#E50 In This Sickcare System, We Will Have to Empower Ourselves, With Dr. Nas Al-Jafari
About Dr Nas
Dr. Nas is a vocal advocate helping bring about a new revolution within the healthcare space, breaking away from outdated traditional practices and pushing for a more holistic approach to health, which puts the spotlight on preventative medicine and care, expanded testing procedures and measures, and the true pillars of longevity.
Read the HYPERSCALE transcript
DR NAS AL-JAFARI - HYPERSCALE
[00:00] Briar: Hello and welcome to HYPERSCALE. Nice to have you on the show.
[00:04] Dr. Nas: Thank you very much for having me. Great to be here.
[00:06] Briar: Yes and welcome to our in-person studio. This is our first in-person podcast. And you're the first person.
[00:12] Dr. Nas: I feel so privileged. It's amazing. Congrats guys.
[00:15] Briar: Thank you so much. So tell us a little bit about what you would like the listeners to really get out of this podcast today. What is the why, what drives you to do all of the wonderful work that you do?
[00:30] Dr. Nas: I think the root of that is why did I move from traditional medical practice to what I'm doing now, which is effectively trying to keep people well and live longer. And I think there has to be a realization that for all the good things that the regular health system has done over the sort of decades and last century, advent of antibiotics and progress in medical procedures, we've got to the limit and the traditional health system hasn't been designed to keep us well, is to deal with this when we're sick. And there has to be a fundamental shift in how we deliver health services. Until then, you really, as an individual have to empower yourselves to keep yourself well. Again, for all the advancements that we're discovering and seeing that's ongoing right now with AI and robotic surgery and cancer treatments, in reality, what keeps us well is nature and a lot of the ancient practices we've been doing for centuries,
[01:32] Briar: Sometimes they say it's all of the things that our grannies would've told us to do, so like sleeping and eating healthy and things like this. Would you say it's fair to say that we live in a sick care system rather than a healthcare system?
[01:45] Dr. Nas: 100% and if you look at the history of it, the healthcare system, which really hasn't changed that much in the last few decades, was designed to deal in times when people got infections, they were given an antibiotic, it either worked, it didn't work. You had a cancer or you had a trauma and you had a surgery. And it was the binary outcomes. But if you look at the diseases and what people are suffering with today, cardiovascular disease, obesity, diabetes, autoimmune conditions, the health system hasn't been designed to deal with them. We're identifying people when they're sick, when actually we should be employing a completely different level of analysis and really using lifestyle, the root to try and prevent these things from getting in ultimately.
[02:30] Briar: Do you think that there are more cases from your perspective of there are more diseases, there are more people getting sick today than there was in the past?
[02:41] Dr. Nas: Oh, 100%. And if you look at kind of life expectancy, we've kind of hit a peak, the benefits of originally sanitation and prevention or limiting sort of infant death during delivery. We've kind of reached the peak of kind of nutrition as well. And now we've reached this kind of inflection point whereby our wealth is disrupting our lifestyle, i.e. our nutrition. We don't have to go out there and fight for our shelter or our food. So we're less mobile, we're more stressed with our work. We're not sleeping as well. And this is kind of creating a vicious storm ultimately. And we're all becoming unwell.
[03:29] Briar: What do we need to do about this? Do you think it's the responsibility of the governments, do you think that people need to individually do a little bit better? Do we need to just change how we view our sick care system or healthcare system?
[03:45] Dr. Nas: There has to be a fundamental shift and I don't think it's one thing. I think if you look at the actual healthcare system itself, again I'm pretty sure that if I went back to medical school now the way that the doctors are being educated now hasn't changed. I'm sure they're using the same textbooks. And unfortunately because of that, we're still delivering the same sort of care as if we're dealing with conditions from 50, 60 years ago. I think on one level, that needs to shift. I think also as well within the health system, you've got various forces at play. I mean, you have insurers who generally, certainly regionally, will insure your life for a year. So the incentive to implement preventative health services, it's just not there. They're designed to keep you alive for a year and limit the cost, whereas there has to be an upfront cost with prevention to really yield the long-term outcomes or benefits.
[04:38] Dr. Nas: If you look at public healthcare systems, they're firefighting. I mean, they don't have the ability or they can't afford to go through that change at this moment in time, even though in the longer term it will benefit them. And then I think on a population level, I mean, I didn't learn anything about nutrition and lifestyle during my early years. I think it should be a fundamental part of what we're taught along with financial management at school. Alongside that, I believe there has to be a change in public policy and limiting things like the lobbying from food and drinks industry, for example, when creating policies.
[05:14] Briar: I was actually just speaking to someone recently. Do you remember that triangle that used to be in school?
[05:21] Dr. Nas: The food pyramid.
[05:21] Briar: The food pyramid. And do you remember at the bottom it used to just have like wheat and bread and I can't even remember what was on it. And it used to go up from there and these days when I think about what I eat, I eat the complete opposite to what the food pyramid told me. Why was that? Why did they have that food pyramid go out and why don't they educate people at the schooling level?
[05:45] Dr. Nas: Yeah, I've often thought about this and I think there are two main reasons as far as I can derive. A lot of them were designed during a time where we were going through that period in the kind of seventies and eighties when fat was demonized and people had made that association between saturated fat and cardiovascular disease. So then they flipped it on their head and started basically cutting fat out and you had to fill the gap with something. So everyone was told to eat carbohydrates. And that's as you say, the kind of basis to that pyramid. I think also cynically as well, coming back to the lobbyist, I mean, I think the food and drinks industry has a big hand in unfortunately how the studies are done and how the policies are created.
[06:31] Dr. Nas: We've got to remember that designing studies for nutritional evidence is quite difficult. They're actually often based on observational data. So what happens is they get a large population of people and they're either given questionnaires prospectively regarding what food they're eating and their lifestyle, or retrospectively they're asking you, what have you eaten in the last 5, 10 years on average? And so you can imagine, I mean, even a lay person knows that sort of level of evidence isn't high quality and you're only going to see associations. There are going to be all sorts of confounding variables. So for me, I think there are a number of reasons for that. And you're right, you have to flip the pyramid on its head.
[07:12] Briar: Yeah. I find it quite difficult to eat healthy. I find I have to put a lot of preparation into my meals. I have to think about it. And when I'm out and about or when I'm traveling, it would be a lot easier and a lot cheaper probably, should I want the croissant or the sandwich or things like this? And when we go to the supermarket, it fascinates me just even the way the supermarket is created. You are at the checkout and you are down past all of those chocolates and the lollies and the candies and things like this and you're mentally fatigued because you've been healthy the whole way. And then you're thinking, oh, let me put this bar in. I don't eat sugar. I quit sugar many years ago. And once I quit and sort of got through those withdrawal periods, I actually don't miss it. And now when I have it, I think, oh, it's disgusting, but I just can't believe all of these colorful, enticing things in the shop and things that you think are going to be healthy for you aren't healthy. I remember thinking that perhaps eating some of those vegan burgers were really good for me at one point because of the way it had been marketed, I think by the organizations. Then one day I checked the back of the label and I was like, this is not good for me.
[08:32] Dr. Nas: Yeah, I completely agree. It's amazing, isn't it? Because you quite rightly say, it's how the supermarket is designed. You go through with your trolley and you've effectively filled up your trolley before you get to the real food. And often I'll tell patients, I'll say to them, listen you should only really be shopping in the fresh fruit, veg, fish, meat aisle, maybe go down the nuts and seeds aisle, but everything else you should pretty much write off or it should be a fraction of your trolley or your basket.
[08:57] Briar: What kind of things do you eat?
[09:00] Dr. Nas: Yeah, I guess that a lot as well. I think when it comes to what you're really asking me is what should we be eating in general? And I think there's a long answer and there's a short answer. Ultimately you'll have the tribal wars between, at one end of the spectrum the vegans and then the carnivores at the other end of the spectrum. Ultimately, what do they both have in common? It's that we should be eating whole real food. We should be eating essentially as close to nature as possible. And in reality, we're not designed to be opposite ends of the spectrum. We're designed to be somewhere in the middle, whether someone is more designed sort of genetically or epigenetically to be more towards the carnival side versus someone else who's probably more towards the plant-based side.
[09:45] Dr. Nas: In reality, if you're somewhere in the middle of that spectrum and eating whole real foods, you're probably not going to go wrong. And that's what I myself will try and aim for. That's covering what we should be eating. In terms of, a lot of it is about how often and when and everyone talks about intermittent fasting or flogged it to death for a good few years. Interestingly, there was an article, you probably saw it that came out a few days ago that said there's an increased risk of cardiovascular disease with intermittent fasting. And that's the problem, you get a lot of these headlines, people believe in headlines without actually looking at who carried out the study, what were the conflicts of interest, how was it designed, etcetera? And they take it as fact and it just becomes a mishmash of information. It becomes very confusing for people, even very educated people. But I try and follow those principles, so don't eat too often, don't eat too late and eat as close to nature as possible.
[10:36] Briar: Okay. And should we be eating like seasonal food, various different colors of food? Should we eat 30 different kinds of food? Because someone told me that I was eating not enough variation in my diet. I was constantly eating like tomatoes and avocados and fish and just kind of like rotating around like six or seven different things. And they were like you have to eat 30 different kinds of food a week. Is this true, including sauerkraut.
[11:05] Dr. Nas: Well, I think it's a kind of hierarchy of what's important. So I think if you've got those basics right that I mentioned, then you can start taking it to the next level. And yeah, there's definitely been a lot of research to suggest and a lot of the research was based around looking at people's gut microbiome that if you improve the diversity of the food that you're eating, particularly the plant-based foods, then you're going to improve the diversity of your gut microbiome. And that has been associated with better health outcomes. I think one area that I want to also highlight within that, is that a lot of people, again, will fight all day about what's better for you, carbohydrates or fats. I think proteins get neglected and in reality a lot of people aren't meeting their minimum protein needs and actually particularly my female clients because it's not often a consideration. And what's happening is people aren't developing that level of muscle mass that they require or bone density. And when you're getting into later life, if we're looking at longevity, you really need to make sure that you're meeting these needs both from a protein perspective, calorically to maintain good health.
[12:09] Briar: What kind of proteins would you recommend and how much protein should we be eating per day?
[12:14] Dr. Nas: Again, I think you need to be looking at animal proteins ultimately as a preference because in reality it's very difficult to get your full range of amino acids and proteins from plant-based sources. You can, but it's a lot harder. I think secondary as well is it's harder to absorb. So you get far more complete absorption from animal products than you do from plant-based foods. And then I think in terms of how much you actually need, certainly this is one of the areas where you shouldn't really look at the RDAs recommended daily amounts that you should be eating. They're often under dosed and they're designed to prevent people from getting sick, not keep them well. You need to be looking in the region of around 1.5 to 1.6 grams per kilo of lean weight a day. So let's just say you lean weight 60 kilos, you should be getting around about 90 to 100 grams per day, but in divided meals, because if you take that 100 grams of protein and you have it in one meal, you're not going to assimilate all that protein. So ideally that needs to be between two or three meals.
[13:23] Briar: Talking about marketing, have you seen people recommending that we start eating bugs?
[13:31] Dr. Nas: Oh, I haven't. Although, I have been to Thailand and eaten bugs. I guess it's probably a cheap way of scaling up people's protein intakes. I suppose it's probably something that's still sociably not particularly acceptable about doing that in certain societies. But just, also, that links into the point you made before about food. A lot of the food that is available in supermarkets and that most people are eating today has been designed for cost, scale and transport. It's not been designed for optimal health. So that comes back to needing to focus on whole real food, which the food and drinks industry aren't focusing on.
[14:15] Briar: Do you think that we're going to start to see a little bit of a shift? I've noticed that this year people's resolutions, New Year's resolutions, were all about: “I'm entering like my soft girl era,” and they did the whole, “No reality TV, only reading my book.” I could see that there was starting to be a shift in how people were thinking about their health and wellness and things like this. I honestly think that part of me thinks that the longevity space is going to be the next AI or the next metaverse, the next kind of hype area, which I think would be really good. Do you think this could possibly be the case?
[14:57 Dr. Nas: I think you're definitely seeing seeds of it in the sense that if I look back, for example university days, I mean even medical school was pretty raucous. I mean, it was more about having fun and the associated food and drink with that, whereas I'm hearing stories out of university now that the whole concept of what we call freshers week, so that kind of first introductory week, doesn't really exist, certainly how it used to. People are a lot more interested in being teetotal, getting to bed on time, more consistently. Even having a gym membership was unheard of, 20 years ago. Now I think it's the normality. So I definitely think there's a change in the generation that's come through, I can't remember what they're called, Gen M.
[15:43] Briar: Gen Z.
[15:44] Dr. Nas: Gen Z, right.
[15:45] Briar: Alpha I think below.
[15:48] Dr. Nas: So those guys, I think what's going to in reality happen is there's probably going to be a two-tier system. So you are going to have probably the wealthier sort of populations or pockets within the wealthier population who longevity is going to be a big priority for them. And we see it now in our practice, but then I think for the masses they're still going to be stuck in this traditional sort of approach in that, again, it comes back to hierarchy of need. I mean, if you are busy trying to put a roof over your head and put bread on the table and you're working long hours, health is probably not a priority for you. But I think people who have that luxury, it will become a top three priority for them. So I think you're going to see this divergence.
[16:38] Briar: I've spoken about this with people on my podcast about how there are some really real concerns I have about our future, but then there's also a lot of optimism that I have as well. And I think if we did just get our sort of shit together, we could create a better future for us. But you're absolutely right, how can we be thinking about the future if we're just struggling to put our heater on and pay our power bill every month? The UK is seeing a real crisis at the moment. I have our business in the US as well and we pay for our business's health, full health insurance in the US but it's like $1,300 per person per month. And that would have to come out of their own pocket should we not pay for it. It's very concerning and I know that the US put so much money towards like nuclear weapons and things like this. Trillions of dollars, like 12 trillion or something crazy and then literally like mere millions went towards longevity research.
[17:40] Dr. Nas: Yeah and on that point I can't remember the exact figure, but the amount that the US spends on healthcare is a factor of, I can't remember how many X above the next second country yet the health outcomes are pretty low average. And I think coming back to sort of change, the cynical part of me thinks that it's not going to happen from the health industry itself. So I think there has to be a revolution more from the people themselves. And often there's a perception that longevity and staying well is something just for the rich. I think that's a bit of a confounder in the sense that it's not a case of necessarily these things are expensive because coming back to what we were saying before, it's just about living as close to nature as possible. I mean, lifestyle trumps anything else. So it doesn't have to be expensive, but it's a confounder in the sense that wealthier people generally are higher up that hierarchy in the sense that they can actually start to prioritize their health and think about their health and spend more time exercising and focus on eating organic food or whatever it may be.
[18:50] Briar: I made a post recently on my Instagram about eating healthy and working out and how I believed it was important for not only myself and my body, but for the people around me as well, so that I can keep showing up as my best self. And I think I had like four or five different people like post really insulting things under it, including someone who called me a narcissist for wanting to keep healthy, like why do you think that people have this kind of perception that it's not okay to take care of themselves?
[19:26] Dr. Nas: Well, I think probably some people jump to the conclusion that it's purely an aesthetic thing. I think also, as well, there's probably a semi-sort of suspicious or jealous element to people because naturally, if someone is living a way or a lifestyle that's different to ours, you're generally, I mean, it's probably human nature that you're going to approach it in a quite sort of suspicious manner. But I think, as we've been saying, this is going to become more of the norm. And you've heard about kind of the whole sort of fat shaming and it's almost gone the other way whereby, if you are of a normal, whatever normal is, let's say the normal body habitus from say, what was considered, in the 1970s, it's almost like you're demonized for looking like that. And it's kind of like, well, really is that the way we should be going? Yes, we need to be inclusive, but we have to be honest and real with ourselves, to live longer we have to be healthier. And with that, it requires some time and attention and focus on lifestyle.
[20:31] Briar: So sleep, I hear is a big factor of longevity as well. And when I did my GlycanAge, I was actually super shocked to hear that it was eight years older than what I actually am. And I was kind of pissy about it to be honest, because I feel like I do all of the things by the book and take care of myself and eat healthy and things like this. But I did wonder if it was because of my sleep. What are your thoughts about sleep and what are the other important elements of longevity we need to consider?
[21:02] Dr. Nas: I mean sleep is definitely getting a lot more attention than it used to. It was very much… everyone focused on nutrition and exercise. And that's probably because there were large kind of commercial sort of industries behind it all. But people are beginning to realize the importance of sleep and prioritize sleep. And I think like a lot of things the same as with longevity because now you have the platforms for a lot of these world's experts who are talking about these topics and the general population has access to it. People are empowering themselves and realizing what effect it has. And I would put sleep on a pedestal in the sense that if you are underslept, you can have the perfect nutrition, whatever that is, and be exercising regularly, but still be in poor health.
[21:50] Dr. Nas: Whereas I think if you're well slept, not that I'm encouraging you to eat badly or not exercise, but you have a lot more leverage with your nutrition and exercise and still be in relatively good health. So I put a lot of importance on it. Have I mastered it myself? No. I think the difficulty is that with exercise you can just decide to exercise. With nutrition, you can just change your nutrition, whereas focusing on trying to get good sleep, I think requires a lot.
[22:17] Briar: So boring.
[22:18] Dr. Nas: Yeah, it's that. And I think it's the same with stress. It's just far harder to manage for people. I think because it's not been ingrained in our upbringing but then also it takes time and effort. It's almost like if you're learning a new skill, you have to train. People say this to me all the time about, when I tell them to meditate or relax, they say they can't do it, my mind won't switch off. Well if you started to play football or tennis, you couldn't kick or hit the ball properly. You have to really get into it, practice. It's an exercise.
[22:51] Briar: Would you recommend daily meditation or how often should we meditate for how long?
[22:57] Dr. Nas: I wouldn't necessarily put a time on it for people. I think it should be integrated into people's daily lives as much as we eat and we try and exercise every day or most days, you should be integrating into your day-to-day life. And for some people that could be as little as a few minutes, ultimately I think it's just a case of doing it. And meditation doesn't need to be, you sat there and you're humming. Traditionally for a lot of people religion was a form of meditating, reading their scriptures or books. Going out in nature is a form of meditation for some people, just going on a walk, being surrounded by nature. They've even done studies on it. They've seen stress levels go down. So if you look again at a lot of these different cultures, they have their various own ways of de-stressing. It's not necessarily the traditional way that we look at meditation.
[23:48] Briar: I've enjoyed wearing my WHOOP watch because it shows me my stress and things. I don't know how accurate it is, but I do try and be quite mindful about it. And I think after receiving my eight years older result, which I was kind of annoyed about, like I have been thinking a little bit more of this day-to-day and breathing and doing things like this. You spoke before about the education system and also about how the medical industry as well is kind of stuck in the olden days. What do you think the future of a doctor looks like?
[24:26] Dr. Nas: Well I think change on that side is going to be, as you said difficult. I think you touched on AI and I know again that's a buzzword alongside longevity. But I mean, of course the two are going to overlap because AI is integrating into all industries, or will. I see the doctor of the future being more of a kind of coordinator and a facilitator of a lot of this information, which is just going to get assimilated by machines. I don't think they'll completely replace doctors or maybe that's just me looking at it romantically, although hopefully I'll be long retired by then. I mean, in all seriousness, I mean, if you take something like for example, radiology, I mean, we can already see now, chugging images to a machine, if they've seen enough images of what's normal, they'll probably look at it a lot more accurately than the human eye, which is actually still a very basic way of analyzing the information. You hear people in the pharmaceutical industry talking about drug discovery being sped up from on average, I think it's 10 years to now, two or three years. So I think it's definitely going to play a big role. And I think you probably may not need as many physicians per patient population but I think they're going to be more coordinators.
[25:46] Briar: Sometimes they talk about how technology and things like artificial intelligence are just going to cause a greater divide and we're going to have the haves and the have nots, so to speak. But I was sitting with someone recently having dinner and they were telling me this fascinating story about how AI could be used in some of these, like smaller communities in say Bangladesh or something like this where people aren't really trained to be a medical practitioner and they find it quite hard to get people to move there, but something like AI could help diagnose a lot of these people and bring it to the masses a little bit. I thought that was a really interesting thing to hear.
[26:25] Dr. Nas: Yeah, I know you're a big fan of chips.
[26:29] Briar: I am, I'm so excited to get my chip next month.
[26:34] Dr. Nas: Yeah, I do envisage a time and then they already have these chips that people are wearing externally where there are many multiple metrics that you can analyze and monitor. And I think they're being used more in kind of high dependency or ITU units. I think that may well become commonplace where we have our own chip, whether it's internally or externally, that's essentially alerting not just a doctor. I'm sure it will be plugged into some central database, but even ourselves. So you'll be getting a lot more early warning signs and you'll probably be giving guidance as to what you need to do. So I think that's pretty exciting.
[27:13] Briar: I think that's very exciting as well, a health chip to let me know, hey, you're short on vitamin C today, why don't you have an OJ or something like this. But a lot of times when I talk about these kind of health chips, people tell me, oh, but then the insurance companies are going to get connected. They're going to charge you a premium. Like everyone's going to hack your data. What are your thoughts about this?
[27:35] Dr. Nas: Yeah, I mean, there's this situation now with the biological aging tests that you mentioned. I mean, they can pretty accurately, they say predict when someone is going to die. So, yeah, imagine if the insurance industry got their hands on this sort of information. There's going to be all sorts of considerations and there's going to be a huge political component to it. And as we've discussed lobbyists, I don't kind of concern myself with that side. I try and you use the word optimist. I try and be optimistic and think just purely about what the health side can achieve.
[28:13] Briar: What are your thoughts about chronic diseases that we're seeing today? So you spoke about how you are seeing more diseases and it feels like almost every man and his dog unfortunately retires. We work hard, we save and then to only have the last glory years of our life, we suffer from cancers and Alzheimer's and dementia and other old age diseases. Do you think that there is a slither of hope of curing aging at the molecular level?
[28:46] Dr. Nas: I think, as you are aware, there's a lot of attention focused on aging. I think that we need to come some way in terms of the research and the barriers to kind of doing research in longevity. Part of living longer is preventing the main causes of death. And so you've got cardiovascular disease, you've got cancer and with the cardiovascular disease, you've got metabolic diseases, obesity, diabetes and then you have cancers and Alzheimer's. I think if you look at cardiovascular disease, we have the testing and the interventions now to essentially bring it as close to zero as possible if you screen in the right way and you have access to the right treatments and testing. When it comes to cancer, I mean, there are interesting developments on both side.
[29:35] Dr. Nas: A lot of the focus is on things like immunotherapy and training the immune system to tackle cancers. In reality, I think it's around about probably only 10% of cancers that are responsive to immunotherapy. But that's an exciting development and I think it'll continue to develop. But on the flip side, in the prevention arena, I mean we're already using tests where we can pick up early circulating tumor cell tests to a pretty high sensitivity for more than 70 cancers in a single blood test. So, there you're two, by far, your biggest causes of death. Alzheimer's I think is a little bit trickier because a lot of the attention is on looking more at the symptoms, the buildup of amyloid plaque in the brain and drugs kind of targeted at trying to prevent this from happening. Ultimately, that's a symptom of the underlying problem.
[30:22] Dr. Nas: And I think because Alzheimer's is caused by so many different environmental insults, nutrition, toxins, insulin resistance, inflammation, people are looking at the wrong thing ultimately. So I think that's going to be trickier. But a learning point is that people just need to use different tests and they need to look at prevention earlier on. Because when it comes to the traditional system and cardiovascular disease, doctors are very much tuned into looking at 10-year risk. So they'll get your data, they'll type in your cholesterol and your sugars and your age and whether you're a smoker, etcetera, etcetera. And it plugs into a computer and gives you a 10-year risk score. Why am I looking at a 10-year risk score when cardiovascular disease is a 30, 40 year disease process?
[31:12] Dr. Nas: I could capture someone who's high risk in their thirties, yet in the traditional system, I'm waiting until they're 55 and already established some disease and using a calculator that's just heavily skewed by their age. So it's just changing the approach. And I think even right now, as I've said, we have testing and treatments available where we can basically prevent, to a high degree of success, cancers, cardiovascular disease, and even metabolic diseases. I mean, you've seen all the people talking about the medication that's injections for weight loss that really actually were designed for insulin resistance and type two diabetes. But because insulin resistance is such a huge part of obesity, they're getting these kind of blockbuster results. I think there's a negative side that isn't spoken about.
[32:01] Briar: What is that negative side in your opinion?
[32:03] Dr. Nas: Well, I think that weight loss is not as simple as people think. I mean, if it was as binary as eat less, exercise more, then pretty much anyone who wants to lose weight would. We all know though intuitively, even though we often take that approach, we know that it doesn't work or we certainly have friends or someone who's tried it. The classic is you'll sit next to someone who eats far more than you, then weighs less than you. Well, if that was the real equation, then why is that happening? It's because it's a hugely complicated process. There are hormonal mechanisms involved, you’re even going as far back as your fetal environment, your early childhood environment, how many times you've lost weight, regained weight. The brain has in-built mechanisms to prevent starvation.
[32:49] Dr. Nas: And we see it, I mean, there was a great study they did in, I think it was season eight or nine of the biggest loser contest in the US, I think it was around about 2009. And they followed them up five or six years after they'd finished the show and pretty much all of them had regained the weight other than the one who had stomach bypass surgery. They also simultaneously looked at the metabolism. They found that they were burning up to 8, 900 calories less a day in the basal metabolic rate. So we've managed to survive on this planet because evolution equipped us with mechanisms to prevent starvation. We need to preserve energy to allow us to procreate, which is essentially our basic requirement or whatever… or basic needs.
[33:30] Briar: You were talking before about fasting. Is there a one-size-fits-all all?
[33:35] Dr. Nas: In short, yes. Everyone should do some elements of fasting. Now we need some clarity on what the definition is. And I don't think there is a kind of overall definition, but I'll tell you how I kind of look at it. Most people, when they're referring to intermittent fasting or talking about daily time-restricted eating, where they're eating the food, whether it be reduced quantity of meals within a certain time period. Now for me, it's been given the label intermittent fasting but that's essentially probably how our ancestors were eating anyway, the problem that's happened in modern day life is that we're up and working later, we're staying up, we're sleeping less hours, were waking up earlier, we're inevitably in a rush. So we're eating something refined in the morning. So that time period that people started to eat over became a lot more protracted than what we were meant to eat over.
[34:25] Dr. Nas: So I think to some degree we need to reinstate a shorter time period and breakfast means breaking fast. It doesn't mean though that first meal needs to be at 6:30 AM. I mean, most people probably aren't hungry at that time, they just eat out of habit when they wake up before they leave the house. If you are eating your first meal at 12:00 PM, that's your breakfast in the strictest sense of the word. I think a lot of people have started talking more about the longer types of fasting and that's because a lot of the evidence that came out showed that when you go through periods of longer fasts and that's 24, 48 hours and longer and that's not dry fasting, so you're allowed non-caloric liquids, the broad body enters a process called autophagy or cellular regeneration or rejuvenation.
[35:15] Dr. Nas: There's an argument to say that ancestrally, we were designed to go through periods of food deprivation and it probably did happen and it just so happens that scientifically we seem to enter this process of autophagy, which has been linked with longevity. So you could argue that yes, we should all be doing some periods of prolonged fasting. There are pitfalls to it as there are with anything, but I think if done in a healthy way, it's certainly something that people can consider alongside the other aspects of healthy living.
[35:46] Briar: Do you do the 24, 48 hour fasts?
[35:48] Dr. Nas: So I'll often do the 24-hour fasts. If I've come off the back of a heavier weekend, then I feel lighter. For me, it's a nice way to cleanse. I have periodically done the longer fast. So the longest I've done is five days. I probably would only ever do that maybe once a year max, maybe a three-day fast, just for me, it's not the not eating that's difficult. It's more, if you're in your regular day-to-day life, sometimes it's often one of the few things that you're getting enjoyment out of if you're going through a stressful time or week. It's very different. A lot of people will go to these fasting retreats or cleansing retreats. Yeah. If you've not got everyday stresses, you relax, you're in nature, you're doing enjoyable things, then it's a far more amenable environment to doing longer fasts for some people.
[36:38] Briar: So we spoke about fasting, sleep, food, stress. Is there any other lifestyle factors we need to be thinking about? Say, I want to live until I'm 300 years old. What should I be doing?
[36:50] Dr. Nas: Well exercise hasn't been given much time and there's definitely a body of research that shows that even if you go from being immobile to below average exercise, and that's even just walking regularly, you de-risk disease by at least 50% over a 10-year period. So I don't think we should neglect exercise. When it comes to kind of anything else outside of stress, sleep, exercise, nutrition, then you're kind of going in the realms of kind of compounds, supplements, medications and I now get lots of patients who come to me and they've got 50 different types of supplements.
[37:34] Briar: I did meet a few people at the Dublin Longevity Conference who were taking a good 70, 80 supplements a day.
[37:42] Dr. Nas: Yeah. It's not unheard of. And it's happening more and more. And we can't definitively say that if you've had an individual compound that has been shown in, for example, a mouse study to external longevity, that may not necessarily translate to humans. I guess the way you've got to look at it is, well, what's the downside? What are the trade-offs in taking that supplement? Well, if it's inexpensive it's not known to cause any harm, yeah, there's potential upside, then why wouldn't you take that supplement? I suppose it gets a little bit trickier though, in my mind, if you're on 40 or 50 different things, how are they interacting? There is that kind of phrase that it could be too much of a good thing or is that the phrase, I can't remember, but you know what I'm getting at.
[38:29] Dr. Nas: What's good for you in smaller dosages isn't necessarily good for you in larger doses. I think that's kind of another analogy in that... If we're say suppressing inflammation all of the time, and there have been studies on antioxidants and taking too many antioxidants or taking them at the wrong times, particularly for example, post-exercise. And that's why there was also a change in the school of thought when it came to ice baths. A lot of people were jumping in ice bath post-training when actually they realize that you're just blunting actually the beneficial inflammatory response that leads to the adaptation. So if you're doing your ice bath, which is fundamentally rejuvenating, you need to do it at a different time to your exercise. It's the same with the supplements, we don't know whether it's just going to be overkill.
[39:13] Dr. Nas: So I try and focus on the main compounds, which I would divide them into two categories. The one that I'm either or my patient is deficient in and or on a population level, what do I tend to see as highly deficient? Vitamin D, I mean, everyone knows magnesium is often deficient, I'd say at least 80% of my patients. It's just often these things aren't checked in most people. Omega-3 is another one. I'd say it's up there with vitamin D. If you're not taking an Omega-3 supplement, you're generally deficient. So they tend to form a basic core of what I tend to recommend. And then there are some more exciting compounds and you've probably heard of rapamycin and that's probably the only compound that's been consistently shown across all species to extend health and lifespan.
[40:04] Briar: Do you take it?
[40:05] Dr. Nas: I take it, yeah. And I have many patients who take it and again, it's one of those where in the dosages that we're applying, it seems to be safe. We've even had proof of concept in humans. So where they've looked at markers of aging, thre have been improvements. So I think that's a very simple, inexpensive intervention that the majority of the population are unaware of because their physicians are unaware of it.
[40:30] Briar: So testing. So you are suggesting we get tested and see what supplements we should be taking from there. What other tests could I come in and see you about so that I could make sure I don't have something coming around the corner in five years’ time?
[40:46] Dr. Nas: I want to highlight the difference between the testing that we do and that you would get in a traditional system. Look at the way that tests are done in a regular hospital clinic. They take your blood tests and look at your blood levels of certain nutrients or proteins or compounds that are coming from an organ. And these tests haven't changed, again, for decades. And they've been designed, the cutoff points and reference points, have been designed to pick up disease and illness. They've not been designed to pick up someone who may be well and not too sick in a traditional sense, but wants to health optimize. So we are employing tests and they're often referred to as metabolomics. Metabolomics is just a fancy term that's looking at a lot of chemicals that have been derived from the cells.
[41:36] Dr. Nas: So you're looking at health on a cellular level, not on a blood level. So we're not looking at what's in the bloodstream. I want to see what's actually coming out of the cells. I want to see what's happening in your microbiome. We'll pair it up with often your genetics and it's a bit of a double-edged sword genetics right now. I think currently there's probably a lot of just data dump of information, but if you're very selective about certain genetics that you're using and you are associating it or putting it together with that metabolome or other metabolic information for that person, it can give you context and be quite useful. So that's just an example of the source of tests that we're using. I referred earlier to cardiovascular disease and cancers, which are your two main causes of death. We're employing very specific testing that is identifying people at risk on a personalized level, not on a population level. And we're able to intervene at the earliest stages.
[42:27] Briar: So I think it's clear that we need an entire upheaval in our society and the way that we view being sick and healthcare. How do you think this can all start? Because to me it seems very clear and I speak to people like you and it almost seems like, okay, I know by changing this to this, then suddenly it would all be good and we could save money at the end of the day. But how can we start driving this? How can we take action?
[42:57] Dr. Nas: I think it has to happen on an individual and on a family level. So, I mean, I'm a father to three children and we all want to do the best for our kids. And I guess, I'm coming from some would say probably a skewed angle because that's what I'm exposed to and what I know. But I'm going to try and instill in them my understanding of health and longevity. And I get it, not everyone is privileged enough to come from that perspective, but it's the same as say someone in finance who would want to make their children financially savvy. So I guess the point that I'm getting at is it needs to happen in the family from a young age. And that's why we have to see a change in hopefully the education system policy. But until that happens, empower yourself. Unfortunately, gone are the days where necessarily through no fault of their own, it's an education thing, your physician may not necessarily, again, intentionally have your best interests at heart. They're being indoctrinated into a certain education and system where they probably think that they're doing the best when actually they're probably not.
[44:07] Briar: Well, it's been so great to have you on the show today. Thank you so much and lots of food for thought. So I think everyone needs to listen to this twice. Go back over the things and I really do hope that moving forward people do feel empowered and they do feel like they have the knowledge and they can be a bit more proactive with their health.
[44:28] Dr. Nas: Yeah. And listen, it's been great. I had loads of fun. We'll hopefully do another one in the not too distant future. But I think it's probably time to meditate.
[44:37] Briar: Yeah, we can.
[44:38] Dr. Nas: All fair.
[44:40] Briar: No, you told me I don't need to do that. Awesome.
[44:44] Dr. Nas: Thank you.
