Episode 27: Gut health and IBS/IBD with Gastroenterologist and Hepatologist Dr Pran Yoganathan!

alright hey everybody this is dr anthony chaffee here with my good friend uh dr brand new gamethan uh he is a gastroenterologist and hepatologist over in sydney and we recently did a carnivore versus vegan debate where we were on the winning side if anyone uh would like to go back and see that or has seen that uh fran how are you sir thank you for coming very good anthony thanks for having me no not a problem your your volume is a bit low are you able to second how's that much better yeah that's perfect great all right well yeah well thank you very much um can you can you let us know like obviously you're a gastroenterologist hepatologist so um if you can just tell people exactly what that is if people don't know and also you know you have your own practice and as you've explained to me you do things slightly differently than than other gastroenterologists and so forth incorporating in lifestyle changes in diet and so forth to help your patients uh directly as opposed to interventionally yeah thanks um anthony so i i'm a gastroenterologist and you know and in in our practice the vast majority of what we see tends to be irritable bowel what's known as irritable bowel syndrome which is fundamentally a diagnosis that a lot of people struggle to understand including the clinicians themselves as to what it is because fundamentally what what what it means is that structurally there's no problem within the gut and we can observe that as gastroenterologists because we do these endoscopic procedures such as endoscopies and colonoscopies we can we can see real time the gut structurally looks normal macroscopically looks normal even microscopically on the biopsies but the person's still left with symptoms so um the way we used to kind of manage i used to manage it which is the classical way which is well there's nothing wrong with you go and see your dietitian about about um utilizing a diet such as the fodmap diet which is a diet that looks to restrict certain food groups a very confusing diet in my um in my own opinion so um i just found myself becoming a little disheartened with practice because we would do these scopes do these procedures and then really not fix the person's issues um you know and i i think that kind of let me down a pathway where i started exploring the concept of nutrition trying to understand and comprehend um what what what adequate nutrition means and how that might impact on the gut and also the liver which is part of part of our specialty as well so um i think over time it's kind of evolved anthony where i've where i've started working with some fantastic dietitian um dietitians team uh called ellipse health led by jessica turton and and a group of fantastic dietitians and we've just merged our practices and and uh i think we try to aim to provide this holistic care where where um you know it's doctors and dietitians working together to fundamentally combat a lifestyle based issue brought on by diet no well that's awesome um so like you're saying you know i you know irritable bowel syndrome um you know this is something that that i know so many people that that have struggled with as well and and like you said you know there's no sort of clear answer you know here to four that says like okay this is your diagnosis here's your pill because that's how a lot of people look at it you know especially with medicine they say just okay there's something wrong with me there should be a pill to fix that what has been your experience uh with with this sort of you know issue addressing this stuff uh you know more from a dietary point of view are you getting good results or are people happy with how things are going do you need to incorporate anything else apart from diet and what sort of dietary changes do you have them do yeah it's um it's it's fascinating anthony i mean the classic paradigm that gastroenterologists have taught from a very early stage of our careers is is you do the scopes generally you exclude disease and then you work down this paradigm okay and that paradigm generally looks like a dietetic review for a low fodmap or a dietary modification and when patients get poor adherence to that diet because it is a very difficult diet to adhere to and we can talk about that later the low fodmap diet if they fail that then it's on to the next drug you know anti-spasmodics proton pump inhibitors all drugs that were designed to be used for very short term you know classically decades ago when they're bought out and then once you fail that which inevitably a lot of people do it's on to the antidepressants because we know there's a very powerful gut brain axis so we start blocking the neurotransmitters using ssris and tricyclic antidepressants and it's really a bit of a mystery how it how it works at a gut level but they do but fundamentally we just blunt the symptoms that people are getting with these with these drugs and and i was very uncomfortable with that i don't think in my entire career as a gastroenterologist i felt comfortable with prescribing a tricycle again antidepressant to treat gut symptoms you know and and when you dig deeper you realize it's very much a dietary dietary issue i think to to answer your question what is it specifically that's doing i i think i think it's that's a difficult one and it's a multi-layered question it's uh it's a really difficult question to answer but i've made this point numerous times that that that our our microbiome with every generation sort of fundamentally deteriorating and so it's like it's thought that the baby inherits uh the gut microbiome signature of the gut bacteria as as it makes its way through the birth canal from the mother right and um with with babies that are born in a caesarean fashion it takes a little bit longer to seed their gut microbiome for obvious reasons but it eventually happens anyway um but if what we're inheriting from our maternal side is already flawed because the maternal microbiome has been exposed to this environment right that that we uh hypothetically saying is so problematic it's like the baby's set up with a poor gut flora i've got microbiome from from day dot and and it sort of goes from there then the baby's exposed to the environment as well so it's not a clear-cut answer because i think there's there's this deterioration pattern that we're we're seeing what drives a poor gut microbiome that's difficult to know it could be the quality of our drinking water which i think is very mineral poor probably very probably very chemical rich one would have to think because it's you know it's treated um and with with various agents it's going through through plumbing that that is old potentially problematic additionally we've got this really hyper processed food environment which i think is the biggest driver and additionally there's other factors like exposure to childhood antibiotics repeated courses of antibiotics you know it's not unusual to see people prescribed antibiotics for what is fundamentally a viral infection you cannot tell me that is not common that is a extremely uncommon scenario and we know antibiotics that work in the setting of a viral infection especially for upper respiratory tract infections and so forth so i think we're overusing these antibiotics um and and and so we have this perfect storm really where where the the gut flora which is thought to be this really critical aspect of the symbiotic relationship between a human being and these trillions of bacteria that inhabit our gut that symbiosis is somehow disrupted and i think that is at the heart of of uh what drives modern illness to simplify what is a what is a complex issue of course yeah and uh yeah absolutely and there's been a lot of talk on the the gut biome especially recently because people are finding this is much more important than we previously thought it was um and obviously food whatever whatever you eat is going to to feed the different gut flora and your gut flora can be changing constantly and that can affect uh you know things on a broader scale as well um have you done [Music] much work or looked into the gut biome on the different diets as far as like a meat-centric diet versus a plant-based diet and so forth and uh and these you know hyper processed carbohydrate driven uh diets and and how that affects the gut biome really good question anthony really good question i i think it's again we've got to sort of unpack that that question um if you look at the data the standard literature there is no doubt about it there's an overwhelming body of evidence that says well meat's bad for the gut microbiome okay full stop that's i think you'll agree with that right it's uh it's a very popular narrative but i think it's important to unpack the package in which the meat is being delivered um to the individual the food matrix in which it's being delivered there is no doubt that vast majority of our dietary protein is now coming from hyper processed meats right that accompany other hyper processed foods other hyper processed carbohydrates and and and fats you know things like meat lovers pizza for instance um that deemed a high protein dish high meat heavy dish but you and i both know that is a very low protein high fat high carb meal which is an absolute disaster so in these epidemiological studies that are often carried out in nutrition whether that's on on you know metabolic parameters or gut microbiome they use questionnaires to then determine um well how is this type of food changing a person's guts in their children and if they're utilizing food such as that which the vast majority of the western world eats then we've got an issue whereby uh you'll find that that um and of course that that that those sort of diets which are high in meat uh associated with poor gut microbiome signatures um i think there's a large body of evidence that suggests that hyper-processed foods are fundamentally the issue you know in a condition called crohn's disease which is inflammatory bowel disease there is a diet that's utilized in pediatric populations it's not so much applied in the adult populations because it's very difficult to get adults to adhere to a diet whereas children you can get them to adhere through basically supervision because they're very dependent on the caregiver or institution to the fed so they get better compliance out of kids obviously so it's been well studied in kids and it was shown this diet we call the specific carbohydrate diet which doesn't eliminate carbohydrates it doesn't eliminate fats but essentially gives it to them in a package that is whole food based you know so we're talking very high protein whole food carbohydrates whole food fats that this this dietary modifications got the ability to help not put the crohn's in complete remission but in some cases it did but it has got the potential to help those from a symptomatic endoscopic and biochemical potential or biochemical perspective for the inflammatory inflammatory boundaries so it shows you that the inflamed situation that we find ourselves in not just from a gut perspective but just from an overwhelming systemic whole body perspective is very much driven by this hyper-processed food environment i think i think that is the that that is what we should point our fingers at and and blame instead of any specific uh macronutrient i think yeah yeah i would agree yeah a lot of these epidemiological studies obviously they look at you know broad sectors of people and they and anytime they're looking at you know the meat cohort they say you know it's self-reclaimed like i eat more than five meals five servings of meat a week or something like that and they extrapolate all this uh you know nonsense off of off of that and then blame it all on meat when obviously there are a lot of other confounding factors um as you mentioned uh crohn's disease obviously this is uh you know ibd is is a major uh concern in gastroenterology and just in the world in general is a very very serious disease crohn's ulcer colitis uh are you know cause a huge burden of uh of morbidity uh in people um is this something that you you see in your practice as well is this something you've been able to address with diet as well as the more standard traditional treatments yeah absolutely um anthony when i first started off training gastroenterology about 13 14 years ago inflammatory bowel disease was a rare situation relatively rare right where you you'd see these occasional young patients come in with absolutely catastrophic uh bowel inflammation they'd spend weeks in there on various cocktails of drugs you know high dose steroids you watch them deteriorate because of the catabolic effect of steroids and then eventually have their bowel out now that was a rare situation a lot of us as medical students or young doctors or young gastroenterologists we would be using that scenario as a test case we'd be taught around that case by our sins you know and uh you often felt quite bad for the patient because you're in there um getting stories from them if they're willing of course but but you saw those sort of cases very infrequently now i can tell you on a gastroenterology water wrong amongst most tertiary and and even so primary uh uh secondary um institutions this is a much more common scenario and that's just not my anecdotes you can look at the statistics to see that inflammatory bowel disease has just exploded upwards the incidence and prevalence disease burden of that is is absolutely enormous and and again this is part of the reason we went down this pathway of looking at lifestyle because i just couldn't contend with the fact that that we were bringing out all these new drugs these biologic drugs that that that are very novel very clever drugs however they cost tens of thousands of dollars and we're bringing new ones out every year and utilizing them um without questioning why is it that the disease is becoming increasingly prevalent why is it that this is occurring it's it's like there's no attention being paid to the fundamentals and and and and so to diagnose inflammatory bowel diseases it's it's it's so common now in a gastroenterology practice and we see some severe cases luckily we've got these biologics these brilliant drugs that worked very quickly and helped put a lot of people in remission but the cost and potential side effects of these drugs may be quite significant later down the track we know that the cost is significant we don't know about the side effect profile longer term because i mean some of these drugs are quite novel but from what i've seen they're miraculous but when does it stop we've got a system that you and me know is already buckling under the economic pressures of of of just chronic illness aging uh inflationary monetary pressures we we can't just keep throwing drugs at a disease that probably has its roots in lifestyle it has to our genetics cannot shift that quickly within a within a decade to to account for um for this rising rise in disease so when you when you start looking at a big picture of you and you start thinking well what is it that's changing in our diet you have to look at the process component we're moving away from a diet that is ancestrally and evolutionarily consistent for us and i think therein lies the fundamental issue yeah and that's you know i run into this every now and then especially when i was first sort of going down this track of noticing that these these diseases and so forth have become much more prevalent and you know this could be and this was right around the time we fundamentally shifted away from from meat and fat you know because of the cholesterol scare um and so many people would say well this was probably happening the same numbers we just didn't notice it we just didn't notice it was in the background we didn't notice the autism we didn't notice the dementia we didn't notice the crohn's and ulcerative colitis and all these sorts of things uh does that does that hold any water as an argument no no because these presentations are catastrophic you just have to live a day in a person who suffers inflammatory bowel disease even if it's a very mild inflammatory bowel disease to know that these people suffer they they go to the toilet multiple times and they get their abdominal pains they have low quality of life they get chronic fatigue um you know they bleed from there from their bowel some of them end up with catastrophic surgical procedures because their bowels block up so so to those doctors and health professionals that say well we just didn't notice it before i i i i call ignorance on that and i call a lack of humility uh to to to the suffering of the population i think there is no doubt there is no doubt in my mind and it sounds like the same with you that these diseases did not exist to the same scale as they did um uh to to in this modern world i think there's no doubt autoimmunity you know what immune illnesses have existed um in history you know there's there's uh bones of of an eight thousand ten thousand year old human that that that shows that rheumatoid arthritis was starting to become prevalent in particular the agricultural era uh interestingly there are there is no rheumatoid arthritis noted in in the fossil records prior to the advent of agriculture some might say well fossil records from back then around that's true um but so many things start occurring after agriculture the diminishing of skull capacity the the uh the deterioration of dentition which we know is a sign of systemic inflammation um i think the the the fact that that we as doctors and health professionals sometimes fail to acknowledge that the evolutionary pressures under which we we have evolved for millions of years are probably the most suited to us uh you know to exist in but but of course in modern civilization that that's very difficult to do so um i've sort of gone off track there anthony but to answer the question i think i think these diseases there's no doubt that statistically are becoming more common i mean for for us to suggest that dementia wasn't um uh wasn't picked up before and that's why i wasn't diagnosed i think that's a disservice to those suffering dementia and to the family members affected with loved ones suffering dementia it's an absolutely horrific illness um and i think we should be paying more attention to um to these rising rates yeah yeah i absolutely agree i mean i think it's um you know it just shows a bit of conceit you know that anyone before born before 1986 was just just couldn't see you know the couldn't see a barn door in front of them uh obviously these things are are hugely detrimental and and then people argue well you know people are only living to 36 and so forth and so they just weren't getting to the age of of of uh you know dementia and so forth for these diseases to present but of course we know that that that's an average from birth and that's only because you know it was a child's infant mortality was so high but actually people did live older and we have a lot of i mean you know socrates was in the 70s you know and that was that was thousands of years ago so um you know mark you know marcus aurelius and so forth very very famous um you know figures throughout history we know that they lived in great ages and we don't uh you know they weren't in you know old folks homes and so forth um so you know talking about um you know autoimmune disease and so forth you mentioned that um there was a specific carbohydrate uh studies with uh children that's showing showing that had uh you know good results for the gut biome and so forth um there are other studies such as like you know looking at elemental diet and fasting mimicking diets and so forth and this showed a pretty good um efficacy in treating crohn's and ulcerative colitis and and sort of getting people out of acute flare-ups and also keeping them in remission uh as well do you do you know you know anything about that yeah i think i think it's anthony with the fasting mimicking diets or the fasting diets let's look at fasting for instance or the elemental diets the elemental diet essentially infuses the elements required for existence basically in in a very basic form through amino acids um carbohydrates and fats it it it it essentially breaks down the essentials for life and then bypasses the gut okay and you're receiving it directly into your into your fundamental circulation so you're resting the gut from that perspective but additionally you're then nourishing your body through very very simple um substrates for existence now that's not you can't adhere to that because we need to we need to eat i mean in maslow's hierarchy of needs one of the things that we've got is an appetite we've got hunger and and so that's important for existence so we can't theoretically keep people on elemental diets long term but the reasons they work is that you're fundamentally resting the gut you're probably removing the irritant which which is coming from food you've eliminated all the hyper-processed foods and you're just basically giving someone the basic elements for life and and the gout's being rested so it it it recovers um and fasting works the same way say you take someone with um with adequate fat stools and and they're given the necessary ingredients for life uh to be sustained they can burn their energy you know people have fasted um for for many many months if they've got enough fat stools i think it's just a form of gut rest um it's got to be people have to be cautious about about you know fasting excessively and and so forth and specifically in this modern era where we've got issues related to under muscled individuals with low bone density and so forth i don't think the trick is to to punish the body through fasting but rather through to to nourish it um you know and so the question is how do you nourish it how do you nourish it is the fundamental question and and you know i think we can we can talk in depth about that a bit later but there's no doubt that eating nothing at all is sometimes better than eating the standard australian or standard american diet and that's why people feel better on with their with their fasting uh but i don't think it's something that's sustainable or people can into long term yeah absolutely and you know like you say you know this is this is resting the bowel and eliminating you know or eliminating you know certain factors that can be irritants which does suggest that there's something that we're eating that is that is causing the problem and you eliminate that you remove that and this is causing problems so in your experience what would be sort of the ideal diet you know for gut health um you know for for your patients and just for for the general public yeah i think it's it's sad in a way and i think you and me have spoken before um just on a personal level um that that we separate a human being into organ systems right like so so what is the best diet for gut health optimal gut health well my response to that generally is the optimal diet for gut health is what is best for your overall systemic health right like it's as simple as that and so i i don't necessarily measure microbiomes or or do the fancy testing to look at people's metabolic sorry the microbiome signature and so forth i don't find them particularly useful i find them very difficult to interpret i think i i don't think anyone knows what the right gut microbiome signature is however i will say that the right microbiome is probably the one that allows you to be metabolically flexible the ability to burn both sugar and fat when needed i think the it is the diet that allows you to sleep at the the microbiome that allows you to sleep well at night the microbiome that allows you to maintain your muscle and and and bone density uh it's the one that allows your hdl to be at really good levels your triglycerides to be low your blood pressure could be maintained your insulin is to be kept within very sensitive range um this is what i fundamentally believe is right for your gut microbiome that overall that you're systemically well if you if you're systemically well it is very likely that your gut is working well you'll find that when you improve people's metabolic health and we tend to do it through low carbohydrate diets which are very high in protein a lot of their gut issues just go away they really resolve and so i've always made the point that potentially gut gastrointestinal symptoms metabolic syndrome in evolution many years before before the hallmarks or the four horsemen of of metabolic syndrome coming to come into fruition i think i think in medicine you and me have been taught to separate organ systems out that people are made up of multiple organ systems and you combine them to make a body but the reality is we're we're we're we're a living organism where all these systems are interconnected into interwoven and we cannot separate them yeah well yeah i would definitely agree with that and um and and you know it it is straightforward and makes sense and if you think about it on those terms you know that's obviously correct you know we we are an organism you know we're not a you know conglomeration of random parts um and so you know that's generally what when people ask me well you know is carnivore you know carnivore is good for this but you know is it good for that and he's looking for this other thing and he's eating meat good for this whatever and once you bought your gut biome what about your cholesterol and i just say look you know from what i can see from the evidence i'm eating in a biologically appropriate manner and so whatever my gut biome is i'm you know i'm pretty happy that it's what it's supposed to be i don't know exactly what it is but i'm doing very well and from everything i can see i'm i'm doing things in a biologically appropriate way and so i don't need to micromanage little things you know like my cholesterol my hdl is high my my triglycerides are low last time i checked my ldl was slightly higher than you know the standard range that we look at which is you know based on uh you know incorrect data and and fraudulent sort of information so they said well that's a little high but you know i don't i don't actually care because that's physiological for me i'm just taking that um [Music] for you know i'm taking that uh with a bit of with a bit of faith but i think that you know the evidence that's been coming out has has been uh backing that up as well as far as you know you're giving people sort of low carbohydrate high protein diet what do you find um what do you find with fiber obviously this is something that so many people talk about when you when you go to a more you know animal-based uh nutrition source people say what about your fiber what about your fiber which um you know i don't think is is necessarily something i need i haven't had it in i don't know how many years but what what do you find because some people this is this actually classes as an essential nutrient which is which is kind of crazy um well at least i think it is maybe you might uh think it is essential but um what do you what do you what is your opinion and experience with fiber yeah sure i mean a lot of a lot of health professionals and dietitians use it as a panacea that a high fiber diet's what you're supposed to do and and i'll kind of never forget and this experience where i took my elderly diabetic uh grandmother who's subsequently passed away and i remember she used to struggle with with difficult to control sugars and she was one of the big reasons why i kind of was motivated to do things better as a doctor um taking her to her um her cardiologist and and she said listen my sugars are just all over the place like what should i do um you know at that time she was suffering fragility fractures she was clearly sarcopenic under muscled had a really poor reservoir too from from which to store the excess sugar that she was consuming with excess carbohydrate and he said to her a high fiber diet and i'll never forget that because he's a person who's fundamentally fall into bits this bag of protein basically protein and fat who was uh failing to meet a protein requirement and that was the advice given now that's a common scenario you will see it every day in healthcare where high fiber diets are used as a panacea it's fine a problem though it's not a problem and there's a lot of inter inter individual variability there i mean i personally myself consume it we've spoken about this anthony i i i enjoy things like like fruits you know from a from a nourishment perspective from a taste perspective um but why i am very convincing is that the fact that there are many different types of fibers there's soluble fibers and there's insoluble fibers okay so soluble fiber is generally like the types found in fruit um generally your your colon receives that in the gut microbiome that's present in the hindgut or your colon ferment that create a fuel out of it called short chain fatty acids which is um butyrate and basically use that as a fuel for your gut now if you've got excess levels of that some of it can be absorbed into the portal circulation into the liver and sent out into the periphery but i think the modern human being's gut microbiome for reasons we've spoken about before is really it's not optimized well for it and i think a lot of people now struggle with fiber both insoluble and soluble insoluble fibers which are found over a lot of these plant based plant-based food sources which which our body can't break down in a microbiome can't ferment so often it just comes out the other side people think it's like a it's like a scrub scrubbing the colon drive it but the reality is it accumulates a lot of water it creates a lot of gas and some people are genuinely uncomfortable with it and some people believe it or not paradoxically can cause constipation so you've got to personalize nutrition for people and if someone feels that they're struggling on five or what you've got to find squeak the diet not just sort of force it down if they're suffering gut distress i'm a big believer in personalized nutrition now how does someone like yourself nourish your colon with butyrate because that's what the colostocytes need how is anthony able to nourish his colon well the reason the way you're potentially doing it is you're doing you're supplying your bowel through your systemic circulation of production of ketones through burning in fat and you produce beta hydroxybutyrate from the breakdown of your own fat that is in your own circulation which then enters the colon through systemic circulation and a lot of people on low carbohydrate um even low fiber diets still find that their bowels move absolutely normally it's just with less bulk um because the obviously the fiber content isn't there which is being passed out as waste now is that optimal for a human being the data would suggest not because often the standard australian diet or the standard western diet is low in fiber there's no doubt about it you know a high fiber diet in replacement of that would be preferred option but um you know there's many nuances to how you would try to attract this that if you if you were to look at optimizing one's diet fiber is not a nutrient i think it is really important to point that out fiber is a substrate that your gut microbiome can utilize to produce a fuel for you as human beings historically and classically only two percent of our fuel requirements come from that process of fermentation to release butyrate 98 of our energy comes from other sources now beyond that two percent it's impossible physiologically impossible for your gut to produce what is required to run a person so a high fiber diet is not necessarily uh energetically um plausible for for a human being say you're a horse fifty percent of your daily energy requirement will come from short chain fatty acids fermented in your heim guard if you're okay if you're a gorilla but potentially about twenty percent if you're a pig about six percent if you're a dog about four percent for humans it's less than two percent so what does that tell you about us as as um as as a species that we're we're less dependent on fiber fibrous plant material or fruit material than most other species in the world because i think as human beings we have a quality brain and we we nourish that brain and the rest of our body through quality foods through quality carbohydrates through quality fats and through quality protein which comes back to my initial point and a very simple point that i made that this is all really about eliminating the processed foodstuffs and aiming for um aiming for quality whole whole foods uh with the caveat that we prioritize our protein intake in particular i think there is no doubt about it human beings through history have always uh prioritize protein first but we live in an era where protein has demonized animal proteins in particular so you'll see that the percentage of protein in people's diet is shockingly low i mean we're talking in america they're made out to be big meat eaters but yet their protein intake ranges from something like eight to i think about 15 to 16 percent which is abysmally low i think uh i think uh for the standard individual with normal kidney function uh keeping protein at 35 at least um it's it's it's kind of a no-brainer yeah yeah and then have you noticed um obviously you know when we like in sort of people like diverticulitis or different sorts of you know bowel conditions we want to again rest the bowel so they generally recommend you know low uh low residue diet so a low fiber diet and so this thing obviously you know this to me suggests that that the fiber can be irritated in those contexts um do you find that there is a problem with too much fiber you know some you know elderly people might have neurogenic uh colons and this might might slow down the motility and the obviously fiber was suggested originally to increase motility give you some your gut some bulk to move this around and so it wouldn't dry out as fast in your colon but you know as people age the motility just goes down anyway and you and um have you noticed that this can this can like you say paradox paradoxically cause uh constipation or even you know obstructions and other sorts of uh issues yeah absolutely i think um what we know is fiber fermented um in particular soluble if you if you overdo fiber say someone's to overeat fiber they'll generally get bloated with it the bloating comes from the intra-abdominal um gas basically colonic production of methane through the fermentation process that the bacteria undertake the methane we know anthony is a potent inhibitor of gut peristalsis which means gut movement so a lot of people with bloating generally will get constipated they'll get gastroesophageal reflux because of poor gastric emitting and and delayed gastric um transit the acid tends to sort of go up and and irritate the esophagus it's not ideal to to create huge amounts of methane in our gut we're not built for that we're we're a species built for absorption in our small intestine that is what separates us from so many other species in in the animal kingdom we are built to absorb quality carbs quality fats quality protein in the small intestine and do a little bit in our column we ferment a little bit and that allows us to be extremely flexible right but here we have a dietary paradigm pushing colonic based digestion as in eat more fiber eat more fiber keep protein low and and and obtain your fuel through short chain fatty acids which we know that that there's a physiological limit to how much our large colon can produce so it is out of keeping with with um what we've been evolutionarily uh trained to do now something like a sweet potato for instance i find that a really good substrate in the context of the training that i do i i like fueling my body with with carbohydrates prior to the workout i know you're you're very different and that substrate that that quality carbohydrate that i'm receiving also comes with a bit of fiber and that fiber is generally soluble and my bowel can use that but at the same time i've been able to extract starch from that sweet potato in my small intestine and assimilate that as glycogen into my muscle into my liver now it makes no sense to me to just consume pure fiber which lacks any other quality nutrient that goes with it this is the thing when you when you're eating foods in their whole food matrix you're generally going to you know hit all the targets quite comfortably yeah um and you talked about um obviously especially on the standard american diocesan australian diet you're going to have far too little protein and i know you've uh spoke about before certainly in our uh the debate that we were in the carnivore versus vegan debate you spoke about bioavailability obviously um that can be very different you know can you talk about that the difference is bioavailability of different nutrients and proteins and meat versus plants yeah absolutely um look i think people assume that that there's calories in the food the calories go in and then we extract those calories and we get on with life it's not really about calories it's about nutrients i think calories are a kind of a side effect of food i think if i was to really simplify this anthony i think people should eat to constitute turnover like our bodies turning over cells gut lining mucous linings like everything hair skin is turning all that over now what is that that's been turned over it's fundamentally protein so protein should be counted as not an energy source because you know it is of it's a fairly poor energy source that body struggles to convert that to uh to glucose uh some people are more adept at it than others but others do struggle with that process of gluconeogenesis protein is turnover it's fundamentally building blocks for our body it is non-negotiable and it should be eaten in high amounts now you can try and do that through plant proteins but there is no question about it there is no debate that plant proteins are harder to extract the proteins out of their matrix now they don't let it go that easily there's a lot of anti-nutrient factors as well which you've spoken about in multiple podcasts in the past and i agree with you on that they're less bioavailable to the human being now a lot of people in the plant base will get around that by by using commercially available proteins such as p protein which but you think of the process that that is required to extract protein out of peas the the chemical experiment that that must entail the the chemicals that must go into strip and to hydrolyze that protein i think and that moves away from that whole whole food paradigm that we we're really trying to sort of trying to approach so yes it is possible to get proteins out of plants but it is a less less readily available source additionally we've got to remember a lot of these proteins like beans and and black beans whatever chickpeas lentils they come with carbohydrates that may not necessarily be absorbed well uh these are things like polyols and fructose these these carbohydrates end up in the colon because they're not absorbed well they're fermented by the gut bacteria they create a lot of gas and create a lot of distress for the person banned up in my office um complaining of gut based issues so it's like well do you want to survive or do you want to optimize your survival and you want to have quality of life and that's what it comes down to there's no question if you wanted to do a combination of animal based foods and plant-based foods that's fine that's great um i've got no argument with that but don't demonize animal-based foods which are which are clearly the most very valuable source of protein to say that plant proteins are better that is um that is incorrect and scientifically inconsistent with uh anything that is available in the literature yeah therein lies the issue now the choice to power your body through fat and carbohydrate that really is dependent on the individual the person like yourself is clearly well adapted to fat and and suited to it and your body thrives on it go for it and there is other people out there that are lowering fat higher in carbohydrate and often these people you'll find if they're doing it properly the carbohydrates seem to be higher in quality um you know ancestrally consistent foods like tubers and root foods and stuff like that some people can tolerate but most people can tolerate them well some can't obviously and for those we can make exceptions but you choose your fuel of choice that's fine um fat or carb but better but i think protein you cannot negotiate yeah but yeah i yeah that's a very good point um you do need just a certain amount of protein and um and it matters where you're getting that from you know it is when people say that you know we are herbivores and that this is our natural uh you know uh food source it is kind of uh funny you know that they can make that argument when you have to use an entire chemical lab to just to extract basic protein and nutrition from peas i mean obviously if you can't do it if your body can't do it then your body's not designed to do it and it's just that simple absolutely and it's the same individuals that having to take supplements often having to inject three monthly b12 injections it's like it's very well to say that that that your plant-based i support that like if people want to do that that's by then but do not push the idea that this is evolutionarily consistent for us because um [Music] it isn't it's it's false uh it's false uh to state that yeah yeah would agree um so last time we saw you we went uh went for steaks and we talked about your sort of your your nutrition you were heavily meat based also again thank you for the steaks i owe you next time you're in perth it's on me um and uh so you're mostly mostly meat based but like you say eating some sweet potatoes which i i think in like the keto community that's something that people have have used for a long time found much more beneficial than normal potatoes which i would i don't see um uh yeah i i see that that would why that would be obviously potatoes are nightshades and have solemny and have other factors in them that wouldn't be as good as a sweet potato what where are you at now in your in your diet and your training and like you know take us through a day in the life of of pran um yeah sure anthony i i mean what what i do works for me and i'm not necessarily suggesting that other people do it but i can give you a snapshot of it um obviously we spoke about our diets and and our diets fundamentally are very very similar i think we prioritize quality meat and we're both off the belief system that the ruminant meat such as beef is the way to go away a lot of beer and also goat um which which which i think are quite healthy sources of lamb as well my my priorities getting my protein targeting for the day so what i generally do i would i would have a black coffee i enjoy coffee um you know whether or not that's necessarily suitable for everyone i'm not sure but i generally enjoy black coffee prior to a workout in the morning and my first meal is generally around noon twelve or one o'clock um i generally have um three four sometimes five eggs depending on how hard i've worked out and a side of lamb i might have a little bit of avocado or something like that with some water lots of salt and then my second meal is at dinner time generally it will be some sort of ruminant food source with um with with sweet potatoes i tend to tolerate potatoes quite well um you know i think i think uh growing up in a third world nation in sri lanka and also in africa i've got a pretty um pretty well well adapted gut microbiome i think for for uh potential ability to deal with toxins so i i tend to tolerate potatoes and i enjoy them so um i'll have a little bit of that as a fuel source and then generally at nighttime for if i get a bit of an energy hunger i generally satisfy that with fruit you know things like mangoes and and peaches and stuff i enjoy the taste of them are they necessarily ideal for maintaining low body fat percentage perhaps not but again it comes down to you know you gotta you gotta have a little bit of um enjoyment and sustainability in the diet so i i i enjoy that and i'm sure they come with some valuable uh nutrients as well and i generally finish it off with a glass of um a good quality um non-pasteurized milk um a great brand of milk made by cow shout out to those guys they're amazing at what they do it's old old-school milk and that's my diet and i kind of rinse and repeat that and people say you need to eat the rainbow or you need to have variability in your diet well i'm 40 heading to 41 this year and and doing pretty well on a very monotonous diet and you know it's kind of proofs in the pudding right like if you're able to train able to maintain high testosterone levels as a man if you're able to have good clarity of thought good mental health good physical health and keep a low body fat percentage um and all your other parameters for metabolic health such as hdl blood pressure and insulin resistance visceral adiposity all of that if that's maintainable who can argue with that i'm not going to go out and send out a gut microbiome analysis to see if my gut microbiome is doing well you know it's so like um just got to be sensible about our approach to things yeah yeah i yeah i think that's a good way of approaching it obviously there's a lot of people that have come to carnivore specifically because they have you know quite serious illnesses um and so they would be more sensitive to uh you know different sorts of foods and so forth and they have to be a bit more careful but you know the majority of people would be like yourself and myself who don't really have much of a problem with it now is it is it optimal uh you know maybe maybe not i don't i don't i wouldn't think it's optimal as in the best you can absolutely possibly do but you know i've done that for years i played professional sports half my career was was uh eating like that um you know so for me it wasn't uh you know to get away from a disease or an illness i felt fine but you know i just like i like living optimally and i like that that uh that sort of uh feeling but obviously you know i try to tell people you know eat whatever the hell you want but you know if you're having it but when people come to me specifically you know how do i optimize my life that's what i suggest and when people say you know i'm having these sorts of issues and these diseases i can say well you know that is something that has been uh you know shown in various studies depending on what what it is um you know to be beneficial to you know these elimination diets but um yeah that's great that um you know that you can you know still you know promote you know meat-based diet and and the importance of meat and you know but still have a have a realistic understanding of it and in your own self and just be like well this this works for me i'm not you know it's not detracting from my health uh all that much and so you know i like to do it which i think is totally fine uh for people to do um but yeah when i i i like the i just i just like feeling absolutely as best as i can and when i when i eat sort of other things it doesn't necessarily change too much but i'll have something something will sneak in and i'll just feel a bit crummy for like 40 minutes and just be but not even that bad it's just sort of my nose is stuffy a bit itchy and just kind of like oh i don't like that or maybe like rice i certainly have problems with rice and beans even just get a little bit in my diet and i'll have like very bad back pain for four days you know i remember the last time i ate rice and beans i had it was on a meal i went out and it just sort of stuck to some of the meat that i ordered and i tried to scrape it off but like it got a bit on there and i remember it was early on uh when i when i rediscovered carnivore and i just sort of thought about i was like well maybe i'll just like take a spoonful and just take a bite of this and just see how it affects me because i was interested in how these things affected me but i said no i don't want to do that that's a slippery slope i might you know keep doing that and i don't want to do that and so i just i just left it with just the little bits and pieces that had stuck onto the meat and even that i was i was my back was absolutely in pieces for four days after that couldn't train properly uh you know couldn't get out of bed properly i felt like a broken old man and um you know so those sorts of things were reinforcing for me just to stay uh the hell away from it but uh yeah it almost sounds like an immunological reaction that you're getting against that and again this is the thing we've got to be able to personalize nutrition for people right like it's no it's very it's detrimental to tell a person like you to eat the food pyramid right yeah you know because if you're feeling less than optimal doing that well what are we doing just to feed a government guideline i think we've got to be able to tailor a diet according to what the person can tolerate we're all different but there's no doubt about it we as a species are very well adapted to me there is no question that is not just specific people in the world we're talking us as a species and i think it does a disservice to our ancestry if we uh dispute that yeah i think that uh you know you raised the issue of uh you know the government guidelines so forth i was actually looking at this the other day in america six out of 10 people have at least one chronic disease or metabolic syndrome something like that and then the dietary guidelines the u.s dietary guidelines say specifically on it this diet is not is not meant to you know treat people with disease i was like okay so this is this is completely inappropriate for 60 percent of americans so they're you know they're even they're just you know fantastically tacitly stating that you know this isn't necessarily the right diet this isn't actually the most healthful diet out there well it's interesting and the same with the australian dietary guidelines they specifically state that this diet might not be for someone with chronic illness which is the vast majority of australia now australian adults it's not necessarily for elderly and for growing people so it's like well what are we doing here if the vast majority of the population is diseased um with some sort of metabolic ailment then we should really be throwing it out and and and starting from scratch but that will never happen because like anything else in life everything has become a political issue and it's been heavily politicized and dietically politicized we're living in an era where where climate change i think will drive a lot of policy making in particular the way we eat uh so it's interesting times ahead uh anthony i i'm not i'm not um i'm not looking forward to them let's let's put it out yeah definitely well thank you very much i am just conscious of your of your time i know you have some patience coming up but thank you very much uh for coming on it was great to talk to you it's always great to talk to you um tell us where we can we can find you and where people can find you and if they're in sydney or you need uh need your services how do they get a hold of you uh thanks uh anthony so um i've got two services that i'm sort of built my gastroenterology service is called the center for gastrointestinal health we're located in castle hill um in gregory hills and also we've built a new service in barrel and so that's staffed by a lot of my my team of gastroenterologists additionally we're building a more nuanced service and built one called the center for metabolic health the website should be out on that center for metabolic health looks to optimize metabolic health and we've got a whole team of dietitians about six dietitians additionally a lot of physicians internal physicians general practitioners with an interest in nutrition uh that kind of um that run that service i look forward to that service building over time because that that that i feel will really help um kind of help restore metabolic health for for people and we're going to do it as a team alongside the dietitians um i might be on social media on on instagram and facebook under my name dr pranjeoga nathan but but i tend to uh get shadow banned a lot for a lot of my posts um you know i don't think a lot of our views on nutrition are supported uh by um by mainstream media and and i think it's going to become increasingly difficult to get the message out because we're so reliant on social media to communicate to the wider population yeah absolutely well i encourage everybody to go uh to your instagram i've always really liked you you're pretty prolific on there you have a lot of very thought-provoking and uh very deep posts i've always i've always really enjoyed that and not just to do with diet and so forth but just everything to do with you know around the world very you know interesting quotes historical quotes and and comparisons and so forth so i encourage everyone to go to that and if you need a uh a doctor in sydney who understands the importance of animal-based nutrition um please see dr pran thank you sir thank you very much anthony and i would love to do it again with you sometime mate um and look forward to seeing you in perth absolutely buddy we'll see you soon all right thanks man bye