immune system to prime us to kill off these cancer cells.

39:57You're saying that there's some recent papers looking at patients fighting cancers using these new immunotherapies. And you're saying that the patients on diets with more fiber, which we know is this key thing that feeds the gut microbiome, and also people with this more diverse microbiome, were actually having a better a response when they took this immunotherapy. So it's been more successful for fighting cancer. Exactly. So I'm pretty stunned by that. You're looking at me as though like, yeah, that's sort of obvious. Is that like, have we known about that for very long? No, we haven't. And no, this was not obvious to me either.

40:35I think I'm thrilled because it obviously is concordant with everything we think is, you know, has been true about the gut microbiome. But I think it raises the issue that really our microbiome is playing such an important role in modulating our immune system and tuning it to optimize our health against protecting us from autoimmunity, protecting us from cancer, protecting us from other infections. I think it's becoming so central to what we call immune homeostasis, the real kind of just the balance of everything in our bodies. So I encourage my patients that have cancer to really be thinking about their diet seriously, because I think that our diets play a huge role in not only response to immunotherapy, but also other cancers as well.

41:25We know colon cancer is very closely associated with our diets, as well as other GI cancers. So I'll mention to you, the National Cancer Institute has identified 13 cancers that have been definitively associated with obesity. And we know obesity is obviously very much associated with our diets. And a lot of these cancers tend to be gastrointestinal GI-related cancers, esophagus, stomach, liver, pancreas, gallbladder, and then, of course, colon. A lot of the other cancers that are listed on this list of 13 are hormonally-driven cancers, So breast, uterine, those types. So I think that we are starting to really appreciate the role of diet and inflammation that probably plays a really fundamental role in our protection against these cancers.

42:20I think that's really amazing. A little terrifying because, of course, the diets that we are eating, whether I'm here in the States or I'm in the UK or Australia, it doesn't really matter, right, are really low on the sorts of foods that support our microbiome and really heavy in the sorts of ultra -processed foods that are bad. I just want to clarify one thing because you've talked a lot about here about how you might be able to improve your diet if you were fighting cancer or something like that. I think you're also saying that if I am just eating a traditional Western diet, that this is going to be directly leading to this higher inflammation and that that inflammation is then liable to increase my risks of, you know, not just what we were talking about before, like the heart disease and arthritis, but also things like cancer.

43:10Yes. I should mention the WHO has declared that processed meats and red meats are considered carcinogenic. And so, you know, again, we're seeing kind of this incredible uptick in our meat consumption when you look over the past century. And I think we need to keep that in mind that not only is it not good for the environment to be eating red meat, but it's also really a problem, I think, in terms of just cancer generation. Colon cancer rates are going up. In the United States, we've decreased the age for screening for colon cancer now to 45. It used to be 50. Now it's 45. And so I think that our poor Western diets, full of ultra-processed foods, full of meats, especially red meats, I think that is driving this uptick in cancer that we all need to be wary of.

44:01Tomika, I think you've painted a really strong picture about why the food that we eat can really affect you. And I think having gone in talking very specifically about arthritis, I think you've really pushed it open as well to think about the broader impact. I'd love to talk now about actionable advice. And I'd like to really focus, like imagine a listener here is living with arthritis or they know someone who is and they'd like to go and share this podcast with them and make sure that it's like really practical. And I understand that you and your colleagues have built a sort of new food pyramid as a way to think about how you could put these sort of anti-inflammatory foods into your diet.

44:45And it's pretty different from the food pyramid that I grew up with. Could you take me through it? you're generous. We haven't built a new food pyramid, but we adhere or we promote a couple food pyramids that I'm particularly keen on. Andrew Weil, who is kind of one of the founders of integrative medicine, I think puts out a very nice anti-inflammatory pyramid. And the other pyramid that I like, I don't know if it's a pyramid, but I am a big fan of Dan Buettner's Blue Zones. I think that, you know, people are probably familiar with Blue Zones where Dan Buettner studied the centenarians of the world.

45:21There were five areas, there's now six, Singapore got added, where people tend to live to 100. And studying their diets and behaviors, I think has been very informative because we're never going to run a diet study for 100 years, let's face it, right? All these wonderful RCTs are short term. I love the fact that there's now this pattern, this dietary pattern that is associated with good health, good quality of life. And I would just like to add that we actually did a podcast with Dan Buettner a little while ago, which was lots of fun. He explained the Blue Zones and what they were doing. He also gave this amazing recipe for a soup in there, which I can recommend.

45:57So if anyone's interested, they can search just for Blue Zones or Dan Buettner and they will find that episode. So tell me what's on the plate. You know, I like the kind of my plate. This is sort of the approach where you take a plate and you divide it up and really half of it is fruits, vegetables, you know, good stuff, the whole concept of eating the rainbow, I think really is apropos because these are foods that are high in phytochemicals, a lot of the antioxidants that are super important for calming down our immune system. Cruciferous vegetables. These are things like broccoli and kale and cauliflower and these really kind of the deep leafy greens that I've come to love and embrace.

46:44And they're so important. I really think food is medicine. And these are incredibly important in terms of helping our liver detoxify. We're living in a very polluted world. And I think that these are super helpful foods that can help us clear our body of a lot of these toxins, these endocrine disruptors, which we haven't talked about. But there's a lot of these things that we need to be thinking about that are super helpful for my patients. So half of the plate, I think focusing on high quality, you know, vegetables, some fruits, and then a quarter of the plate being proteins, preferably plant proteins or lean proteins.

47:24But, you know, things like beans and lentils. I'm a big fan of tofu. You know, a lot of – and then whole grains. I think the thing to keep in mind is that, as we know, with our ultra-processed foods, we tend to eat a lot of these very refined grains. You know, the white rice, white pasta, white bread, these things that have had a lot of the nutrients stripped out of them and a lot of the fiber stripped out. So refined grains is where we want to go. And so really whole wheat and whole, you know, things like quinoa I love. And some of these ancient grains are also really good, like farro and bulgur and millet.

48:02But if you kind of imagine, I guess it's really the plate method, the pyramid method is a little more complicated to think through. But those are the key staples that I try to encourage my patients to aim for. Again, animal products in moderation, really limiting them. If you look at the blue zones, they say that the majority of blue zones ended up eating meat less than five times a month. So really that comes down to maybe once a week. Meat should be considered a treat. The other thing I'll mention that I love about the blue zones is that one thing that was commonly shared across all the five blue zones is they all ate a half to one cup of beans a day.

48:43Beans or lentils, so these legumes that are so good for us, packed with protein, packed with fiber. Another food type that I love a lot are things like chia seeds and flax seeds. I think chia seeds are the perfect food. They're high in fiber, high in omega-3, high in protein. They've just got so many great components that I add them to my smoothies. I just try to incorporate them wherever I can. I get a big bottle of them and add them wherever I can. Is there any view around oily fish and arthritis? Because I know that there's a sort of spread of opinion, I feel, between the people that I interview.

49:24But there seems to be quite a lot of people talking about oily fish as being beneficial. In general, you've been talking about very much plant-centric diet. What's the evidence with people with arthritis? So fish, I think, can be a helpful component because of the omega-3s. So we know omega-3 fatty acids are incredibly anti-inflammatory. That being said, I also encourage my patients to not go too heavy on fish, to eat the smaller fish. So not so much the tuna and the swordfish, you know, things that are much larger and can end up bioaccumulating things like heavy metals and toxins, trying to go for the wild caught instead of the farmed.

50:05But again, I would say, what do I do? I end up taking the vegan omega-3, which is from algal sources, so algae. I think there are different ways of getting omega-3s. I mentioned chia seeds also have them, and there's different types. So fish, I think it can be a good thing, but not to overload. And I tend to also recommend, I tell my patients, check out the Monterey Bay Aquarium's resource called seafoodwatch.org. Seafoodwatch has a lot of the examples where fish, what's sustainably caught and which ones are thought to be healthier. We have to be thinking about pollutants. Our oceans are not the cleanest, so we have to be thinking about that as well.

50:47That's really interesting. One thing I haven't heard you mention is probiotics, you know, like live bacteria or prebiotics or fermented food or things like this. Does any of that matter as we're thinking about inflammation and arthritis? Absolutely. We don't have data yet specifically on arthritis, but I will say the prebiotics and probiotics are all so critical in maintaining a very healthy gut microbiome. I think the best study on this is called the FIFO study done by my colleagues Christopher Gardner, Justin Sonnenberg, Erica Sonnenberg, where they did a very elegant study using equipoise, meaning they didn't try to, you know, game the system in any way.

51:33They didn't know. They basically put head-to-head high-fiber diet compared to a high-probiotic diet using fermented foods as the source of a lot of these bugs. And they ran this study head-to-head comparison, didn't know which one was going to end up being more, quote, anti-inflammatory. And what was so fascinating about this study is it was the probiotic fermented food arm that ended up showing a more substantial anti-inflammatory effect. That being said, the devil's in the details. So basically, the fiber was super, super important in having an anti-inflammatory effect, but that was seen only in the subgroup of patients who already had a very robust, diverse host microbiome.

52:22In the patients, the participants who ended up not having as much gut microbiota diversity, they ate a ton of fiber and they ended up actually getting more inflammation. So it was really about, I think about it as the soil and the seed, the soil being the fiber that we need to consume, the prebiotics that are feeding our gut bacteria, that are helping our gut to maintain the epithelial barrier integrity, and then producing that very strong mucus layer that is the important barrier. We need the fiber for those reasons. But we also need the fermented foods that have the bacteria that populate our gut microbiome.

53:05And you need both of them together in concert in order to have a very healthy, diverse microbiome that protects us against inflammation. And one thing I'd like to clarify, because you talked about probiotics and you talked about fermented food. And I think most people, when they think about probiotics, think about like a capsule that they can buy, you know, from the store and pop. And fermented food, they think, well, that's something that I buy from the supermarket and it's a food. Were you testing both at the same time? What do you... So I guess one could argue fermented foods have a lot of these probiotic bacteria in them.

53:39And so they actually, they're very effective as probiotics. I'm referring to those not... And I think capsules are interesting. I'm not sure how effective they are compared to just eating probiotic foods that are full of these good bacteria that end up staying in our gut. So when you're saying taking probiotics, you're actually meaning like eating these fermented foods full of live bacteria, right? Correct, correct. From like a yogurt to a kimchi. Exactly, sauerkraut, kefir. Or sauerkraut or whatever. You're not talking about like individual capsules. So within this plate and this design, are you recommending people take these probiotic capsules or are you actually saying, no, I'm recommending these fermented foods?

54:25I think of food as medicine. So I would encourage my patients to incorporate as many of these fermented foods as they're able to because that really helps. And especially after, let's say, they've taken antibiotics for some sort of infection that can deplete the microbial diversity. So eating the fermented foods provides a lot of the bugs that help to repopulate our gut, really providing the seeds, as you then chase that with fiber, which is the soil, the prebiotics. I think both are equally important in terms of really creating a good gut microbiome. Do you know someone living with arthritis?

55:03Why not send them this episode right now? Help them understand how to manage their symptoms with the latest advice from a world-leading rheumatologist. I'm sure they'll thank you. We're sitting in California today, and I feel like the number one question that we would get from listeners who are in California to this is, that all sounds great, but I'm really worried that I'm not going to get enough protein in the plate that you've just described. And I know that protein is really important for my health, but you've just taken sort of all of that. You haven't even really pushed meat at all. Aren't you worried that your patients aren't getting enough protein?

55:43So when we think about protein, you know, not to get too far into the details, I think that the recommended daily allowance is 0.8 grams per kilogram. So let's say for 150 pounds sedentary person, it's about 50 something, you know, grams of protein, which can easily be achieved with a lot of the plant-based foods. When you think about, you know, tofu and tempeh and soybeans and all these other beans and lentils and whole grains also have protein. And so I think that people are almost a little overly obsessed with protein. The RDA, by the way, really is even a high estimate of what we need. It's two standard deviations above the average.

56:28So I think what I am focused on is we are very fiber deficient in our diets and that in general, the vast majority of us are, we have too much protein in our diets. And I'll just also make the point that protein cannot be stored. So protein can be kind of in the instant, you know, can be converted into glycogen as a source of energy, but the remainder, the excess, ends up getting converted into fat. So I feel like all the excess protein we're dumping into our bodies could be actually causing more problems, you know, so we need to be thinking about that. You know, kidney patients, They can't tolerate too much protein either.

57:07So I don't have concerns about too little protein in our diets. You talked a lot about fiber. I just have one specific question about this, which is like, how much should someone be looking to eat during the week? Because you talked about the importance of that for feeding the microbiome and then pulling down this inflammation. What if someone was trying to understand, like, what should they be trying to achieve? And what is, you know, the average, you know, American since we're sitting here, what's the average American actually eating today? So the average American is eating about 15 grams of fiber, and the amount we should be targeting is between 28 to 35 grams of fiber.

57:48That being said, there's a tribe in Africa, the Hadza tribe. Dustin Sonnenberg and his group studied this incredible group of folks, and they were getting upwards of 100 grams of fiber in their diet. 100 grams. 100 grams of fiber. And the average American is eating 15. Yes. And the Hadzas, you know, they had no chronic diseases, no issues with inflammation, incredibly, you know, healthy. So I think that it just goes to show how little fiber we have been eating and how much that's probably impacted our gut health. And so to get that fiber, again, fiber is only found in plants. Final question, because we're over time, It's been fascinating.

58:33You've laid out a really big overhaul to our diet. And so lots of people listening to that will be saying, like, you know, I'm not ready to make like all of those changes. If you're going to say to them, like, here's one small change that you can make tomorrow. Start small, make swaps that are barely noticeable. So I tend to, you know, like plant-based milks, soy milk, oat milk, things like that, or take a day of the week, do the meatless Monday, where meat becomes the condiment and the main highlight are the plants in your meals. This doesn't have to be overnight. And again, I don't think that the goal is that the world is gonna turn vegan, but I do feel like we do need to move that direction in terms of really, I mean, there's so much evidence supporting plant-centric eating patterns that correlates with good health, with less inflammation, with a lot of these chronic diseases.

59:29that are plaguing our society. Not to mention that it is a helpful thing for the planet and a helpful thing for so many other things. Tomiko, thank you so much. I would like to try and do a quick summary. And this is a new topic for me. So please correct if I got anything wrong. So if I think back across it, like the thing that's most in my mind is for most of us eating like the regular diet, our whole body is on fire with inflammation, which is like this terrifying image of like every bit of it like burning down. And the issue is like inflammation is like our damaged repair system. So we need to have some, but it's supposed to just come on some of the time.

1:00:08But because of the food that we're eating and the lives that we live, it's sort of like switched on all the time. And this is your image of it all sort of burning down. Diet is the central issue here that you're saying is causing this inflammation because of the sorts of foods that we eat, but critically also that our microbiome is so damaged compared to the microbiome of our ancestors. that our ancestors had this much better gut health and that really protected them. Whereas today, because of what we have combined with our food, we're having this like always-on inflammation. And that is not just leading to sort of the arthritis that we spent a lot of time talking about, but actually it's this risk factor for any autoimmune disease, but also cancer and heart disease and all the rest of it.

1:00:52You gave this brilliant story of saying, well, if I ate a big hamburger right now and then you took my blood, like a few minutes later, you'd actually see in my blood that it just doesn't look like it normally does and it's cloudy and it's full of all this saturated fat. And that is this first step leading to inflammation, which is a very scary image. We talked a bit specifically about how this links to arthritis. And you said there's sort of two main types of arthritis that listeners might be living with. osteoarthritis, which you said is the most common, which historically we thought of is only wear and tear.

1:01:27But you're saying now you think there is this inflammatory component because you see the impact of food improving it. And then rheumatoid arthritis, which we know is this sort of auto immune, meaning it's like our own body attacking us. And it's this very direct explanation of how the inflammation is causing this problem. And therefore, if you can reduce the inflammation through food, you ought to really be able to have this direct impact. And you, I think, painted a picture of just how much this impacts your quality of life. And so this is another way in which if you can't keep the inflammation under control, we end up having our quality of life really impacted.

1:02:01Now, all of that was a bit depressing. But then I think you switched to like actually really positive news that it is possible, like within eight weeks of changing your diet to have a profound impact on your arthritis, because it's having this profound impact on inflammation. And then you described to us, like, let me describe to you like an anti-inflammatory plate, like the plate that you take to your patients in Stanford. And, you know, what I took away was, you know, for your plate, half this plate is vegetable and fruits. You want to eat the rainbow. You particularly like certain plants that you felt were particularly good for anti-inflammatory properties broccoli kale cauliflower this was your cruciferous i don't know what else is in cruciferous i'm gonna look that up later you were selling chia seeds there's another one that like you really feel like packs all of this in quarter of the plate is protein but when you talked about protein you immediately went to like beans lentils tofu so you're talking about plant proteins because they were giving you protein but they were also giving you all of this fiber and more of this anti-inflammatory.

1:03:09And then, you know, the other quarter being sort of like whole grain. So avoiding all the traditional sort of refined grain. I was brought up with like, you know, you start with potatoes and pieces of bread. And here you're talking about whole wheat, but also quinoa. And you mentioned a lot of fun, like ancient grains that I think, you know, were not in my supermarket 20 years ago, but are now like farro and bulgur and millet. I don't know what millet is, but I can look that one up as well. And then like animal products, you can have animal products, but you want this to be in moderation. So rather than like your plate is mainly a piece of meat with a little bit around it, it's like, you know, you're going to have it from time to time.

1:03:45Oily fish, you know, can be helpful. If you don't want to eat fish at all, then you're talking about supplements that allow you to get those omega-3. But what you're saying is, I just want to play this back because it is sort of amazing. You're saying like, if you are living with arthritis and you were to make that sort of change in your diet, you think it can really change not only your symptoms, but even potentially get you to a point where you say, I don't even need to take all the medication I'm taking today. Absolutely. Incredible summary, Jonathan. Thank you so much. You're very welcome.

1:04:18Thank you. Now, if you listen to the show regularly, you already believe that changing how you eat can transform your health, but you can only do so much with general advice from a weekly podcast. If you want to feel much better now and be on the path to live many more healthy years, you need something more. And that's why more than 100 ,000 members trust Zoe each day to help them make the smartest food choices. Combining our world-leading science with your Zoe test results, Zoe is your daily companion to better health for life. So how does it work? Zoe membership starts with at-home testing to understand your unique body.

1:04:56then Zoe's app is your health coach using weekly check-ins and daily guidance to help you shift your food choices to steadily improve your health. I rely on Zoe's advice every day and truly it has transformed how I feel. Will you give Zoe a try? The first step is easy. Take our free quiz to find out what Zoe membership could do for you. Simply go to zoe.com slash podcast, where as a podcast listener, you'll get 10 % off. As always, I'm your host, Jonathan Wolfe. Zoe Science in Nutrition is produced by Julie Pinero, Sam Durham, and Richard Willen. The Zoe Science in Nutrition podcast is not medical advice.

1:05:34And if you have any medical concerns, please consult your doctor. See you next time.

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