B (2:47)

Yeah.

A (2:50)

So sorry about that.

B (2:51)

It's all good. My pleasure. My pleasure.

A (2:53)

Well, I really appreciate you being here and you know, as a fellow physician, I truly respect what you've done. You've, you know, put yourself out there and really taken a chance doing this to call out some of the things that you hear online. And, you know, I think as doctors, we all have a little bit of this sense of humility that we just give people information. We don't really, you know, we let people make their own choices about what's good and bad for them. But you've taken the tactic that people need better information and people don't know really what's real and what's not. And even I get educated from some of the things that you tell me, just personally and also on your social media posts. And it's really true how easy it is to be misled. Even being a physician, I can be misled. So I thank you for that.

B (3:42)

Yeah, no, thank you so much. It's a fantastic point. I think you touched on a really key topic there, which is, you know, it's all about informed consent. Right. So, you know, people are free to make whatever decision that they want to make regarding their health and lifestyle. No one can make anyone do anything.

A (3:59)

Right.

B (4:00)

But the problem lies, especially in the online realm is when people are given a skewed perspective or a very narrow perspective on a certain topic. And that can be combined with, you know, fear mongering rhetoric, anxiety inducing language, sensationalism, hyperbolic claims. Right. And that is not how you advise or give information to patients and the public. Right. So what the purpose of my page is trying to do is we objectively evaluate a topic, we look at the data on its own merit. You present that in a concise, well balanced way. Right. To try and minimize as much bias as possible. Obviously, it's impossible to eliminate all bias, but to as long as you're presenting both sides of the argument, then people are then free to decide what it is they want to do with that new information they just learned. Right. Whereas what we don't see online is, you know, we see too much of the people in different camps or different ideological camps. And what they will do is they will often downgrade or push back on the alternate camp at the same time as heavily Skewing their language and rhetoric to push a certain narrative. That's what I try not to do. So if you notice in some of my posts, right, I will talk about how, you know, replacing some of the fats from animal products and to plant based products actually shows improvements in many metabolic markers and randomized control trials, etc. But, but I myself eat meat. Right. I myself am not a vegan. I'm not plant based at all. Every single day I'll probably have something that contains animal foods. Right. But the evidence does not care about my feelings. That's what I have to remind everyone. Right? So don't copy what I do because I don't live a perfect lifestyle, I don't have a perfect diet. But I'm trying to teach you guys what the, you know, what the evidence actually says on its own merit and not to fall into these ideological camps where things can get skewed and misled.

A (6:12)

Absolutely. I mean, so well said. And you know, I would say one of the things that really confuses people is when you have an influencer who can even be a doctor. Right. Or a scientist or a PhD. A lot of people use the word doctor now, but as. Yeah, exactly, with air quotes now. And number one, first of all, there's a lot of misrepresentation of the word doctor. A lot of chiropractors use this term and they're talking about topics that they've never been educated on, for example, neurological diseases, et cetera. And so really, anyone who is listening to a social media influencer and they're using the word doctor, what type of doctor you could be, a doctor of philosophy doesn't mean that you can give health information. Right? So I think that's one thing is misrepresentation of credentials and experience. Yeah. Another, another problem is picking and cherry picking, actually studies that push your narrative. Right. And I think this is one of the hardest pitfalls out there for people to protect themselves against. How can you give the audience a tool or technique to know when a study is being cherry picked?

B (7:20)

Yeah, it's a good point. You know, I feel like we're in the era now where probably seven, eight years ago on social media, it wasn't really cool to cite evidence, right. People weren't going, this study shows this. This study shows this. Right. And now with the new, the post Covid era where, you know, people like myself jumped online, some, like my colleagues, many other doctors and physicians and healthcare professionals have jumped online now saying where is the evidence? Right. If you're not showing evidence to support your claim. You know, we say that which can be asserted without evidence can be dismissed without evidence. Right? So if you're claiming something without showing any evidence, then you may as well not have said anything. So now in this post covert era, people are beginning to realize, okay, if they're not showing any evidence for their claim, then ignore it. So now what people are doing is they're finding any old bit of evidence, right? It can be anything. It just literally, if, if the title remotely resembles what it is they're saying, they'll be happy to cite it.

A (8:22)

Okay, right.

B (8:23)

So now we see this with the likes of, you know, glucose people. I'm not gonna, you know, glucose people and you know, animal based people and perhaps carnivore rhetoric people, and even, you know, extreme, you know, raw vegans. And you know, there are, there are people on both sides on kind of the spectrum. The problem is now is how do you begin to decipher what evidence is more robust and what evidence is less reliable? Basically, it's basically the crux of your question.

A (8:53)

Right? Right.

B (8:54)

So there are several ways to go about this. One is the language in which they use surrounding that given piece of evidence. So what I mean by that is if they're highlighting a singular study, and that's fine to do, right? But they're saying stuff like this study now proves that XYZ leads to XYZ outcomes. Okay? What they're doing is they're framing this single piece of evidence as being the turning point in the scientific consensus. That's not how scientific consensus works.

A (9:28)

Right, right.

B (9:29)

Too many people say we have a new study that shows has, that has undone all of the past decades of research. No, that's not how it works. What you do is you evaluate that new bit of evidence in the context of the totality of evidence.

A (9:45)

Right?

B (9:46)

So if that type of language is not part of their phrasing, it's immediate red flag. No single bit of evidence overhauls decades of past evidence. That's not how it works. Right, right. In, in a specific scenario when that could be the case is, for example, let's say there's a supplement, you know, let's say it's a random supplement that no one's ever heard of. Some kind of random leaf extract. Okay? Now in the past, there's only been five very, very small pilot controlled trials on this random supplement. But now for the first time, there's a year long, multicenter, 300 person randomized controlled trial looking at four different health outcomes on this supplement, a specific Dose. And they found that this supplement now does xyz. That is a very specific situation in which those sorts of phrases can actually make sense.

A (10:40)

Right.

B (10:41)

In that situation, you can now say, okay, this study now shows that or proves that this compound does X, Y, Z. Only because the totality of evidence before that was so minuscule.

A (10:54)

Right.

B (10:54)

But in all of the topics that influencers talk about, like blood glucose, like insulin resistance, like heart disease, these are not new topics. No, they are available in the data. They are available in medical journals for over 50, 60, 70 years. So in that sort of chronic disease framework, right, you will never get a single bit of evidence that now proves X, Y, Z. No, you have. That person has to communicate the point that we have to now look at this study in the context of the overall body of evidence. That's the first thing. There are other ways that you can identify whether someone's citing something particularly garbage. One is, is it a pre clinical or rodent trial? Okay. The reason for this is, is because we have ample data. Now, I think there's one paper I like to cite, especially some of my other colleagues like to cite it as well. It's showing the translatability or the transferability of rodent data on human health outcomes when it comes to pharmaceutical medication. Okay. So obviously big pharma, before you get ethical approval to test on humans, you have to have tested it on animals. Right. Because we need to figure out what the specific, you know, toxic doses, what the safety profile is like, how much can we safely give to animals before we even consider giving it to humans, Right? Now when someone cites rodent data and says, like, I literally just got sent the other day, someone going new study or something, study on beef tallow versus seed oils shows seed oils cause more alcoholic fatty liver disease in rats.

A (12:35)

Right.

B (12:36)

And he's talking as if, oh, well, so if you like to drink alcohol with your evening, then make sure to cut out the seed oils. It's like, my guy, are you a rat? What? Why are you basing your recommendation on a singular rat paper? That's not how it works. Right. Rodent studies exist for a very specific reason. They are for safety testing before you test on humans. Okay. And secondly, they are hypothesis generating. So if we see a mechanism in rodents, okay. Then we can begin to design studies looking at humans to see if that same effect happens in humans. And what we find most of the time is that those effects don't happen in humans.

A (13:21)

Right, Right.

B (13:22)

We see actually using this tallow versus seed oil study I mentioned earlier, in rats yes, it might exacerbate fatty liver disease, but actually multiple controlled human trials show that commercially available seed oils can decrease liver fat and the saturated fat groups increase liver fat. Why is that? There's a 202012 study by B J E R N O Helena Bijarno et al. 2012. There's other studies in 2018 where they overfed saturated fats and seed oils and showed that seed oils had the least damaging effect on liver fat. Right. There are dozens and dozens I've covered multiple, multiple times. The point is, is that you don't take a rodent study and apply that to humans. If you want to talk about an interesting new rodent trial in the context of pre clinical evidence and hypothesis generating, that's perfectly fine. I have no problem doing that.

A (14:17)

Right.

B (14:17)

Rodent trials exist for a very important reason and we would not have the data on anything if it wasn't for rodent data. Right, but you don't, but you don't use that as the final end advisory position. You're not using it as advising for humans. Right. We use it to generate hypotheses. And I could go on and on, but there are many ways to determine whether someone citing something is a bit dubious or not.

A (14:43)

Those are two really great pieces of advice. Right. So just to reiterate, the first piece of advice is one study canceling out decades and decades of other research. It just doesn't happen that way. Right. Unless there was no research done in the past or minimal research done in the past. And you see that a lot when there are people online quoting studies because they'll pop up the study, they'll have a PMID number and they'll just talk about that one study and not even reference any of the data prior. And so it's critical, I think, being a physician for us to reference what does the data show prior to this study being done. Does it agree with this, has it prove, Is it further the proof? Or does it take away from decades of study? And that's a responsible way of doing it with rodent studies. The other thing that I noticed, the second thing that you talked about is people quoting rodent studies. I mean this is massive. This is always being done. Generates great headlines.

B (15:46)

Yeah.

A (15:46)

You know, apples prevent dementia, you know, like it's just crazy the amount of stuff that people will quote Ronin studies on. And I think that those just, that's just irresponsible. I think it's great to talk about the hypotheses, but really does not apply to humans until a human study is being done. The third thing that I think is another thing to talk about here too. Another kind of way to spot a problem is when someone's inferring human clinical outcomes from a study that's done for mechanistic purposes only. Right. And so that's where you see a lot of these seed oil studies, a lot of people talking about, well, here's a study that shows that, you know, this supplement affects this pathway a lot of times also on rodents. And then they assume or infer that that's going to prevent Alzheimer's disease or lead to higher rates of cardiovascular disease. But we also know that's not true.

B (16:41)

Yeah.

A (16:41)

Or very rarely is it true.

B (16:43)

No, it's a very good point. It's, I like to call it, you know, mechanistic speculation. So people, people that spend all of their time speculating over random mechanisms that might be valid or might not be valid, they're missing the all important point that human outcome data supersedes mechanistic speculation. Because what we, what we actually end up caring about is how does this thing affect human health over the long term? We don't care what, we do care about what mechanisms are taking place. But the point is we don't advise people based on specific mechanisms we see happening in a specific organization. The reason for that is, is because when one mechanism might be present, there might be 10 other mechanisms happening simultaneously that could be counter, that could be counteracting.

A (17:34)

Right.

B (17:34)

Or having a counter effect to the mechanism you're talking about. So if you're talking about a specific mechanism and then jumping from A to D, Right. Then you need to basically stop and think. Human outcome evidence matters far more than a specific mechanism happening at a specific time in a specific organ. So. Yeah, that's very well said.

A (17:57)

And this is a rampant problem in the longevity space. Right. Because there's so many mechanistic studies about specific molecules affecting, for example, the MTOR pathway or you know, the AMPK pathway. And then there's an assumption made that because it either positively or negatively affects that pathway, that somehow this will lead to you living longer. Right. Or, or living less long. And the reality is, to your point is, there's, especially with those particular longevity pathways, there's so many counter mechanisms and modification mechanisms that also have an interplay there. And you know, just because it works one way in one cell doesn't mean it doesn't have a different effect in another cell in the human body at the same time too.

B (18:40)

Yes.

A (18:41)

Which you see a lot of as well.

B (18:41)

And also, also it's important to note that many of these mechanisms are established in what we call in vitro analysis. So basically, petri dish studies, right, where you isolate some liver cells and you put them in, you know, agar and you, you know, you add certain things to it in a specific culture and a specific concentration and you go, oh, it actually caused the death of these liver cells.

A (19:06)

Right.

B (19:07)

And you're like, yeah, but we're not a bunch of cells living in a petri dish, Right. We're a complex multi organ, multi system organism. Right. Where there are many other adjacent pathways that could actually protect those cells in a specific environment or could cause even more harm. Right. So what happens to cells in a petri dish is not representative of what happens within the human body. That's another important point is like these mechanisms might be valid when you isolate the cell. Yes. But cells don't exist in isolation in the body. Right. There is no cell that is working by itself at all times. Exactly. Right. So, yeah, another important point for sure.

A (19:48)

Yeah. And then you have this thing called the immune system, which is incredibly robust, that is going throughout your body constantly modifying cellular pathways and interacting with every cell in your body. So there's so many effects that we're not counting in these petri dish studies on mechanistic studies. And I think it's really important for people to know that it's not about creating more confusion here. It's more about not taking the leap into something without understanding the nuances and just by believing somebody. And I mentioned that because a lot of people come to me as a doctor saying, look, I heard so and so said I should go carnivore because I have a gut health issue. And they jump into a specific type of diet, for example, because they heard someone say that this is the magical cure all for everything. And the reality is, number one, it works about 20% of the time, another 20% of the time does nothing. Another 20% of the time, it causes more damage than good. You know, it's like, it's like there's so many different effects to doing something. And just because you're one of those 20% that had a positive effect doesn't mean it's going to work for everybody.

B (20:56)

Yeah, that's, that's a fantastic point as well. I think people need to remember that the online space, Facebook, community, social media platforms, they are all echo chambers of the type of thing that resonate with you. Right? So if you spend all your time watching pro carnival content, then you're going to get a skewed Perception, you've got a selection bias of the type of stories and anecdotes that you're going to come across. Right. So you might get that false perception of, oh, well, everyone that I've seen online is all having benefits from the Carnivore diet. Yeah. It's because you've curated your own feed to show you that type of content. Right, right. Whereas the actual reality is many people who experience negative effects don't actually talk about it online because, you know, for, like, for example, if I started a new diet and, you know, after two weeks, I was having raging diarrhea, I had acne breakouts, I had abdominal pain, bloating, you know, am I gonna be likely to shout about it online? No, obviously not. Who wants to know about my explosive diarrhea for two weeks? You know what I mean? It's in no one's interest to show the messy side of themselves online, because social media is one big highlight reel of everyone's positive experiences. Everyone loves talking about their achievements, about their wins, about their weight loss, about their weight loss and, oh, I've reversed my diabetes. But if something really bad happens psychologically, people are less likely to talk about it publicly because either they're, you know, they feel hurt, they're ashamed, they're guilty, whatever. The point is, is that you can't use social media observations as a means to justify a lifestyle decision for you because it is a very skewed perception of what the reality is across all people. Right. So people need to really unwind and, like, think logically about the type of content they're seeing and try to understand that it might not be representative of all people.

A (23:05)

Yeah.

B (23:06)

So that's. So that whole 20% thing you were talking about, it makes a lot of sense because you might not actually see the remaining 60%.

A (23:14)

Right.

B (23:15)

You might not. Like. It just won't come to you because social media algorithms know how to keep you on the platform. It's trying to reinforce what you believe in and what you think is right. So this is all part of critical thinking. This is how we try to objectively assess a topic and not make decisions based on emotional pulls and hooks.

A (23:38)

Exactly.

B (23:39)

Yeah. Very important.

A (23:41)

Yeah. And I think another thing about social media too, is that the content creators that are putting content out there, a lot of it has to do with creating controversy and picking a side as well. And so you have to kind of do both. You have to create a controversy that probably doesn't even really exist and then pick a side and then you prove your side and that's what gets you more views, gets you more view time, et cetera. And you know, you've been talking about this for a while. Is this carnivore diet, right? I mean, I think there's so many influencers there that they almost shame people that are not carnivores. Right? And like, I'm not a carnivore. You're not a carnivore, but. And I'm not a vegan. And you're not a vegan. But you have to look at the information put out there as maybe it worked for them, but it definitely works for them to shout about it from the rooftops and develop a huge following, Right?

B (24:31)

Yes. You know, one of the, one of the false equivalencies I see them, you know, portraying, which is another example of a logical fallacy, is where you present two things that are not logically equivalent. So one they will say is, oh, you know, anyone that's against the carnivore diet is promoting junk food and sugar and refined grains.

A (24:52)

Right?

B (24:53)

Sorry, what, what healthcare professional do you know that is advising their patients to have ultra processed fried takeaways, refined carbohydrates and you know, like, and sweets? No one, like, no one's saying that. So they're literally creating controversy by making a completely illogical false comparison, a false equivalence to then make it out as if their side is the more logical one.

A (25:20)

Right?

B (25:20)

Not like all professionals around the globe unanimously agree that a minimally processed diet is far healthier than an ultra processed one. Everyone, everyone agrees the issue isn't, you're either pro meat or you're pro added sugar and refined carbs. That's not, those two things aren't logically equivalent. Right. Like, but because the truth is not that exciting. It's like, okay, either you're pro carnivore or you're pro plant, minimally processed plant foods. Like, why is that a bad thing? What's wrong with beans? Like nuts, seeds, Right. Fruits, veggies, you know, like, what's wrong with those things, right? So like they're presenting a false equivalency, which is another logical fallacy in its own right to then build this ideological camp that anyone who doesn't agree must be pro junk food industry.

A (26:10)

Right?

B (26:11)

So like, that's also another way to decipher whether someone is giving you informed consent. Right? And these people aren't because they're not portraying a balanced narrative. They're not giving you both sides of the argument. Yeah, right. So that's another problem. So there's the list of problems just keeps growing.

A (26:31)

Yeah, absolutely. And I think having a mindset shift like you said, and just being able to understand whether someone's talking to you with a respect for you as a human being with a brain that they can give you both sides of the story and let you make the decision and tell you what the nuances are and tell you what the previous body of evidence says. I think that's a person that you want to listen to. Right. Because they at least respect you enough to give you the all the information, not just trick you with just a little piece of information. Unfortunately, a lot of people are very easily manipulated, especially in the world of social media where you have to make a decision on something in 1.5 minutes.

B (27:13)

Right.

A (27:14)

And so it's, it's, it's really driven a lot of false narratives since social media became a thing, especially in the wellness space.

B (27:23)

Yeah. You know, you just kind of brought, you've made me think about another aspect that we haven't talked about, which is, you know, social media rewards simplistic advice.

A (27:35)

Yes.

B (27:35)

And the reason I say that is because, you know, this is no dig at a certain population, but we know, for example in the US and also the UK is not that much, far, far better, is that, you know, the average literacy ability of an adult in these countries is like that of an 11 year old. Right. So the average adult can only read to like the equivalent of a sixth grader, basically. And what this means is, is that people typically aren't used to taking in large amounts of information in a short period of time, weighing up that information and then responding with an informed response.

A (28:17)

Right.

B (28:17)

People are not trained to do that. They're not learned enough to do that, basically. So what social media really thrives on is taking a tiny un nuanced take, shouting about it from the rooftops, making it easily digestible, understandable, and creating these camps that are very black and white because the majority of people can actually comprehend what it is, is what, what it is that is being said. So another problem with science communication, like, you know, that creators like myself have, is trying to make complicated information more accessible to the masses. So how do we simplify things in enough way where the majority of adults don't feel overwhelmed? Right.

A (29:01)

Number one.

B (29:02)

But how do we do that at the same time as providing a balanced perspective? It's very hard to do that.

A (29:09)

Right.

B (29:09)

We know like the average attention span is at an all time low right now with all of the scrolling features and all of the quick, you know, like Brain reward responses that we get from social media scrolling and people aren't really bothered to want to list it and listen to a certain thing for like two, three minutes at a time. So if that piece of content hasn't grabbed your attention by the first 10 seconds, the chances are they're just going to scroll on, right? So what influencers and people who are very kind of charlatan like or snake or salesman and griftery, they know that if you want to make it big, you have to have very black and white takes three, controversy, don't make it complicated, don't give both sides of the argument, right? And people will lap it up because they can comprehend it, they can emotionally attach to it, they can, you know, it's easily actionable because they haven't got to consider the pros and cons of something, right? So imagine, right, if someone's saying the carnivore diet is what our ancestors used to eat, be more like our ancestors, they were healthier, full stop, right? Everyone can understand those four sentences, right? But if I was to come along and make a video saying, well, actually, you know, our ancestors never were actually full carnivore, they were mostly foragers, they were scavengers. You know, dental records show this, digestive records show this. They actually ate lots of, you know, even tree bark and fruit and berries and, you know, stems and, you know, they ate lots of plant matter as well. And actually meat was actually quite a rarity. And, and actually, if you look at the data, excess saturated fat, you know, more than 10% of total energy leads to an increased risk of ischemic heart disease, stroke, heart attack. And I go on for two minutes, right? Chances are I'm going to lose many of the people that are not used to intaking lots of information in a small amount of time.

A (31:10)

Exactly.

B (31:10)

So the issue is, is now how do we employ the same tactics that charlatans are using, but be able to present a logically balanced and nuanced discussion in a way that is easily understandable by people? That is a lifelong struggle and I'll be trying to improve for the rest of my life? Because there is no easy way to answer that, right?

A (31:37)

It just takes a longer time to explain something that's more nuanced. And there's a lot of variables that you have to talk about. It's not as simple as one variable. So it's, it's tough. If you figure it out, you will become a billionaire just because you figured out something that no one else has figured out. About educating people in the ease of.

B (31:55)

My friend, to be honest, if I, if I've, if, if you realize that I figured it out by that time, it's too late because I'm going to be on a beach in Hawaii smoking cigars.

A (32:03)

Exactly. Right. Right. Exactly. Hi, Dr. Shah here. I want to take a minute to talk to you about cellular health. So in my clinics I've actually seen 30 year old people with cells that look like they're pushing retirement. And I've also seen 60 year olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones and they have limited cell phone battery, poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with iM8. IM8 powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection, the clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, Im8 actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMAID had partnered with Oxford University, the International Space Station San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should. Unfortunately, you don't have to be one of them. Try ima. I actually have a discount secured for you if you go to drshaw.comima or go to im8health.com discount DrShaw and you can get 20% off with my discount code. Dr. Shah, you can also find the link below. Okay, so on that note, let's dissect a few nuanced topics here because I think it's important and you have a really good way of explaining and talking about these topics. Let's do two or three of these topics. So let's talk about sugar and artificial sweeteners. Okay, so there is a massive amount of attention on sugar and artificial sweeteners because of a relationship to metabolic health and metabolic health. Being a core problem in chronic disease risk, specifically cardiovascular disease. So let's talk about this. What are some of the things that we're convinced of that potentially are not true?

B (34:42)

That potentially not true? Okay, so you made an interesting kind of combination there. You said about sugars and artificial sweeteners.

A (34:52)

Yes.

B (34:53)

Right. So I want to separate these two because they're vastly different.

A (34:56)

Right, let's do it.

B (34:57)

Yes. So the scientific consensus, you know, is without a doubt that consuming regularly consuming sugary drinks and beverages that contain added sugars, Right. That are void of any additional nutritional benefit, they are largely detrimental to our health anymore. I think the, I think the, the dosage where it becomes a problem is like 5 to 10% of energy. So if you're, if you're getting around 250 to 400, right, like calories from added sugars in the form of drinks or cakes or biscuits, whatever, then that's when you start to see meaningful increases in the risk of cardiovascular disease. There perhaps might be some links to some kind of cancers, overall, metabolic disease, risk of type 2 diabetes, etc. Now remember, when we look at harm and human health, there will always be a point at which something is harmful and something is not harmful. Okay? So the point at which something becomes harmful looks to be around 5 to 10 and maybe slightly higher than that percent of energy coming from that thing. Okay, got it. Now that's added sugar specifically. Now when we look at artificial sweeteners or low energy sweeteners or non nutritive sweeteners, they are called in the literature, lots of different things, but the point is, is that they are meant to mimic the taste of sugar or sweetness without containing the caloric load. So without containing any energy. Right. Or a very small amount of energy because most of them are like several hundred times sweeter than table sugar than sucrose.

A (36:35)

Right.

B (36:36)

So when we look at the evidence for how artificial sweeteners impact overall cardio metabolic health, we see in many meta analyses of randomized control trials where they substitute added sugars for artificial sweeteners, or they compare artificial sweeteners to water. Right. Or they compare sugars to water and they look at these three different pathways. Right. How does it compare from sugar to water, water to sweetener, sweetener to sugar and back to front. Okay? So the data has been focused on looking at the relationship between these three variables. Now what we tend to see is in analyses by things like Nima D. McLean, McGlynn et al. 2022, as well as other analyses in 2524 as well, by other authors, we see unanimously that replacing added sugars with artificial sweeteners leads to improvements in BMI in waist circumference, in body weight, in body fat. We see improvements in glycemic control, HbA1c. Sometimes we see improvements in liver markers like AST, ALT. Sometimes we see improvements in, I want to say one of the blood pressures, I'm not sure if it's systolic or diastolic, but one of the markers of blood pressure and generally an overall improvement in overall cardiometabolic health.

A (38:06)

Okay.

B (38:06)

That's what we see in up to randomized control trials from, from anywhere from a few weeks up to 12 months in duration. There are a few that are longer, but I can't remember the results from those right now. So anywhere randomized controlled trials where they directly replace added sugars to low energy sweeteners or artificial sweeteners, we see generally an improvement in health markers across the board. Okay. Now when we compare artificial sweeteners to water, because that's what people, you know, people are very hot on this topic right now. They want to know, okay, it might be better than sugar, but then, you know, so is anything. Okay, fair point. So we have multiple control trials over the long term. I think one of them is by Rogers in 20. Can't remember the exact year, but there's one where you compared. I think it was at least a liter of water versus a liter of artificial sweetener every single day for 12 months. And it was on around 300 people. And it was a randomized controlled trial. They saw that over 12 months the both groups lost weight, yet the water group lost around, I think, two to three kilograms, something like that. And the artificial sweetener group lost over twice the amount of body weight as the water group right now. Why do we think that happens? And we see this when you look at other comparisons between water as well. Now, there are some hypotheses as to why this might happen. One is that as is the case with myself in my lived experience, right, I've got a water bottle here with, you know, a low calorie sweetener already in it. And what I find happens is in people that are susceptible to consuming lots of sweet foods, lots of desserts, maybe they like cakes, maybe they like adding sugar to their coffees or teas or whatever. In those kinds of people, finding something similar that has the same sweet taste or slightly different, that allows them to feel satiated and satisfied with that sweet craving, right, Will often mean that they are less likely to compensate by consuming other sugary foods. So imagine if you're getting that satisfaction from a low calorie sweetener and you're usually someone that has a cookie every day, maybe two sugary drinks every day, and maybe you add some sugar to your tea, right? Now, if you can be satisfied from that little bit of artificial sweetener, therefore the other parts of your diet are then slowly starting to improve, right? You're then beginning to subconsciously lower your total energy intake and reduce your intake of added sugars. So this is almost like a subconscious net positive effect of actually including some of that sweetness in your diet. Now if you're someone that just doesn't have a sweet tooth at all, you don't like anything sweet. Like my father, for example, he won't eat anything sweet. He has like one to two meals a day. Just loves savory food, love salt, loves loading up the, you know, MSG and the salt and stuff, right? Like he's someone that perhaps won't find any benefit to including a diet Coke or, you know, whatever, like a low calorie squash or something, right? Now this, this shows you that there are different use case scenarios when it comes to artificial sweeteners. We have to remember that they exist for a specific purpose. What is the specific purpose is to give people that like sweet drinks and products an alternative to consume. So if you're not someone that likes drinking and consuming those sweet products, then why would you include them in your diet anyway? Why would you include a low calorie sweetener anyway? Right. So it has a specific use case. It's not, you know, no one's saying, oh, everyone should be consuming an artificial sweetener. No, no one's saying that you don't have to consume it. The point is, is that because we live in a very sweet food environment, a very hyper palatable food environment where food is almost irresistible, right. Adding a bit of zero energy sweetness to your diet can actually lead to a net improvement over the long term. Right? So that's where the nuance gets often missed. It's like, you know, people talk about, oh, it can be damaging your gut microbiome. No evidence whatsoever. Ironically, some of the sweeteners have been shown to increase numbers of bacteria associated with improved health outcomes. That's a big, a, big irony of the whole thing. You know, the whole cancer thing has been debunked over and over again. You would need something like 12 to 18 cans for a normal 70 kilogram adult every single day for decades before you're at any increased risk of cancer. People like to bring up the IARC classification for aspartame. They don't even know what it means. Right. It's a group 2B that mean that literally means limited evidence in humans. If you actually look at what that classification means, it literally says limited evidence in humans. And all of the world leading bodies like the Joint Expert Committee on Food Additives, the European Food Safety Authority, Food Standards, Australia, New Zealand, the nhs, they all reaffirm the safety of most artificial sweeteners like sucralose, aspartame, etc. You don't need to worry about consuming them. If you are gut sensitive, then yes, you know, no one's saying you have to consume it. If you find it gives you diarrhea or gut problems or bloating, that's fine. Everyone has intolerances to certain foods and certain products. Right. You know, just because someone has a peanut allergy, am I going to now say that peanuts are bad for you? No, obviously not. Right, Right. So that's, that's what I'd summarize. We have to distinguish between added sugars, low energy sweeteners. Not everyone should consume low energy sweeteners, but they have a place if you're someone that likes sweet food. There you go.

A (44:04)

Right. And you know, this brings up the whole topic. Number one of, you know, the example that you gave of people actually losing more weight with artificial sweeteners because of the kind of the psychological need for sweetness throughout their day being met. It just shows you how mechanism versus reality can be different. Right. And so the reality is this is something that probably people didn't even think about being part of the nuance of this conversation gets brought into place as someone's psychological need for that sweet tooth being said, satisfied over the course of the day. And also it brings up to me how much n of 1 science trumps all science. Sometimes it's like you have to see how something works for you versus what the science sometimes shows on a population basis. With some caveats there, of course, but I would say that a lot of the N of one kind of studies that you do on yourself should also be taken into account as to what choices you make for your long term health outcomes.

B (45:09)

Yeah. And you know, the interesting thing is like no one discounts personal experience or what happened to someone's, you know, health when they did something. But the problem is, is that you are not an objective person when trying to assess the effect of something that you've done. The reason I say that is because we all have our own internal biases Right? Like if I, you know, let's say a month ago, I decided that I was going to start taking a type of supplement, right? And then I noticed over the last few weeks, ever since taking this supplement, my sleep has improved, my energy has improved, my workouts are now better and my bowel movements are far more regular. Right?

A (45:52)

Yeah.

B (45:53)

Now I can easily say, well, I did an N of one experiment on myself and, and I've made the conclusion that this supplement does X, Y, Z. Right? But actually, from an actual scientific perspective, how do you know that those things were as a direct consequence of the supplement you're taking? You have no idea. Because you can't account for the hundreds of other variables that have happened in your life, right? Maybe you might have been less stressed, maybe you got a promotion recently, maybe your wife has made you happy recently. Maybe you were given, you know, much better home cooked food compared to the previous month. Maybe you know, your sleep was better and therefore your workouts were better. Maybe you were slightly more hydrated on that day. Maybe that's why your bowel movements were slightly better. Right? The point is, is that personal experience is valid, yes? If it happened to you, it happened to you. But you, but there's a massive jump between what you've observed as an individual to then saying this means that this caused X, Y, Z in my life. You can't say that.

A (46:56)

Right?

B (46:56)

That's why we have research. Research exists because we have to externally observe what happens to other people. You can't observe what happens to yourself. That's not how science works. Right. We can't account for all confounding variables on ourself. And the other thing is, is even if something makes you feel better, right, how do you know that over the long term this is going to be beneficial for you or not?

A (47:24)

Right?

B (47:25)

Like for, like, for example, people might say that, okay, well, I've been on the carnivore diet for six weeks and I feel fantastic, right? I have more energy, I feel fantastic. Okay, but can you feel everything that happens to your health? No, you can't. Can you feel atherosclerosis being deposited into your right, happening in your arteries? Can you feel cancerous cells growing in your colonial? Right. Can you feel these things?

A (47:50)

No.

B (47:51)

No, you can't feel these things. So just how you feel and what your own perception of your experiences are might not necessarily reflect the reality of what's happening to your body, right? Like some people feel fantastic having cocaine. Does that mean, does that mean cocaine's healthy for you?

A (48:10)

Yeah.

B (48:10)

Right, exactly. Some bit genuinely, I've had friends, right, who feel the best. Like, you know, for example, in med school I had many friends and I had a couple friends who actually, before going to the library, they would have one or two drinks of alcohol, right? And they say, well, you know, I feel like my cognition is so much better, I'm able to retain information better, I sleep much better afterwards as well. Right. They're using that individual experience to justify doing a health intervention, right? Because they want to revise better, etc. But obviously we like, we know that having two drinks every single day is not going to be beneficial for long term health. But how do we know this? We don't know this from personal experience. We know this from external research data on millions of people conducted by research that is independent of yourself, right? So n equals 1. I have no problem with talking, with talking about your own individual experience. But when you use your n equal 1 to then give advice to other people, that is a massive red flag. Like, you should not be doing that. And people like, you know, I don't want to name names, but I've had back and forth with, you know, Nick Norwitz and I've had back and forth with other. They don't understand this concept that N equals one literally means nothing in science. It means zero. Like zero.

A (49:31)

Yes. Yeah, absolutely. It means it basically, you know, well, if you look at every biohacker that's on social media trying all these unproven interventions on themselves, that's all n equals 1. It means nothing to you personally. It's interesting, it's something you might want to look at, dive into the research, even try it if it's safe and see how you feel on it. But it doesn't really mean that one person's experience is going to match you. And it's also, it's not a study because there's no control of variables.

B (49:59)

Like you have no idea if the information they're relaying is even correct, right? Like you literally have no idea, right? They could be saying anything. They could say, yeah, you know, I lost three stone on this new supplement that I've just made and my blood markers improved and my sleep is better. You have no way of verifying any of that information, Right? Literally zero way, right? This is why the scientific method is so important. That's the reason why open peer review, access to medical research papers is so important because everyone and anyone can verify the information being said. You can't verify an n equals one experiment. Like there's literally no way to do that?

A (50:41)

No, I think it's only something that people I like to talk about. N equals 1. Because I like people to try things for themselves and have specific criteria that they're measuring to see if there's a positive or negative effect. One of the ones I talk about all the time is a carnivore diet. Because a lot of people come to me wanting to try it and I say, look, you can try it. Obviously you're gonna see how you feel. That's just natural. But let's also monitor your apob. Let's also monitor the quality of your stools, let's monitor a few things to see what it's doing to your overall health. Because to your point, you can't feel everything that's going on inside your body, especially not a polyp developing in your colon. Right. These are the kind of things that we have to always talk about. Of course. And you know, something might be good for a temporary intervention. Maybe the carnivore diet's a great elimination diet for, for temporary intervention. You might even go into ketosis and that might be good temporarily, but long term there could be consequences too to think about.

B (51:35)

Exactly. Yeah. And that's. You see what you just did, There was a balanced rational argument for a specific use case scenario for the carnivore diet. I have no problem, like if people, you know, if someone's got really bad IBD or really bad ibs, right, and nothing has worked and they say, look, doc, what can I do? Right, yeah. An extreme elimination diet like the carnival diet might actually be very therapeutic. In the short term, it might be very therapeutic, but you then have to caveat that by saying it. By no means. All of the evidence points towards this not being suitable for a long term dietary intervention. Right. Because of X, Y, Z, because of all the data, because of, you know, the long term effects on cardiovascular risk and metabolic risk, et cetera, et cetera. So what you just did was a nice like one minute summary of a specific use case scenario, providing both sides of the argument a balanced perspective, which is what we don't see online. Right. We don't see this type of nuance being had.

A (52:36)

Exactly. Yeah. And you know, it's because there's only 1.5 minutes to put a reel out and then Instagram cuts you off. And so I think a lot of times it's. It's hard for people to then go and take that information for themselves. But, you know, to your point, there needs to be more responsibility in educating in how you're Presenting materials online. This episode was brought to you by Nextel, a health optimization and longevity clinic located in Los Angeles, Manhattan and soon to be opening in Montecito, Nashville, Miami and many other cities in the United states and Canada. NextHealth is the apple store of wellness where you can optimize your health span and lifespan using cutting edge technology. I actually founded NextHealth eight years ago to give my patients a place to go, get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit and NextHealth using hyperbaric oxygen, sauna, cryotherapy and LED light is a game changer. In addition, the doctors at NextHealth measure thousands of biomarkers and put into place a longevity optimization plan using advanced tools like ozone plasma exchange and peptides. Go to www.nexthealth to check it out. You know, you wrote a book which was really saturated facts, right? Yeah, Saturated facts, great book. And I bought it. I read through all of the different kind of controversial topics that you talk about in there and I realize, you know, the moral of the story, I realize is that there is so much nuance to all of this and it's hard to apply bite size information to something as complicated as a human body. We're very complicated. The only things that are not complicated is if you jump out of an airplane without a parachute, you're very high likelihood you're not going to survive that. Otherwise, things get really complicated.

B (54:41)

Yeah, yeah.

A (54:41)

So what is your advice to people? You know, they're, they're going on this health journey. They're trying to figure out what to do with their nutrition, their exercise, their sleep. How do you tell people to curate a lifestyle for themselves by based on real evidence and science.

B (54:59)

You know, this is such a. I get asked this a lot. You know, whether it's people working privately with me, whether it's in DMs, whether it's other creators and patients when I used to work in the hospital. And it's just like the irony is, is that lovely synthesis and kind of summaries have existed for a very long time. You know where these exist? They exist in the dietary guidelines, right? This is where they literally exist. Okay. I just did a video on the new dietary guidelines that got released today in America. I'm not talking about those ones. Okay. And you can watch my video. It's quite an in depth video on them.

A (55:40)

I can't wait. I haven't seen it yet.

B (55:42)

Yeah, I'm talking about all the previous Iterations, right? We had the MyPlate, you've got the Canadian dietary guidelines that are fantastic. You've got the UK Dietary guidelines, very similar. You've got Australia, New Zealand, you've got Singapore guidelines, right? You have to remember that people that are advising and presenting evidence on these dietary guidelines across all of these institutions around the world, they have been dedicating their entire lives to this one flipping topic, the one topic of what should the people consume to have the best chance of living a healthy life long term? Okay? There is no global conspiracy from every national organization in the world to make you ill. It's in no one's interests, right? Many of our countries, many European countries, the uk, we have free socialized health care. We do not want more ill people. Ill people cannot work. If you don't work, you cannot contribute to the economy. You can't make more money, right? We want people to be healthy and working for longer. That is literally how a free socialized healthcare system works, right? If we don't have people paying taxes, we can't fund the healthcare industry, we can't fund it. Yeah. So let's just quickly just acknowledge that there is no global conspiracy around the world, okay? The evidence consistently shows that the basis for all of these dietary guidelines are largely sound, very, very sound. They are comprised of minimally processed foods, largely plant based loads of fruits and veggies, lots of whole grains, lots of nuts, seeds, legumes. You can have fatty fish, you can have an egg or two a day. You can have, you know, lean protein sources like beef, obviously of the, the more leaner variety. Preferentially you can have, you know, dairy. Dairy shows generally neutral or protective effects for cardiovascular disease. Lower fat is generally better because of the less caloric load. And to try and keep your saturated fat to a, to a lower level and you want to prioritize unsaturated fat and fiber. That's literally. It doesn't get like any more complicated than that. The problem is, is when the average person is spending 2, 3, 4 hours, right, scrolling on social media because they're hit with 500 different pieces of information, they now think that all of a sudden the science is so confusing. No, it is not. The science has been consistent for several decades. Literally several decades, right? Like all of the dietary guidance from back in the 90s. I know, like the old food pyramid gets criticized in 1995, whatever. But ironically, if you actually read the fine print of that old pyramid, it still said to make sure the majority of your grains are whole grain. It still said that, right? People forget this nuance. They think, oh, it recommended breakfast cereal and flipping white bread and pasta. No, it did not. Nowhere in any of the dietary guidelines has it ever recommended to have lots of added sugar and refined grains. Nowhere has that ever existed. Right? People just love this kind of conspiracy mindset where we're now overhauling the whole corruption, right? Big pharma, big food, wellness rhetoric, whatever. The point is, is that I would rec, if there was one guideline to look at, I would suggest looking at the Canadian dietary guideline from 20 2019. It's fantastic. They have a lovely plate, a picture of a plate with real images of food all over it, showing you the proportions, how much you should be consuming. It's an easy illustration that anyone can understand, right? Anyone. It's, there's no pyramid, there's no up down, there's no broader, smaller. It's literally just a picture of a plate with real food on it. And it shows you from memory. On the left hand side, lots of colorful fruits and veggies, lots of berries, lots of cruciferous veg, high fiber foods, minimally processed foods. On the top right corner is full, lean protein, fatty fish. There's a boiled egg in there, there's some beans, there's some nuts, there's some, you know, legumes, there's a bit of meat in there, right? And then the bottom right is like really dark grains, whole grains, right. Like lots of fibre, B vitamins, right. So like it doesn't get any simpler than that. So the Canadian Dietary Guidelines is a perfect place to look at it simplifies everything on a couple of pages. And just remember, there is no global conspiracy to make you ill. You know, there are health care professionals that genuinely want you to be healthy and strive their entire life to try and make you healthy. So let's just try and objectively assess the evidence on this and try to simplify things because I think social media makes it so. As you said earlier, controversy is really kind of put on a pedestal and like clickbait, black and white thinking, high engagement, framing, sensationalism, these are all things that are rewarded online. But the academic space has not differed on this for many decades. The actual scientific consensus has been pretty robust for many decades and it's not differed.

A (60:58)

Right.

B (60:59)

So that's what I'll say.

A (61:01)

I love that. That is such a great summary and a great way to wrap this up with a mic drop moment. Always love listening to you and I learned so much from you. Like I said at the beginning of this podcast, and to hear more of really good scientific evidence, please follow Dr. Is online. Instagram is where I follow him. Where else can people follow you?

B (61:25)

Yeah, so I'm on TikTok 1.9 there, Facebook 550 something there. So Facebook. I've had a lot of problems with fake accounts on Facebook. So it's Dr. Ids and there's about 550,000 followers there. Any other page is not me. There's probably dozens of. But I've only got one Facebook page. I've got one Instagram page and one TikTok page. They're my main accounts for sure.

A (61:50)

Great, great. And can people. Do you have a website or a newsletter?

B (61:54)

Yeah, yeah. So I've got the School of Dr. Ids, so www.schoolofdoctorids.com and it's where I have an online education platform and you can find the links to all of my platforms in any of the bios.

A (62:07)

Great. Thank you so much for joining us today. This was a fantastic conversation. I look forward to having you on again. I feel like there's so many more topics I had listed I wanted to talk to you about, but we ran out of time. So we're going to do this again for sure.

B (62:20)

Thank you so. Well, you know, this is funny because, like all of these topics require so much nuance. You possibly can't cover more than two or three in a single hour. Well, you can, but you just have to simplify things a lot. And obviously, you know, you know me, I don't like simplifying things.

A (62:35)

No, you're here because you tell us a nuance. Yeah, yeah.

B (62:39)

Thank you, my friend. It's been a pleasure and I hope it was beneficial for everyone listening. And I will be back for sure. I'll be back for sure.

A (62:45)

Thank you so much.

B (62:46)

Thank you.

A (62:50)

What a fantastic conversation with Dr. Itz. We were really able to get deep into why science should be interpreted with nuance and not through quick clips on Instagram. Here are my top five takeaways from this episode with him. Number one, one study never proves anything and a claim to that effect is a major red flag. So if there is a social media influencer or really anyone that cites a single study overturns decades of science, that's almost always misinformation and a red flag. Unless that study has superseded a very small amount of information with a large amount of new information that was well planned, there is no way one study can supersede decades of other information. Scientific consensus is built from many high quality human studies over time and is not cherry picked data, rodent trials or petri dish experiments taken out of context. Number two Credentials and citations matter, but how evidence is used matters even more. Calling yourself a doctor doesn't automatically qualify you to give any type of advice, and citing any study isn't enough. Watch for misuse of preclinical data, mechanistic speculation, or outdated research presented as definitive proof. Human outcome data always trumps anything else out there outweighs all theories and other findings. Number three Social media algorithms amplify fear, not truth. The more you watch content about a specific diet or health trend, the more the algorithm feeds you the same viewpoint over and over again, creating the illusion that everyone's agreeing. This is an echo chamber combined with controversy driven content and is one of the biggest drivers of health and misinformation online. Number four Nutrition is not black and white and personalized anecdotes are not evidence. Just because a diet, supplement or detox worked for someone online doesn't mean it's safe or effective for you. End of one Experiences are important, but they can feel convincing if someone is trying to push it on you. They ignore the long term health outcomes that you can't feel like plaque buildup, cancer risk or bone loss. Personal results should never be used to guide public health advice and everyone needs to understand how to follow their own biomarkers to see if a particular intervention is working for you. Number five the fundamentals of healthy eating have not changed. Despite what the Internet says, there's no global conspiracy around dietary guidelines across countries and healthcare systems. The evidence consistently supports the same basics, minimizing processed foods, fiber rich plants being the basic element of every diet. Unsaturated fats are healthier than saturated fats, having adequate protein intake is a good idea, and having dietary variety. The science has not become more confusing, it's just that there's more misinformation out there. Thank you so much for watching this for listening to this podcast episode with Dr. Idris Migal, Dr. Itz on social media. Follow him for more science based information and for a true nuanced explanation of science. Thanks again. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.