Breathing Dysfunction, Red Light Therapy & Modern Health with Dr Steve James

Metabolic health is becoming one of the most important conversations in modern medicine, yet many people still underestimate how deeply it influences energy, performance, resilience, and long-term health.

In this episode, we sit down with Dr Steve James, Consultant in Metabolic Health and Performance Medicine, to explore how physiology, behaviour, breathing, and environment shape health outcomes in the modern world.

With a background spanning critical care, cardiac anaesthesia, and performance medicine, Dr James brings a unique perspective on human physiology under both extreme stress and high-performance conditions. His work now focuses on helping people optimise metabolic health through a more integrated and preventative approach to medicine.

We break down what metabolic health actually means, why it matters far beyond weight or fitness, and how modern lifestyles may be driving widespread metabolic dysfunction. A key focus of the conversation is VO₂ max - what it tells us about cardiovascular fitness, resilience, and longevity, and why it may be one of the most important health markers we can track.

We also explore the role of breathing and respiratory health, discussing how modern life may be changing the way we breathe, the physiological consequences of poor breathing patterns, and whether breathwork should become part of daily health routines.

The discussion expands into environmental and recovery factors, including light exposure and red light therapy. Dr James explains the physiology behind these interventions, what the evidence currently shows, and how light may influence inflammation, recovery, and overall wellbeing.

Beyond physiology alone, we explore the behavioural side of health. Dr James shares insights into why sustainable behaviour change is often the missing link in long-term health outcomes, and why understanding psychology, motivation, and habits is just as important as understanding biology.

Finally, we discuss the foundations of long-term resilience, the highest-impact habits for improving metabolic health, and why many people may be overlooking the fundamentals while searching for quick fixes or interventions.

🎙️ In This Episode, We Cover
• What metabolic health actually means
• Why metabolic dysfunction is becoming increasingly common
• VO₂ max and its relationship with longevity and resilience
• Blood sugar regulation and energy metabolism
• How the body produces and uses energy
• Why breathing is often overlooked in health and performance
• The consequences of poor breathing patterns
• Breathwork and respiratory health
• Light exposure and red light therapy explained
• The relationship between environment and recovery
• Behaviour change and long-term health outcomes
• Why psychology matters in health optimisation
• Modern lifestyles and their impact on physiology
• The highest-impact habits for long-term health
• Practical ways to improve resilience and recovery

🎯 Who This Episode Is For
• Anyone interested in improving long-term health and resilience
• People looking to optimise energy, recovery, and performance
• Individuals interested in metabolic health and longevity
• Those curious about breathwork, VO₂ max, and recovery tools
• Clinicians, coaches, and practitioners interested in preventative health

🎙️ Powered by Mayfair Health

At Mayfair Health, we specialise in recovery, performance, and proactive wellness. Whether you’re looking to optimise your health, improve resilience, or better understand your physiology, our multidisciplinary team is here to help.

🔗 Website: https://www.mayfairhealth.co.uk
📩 Contact: info@mayfairhealth.co.uk
📞 Phone: 020 3985 1500
📱 Instagram: @mayfairhealth

Transcript

SPEAKER_03 0:00

Welcome to another episode of Move Well, Live Well, Perform Well. I am super excited today to dive a little bit deeper about lifestyle medicine and about all things that help us to get better, but also help to hold us back in terms of modern lifestyle from improving and from optimizing our well-being. Today I'm joined by Dr. Steve James, who is a consultant in metabolic health and performance medicine. He works across the 40th clinic and also at other private centres in London. And he works at the intersection of physiology, performance, and long-term health. He has a diverse clinical background, including work in critical care and cardiac anesthesia, giving him really deep insight into human physiology under extreme stress as well as in high performance environments. His approach integrates metabolic health, physical performance, behavior, and psychology. He incorporates tools such as reflective work, breath work, mindfulness, and light-based therapies to support recovery and long-term health optimization. Steve has a particular interest in lifestyle medicine and how modern life and our beliefs impact our ability to recover. His work reflects a shift towards a more integrated, preventative, and patient-centered care. Welcome, Steve. Thanks for thanks for your time. Good to be here. Excellent. So you've got a pretty fascinating backstory. Can you just walk us through what your sort of career pathway has been like?

SPEAKER_01 1:32

Yeah, so essentially there were a couple of streams that were important to me for the first sort of 15 years of well, sort of when I was sort of 20 to 35. So I'd uh met a Buddhist teacher, I invited him to the UK, I helped set up a Buddhist charity in the UK, and I taught Buddhist meditation on the weekends and went on Buddhist retreats and did Buddhist courses. Wow. And that was one big chunk of my life. Another chunk was becoming a consultant in Midsen.

SPEAKER_03 2:01

Okay, wow. So we're gonna dive into a few of those in a in a second. So so the Buddhist meditation and retreats, that was before becoming a consultant?

SPEAKER_01 2:14

Yeah, so I started medical school and invited a Buddhist teacher to the UK in the same year. Okay. Uh and so they sort of those things grew up as part of my life together. Okay, wow. And then I started to do research on exercise testing. Yep. And when I became a consultant, I ran a clinic using exercise testing. And then I saw that exercise capacity and so VO2 and AT anaerobic threshold, VO2 max, um are not just values that can tell you how fit you are, but they can actually help you diagnose breathlessness fatigue limitations. Yep. So I suddenly started to sort of bring my physiological and integrative physiological view together with an integrative psychological view together. Yep. And see, oh actually I've got quite a few tools here to work with people. And so I just sort of kept on developing my portfolio of skills from there.

SPEAKER_03 3:12

Okay, amazing. So you've worked across uh critical care and being a cardiac an etherist as well, which puts you in a space where there's a lot of very unwell um individuals. Yeah, yeah. And you've got to pick up a lot of strategies and sort of tools to be able to help to optimize them in those sort of, you know, where they're where their bodies under high sort of degrees of stress.

SPEAKER_01 3:42

Yeah, so I so the approach I took in cardiac anesthesia is to work out as much as you can about the patient's physiology before you put them to sleep. So look at brain oxygenation, cardiac output, to use the latest models we've got for delivering drugs during um the anesthetic, uh, to be very careful with blood management and kind of do everything I could to kind of you know optimize them as they're going through this process. Um and uh I was always fascinated by that sort of it is a kind of um marginal gains theory work, which is what enhanced recovery after surgery sort of specialized in. I did some work with that as well. Um but that you know to try and edge someone through in the best possible way and take everything into account at the same time, you can't ignore the brain if you're a cardiac anesthetist, and you can't ignore the kidneys, and you can't ignore the clotting system, and you can't ignore the vascular system, you can't ignore the brain, you've got to see the whole person together. Yeah, yeah. If you miss something, you've got a big problem at the end of the case.

SPEAKER_03 4:48

Yeah, yeah. Fascinating. So, what has led you sort of to move away from that into more of a preventative approach, or really trying to perhaps optimize individuals who aren't needing to be anaesthetized or in an operation to improve their performance or improve their function, to now be working with individuals who are perhaps unwell in different ways.

SPEAKER_01 5:16

So I'm still a full-time consultant in the NHS. I'm still doing critical care. And what I see my role in critical care is that um I'm not able to achieve prevention, but I am able to bring some uh reflective psychological approach to particularly the patients, or particularly the families, sometimes the patients, yeah, and look at those situations slightly differently, maybe. Okay. That's the area that I think I'm I'm most able to support people in that area. Yep. And I simply enjoy doing the job. I really love the colleagues I work with. And while I don't sort of philosophically think it's the most aligned approach in medicine to myself, I really enjoy my job. So I've decided to kind of carry on doing that. Um, but I always had this desire to, well not always, but um uh I started seeing in around sort of 2018 every patient I'm looking after nearly, bar a few who had inherited valve problems with their hearts, didn't need to be there on the table. That was all preventable. And then I went into intensive care and uh I saw that the vast majority of people had metabolic health problems and a lot of psychiatric or stress-related issues that had brought people in in one way or another. So alcohol was related to the road traffic accident they had, or you know, there's there's other issues. And I came into intensive care at a time when COVID was happening, and it was very clear that it was people who are metabolically unhealthy who were in the intensive care. Okay.

SPEAKER_03 6:50

So you've mentioned metabolic health a couple of times there. Can you just give us a brief definition around what you mean by metabolic health?

SPEAKER_01 6:59

Okay, so principally for each cell to do its job, it's got to have an energy system that allows it to utilize fuel and create the energy molecules uh in that cell, which allow that cell to do the particular functions it it's got to do. Yep. So that energy production system is often associated with the mitochondria, part of the cell. And there are lots of different parts in the system of the mitochondria. Now, mitochondria are quite similar, whether they're in your eyeball or they're in your muscle. So your mitochondrial health tends to go across the systems. Um, and so that's that's part of your metabolism, is your actual energy production. There's also the question of waste removal and you know fuel supply. So you've got the food that's going, the fuel that's going into your mitochondria, yep, how the different proteins in the mitochondria work, whether they're blocked by certain things or not, uh, how they get rid of the uh um uh oxidative stress molecules that are produced um through the f the the burning of oxygen and the creation of ATP. Yep. Um and so there are lots of different parts to that. So it's a really simple system. Yeah, it's really simple, and it's affected by everything. So it's kind of a nub. You can't really look at something in medicine and health that doesn't really have a link through to it.

SPEAKER_03 8:20

Is that part of the problem in in medicine these days? Because we are so siloed off in terms of our general approach that someone like yourself who is trying to look at someone holistically needs to think about all the cellular reactions that that impact the whole system.

SPEAKER_01 8:41

So you've got pediatricians, you've got anaesthetists, you've got intensive care doctors, and you've got GPs who are all broad and how they're looking at things. Yeah. And then you've got a lot of people who s who are specialized and super specialized. Yeah. Now, the thing is that there are things you learn in different fields. So it has a GP specialized and done specific medicine, have they looked at nutrition and what psychological training do they have? Yeah. Do they know about exercise physiology? Yeah. And those things, together with the toxic load or your genetic background and your social network, really go to drive health. Yeah. So if you mostly we're when A, we're not generalists, but we're not seeing how integrative things are. Yeah. So it's not just that you need to know about the different areas, you need to see how they influence each other.

SPEAKER_03 9:30

Yeah, definitely. And I think that's why we're almost seeing a shift, and a lot of people are starting to talk about metabolic health, you know. We're seeing a lot of people monitoring their blood glucose levels with CGMs these days, and I think there's been a bit more of an understanding that this is something that we need to uh really take on board and and think about as a society. Um, so in terms of metabolic health, how do you think about approaching this with patients? Is this to do with you know their blood sugar levels? Is it to do with looking at um how they're optimizing their energy? How do you approach this?

SPEAKER_01 10:17

So first of all, I think it's very important to look at now, not just at longevity. Yep. And to say, how do you feel now? You know, what's what's working well for you, what's not working well for you? You know, how do you feel when you wake up in the morning? Do you feel like you've got energy at the end of the week to go and do things on the weekend that are fun and refreshing if you work long hours? Yeah. Yeah. Um, so I would look at people's uh cardiorespiratory system. So I would do a VO2 max test on people and and measure their kind of oxygen consumption both with their anaerobic threshold and their total capacity with their VO2 max.

SPEAKER_03 10:50

So do you know what your VO2 max is?

SPEAKER_01 10:52

Mine was 52 when I was 50. Okay, so that's good. Thank you. Yeah, nice. And then the question is how do you train that? Yes. What do you do with that? Yeah. Then I look at people's sleep because if you're not sleeping properly, you're not going to clear the system. Yeah. It's a key part of clearing. And then if your if your brain doesn't work well, sleep's the first thing. Yes. And then you've got your nutrition, are you supplying an appropriate amount of the right kind of fuels? Can you clear those? Are you gaining enough protein? And is there a marker then within the sugar uh diabetic range that's telling us that actually you're not diabetic, but you are on that pathway? Yeah. Yeah. Pre-diabetic or even before that as well. So they're sort of pre-pre-diabetic levels. So you can see type 2 diabetes coming 15-20 years and watch it develop.

SPEAKER_03 11:46

Yeah. And are you then when you're looking at this and trying to identify that pre-diabetic state, are you looking at a range of blood markers that might be normal within the lab results, but but actually, if you look at them in conjunction with each other, they're probably uh telling us a pattern. They're probably part of a syndrome that is occurring. Yeah.

SPEAKER_01 12:11

So we can look at HBA1C, which is a marker of how much how well sugared a red blood cell is. So red blood cells last for a few weeks and then they get sugared. And if they've got more sugar on the end of them, then you know that your overall sugar levels have been a bit higher. You can also compare it, the sugar levels in your blood with insulin, because insulin will tend to rise earlier when you're sort of fighting to handle the glucose that's there. Um, you can look at um your cholesterol markers, so HDL and triglycerides, the ratio of those is quite good. You can look at liver uh markers like ALT or gamma GT. Uh-huh. And there, for example, um so when when normal ranges are created, we look at say 95% of the population, and we say 95% of the population is uh who are not known to be sick, let's say, um, are in these ranges. So we'll call that the normal range. But as society's got sicker, we've just changed the normal range. Yeah, yeah. So so what was a high level has now become a normal level.

SPEAKER_02 13:12

Yeah.

SPEAKER_01 13:13

So that's not suddenly become healthy. Yes, yeah, yeah.

SPEAKER_03 13:17

So do do you think people fundamentally misunderstand how to manage their energy levels within their system or what goes in and what goes out with and is that sort of modern life that's led us to that?

SPEAKER_01 13:35

I think there is a um a surplus of opportunity as far as things to do goes. Yeah. So um uh there are a lot of reasons to stay up late if you want to. Yeah, there are a lot of potential distractions, a lot of things that are quite entertaining to do, and there's very much a culture of doing more is better. Yes. And we promote the activity side much more than the rest side. The rest of the scene is a bit lazy, it's a bit nothing, you don't tell. So that together with the way the brain functions, where it's kind of gets a reward from going off and doing things that are exciting, really tips the balance into a proactive, proactivity mode. Yep. And we're not recognising the central importance of rest and recovery.

SPEAKER_02 14:31

Yes.

SPEAKER_01 14:32

And it's seen, and I was very much someone who was like, I'll sleep when I retire and spent 20 years trying to sleep less than six hours a night to make sure I could get as much stuff out of the day.

SPEAKER_03 14:43

And how did that impact you?

SPEAKER_01 14:44

Oh, I've only got a few good stories for that. Um, so I hope my insurance company isn't watching, but um, so I identified quite a long time afterwards that I'd had four road traffic accidents all on the way home from night shifts. So I would have thought that's quite common. I would be I wouldn't be surprised. It is true. But I found that I got particularly tired on my night shifts because I was sleep deprived before I went into the night shifts. Okay. I used to find that I get very tired and have sort of something micronap on the way home in the evening, so I couldn't drive after 10 o'clock. Yeah. Um, I wouldn't drink any alcohol, I wouldn't eat anything after midday because I was starting to fall asleep with you things. I had a terrible memory. People laughed at how I would ever get through medical school because I used to fall asleep reading in a flash. Because the sleep deprivation had built up so much that I would nod off at the first opportunity. I fell asleep dancing once. I think that was a bit of a Really? Somebody I shouldn't have noticed. I and I went and had a sleep study dance.

SPEAKER_03 15:48

How does that happen?

SPEAKER_01 15:49

You just simply find yourself dropping towards the floor. And I had a sleep study done because I was questioning whether I had narcolepsy because of this falling asleep very quickly. And um I had a sleep study done and I was in this lab all wired up in Chicago, and um I was lying there in bed thinking, oh, it's taking me so long to get to sleep. Yeah. And then the next morning I told my friend who was a technician in the lab um that this had happened, and he said, But it only took you one minute to fall asleep. So what felt like an age to me, yeah, because I actually was lying in bed thinking. Because normally I never would have a single thought, not a sentence that would go through my head. Oh, really? And that's a key pointer to being sleep deprived. Yeah, if you're sleep-deprived, you're on you're trying to do the rebound, which is to get immediately into deep sleep the next night as fast as possible. Yeah, yeah. So actually they missed the trick. They should have said how often how much are you sleeping? Yeah. And we could have spotted it.

SPEAKER_03 16:46

Yeah. Okay, so rest and recovery. Super, super critical. And we I think you're right, we underplay the importance of that. And there's more noise out there now around how important and how critical sleep is. But is uh is sort of how we sort of regulate blood sugar a key component into our overall well-being, though.

SPEAKER_01 17:13

Uh yes, but is CGM the answer? I don't think so for most people. Yeah. So I think CGM is a way of uh for most people who are using it, a way of sort of shifting the same chest pieces around on the board into a slightly different sequence, but you still basically got the same chest pieces on the board. Yep. You need to uh make what's really going to matter for your long-term blood sugar regulation and all the risks that go along with hyperinxulemia and hyperglycemia. You need to decrease the amount of carbohydrates you're eating. Yep. You need to increase your muscle mass.

SPEAKER_03 17:50

And why is muscle mass important? I mean, we talk about it a lot, but yeah, it's super critical to prevent sarcopenia and and also if you if you've got more muscle mass, you're probably likely to have less of a risk of bone health issues. But muscle is your biggest glucose metabolizer, isn't it?

SPEAKER_01 18:07

It's clearly the biggest organ in the body. If you add all the bits of muscle up, it it's a huge organ, right? Yeah. And it's metabolically active. Yeah. So it's uh it's um using up glucose for its activity. So if you have a few more kilos of muscle, you'll burn a few more calories. Yeah. But a huge amount, it's not gonna make you lose weight. You know, you're not gonna lose weight by burning lots more sugar, but if you carry five kilos of extra muscle for a year and walk extra, you'll have a hundred metabolic. Not a lot, but enough to offset that one or two kilos of weight gain that most people have got. Yeah. So the walking matters if you do it long term, you know, the climbing the stairs matters if you're doing it long term, the muscle mass matters if you're doing it long term, won't help you lose weight over six weeks. Yep. But those things will keep you where you kind of should be. Yeah. So it's a great um and it's a great, it's like a reservoir and it's a sump. It sort of allows us to handle things. Yep. If you take a bodybuilder, you can give them, you know, a 400 carbohydrate, 400 gram carbohydrate meal. That budget won't budge. Yeah, yeah, yeah, yeah. So they've got this off the muscle, we'll use it when you use it.

SPEAKER_03 19:13

They're probably not used, their their system's not used to carbohydrate, probably anyway.

SPEAKER_01 19:18

Well, well it it's it's because of the muscle mass. It doesn't really matter whether they're on a low carb or high carb diet or whatever they're doing. The muscle mass is protective against the swings. Yep. And so, you know, this idea that really just by changing the order in which we eat things, I don't think we know that long term that actually stops us having the kind of vascular disease problems that are associated with eating it. So it's not a question of eating healthy food in a different order, especially not eating the food that our body's not well designed to eat.

SPEAKER_03 19:49

But doesn't doesn't a CGM help sometimes give that insight to people for periods of time?

SPEAKER_01 19:57

There's certainly a place for it. I think there's a place for aura rings and other kinds of monitoring. It's because you're not going to tell me not to wear my whooper, are you? Um well, it depends on what you're like as a person. Yeah. Um, you know, I've had some clients where the best thing I did for them was to tell them to throw away the whooper. Yeah. To too obsessive about it. Yeah, really easily. Yeah. And you just will continue to drive a negative pattern with that. Yeah. Yeah. And I think it's important as a physician to say, no, don't do what everyone else is doing just because everyone else is doing it, and because there's a trend around you've got to monitor your your data. Yeah, you've got to look at you as an individual. Is that gonna work for you? Yeah, okay.

SPEAKER_03 20:37

So we touched on a bit of respiratory stuff that you've you've you've gone and and done quite a bit of work in that area. So why is breathing such a fundamental aspect of our general well-being? You know, we're constantly uh telling patients actually you're not breathing properly, you're not you know, you're not um allowing the system to oxygenate. So what's your belief around this?

SPEAKER_01 21:06

So um we we do oxygenate when we breathe badly. Yeah. There's not you know, and um uh but we just don't do it in a very efficient way. And we also um affect our nervous system a lot. So when you are under stress, you have certain kind of breathing patterns to do with that. So if you're running for a bus, you're probably gonna open your mouth so you can get large volumes in and out with low resistance and meet the demands for that mouth breathe. Yeah. Similarly, though, if you mouth breathe when you're not running for the bus, your body still thinks you're in that state. Yeah. When you breathe through your nose, you release something called nitric oxide. Uh or nitric oxide synthase, which helps you to make nitric oxide. Um and nitric oxide is important in blood vessel. Um dilation. Yeah. So when we breathe through our nose, we tell our brain that we're calmer in a calm situation. And we help our blood pressure to go down. Yeah. So it's a it's a two-way relationship.

SPEAKER_03 22:15

So essentially your breathing well is activating your parasympathetic nervous system.

SPEAKER_01 22:20

Yep. Breathing well meaning a slow breath. Yes. Nice diaphragmatic kind of breath. Yeah. And if you breathe in a more stressed way, that can be either very rapid, high volume, open mouth breathing, or it can be a sort of an upper chest accessory muscle breathing pattern. Both of those will put you into stress. Yep.

SPEAKER_03 22:42

Which is one not efficient, so it uses quite a lot more energy as well. Yep. But can drive that sympathetic nervous system. Yeah.

SPEAKER_01 22:49

So there's a lot of sweet spots in physiology, you know, at Goldilocks point where breathing at too high a rate will be different from breathing at a low rate, but the volume, so you've got to kind of find the efficiency for that particular situation. And if you hyperventilate, which is what I saw with a lot of patients that I was doing the cardioprimary exercise testing with the VO2 max testing, whereas you hyperventilate, you drop your carbon dioxide level by by hyperventilating. Your oxygen levels are fine. You hyperventilate, you drop your CO2, and then your carbon dioxide level being lower decreases the blood flow to your brain, which gives you a lot of brain symptoms like brain frog. Yep. It will also make uh the ability of red blood cells to release oxygen worse because red blood cells like to release oxygen where there's carbon dioxide present, because that's the signal that that's where the work is going on, the carbon dioxide being present. Yeah, yeah. And then it triggers your nerves to have a different threshold for responding. So you get pins and needles, you get odd sensations all over the place. Yeah. So just hyperventilating can trigger a lot of symptoms.

SPEAKER_03 23:51

Yeah. Is that why we sometimes see sort of pins and needles and sorts of symptoms associated with anxiety? Because that can often drive that hyperventilated sort of state? Yep. Okay, so we you've just touched on some of the poorer sort of breath patterns and some of the consequences of those. Do you think our modern society has driven that? Or you know, we're in our desire to be more proactive and more efficient that we've forgotten to be able to stop and rest and slow things down?

SPEAKER_01 24:32

I think we have forgotten mostly. Yeah. I think that's why people are now looking for something to do. Now you have to learn how to do something which is resting. Yeah. Or but then you end up a lot of people go to a yoga studio and they then compete in how they do the yoga. Yeah. And so you can also compete in meditation, you can compete in lots of different things if that you take that framework to it. But um there's often a sort of a uh a balance in physiology between action and non-action, yeah, between night and day, between light and dark, between hot and cold. Yeah, that drives our physiology. We like those different extremes. Yes, yep. And you know, strangely enough, said balance. Yeah, strange strangely enough, there's you know, there's there's a thing called night and day, yeah, which has been there for an awful long time, yeah. And our physiology has learnt how to work with night and day. Yeah, yeah. And if we try to uh hack that or resist it and go against it, we've got a lot of work to do to compensate. Yeah, yeah, yeah. What I think's really key is that doctors and most patients don't understand that before they get a diagnosis and they get sick, they get all these other things that are going on before. Yeah. Sicknesses don't appear. They don't just suddenly happen. No. And so there's a sort of plastic stage and then a more resistant fixed stage for a lot of pathological changes. Yeah. So you want to be looking at things when they're still in the plastic state rather than in the sort of fixed scarred state. Yeah. And if you get it in that mode, it's not a pill that's missing, it's not a supplement that's missing. In general, it's do the real foundations really, really well. And that's what I saw with this fatigue clinic and this breathlessness clinic. Yep. Is that almost every patient had a problem with light exposure and being outside and getting a good circadian rhythm, and their sleep was was poor as a consequence. Yep. And then light. They weren't getting light. Their nutrition was atrocious and was often very, very low in protein. Yeah. They weren't exercising and doing very much there. They'd often reduced their social life because of their health. Their symptoms. And they had a stressful, often a stressful primary relationship in the home environment. Yeah. So those were all the biggest drivers for getting sick.

SPEAKER_02 27:02

Yeah.

SPEAKER_03 27:03

Yet the body's very good at compensating for a reasonable period of time. And a lot of people sort of get to a stage where they fall off a cliff without realizing all of these things have led to that cascade.

SPEAKER_01 27:21

Yeah. We we we have parts of our culture where we blame people for what's happened. Yeah. And no one likes to be blamed for something. Yeah. Um, you know, the patterns that we develop in our psychology often were the smartest psychological pattern to have as a child or at an earlier stage in our life in order to cope with and deal with a potential threat or a difficult situation. Yeah. Yeah. And those then influence the way we behave in the next period of years and influence the way we behave in the next period of years. Yeah. So these coping strategies are really the smartest thing we could possibly do, usually, at the time. Yeah. And the thing is that that strategy might be something that we then end up beating ourselves up about. Yeah. So, you know, drinking alcohol, it might have been better to have emotionally numbed through alcohol than to have faced the things that you didn't feel you had the right sportive environment to face. I'm not saying we should all go out and become alcoholics, yeah. But um, you know, if you look at it with a kind if you look at your own behaviour patterns in a kindly way, if if the doctor you work with has some compassion for those things, yeah, and you share a curiosity, you can go, oh, that's interesting that I do this, that's interesting to do that. It's interesting that I know I'd be better off if I slept more, but I can't take my pigs off. Yeah. Yeah. So so what what does that serve? Yeah. What does that serve for you? Yeah. And can you become aware of that? And when you become aware of that and someone talks to you and and listens and sees where you are, yeah, that shifts things.

SPEAKER_03 28:56

Yeah.

SPEAKER_02 28:57

Yeah.

SPEAKER_03 28:57

Big time. And I think, you know, what you're describing is some underlying belief and value systems that drive behaviors.

SPEAKER_01 29:08

I think nature's intelligent.

SPEAKER_02 29:10

Yeah.

SPEAKER_01 29:10

I think we're part of nature and nature around us is is pretty intelligent. Yeah. And we shouldn't, you know, when we call ourselves stupid or someone else stupid or the something else, it's it's really a misunderstanding of what's going on, the complexity and the idea that we can just see it and know it. Yeah, yeah, yeah, yeah. I mean, nature's just incredible. Yeah. And to say, understand why these things have happened and give ourselves some options and start to, you know, be a little bit playful with how we we treat ourselves, or you know, what tends to come in my mind if I think about all the negative consequences? What comes to tend in the mind if I think about things I want, where I might want to lead myself to, what can I bring myself into? Yeah, fascinating.

SPEAKER_03 29:57

And I I think there's not many doctors that will touch on those aspects with patients. Yeah. Or probably have the time to, and I know you spend a lot of time with your clients. Um, so that probably gives them a bit more space to open up and to dive into some of these conversations.

SPEAKER_01 30:20

Yeah. So when I started this exercise intolerance clinic, just because the the exercise test took around an hour, yeah, I could only see a certain number of patients in a morning. And so I had a morning divided by four patients, so I had an hour each for each patient. So I got used to minimum one hour, and if it goes on a bit, it goes on a bit. Yeah. So that gave me the space to really ask in-depth stories, yeah, retell that story to the patient, and let them see they understood things. And that was in the NHS, which was which was a really unusual experience. I'm very fortunate to have that. Yeah. But I felt still uncomfortable with, I had a lot of ideas about the psychological side and the stress, but felt untrained and unwilling to go there with people. Okay. And so I did this training with Gabomate in a system called Compassionate Inquiry, which enables you to be comfortable with someone becoming into a really deeply disturbed emotional state if something comes up because you're you you learn the skills to support someone in that situation. Yes, yeah. And once that had happened, I felt confident as a professional to be able to sit with someone, and if I opened something that was really difficult, I could give that person the support if they wanted to carry on, or also give them the option to not carry on and still support them and feel comfortable with that. And so more and more I've done that, and then I think in the last couple of years now I've started to accept that not only have I got 30 odd years of training in lots of different medical specialties, but I've been training with the mind in Buddhism and shamanic traditions and breath work and just lots of aspects of psychology. Yeah. And so as a human being, we've got all these things going on, right? Completely complex.

SPEAKER_03 32:07

Share with someone else on the broadest level that's necessary. Yeah. I mean, you've got a an amazing breadth of knowledge across all these spheres. So should breath work be a daily exercise for everyone?

SPEAKER_01 32:25

No. Okay. I don't think so. I think that um for most people to find balance in their life, yeah, they need to find something that is their way of knowing center, their way of finding their middle, the way of being able to return quickly. If you don't have a period on a daily basis of knowing, oh yeah, I'm I'm I'm in me, I can trust what's going on in myself, I can see that things are coming, going on the other level. Um I'm I'm okay, I I've got myself. Yeah. Yeah. I've you know, I've I can deal with this. Yeah. And if you don't train that these days, you don't have four hours sitting in a chair in the afternoon doing nothing, yeah, to just have the space of mind to experience that.

SPEAKER_02 33:20

Yeah.

SPEAKER_01 33:20

So you probably need something in your life. Uh-huh. Be that the way you listen to music, the way you walk your dog, the way you do something or other, ideally something that's really just you on your own, because it's easier to get distracted. Yep. But I think you need something in your life.

SPEAKER_03 33:37

Okay. And so is is that breath work or meditation or exercise for a lot of people? Is that the balancing that you that you're talking about?

SPEAKER_01 33:51

Yeah, so I I think you can do it with lots of different methods. Yep. I don't think that one method will work for everybody. Okay. Some people will go nuts if they try and sit on a cushion and meditate for half an hour a day. Yes. Just they just don't feel comfortable right or whatever it is about doing that. Yeah. Um, but you can also you can meditate and not get it. You can get the you could do meditation as a mind competition and as a mind control exercise, yeah, rather than relaxing and seeing what's there. So it depends how you do it, but I think people can easily find it through meditation, through breath work, through kind of reflective uh um yoga practice or reflective journaling. Um, some people can find it through sport. I think in general you're not getting it through through sport because there's usually quite a focus on what you're doing. Yep. I can imagine a rower gets into a flow state quite nicely. Yep.

SPEAKER_03 34:50

Or someone who maybe runs for not a competitive and running, yeah.

SPEAKER_01 34:55

You you can get into it like that. That's probably not as easy a way to access it as actually some karma methods because I think you've got to become fairly competent at running before you get those states. Yep.

SPEAKER_03 35:10

So how does the Buddhism come into things for you? How has that helped you to um practice? Or has it helped you your sort of style of practice?

SPEAKER_01 35:24

So I think um there are a lot of elements that I've taken from Buddhism. Yep. Um, one is is something called Buddha nature, which means that uh within everybody there is this essence of a Buddha, this potential to be a Buddha. So uh we say that you know there's the experience of samsara and there's the experience of nirvana, yeah. So being enlightened and and experiencing, you know, endless life of suffering. Yeah. Okay. And and really both require mind, yeah. Yeah. And in one you think things that are not real are real. Okay. In another one, you see the things the way they are. Yeah. And um when you understand that you've everybody's got that potential to be a Buddha, to be enlightened, to be a huge gift to the world, to experience things with joy, you you you'll never see someone in a limited, truly limited way. You might see that right now they're a bit stuck here. Yeah, and maybe one can provide support, or there's a way through that, it's part of their journey. So never to kind of see people in a limited or stuck way, and that with the right conditions and settings, people can always blossom, and there's no time point in which that can't happen. To really see that there's impermanence in a lot of situations, both that your life is impermanent and you're gonna you're gonna die one day. And that's a terrifying thought for a lot of people. Yeah, I I I I I I've not been terrified by by death.

SPEAKER_02 36:55

Yeah.

SPEAKER_01 36:55

Um, I've also done a lot of meditations which were about the time of death. Oh, really? So I might have learned something there from that, but I started doing that when I was 20. Um, a meditation where you train what your mind will do at the time of dying. Oh, really? Okay. There's a system meditation system known as Poa in Tibetan Buddhism. Um but you're training early. I started I started at 19 with quite a regular Buddhist practice. And I'm you know, in my early 50s now, so yeah. I've been meditating most days uh in that last 30 odd years. Okay, and what does your meditation entail? So now I don't have such a structured practice, I don't practice Buddhism on uh on a regular basis, uh-huh, but I'm uh settling myself, I'm becoming aware of what processes are going on. Yep. Uh are you seated? I'm seated, yeah. Um and I'm coming into my middle, I'm maybe calming or grounding myself with a little bit of breath work, first of all, no sensations in the body, and then I'm seeing what's there in my mind, and seeing what the patterns are and sort of trying to recognize um where I might be getting caught up in certain ideas without analyzing those ideas, yeah, but being aware of where my mind is, okay, and seeing whether it's trusting its rich nature. Yeah. Because for me, that's key. I know that I can trust the richness of my mind. I know that um I can be spontaneously happy and jolly when I don't have any reason to be. Okay, yeah, good. And if I'm not, then what's yeah, am I getting caught up something else with my mind wondering off what might I need for that situation? I might not need a nickname for that situation, I might just need to come back and rest in myself.

SPEAKER_03 38:59

Yeah, okay, cool. So it's I mean, you talk very calmly in when we're talking about this, and it almost exudes a sense of calm. So you've clearly brought that into who you are and how you you manage sort of daily functions, and that it sounds like what that meditation does for you.

SPEAKER_01 39:20

Yeah, I mean I I I'm always aware that there's no twin control who hasn't done it, and you know, what would I have been like if I hadn't done all these things in my life? One can never know, yeah. Yeah, but I know that um I'll go through periods in my life when I get really busy and really excited about lots of things in the world and I won't meditate so much, and then I'll start to notice that you know topics start to creep in. So if you keep it regular, yeah, you can feel for yourself that it makes a difference. And we've now got so much evidence that it shifts the immune system, it shifts depression, it shifts lots of different things.

SPEAKER_03 39:57

So you said no to doing breath work every day. Breathing. Yeah, yeah, yeah. But but but should people be doing mindfulness?

SPEAKER_01 40:08

Is is that is that I I I my toenails curl at the word should. Okay. That's not that's not me. Yeah.

SPEAKER_03 40:17

Is it a good practice for people to consider Oh yeah.

SPEAKER_01 40:21

Yeah. Lots of support for that. Yeah. But you know, for me, one of the key things is that patients start to um have agency themselves. Yep. And that you know, going to a doctor should be a process of increasing your agency by becoming more informed about what's going on, actually having a real understanding of the pros and cons of doing it or not doing it. Yeah, that's four bits of information already, yeah. Um, rather than just should. Yeah.

SPEAKER_00 40:51

Yeah.

SPEAKER_01 40:51

Yeah.

SPEAKER_03 40:52

So giving empowering them, empowering the patients. Yeah. Yeah. So moving on a little bit, how important do you think behavior changes? We've sort of alluded to it quite a bit here in long-term health outcomes. Because you know, you're in critical care and seeing a lot of people who were there with illnesses or being unwell because of things that could have been pre prevented. Is that, you know, a lot of these chronic diseases that we have? You know, Peter Atia, maybe I'm not allowed to mention his name at the moment, but you know, talks about the four horsemen, you know, the new e-dogenitive conditions, cancers, cardiacs, and and metabolic conditions. And these are the things that are probably gonna knock us off.

SPEAKER_00 41:44

Yeah.

SPEAKER_03 41:45

Are they can we change this with okay, more understanding, but behavioral change?

SPEAKER_01 41:56

So there's a few bits to unpack there. Yeah, sorry. That's all right. So one is um the data on actually doing anything that really makes you live longer is pretty poor.

SPEAKER_02 42:12

Yeah.

SPEAKER_01 42:12

But we think that VO2 Max is a really good marker, but we don't really have studies that say when you change someone's VO2 Max, they do live longer. We probably know that the correlation is so tight, it would be extremely unlikely that it doesn't work. Yeah.

SPEAKER_03 42:32

And we probably know that they're likely to optimize their last years of their life, i.e., improve their health span, if their VO2 max stays higher over a longer period.

SPEAKER_01 42:47

They're likely to not be able to live well if their VO2 max is low. Yeah. They're likely not to be able to do things and have problems if they don't have muscle mass. Yep. But the data to say making that change is a guarantee, or it will, that's something that I think has been sort of oversold to people. Yep. In the longevity space at the moment. Yes, because you you you've got to people are selling. Yeah. Um, so that's something to understand. And I don't think people should decrease their quality of life now, not much anyway. Um it's a bit like saving, yeah. If you weren't to be able to not afford to eat now because you're saving for later, that's silly, right? Yeah. If you make your life so annoying because you're caught up in everything that's designed to make you live longer, but you can't live now. Live now. Yeah. I mean we need a bit of we need a bit of longevity. Yeah. Yeah. So there's there's there's that there's nothing. I just made it up. Yeah. Um I probably trademarked it now. Yeah. Um, so there's the the the long term versus the now, there's the actual lack of proof that this happens, but we've got a lot of evidence that. That we know what's really going on. And I think that for the for the majority of people, probably for 80% of the population, because that's probably the the number the percentage of the population that actually develops one of these conditions we've been talking about. We do think that you can pretty much prevent that shift. So high number, 80%. Well, yeah. Yeah. It's it it there's not a lot of people who who who I see in hospital who haven't got in a metabolic disease or low VO2. Do you know how many patients I see with a high VO2 max and good muscle mass in heads of care? No. Basically, only those who've been hit by a truck. Yeah, yeah, yeah. Yeah. I was gonna say a car accident. Those who've had a car accident or a bike accident. Even the fit and strong young who've had a car accident will do way better than the elderly in that particular who've had a car accident.

SPEAKER_02 44:51

Yeah.

SPEAKER_01 44:52

It's a huge protection. Um so you can probably give yourself 10, 20 more years of good quality life. Yeah. Not not overall life extension, but years when you've got a extension of your health span. Yeah. If you really get things right.

SPEAKER_02 45:12

Yeah.

SPEAKER_01 45:13

And the question is, a lot of people know what's eating well and not eating well. Well, they know on an individual basis what's healthy or not. I mean, I mean, if I I could if I got a pound for every time someone says to me I have eat a balanced diet, and then it turned out not to be what I would consider to be a healthy diet. Yeah. That's that's another story, yeah. But um well, patients don't always tell the truth. Are you saying? No, I'm not saying they don't tell the truth, but their truth is not aligned with mine. Yeah. So we you know that what we believe to be healthy um is also to do with what's been marketed as healthy. Yeah. So there's they've listened to lots of inputs, yeah. But those inputs might have been having other agendas behind them. Yes. And then then there's the question of you kind of know what to do, but why don't you do it? And in functional medicine, there's this uh term that's used it a lot, used a lot, which is called uh root cause medicine. Yeah, yeah. So what's the reason for your unhealthy state now? Well, let's say it's the root cause is your nutrition rather than it being a lack of something or a disease process. Yeah, it's what's the root cause of it? For me, it's why are you in that root cause situation? So, what's the root cause of the root cause? Yeah, yeah. Why is it suiting you to you know eat donuts at 10 o'clock at night or why do you have a good donut occasionally? Very occasionally, not uh the first bite. I I like a first bite of something like that. But um, you know, if you I I I work with quite a lot of uh executive CEOs, and they are often under pressure or they feel they're under pressure to go out and eat late and drink with clients. Socialize. And socialise, and they travel a lot, yeah. And some elements of that are truly essential for their job, and some elements are where they have difficulty saying, No, no, I just don't want to. And actually, if they got more confidence in themselves, or if they could take it on as an expression of just them being themselves, it's no reason why they should you know lose the client relationship with that. It's a question of can you carry yourself in that situation? Yeah, can you make the right choices for yourself? Or if you say, I need to do that to get this result, I'll balance it in this way. Yeah, yeah. And how you know, if you then worry about the way you have to drink with clients, you then also multiply the problem, yeah. You know, do you then do that and sleep four hours and fly back the next day? Yeah, you know, where have you got agency? And if you don't think you've got any agency, then life's pretty poor. Yeah. So really encouraging people to see what you can do to shift, what are the exchanges? What were you supporting that, you know, what you know, why do you think you've got to work, you know, 70 hours a week to make money to bring that home to your to your family, let's say is that because that's where you find value? Is there other other things that you can do where you can find value for yourself in your life and worth? Is that how you are valued? Do people value you because of the money you bring home or other things? And just opening that and allowing people to look at things differently and to choose, and having more agency, having more sovereignty is really important for people.

SPEAKER_03 48:41

So, what you're suggesting is that the reason that people aren't able to drive the behavioural change themselves is that they're not really getting to the underlying root cause of what's driving some of their behaviours.

SPEAKER_01 49:00

Yeah.

SPEAKER_03 49:01

And they're not having an understanding. In the first place, and not having an understanding about, okay, well, if I stand back and look at this, I I could make some change. But there's sort of either long-held beliefs or their value system that is tied up in why they're continuing that poor behaviour.

SPEAKER_01 49:21

Yeah, and it can also be social custom to do things a certain way, and they've just never questioned it, they've never really sort of thought about it differently, or they've listened to a certain messaging, you know. So one of the things that really struck me when I was running this fatigue clinic was 90% of the patients were vegetarian and vegan. Now, a healthy user bias is something which says when people search for one healthy behaviour, they tend to come along with other healthy behaviours as well. Yep. And most people who've become vegetarian and vegan were doing it for health reasons. So they should have been less likely to appear in a hospital setting. So you what you're saying. But it was completely opposite. Don't be vegetarian and vegan. Well, I would say it's extremely difficult to be vegetarian and vegan and really meet all your nutrients. Particularly protein requirements. Proteins the most difficult. So if you take vegetarian proteins versus um uh plant-based proteins versus animal-based proteins, on average, across a broad spectrum of the different proteins, you have to eat two to three times as many calories to get the same amount of protein. Yeah. So you either have to literally overeat the amount of calories that you eat to reach the optimal protein targets, or you have to compromise on your protein. That's difficult to do. Yeah. And that's if you start to calculate things. So the only I met one vegan whose protein requirements were appropriate, and she was a nutritional therapist, and she literally calculated everything that she ate all week.

SPEAKER_03 50:51

I mean, vegetarian isn't like my wife's a vegetarian, so are my kids, um, for different reasons. And when we were having children, I was like, okay, that's your belief, that's okay. If there's any growth issues, okay, we have to have this discussion about protein intake. And my 15-year-old's five foot eleven with a size 14 feet, so I can't I can't use that argument. But we've always worked, and my wife has, incredibly hard to ensure that there's a very balanced diet with lots of protein. But I think veganism is really tricky.

SPEAKER_01 51:26

If you want to reach what are more and more widely considered to be optimal protein targets, and you're vegan, essentially you have to supplement, you have to use processed uh protein powders. Yep.

SPEAKER_03 51:39

To me, and there's quite a few nutrients that you're that you're missing as well. Yeah.

SPEAKER_01 51:44

But yeah. And one of the things is that well well, just our our DNA, you everyone knows the DNA is really important, right? I mean, that's what gets passed on. That's the the basic framework, the blueprint here. It's all about the plan for a protein or the plan for something that helps you to make proteins. Yes. Proteins are so prevalent, they're the clever things in your body. Yeah. And they're so important that if you start to under-supply with protein, your body will have to adjust and say, we're not going to recycle the proteins that we've got because we can't afford to replace them because there isn't enough amino acids from the proteins to make the next set. So we'll just keep them. We'll just keep them and they'll have to just manage even if they're not working so well. And we'll just and they end up over a long period of time. You don't get sick if you eat a low-protein diet for you know a few weeks. Yeah. You get sick over a long, long period of time. And then once you get sick, it's even more difficult to get back because you might have lost muscle mass or other things. So if you are recovering, yeah, or if you want to optimize, if you want to change, you know, if you if you want a trajectory change in your health, it's really important to up your protein intake. Yeah. And that's easiest by focusing on animal-based proteins.

SPEAKER_03 53:03

So how much are you how how much protein are you suggesting someone might take on board? You know, we'll be using sort of 1.5 to 2 grams of protein per kilogram of body weight for most people.

SPEAKER_01 53:17

And that's uh you know, it's a concentrated effort. Yeah, yeah, yeah. That's hard. For most people. Most people are not eating. I mean, I will tend to focus on one to two portions of animal-based protein in the two meals I have. So I'll probably eat three to four animal-based protein. Okay, so you f intermittent fast. Yeah, I do tend to, but not in a strict, a strict, strict way. So I'll probably just have coffee in the morning. Sometimes I'll have breakfast. It depends, yeah. Yeah. But my luncheons, sort of dinner, tend to be quite high protein based.

SPEAKER_03 53:48

Well, we just had a nice pokey bowl with some tuna and it was nice. Yeah. And salmon. So but a protein fix.

SPEAKER_01 53:55

Yeah, and I had a fantastic lunch because I bought a whole fillet of uh a steak fillet or fillet um a couple of days ago to share with some friends, and then their flight was delayed coming home, and so I've got this in you know, one and a half kilos of fillet to eat at the moment. So I took three steaks with me to lunch.

SPEAKER_03 54:13

Three, very little ones, yeah. Nice. So the behavior change, how do we encourage patients to make it? How do we open them to that light bulb moment where they go, oh shit? I've been driving that myself. That's why I've been doing this.

SPEAKER_01 54:38

So the f the first thing is, does that person feel comfortable with me? Yep. Just on a human basis. Yep. Are they prepared to share and explore? Yeah. Yeah. And not feel that they're getting it criticized and blamed for something. Yeah. So actually that that style that was there in what's called compassionate inquiry of Gavamate systems, it's very good as a sort of approach to just asking questions. Yeah. Can I be compassionate and can I inquire about what's going on in your health? Yeah. Yeah. And for me that's a technique you use with all your patients. And and for me, I think if I could deliver or not deliver, well, yeah, let's say I could deliver something as a doctor. Yeah, I don't think in that sort of paternalistic way, but if I was delivering something and I could deliver openness and curiosity about your health versus a shift in some biomarker, I'd go for the openness and the curiosity because I think life's going to be more fun if you have that.

SPEAKER_03 55:41

Yeah, yeah, yeah. Yeah. I mean, very, very true. Okay, so you've just touched on it, but how do how do we try to create that sustainable behavioral change that's going to lead to, is it through the cure being open and curious, curious about your health? Is it them asking questions about well, how does this make me feel? How do I optimize myself? How can I change my patterns to improve what I'm what I'm doing? Is that an approach that you might take?

SPEAKER_01 56:19

So I tend to think um I do quite a broad base of testing. So I also do sort of a broad blood panel with people, um, lots of standard things that you'd be testing? Um, well, a full blood count, um, a kidney profile, but I'd look at something called cystatin C rather than correcting, and look at all the different metabolic markers, and do um sort of different uh hormone panels, um testosterone as well as thyroid and sex hormones. Um and then I'm gonna do a sleep study and I'm gonna look at um how do you do the sleep study? Do you send them off to a sleep lab? No, I've got a system called sunrise. So it's a once with a disposable unit that you use on your jaw. Okay. And it measures um respiratory effort and jaw movements through the vibrations there. Okay.

SPEAKER_03 57:11

And so that can identify if you've got something like sleep apnea.

SPEAKER_01 57:14

Identify sleep apnea and other issues to do with uh sleep problems. Yeah. Okay, interesting. Um and I'm gonna do body composition, ideally with MRI and Samara or or DEXA? So I tend to use MRI if possible. It's much more accurate. Full body? Uh so you do a nose-to-nipple, sorry, nipple to knee scan. Yep. It's a low res scan, it's quite fast, so you haven't got to spend a long time in MRI. Yep. And then it actually measures the the volume of visceral fat that you've got. Okay. Um the muscle your muscle mass uh gives you values for anterior and posterior thighs. Um it will measure liver fat and subcutaneous fat. So you've got actual values for those things, and it'll plot that against a UK biobank database spread so you can see which percentile you're in in the population.

SPEAKER_03 58:02

Okay, cool. And how does that compare to DEXA body composition scans?

SPEAKER_01 58:06

So DEXA's just not as accurate.

SPEAKER_03 58:08

Yep.

SPEAKER_01 58:09

Um and uh you're not gonna get that population comparison for yours for yourself for your age group. That's just what the what the MRI is gonna give you. Um and it's talking to you about um so it's about a five centimeter normally um section of your abdomen, yeah, just above uh around L2, L3, so mid-lumber area. It doesn't well it's not measuring what's going on above that or below that. Yep. So it's just what what that slice averaged. Okay. Whereas this is taking in the whole uh intra-abdominal uh area. So when I see some people's scans, and I always love to talk with trainees at intensive care, uh the visceral fat you can see on CTE scans, which we never report and never discuss. Yeah, some people will have it in some areas more than others, so your DEX is just gonna miss those things. Yep, yep. Okay, and so you run these Yeah, and then I'm gonna say to someone essentially, this is the lowest hanging fruit. This is where you can most easily get an obvious reward. Yep, and these are the rotten apples in your barrel, you need to deal with these, or they're gonna they're gonna bite you. They're gonna hurt you. Yeah, yeah, okay. And then I sort of see with that, are they more carrot more stick oriented and how they're gonna move forwards? Yeah, what gets them going? I mean, I had one client who had a very high visceral fat content, and when I said to him, Yeah, that's that's worrying, yeah, that's kind of scary, that's gonna lead to problems, that just you know, put the fear of God into him, but in a very positive way, he could take that energy and use it the right way. Yeah, yeah, and other people it's more about maybe the first thing to do is get a win on sleep, yeah. So that you're a bit more energized and you can start to make some changes there.

SPEAKER_03 59:58

Yeah, okay. Fascinating. So you're uh you have a very holistic approach. It it it definitely you're testing multiple systems, multiple areas, and you're looking at someone very holistically and and bringing in a psychological approach to that and looking at sort of some of their belief system. But but uh the reason that we're failing with a lot of uh chronic illnesses is because we're uh not fixing the fundamentals and we're going for sort of these quick short interventions that don't actually capture the big picture.

SPEAKER_01 1:00:42

I think very few people or doctors realize the power of those foundational things. Yeah. If you get a really decent nutrition and a decent sleep and decent stress management and decent exercise and movement, but consistently for a period of time, you are going to feel so much better. And you might need some guidance because it might not just be about eating better, you might want to fast or you might want to be a low-carb diet for some period of time or protect your protein or get certain nutrients in that have been missing because of what you've done before. But getting those things right for you, not necess not just pulling off a menu from somewhere else, but getting them right for you, is enormously powerful. Yeah. And a lot of people tell me, you know, they tell us a balanced diet and I sleep okay. And then you dig in and you dig in and you find there's an issue here and there's an issue here, and there's you know, two, three, four issues that are quite multiple and you put those all together, and I'm sorry, it doesn't work. And and the the proof is that you don't feel very well. Yeah, yeah. And that's why you come and see someone like me. Yeah. Yeah. And most people who come and see me aren't expecting a standard GP consultation. Yeah. They want to discuss, yeah, they want to be curious, they want to think about how can I do this because I've seen that the healthcare system isn't really going to nurture my health. Yes. Or the NHS possibly.

SPEAKER_03 1:02:24

Yeah. So if someone wanted to improve their metabolic health, and I love how you've just said, you know, the foundations are the key thing. Exercise, sleep, good nutrition, manage your stress levels. What uh is there anything else that we're missing from those?

SPEAKER_01 1:02:47

Um I think pleasure and purpose.

SPEAKER_03 1:02:51

Yep.

SPEAKER_01 1:02:51

Like, I don't think we Is that social relationships that come into that or people can find that in different ways. Yeah. Um, but there is a whole neurotransmitter hormonal system set up around enjoyment. Yeah. And um I'd I'd love to be able to prescribe uh enjoyment or pleasure. Uh I think that's a topic that I'm still looking at how I can bring that more into my medical practice. Yep. Um, but if you enjoy life, uh it's also really key to health. Yeah, yeah. So if we're going to talk about health, we need to include pleasure, happiness, purpose, spirituality, eroticism. How you know I I I need more training is my my you've done a lot, I think, haven't you? I've explored a lot of different topics. Okay, I find that interesting. So I try to bring what I've what I know about those things and okay to give people chances. Amazing.

SPEAKER_03 1:03:51

And so what are the key daily behaviors that you've been able to identify that help to build someone's long-term resilience?

SPEAKER_01 1:04:06

So I think probably the most commonly applicable shift is giving yourself enough time to sleep. Yeah. Having a pattern that it means that you wake up at pretty much the same time seven days a week.

SPEAKER_03 1:04:24

Yeah. Is that so critical? Are you allowed to sleep in at weekends? Well, if you're of course you're allowed to.

SPEAKER_01 1:04:33

Is it advisable? Well, if you're playing catch-up at the weekend, it's just proof you didn't get enough during the weekend.

SPEAKER_02 1:04:40

Yeah. Yeah.

SPEAKER_01 1:04:42

Um so if your system doesn't wake you up at the same time each morning, that's a pretty clear indication that your circadian rhythm and your overall amount of sleep you're getting is not sufficient. Yeah. Sure, if you, you know, go out late on Friday night and that's uh, you know, what that then happens, there's some some balance of compensation. Yeah. If you haven't particularly been up late, and if you are just you know, Friday night, Saturday night, go to bed three hours later than the rest of the week, you're getting social jet lag. Yeah. So you're shifting your your your rhythm. Social jet lag. I haven't heard that term before.

SPEAKER_00 1:05:19

Yeah.

SPEAKER_01 1:05:19

That makes a lot of sense. Yeah. So it's like traveling through you know, if you go to bed three hours later and your whole system is on a three-hour stack, it's like you've gone to, you know, um time zone in Greece and come back. And then you notice a bit of jet lag. Yeah. That's what you have for Monday, Tuesday, and Wednesday. Yeah. Yeah. Because your body can sort of adjust back by about one hour.

SPEAKER_03 1:05:40

Makes complete sense. Okay. So one of the key daily patterns is is is optimizing your sleep, regular wake up times, and regular to bed times? Not as important.

SPEAKER_01 1:05:53

So regular wake is much more important. Yep. Because that that's a real it's what we call it zeitgeber in sleep medicine. So it's a it's a anchor point for your circadian rhythm. Yep. Yeah. So if you ate normally at seven, then at six o'clock a whole bunch of hormones start to rise, another ones start to drop. So that at seven the sort of switchover happens. Uh-huh. And you've things that were high and now low, and things that were low were high. And once they sort of cross over, you go from a sleep state to awake state.

SPEAKER_02 1:06:20

Yep.

SPEAKER_01 1:06:21

Yeah. So you wake up with all those things rising, getting ready for the day, you want to be active, you want to get out of bed. Yep. Ideally. Yeah. Um, and then you want light. Yeah. Because light will then confirm for your body, okay, everything that's for the night time can be put to rest, we can go on with all the daily light activities. Yeah. I often see that patients who are in intensive care are often quite sick because they're intensive care. And you know, if I um took you or me and put me into an intensive care bed, yeah, and also possibly fed me, you know, nasogastric tube feed or yeah, whatever else, yeah, and I wasn't allowed to I didn't move or get out or have light or fresh air, and particularly I think the light is important, yeah, you'll get sick. Yeah. So when you're sick and you're at home and you stay in bed, or you just go from the sofa to your bedroom and order some food online, you you'll be more sick because you stay indoors. Yeah. Yeah. So, you know, light is so crucial. Um, it's something that a couple of years ago I was thinking, okay, red light boxes, is it all just a bit too woo-woo? What's going on there? And then last year I started working with a professor of neurobiology um uh uh from UCL. Okay. Um and uh he's done uh research on light, and he shows that if you shine light onto someone's back, or don't shine light, so it's a controlled study, light, no light, for 15 minutes, not a particularly bright amount of light. Is this red light or this is red light? Yep. And then uh you give them what's called an orogluco oral glucose tolerance test, yeah, 75 grams of of uh sugar basically, uh-huh. And then you watch their blood glucose profile afterwards, it's 27% lower if they've had the red light shone on them. Now that is a tiny physiological input. And they don't know it's being shone on their map. No, there's no physician. There's no placebo. No, that's pretty remarkable. Massive physiological outcome.

SPEAKER_03 1:08:32

So um so that's impacting, it's got to be impacting your mitochondria in some way.

SPEAKER_01 1:08:39

Yeah. So this is Prof. Glenn Jeffrey's work. Yeah, he's got quite a few podcasts out. People are interested to see what he's he's doing. He's really good guy. Um he and his group of sort of international light specialists think that the impact of light on our health is as important as exercise. And we are in an environment now where you know we're sitting here under bright LEDs, yeah, because we've said to ourselves, if we can see, that's an everything, that's all we need, yeah. But outside of the visible light spectrum, there's a non-visible light spectrum, yeah. And that's ultraviolet light and uh infrared, and those things are part of nature's gift to us through the sun, yeah, yeah, and our body tuned up to use those things. So we now know that in particular in the red and the infrared zones, there are the energies of the photons that come from light, our bodies have got used to using. Yeah. And what's really fascinating is that the sun sends out a complete spectrum, but only parts of that spectrum reach us because they get it gets absorbed by water. Yep. But our metabolic needs in the stratosphere, yeah. Water absorbs certain parts of the red and infrared spectrum. Yep. So in the gaps where the light doesn't get through, the energy corresponding to those gaps doesn't have a matched metabolic need in our body. Okay. So we can be fairly confident that either it was an enormous look of nature, which doesn't really happen, or our mitochondria, which have been around for such a long time, way, way longer than we have, they're present across so many species. Yeah, they learned how to use the energy of the sun. Available, yeah. Because why not? You get a competitive advantage compared with the next mitochondria. Yeah. So that light is doing lots of functions. So in order to produce the energy molecule ATP, we have to not only have a fuel source, but we have to convert that fuel source a little bit and then start to use it in what's called the electron transport chain of our mitochondria. Okay. So all the proteins that are responsible for that get upregulated, meaning that there's a signal from light that says, let's make some more proteins. Yeah. Then there's also a process where the light tells something called nitric oxide to release from one of the complexes. And then we know there's also a a process where we think that the light is affecting the nature of the water, which is around something called the ATP pump, allowing it to decrease its viscosity, meaning this pump, which is the smallest engine in the universe, or the smallest engine we're aware of, can spin. It's an ATP pump. Yeah. And ATP is ATP is a molecule of energy, adenine triphosphate. Yep. Yeah. Adenosine triphosate adenosine triphosphate. Yeah. Um, and it's what makes the ATP. Yeah. It's an ATP maker. So it takes ADP adenosine diet. ATP is for our listeners, is it's the molecule which all our muscles and produces energy protons and everything else use to actually make things go. Yep. Yeah. We make more than our entire body weight of body weight of ATP in a day.

SPEAKER_03 1:11:57

More than our entire body weight.

SPEAKER_01 1:11:59

Yeah. So we're making it, using it, regenerating it. Yeah. So it's a huge process going on. And so that's a fascinating number. It's phenomenal. Yeah. Nature's incentive. By the way, 84 kilos. Yeah. So I've made four kilos of ATP.

SPEAKER_03 1:12:14

84 kilos of ATP today. Yep. And reused it. Yeah. That's remarkable.

SPEAKER_01 1:12:21

Yeah. So that whole process is really positively influenced by uh red light and infrared light. Yeah. Then we can sort of go to the other end of the spectrum, which is ultraviolet light. Um, and uh we might well be aware of well, we're aware of the skin cancer risk with ultraviolet. Yes, yep. Being Australian, we're very aware. Yeah. And so but because of that, because we've got people who are very fair-skinned in a very hot part of the world, we've seen what happens when you get too much light, too much sun. It's damaging, yeah. And so, you know, UV is is damaging to the skin. That's why we develop melanin, that's what gives us tan or dark coloured skins. That's protect that's the protective agents against melanin. So, yes, it's a damaging process, but we also produce um uh not only vitamin D, but a whole load of other hormones, so something called POMC, and that's a precursor to lots of other um hormones in our body. Okay. So when we don't get enough light, we don't get enough vitamin D, but we don't get enough other hormones. Yep, yep. So we know that vitamin D is a marker of poor health status. We know that it increases your risk for cancer, for cardiovascular disease, for uh acute illness, yeah. But we also know that if you fix someone's vitamin D, it doesn't fix those problems. Yep. So vitamin D is a marker of whether you're getting enough light or not. Yeah, and you might fix some of those vitamin D associated problems by taking vitamin D, but you don't fix it. That's the root cause. Yeah. Yeah.

SPEAKER_03 1:13:59

So how much light therapy do you advise your patients? Okay, clearly we know that getting outside early in the day and trying to get light directly on us is really, really critical. Um, sometimes difficult to do in this country that we that we live in. But do you think that red light therapy has a role to play in creating a healing environment, optimizing our cells' energy levels?

SPEAKER_01 1:14:32

So I think the the best form of light delivery is sunlight. Yep. And we really should say sunlight three times in our recommendations before we start to say other forms of light. Okay. Um we need to understand how you get UV light and how you get infrared. Um and uh, you know, we can get infrared with clothes on. Yeah, so infrared will pass through five, ten layers of uh clothing, yeah. And because it doesn't get absorbed by very many things in our body, it hits the surface and then bounces left, right in this way. So it'll travel all the way through your body. Yep. Red light. So if you put an infrared detector on the back of your body, it'll see sunlight coming through you. Okay, that's amazing. Yeah. Um, so you get it when you go outside, even if you've got clothes on. Ultraviolet, you need to not have clothes on. Um, indoors, you are getting lots of 420 nanometers of light, which is the blue peak in all our LEDs, and that's damaging our mitochondria. Yeah. So that's actually turning on the opening up a porphyrin, which is like a pore, which means you then lose the biochemical relationship that you're trying to build up, which is a charge difference between the inside and the outside of mitochondria. So let's try to have less the things that are harming us and have more of the things that are driving our biology in the right direction. Yep. Okay. So getting outside, getting somewhere that's green because gre green leaves, green trees, they're super reflectors of infrared. So we should be getting rid of our LED lights. So I've so the the first thing to do at home would be to get an old-fashioned uh light bulb, incandescent light bulb, put it into a lamp that's like an angle poise that's metal, that's not going to melt because most lamps these days are no longer designed to use 50 or 100 watt bulbs. Yep. And have that on your desk at home. Have it on all the time. Yep. Give yourself some infrared. Yep. Um good work coming out now showing that that we can clearly see a difference in the mitochondria in your eyes, your eyesight's better if you're using an infrared, if you're using an incandescent bulb as a source of infrared. Yep. Uh, and you know, everyone noticed when we introduced LEDs that people felt worse. And then we got used to it. Yeah. I've got a bit of a headache sitting in these lights now. Yeah. So not because of the stimulating conversation that we're we're having.

SPEAKER_03 1:16:57

You know for giving people a headache.

SPEAKER_01 1:17:01

So get the right light sources ideally outside simple replacement. Yeah. Yep. Have that as part of your normal culture. Okay. Then there's a place for infrared and for ultraviolet. Yep. And I think that if you've got fatigue and you don't know the cause and you're struggling to get outside or you're wanting to get better, a bit like with a high protein diet, a high light environment might be really appropriate for you. Yep. Uh, and so trial, trial and uh a red lamp infrared device. Would you go a SAD lamp? Like the No, so SAD's giving you lux, it's giving you intensity. Okay. It's not giving you the wavelengths that your body needs. Yep. Okay. So I've got some patients with fatigue who are using those red lights and they're reporting back to me, feeling a lot better with it.

SPEAKER_02 1:17:59

Yeah.

SPEAKER_01 1:17:59

Now, a lot of patients who've got long-term fatigue don't feel better with anything. Yeah. So it's great when they say they feel better with something. Yeah. Is that a study proving it? No. Similarly, I've got patients who've been trying um ultraviolet light, you know, having you know 10-minute sessions on a sunbird a couple of times a week, they feel better with that. That's stimulating the whole of that light cascade that we done a hormone cascade that we talked about before. Is there evidence to say that's right? No. Um, should we listen to patients' experience? Yes. Should we guide them to not uh do things that are dangerous? Correct. Yep. Um is there looking like a mechanistic method? Yeah. Yep. What I'd love to do is to do a study in intensive care where we try to deliver back the non-visible part of the light spectrum to intensive care patients. So can we have a red light, infrared device, uh ultraviolet device that basically delivers that light to the human body so that they don't lose that while they're in hospital. All right, NHS can fund that one? Uh not too difficult to fund, actually, because I've got a source that will make the lighting device. So um I'm looking at contact with a few other critical care units about it.

SPEAKER_03 1:19:14

Okay, amazing. Steve, this has been utterly fascinating. I know we're sort of running out of time. I could honestly keep talking for a long time. Sounds like you almost could, but the we we need to get you out of these this light source. Um but quickly, three big things that people need to prioritize. I think I can probably guess what they what they are going to be.

SPEAKER_01 1:19:42

Um I think probably can. Um I think you the first thing would be the sleep window.

SPEAKER_02 1:19:54

Yep.

SPEAKER_01 1:19:55

With uh morning wake time and and light. Yeah. That's a really easy win. Yeah, but you're just extremely likely to feel the difference between having seven hours of bed and having eight hours of bed and getting enough light. It's such a low-cost intervention. Yeah. Secondly, nutrient source and for me, switching into an animal-based uh protein-rich diet where your guarantee for getting all the nutrients you need is met really easily, and then you can relax. Then you can have a beer or two and have this and that on the weekend if you're if you're really healthy and you haven't got any food intolerance, etc. Yeah. So guarantee your nutrient intake easily by upping your animal protein intake. Uh-huh. And the third thing would be find you know, find you. Yeah. Find your sovereignty, find what it is you want in life. Your purpose. Be clear. Yeah, and be clear about what you want, not about what you don't want to have in your life.

SPEAKER_03 1:21:02

Yep. I would have thrown exercise as one of those three, but I but I but but I love I thought I had four. Yeah. But I then it would be really high resistance work. Yep, yeah. Strength work to optimise muscle mass and bone loading.

SPEAKER_01 1:21:15

For me, it's really about bone loading. It's got to be really high intensity. Yep. Really, really pushing it up though.

SPEAKER_03 1:21:22

Yep. Okay.

SPEAKER_01 1:21:23

Not about hours and hours in the gym.

SPEAKER_03 1:21:24

No, because that'll boost your VO2, because you like the exercise, the quick hits, and give you sort of good bang for your buck.

SPEAKER_01 1:21:33

Yeah, so I think zone two is really overemphasized. I think that gener the sort of general way people do resistance training in a gym where they sit for more than half the time on their phone, yeah, is like that kind of zone two. Um, I think the body really responds to challenge extremely well. And if it's challenged, yeah, if my body is not really stressed when I'm in the gym exercising, I'm getting much less reward for my time that I'm there. So really high loads done really safely, done with a really long recovery period, yeah. Uh, is I think like doing a hit. So I think essentially it's a high intensity or maximum intensity resistance as well as a maximal intensity cardio. Perfect.

SPEAKER_03 1:22:25

So love that. So high intense exercise needs to push load, but it'll also optimize your VO2. Yeah. Brilliant. See, that's been utterly fascinating. So thank you for your time. And um, yeah, love to chat again. Yeah, great.

SPEAKER_01 1:22:39

We will do.

SPEAKER_03 1:22:40

Thank you.