Dr. Rangan Chatterjee (2:28)

Eating disorders are on the rise. Yes, fasting can be a powerful therapeutic tool, but it's not for everyone. If you are suffering or recovering from an eating disorder, the advice in this episode may not be suitable for you, so please do bear that in mind as you listen. Regardless of where you currently are with your health and life, I think you will get a lot out of today's conversation. Dr. Janadas is knowledgeable, he's passionate, and this is a conversation full of inspiration, practical advice and wisdom.

Dr. Rangan Chatterjee (3:08)

I've been pretty excited about talking to you for a number of months now, ever since I saw some of your YouTube videos. So, first of all, thank you for making time to come onto the show.

Dr. Pradeep Jammadas (3:17)

It's a pleasure for me. I'm honored, actually. You know, it's always a pleasure to talk to people like you, especially you. I've looked at and listened to a lot of your videos, are amazing.

Dr. Rangan Chatterjee (3:30)

Amazing.

Dr. Pradeep Jammadas (3:31)

You're so broad. I mean, you look at things from all aspects, and that's what's fascinating. I love it.

Dr. Rangan Chatterjee (3:36)

Oh, thank you. Well, I think there's a lot that we're going to share a common view on, and I want to unpick a lot of that. To start off, though, you were a cardiologist, and you're very proactive about promoting the benefits of fasting with your patients and I guess across society as a whole. So right at the start of this conversation, I wonder if you could outline what are the key benefits of fasting that you have seen in your patients?

Dr. Pradeep Jammadas (4:08)

Traumatic. You know, I've been a cardiologist for 30 years, and I've tried everything. But when I tried fasting, I started seeing changes. People began to lose weight. People's blood pressures came down. Diabetes got reversed. The progression of coronary artery disease went down. See, I had the benefit of seeing patients from day one, so I saw that they were having a second angioplasty, another heart attack in two years, five years. I saw the numbers going down on those whom I was able to get them to lose weight through a fasting program. And I tried lots of diet programs. They didn't seem to work, but fasting did. So decreased blood pressure, decreased diabetes, re hospitalization, LV function seemed to stay good, which means that heart muscle function continued to do well. Patients mentally also seemed to be doing better. So fasting gave me not just this benefit, but a lot more. Also, my patients didn't end up in the hospital with fractures or falls, and they had stronger muscles, and mentally, they were better. So I started seeing that just generally patients were doing better. ER doctors telling me, how come your patients don't end up in the ER with acute heart attacks? All these benefits I saw with fasting.

Dr. Rangan Chatterjee (5:28)

With all these, you know, quite different benefits that you've just outlined for us, why is it, do you think, that very few medical doctors are promoting fasting with their patients? Of course, as you've demonstrated, it has huge benefits. It's very effective. It's also kind of free of charge. So why is there such a resistance among, you know, like our profession, to recommend this as a treatment, it's a.

Dr. Pradeep Jammadas (5:58)

Tough sell and it takes time. You see, you're only as good as getting into your patient's brain. Can you get in there and make them, make those changes? And that's a tough one because all you're doing is you're giving them the advice. There's no tools for me to give them, there's no tablets to give to them. They got to make that effort. And all I got to do is get into their brain, change the way they think. And if they get convinced that yes, Doc is telling me something that resonates inside me and I'm going to make that change, then they'll do it. So the trouble is that most of us doctors are too busy. We're actually taking care of disease processes rather than prevention here. We're really talking about a lifestyle change. And that's the hard part about fasting and talking to someone about fasting. Physicians find it very difficult to talk to them about that because you can just tell them that, okay, these are the benefits. That's not good enough. It takes much more than that. It's a deeper dive into the patient's lifestyle. How do you wake up in the morning? How do you feel in the morning? What are the main issues in your life? So it's not just about fasting. It's about your relationships. Who are you? What's your life all about? All that affects your diet. Because see, fasting is also about, it's much more, it's about your whole life. It's about who do you think you are and can you empower yourself to do it or are you just a slave to your day to day routines and advertising. So to get somebody to fast, you really need to change their whole outlook on who they are. You are not your habits, you are not even your body. You are something that can change everything. There's a separate part of you besides your body, even your mind, there's a separateness, there's an awareness inside you. And if I can get into that awareness, then I can empower you. And if I can empower you, then I can make you fast. So doing this whole thing, it's not easy for most physicians and even, even people who are dedicated to teaching people about diet, it's a hard sell. And I think that our approach has to change. Our approach. I first look at patients and I have to empower them to say, you are more than what you think you are. You can do it.

Dr. Rangan Chatterjee (8:31)

Your videos on YouTube have been going viral for a number of years now. And I've read a lot of the comments and I've watched a lot of those videos and I think one of the many things people deeply resonate with you and your message about is this real passion to help people and this real passion to empower people. And I want to sort of dive in there a little bit because you are, you know, a very well respected cardiologist. You literally go into people's hearts, you put in stents, you do all this kind of stuff in some ways, you know, as life saving as putting a stent in someone's heart potentially can be. You know, it's slightly disempowering, isn't it? It's kind of like, well, I've got to rely on the skill and ability of my doctor to be good at what he does, to be sharp on the day, to have slept properly the night before. Right. Those, all these things are out of my control as a patient. Whereas pretty much everything you're talking about and we're going to go through in detail today is about putting the patient back in control of their health and I guess I would argue their wider happiness as well.

Dr. Pradeep Jammadas (9:45)

Absolutely, absolutely. And that's the thing that the patients have to take responsibility because the medical profession, the way it's set up right now, we're not in a position to do that. We have to, you know, we don't have enough resources, we don't have enough time. So what we can do is we can educate patients and we can throw light on the issues that have brought them to where they are now and show them how they can get out of it. Show them, empower them and educate them so that they make their decisions. And when they make their decisions, they will do it. And then it's self empowering, it feeds back on themselves and say, look, I was able to do this and I didn't think I could do this. That brings us to that issue that there are so many layers of onions that we can peel off. And fasting is the one that really seems to me to open up aspects of their lifestyle which they would not have otherwise looked at. Because fasting does bring in lots of issues into their life. It opens up the introspection into their life. What's going on, what's driving these things in my life. And that's what I like about fasting. It's so different. Imagine if I just give them a diet and say, okay, you're just going to eat this. Okay, they're just going to eat that. That's it. But in fasting, it's self control, it's deeper thinking about the habits and all the other things that we're going to talk about.

Dr. Rangan Chatterjee (11:12)

Yeah, in many ways fasting is, you know, really swimming against the tide of societal norms because we live in a society of abundance, yet fasting is self imposed scarcity. And you know, we're going to talk about fasting from food and the benefits for various different disease processes, but also for promoting health and well being. But you could take it a little step further, couldn't you, if we're going to sort of link mind and body and heart all together? Well, it's not just about fasting from food, is it? Also, we can take social media fasts, we can take alcohol fasts, we can take caffeine fasts. Even that term fasting, it goes far beyond just food really, doesn't it?

Dr. Pradeep Jammadas (12:06)

Absolutely, absolutely. You have so much insight into this. You've just hit onto something very important. When we talk about our habits in fasting and our addiction really to eating and this pattern. You also talked about digital addiction. You almost just, you didn't quite say it in that way. But there is digital addiction, there's alcohol addiction, there's gambling addiction, there's other forms of addictions and sugar addiction. And all these things seem to go to that part of the brain that gives us that reward. So we're living in a society where it's all about the instant rewards. And when you prime yourself in one area, you can slip into other areas as well. And that brings up this whole addiction thing that perhaps this pattern of eating that we've developed and this addictive pattern of eating every few hours all the time, it's really an addiction. It is an addiction and it seems to give us that instant reward and doesn't really matter what you're eating, but it's the fact that you're eating all the time. And we need to get out of this. So we need to really look at our whole life to say that, look, the dopamine centers are primed already from a young age. And yes, we are addicted. We're an addicted society. You know the book that I just finished reading a few months ago, Dopamination, I think it's called.

Dr. Rangan Chatterjee (13:30)

Yeah.

Dr. Pradeep Jammadas (13:31)

Fascinating insights that, you know, you prime yourself in one area and then you'll slip into another addiction. Very easy. And I think that food is one of them. I'm convinced that food is one of them. So yeah, no, you're absolutely right. It's a whole lifestyle. And I tell my patients that if you really want to come off your current eating habits, we need to look at your whole life as well. Are you addicted to alcohol? Are you addicted to caffeine? Are you addicted to sugar? Are you addicted to even digital media? Because it's just the way we're priming ourselves. And when they start looking to that, they do see insight that, oh my God, he's right. I am probably addicted to this pattern and I can get out of it.

Dr. Rangan Chatterjee (14:16)

I've read that book Dopamine Nation. I actually spoke to Anna Lemke, who wrote that just a few weeks ago on this show. A great conversation. I agree. It's an awesome book. Many of us have heard of fasting. We've heard that various religions have used fasting for years. Many of us, depending on what culture we have grown up in, may know that our parents or our grandparents would fast from time to time. Yet despite knowing that, certainly in our current society, many of us aren't taking that next leap. Many of us think, you know, and I know you, I've heard you say before that you were a bit skeptical of fasting when you were at medical school. Many of us probably have thought in the past that, oh yeah, you know, what did my grandparents know? You know, I'm not going to fast. And what I'd love to do, because I think you do it so well, is really go through what happens in the body biochemically, physiologically, when we start fasting. Because I think for many people, they're going to need that knowledge and that science to convince them that actually, you know what, maybe I should give this a go.

Dr. Pradeep Jammadas (15:26)

Yeah, yeah, yeah, no, absolutely, absolutely. You know what fasting does? It allows your body to do what it was made to do. You see, we eat, eat, eat. Insulin comes in, puts everything into storage, so you build up some fat and then you're supposed to live. So when you live, you now start utilizing your calories and you start burning the sugar. When that goes out after maybe about four hours or five hours, then the glycogen stores in your liver and then your muscles start breaking down, start giving you the calories that you really need to burn so you can run, do your day to day activities and all that. And when you run out of that by, let's say about 18 hours or 20 hours, and then the body says, hmm, I need to start burning fat. Now that's what you're supposed to do. That's why you put on fat in the first place. That's why we have fat. It's A storage. And then you start burning that fat, and therefore you start burning that fat. So the fat comes out, comes into your liver, gets converted to some ketones, perhaps, and now you're making ketones, and the ketones are being utilized for energy, and then you go for your next meal again. So the body was made to do this. It was not made to just pile on, pylon, pile on all the time, because that results in increased fat stores, which you'll never break down. So your body was supposed to do this. From the design, you're supposed to do this. So the important thing is that when you eat and you're taking calories, your insulin level obviously goes up.

Dr. Rangan Chatterjee (16:53)

Why?

Dr. Pradeep Jammadas (16:53)

Because insulin has to get that sugar out of the bloodstream. Blood sugar must always come down because otherwise you get damaged from that high glucose level in your bloodstream. That's why we treat diabetes, right? Because the blood sugar, or the glucose, rather attaches itself to proteins, glycation, end products, and therefore these proteins become. They become dysfunctional. So insulin says, I'm going to take the glucose out, put it down into the blood, into the storage. First place it puts it into is the liver. When the liver stores are full, then it spills over into the pancreas. More calories come in, there's more glucose, then it goes into the muscles and it stores everything and from there into the skin. And that's the way it was supposed to be. But now when we continue to do that, we just keep piling it on, piling it on. We never get a chance to burn it down, and we're supposed to burn it down. So the biochemistry of the body was made for feeding fasting cycles. And this is the way the bioengineering of our body was. But we became dysfunctional because as food became more available, we just kept piling it on and on and on and on. And that's the problem that we have today. It's exactly what you said, excessive calories too frequently, so our insulin levels stay high all the time. So that's the biggest problem I found as a cardiologist. You're eating all the time, you're stimulating your insulin all the time. Insulin stays high, stays high, never gets a chance to come down. And because your insulin doesn't come back down again, you're always in a storage mode. This high insulin is the problem. We've hormonally changed because we're eating too frequently. We're not designed to eat that frequently. Insulin is supposed to go up, then come back down again, up and Back down. We stay up all the time. So our body develops, in a simple terms, insulin resistance. Now, the next time you eat, you need even more insulin, because just like wearing a jacket, you first feel it, then you don't feel it. The body, when it has high levels of insulin all the time, it becomes insensitive to it. And that's what's happening. We are a hormonally modified human being now. We're becoming insulin resistant. And this insulin resistance results in higher and higher insulin levels. And that's the problem. And I just want to digress a little bit, and I'll tell you how I came to this. In my practice, what was happening is patients were coming in with heart attacks and hardening of the arteries and angina. And I said, okay, there must be a cause. And I look for it. And the cholesterol most of the time was okay. Blood pressure was okay. They were not diabetic. And then I see all this hardening of the arteries, and I'm wondering why. So about 12, 15 years ago, I started doing sugar tests on them, and I found that they actually had mild diabetes, what we call glucosine tolerance, or impaired fasting glucose. So the sugars were just slightly high, but not enough to make them a diabetic. So I said, okay, fine. So I should put these patients on something to sensitize them and make them better. And I put them on metformin, and I got a lot of resistance from a lot of physicians in the community, plus patients. But the outcomes were better. They actually did better. Then I started doing insulin testing in my office, and I started doing this when I read some information from a physician who wrote a book on insulin, and he got Kraft, so it's called the Kraft test. So now what we do is we give them sugar water patients, and we measure the sugar levels going up and back down again and said, okay, it went up a little bit, not too bad. But I looked at the insulin response, and it was massive in these patients. I took 100 patients, and I saw that they were making so much insulin. This is ridiculous. Why are you making so much insulin? Well, that insulin resistance. And then I linked the fact that it's the high insulin level that's actually causing the hardening of the arteries because the sugar levels are okay. Of course, what happens is, over time, it's taking a gallon of insulin to bring your sugar levels under control. Eventually, even that's not enough. So then the sugar level goes up, and then they go to the doctor and say, oh, yeah, sugar Levels are high, or your hemoglobin A1C level is high. Now you're a diabetic. Well, guess what? It's too late. You already have all the hardening of the arteries. You've done so much damage to your arteries, you probably did it for 15 to 20 years. And that's the discovery, and that's what really motivated me to make these changes in my patients, to say that, look, you know, I got to get that insulin level down. And it is that high insulin level that really motivated me to really do the fasting program. Because I said, okay, how am I going to get insulin levels down? How do I do that? I don't have a drug. So that's what, look, the whole thing comes down to insulin. For me, it was. Now, as things happen, I discovered more and more fun things in this fantastic journey. But the bottom line is it was the high insulin level that really got me into this because I found that when I brought the insulin levels down, my coronary artery disease, atherosclerosis just went down. Patients did so much better. And that high insulin level, the only thing I know that really helps to bring that insulin level down, besides metformin and a few other drugs, really, is fasting. Because when you don't eat, guess what, you don't make insulin. That's it. Your insulin levels plummet. And then the next time you eat, you make insulin, but a much less amount because you're now sensitive. So this fasting, I got into it through this way not because I just wanted to make them reduce weight, not because I just want to reduce blood pressure. It was really the insulin that got me into fasting. Then, of course, I discovered as time went on that, my God, the blood pressures were coming down and I realized that insulin is a vasoconstrictor. It reduces nitric oxide in your blood vessels, so therefore your blood vessels can't dilate. Now, that brings me to hypertension, that I said, oh, my God. I was taught, and you were taught that 95% of hypertension is essential. And this very word, essential, there's nothing essential about hypertension. You don't need it. So I discovered.

Dr. Rangan Chatterjee (23:15)

Should we explain to non medical listeners what does that term, essential mean when we say essential hypertension? What do we mean by that?

Dr. Pradeep Jammadas (23:23)

Which means we don't know the cause of it. It's idiopathic. Idiopathic is another word we use, which means we don't really know clearly what the cause is. It's just something that just happens. So this essential hypertension is not really essential. You don't really need it. And I found through my own experiences here that the fasting brought the blood pressures down. And I said, okay, so what's the correlation? It's insulin. I started reading more about insulin and sure enough, when you give patients an insulin shot, the blood pressure goes up, you take them off insulin, blood pressures come down. Insulin causes nitric oxide depletion in the blood vessels. Nitric oxide, by the way, is a vasodilator. Nitric oxide is a natural endogenous product that makes your blood vessels dilate. And then when nitric oxide goes down, vasoconstrict. This is a dynamic state that you're supposed to have. You walk into a cold room, you vasoconstrict. That means your blood vessels go down. When you go into a hot room, you vasodilate. That's a normal response. This nitric oxide is most essential in our body. It is so important for blood vessels that in fact there was a Nobel Prize awarded for this nitrogen, as you know. So for the audience to realize that insulin, when it comes down, your nitric oxide production goes up and therefore you vasodilate appropriately. Your blood vessels are not imprisoned anymore and blood pressure started coming down. I said, this is amazing because for the first time in my life, I felt that the patients were doing something that was actually bringing their blood pressures down. I mean, we always tell patients who have high blood pressure, okay, avoid excess of salt and go do some exercises. And those are fine because they also can improve nitric oxide production. But this was a very powerful one. When I brought that insulin levels down on these patients through fasting, blood pressures just plummeted and I had to actually take patients off blood pressure medications. So that's a huge thing that I found with insulin. So fasting seemed to me the best way to really make the patient's blood pressures come down. And I found that the weights came down. The question is, why did the weight come up?

Dr. Rangan Chatterjee (25:38)

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Dr. Rangan Chatterjee (27:50)

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Dr. Rangan Chatterjee (27:52)

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Dr. Rangan Chatterjee (27:56)

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Dr. Rangan Chatterjee (28:29)

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Dr. Pradeep Jammadas (28:36)

Insulin in the bottom line for all your listeners. Insulin just is a storage molecule, puts everything in storage so when the insulin levels come down, the storage padlocks are taken off so your fat can now be mobilized. Now this of course I can go into all the enzymes that are involved and the hormone dependent lipase, et cetera, et cetera, et cetera. But the bottom line is when insulin levels come down. Now your fat pads are available for metabolism and I found that the fats just started coming off the patients and when I would look at these patients who do the fasting program, I'd look at them and they look great. It's not like their faces are all, you know, the excess of skin hanging off or they have skin hanging off their arms. No fasting patients seemed to lose weight in a more beautiful way that they were actually losing fat, but they were also losing the right amount of skin as well. Because you see, prior to this, prior to this, I used to tell patients, okay, you want to cut your calories to only 850 calories a day and you're going to have four meals a day, each one is going to be this much. And the patients would come back, sure, they lost some weight, they would lose a lot actually, sometimes, but they would look terrible. They would look absolutely terrible. Their faces, their skin. And plus they were miserable because they just never, they didn't feel good eating small amounts of food frequently. This advice that we gave patients previously, that hey, cut your calories down by eating four small meals a day or nibble throughout the day, totally wrong in clinical experience, they lost temporary weight. They all would put it back on again. Did it for years. I did it for 15 years and I was sick and tired of it. They would come back miserable saying, doc, my life's miserable. I only eat this much and I just feel terrible. I'm hungry all the time. And I look at them, they surely even look miserable. And their skin was just so. When patients were fasting, they would come back and they were laughing, they were so happy, the mood was better. And I said, well, why is this guy's mood so good? He hasn't eaten for two days now. And he says, doc, my mood is better than it ever was before. I'm sleeping better as well. And he empowered himself. And I said, no, this is psychological. He's just, you know, he was able to do it. So he's feeling good about himself. He says, no, doc, I do feel good that I was able to do it and I'm self empowered. But also they felt better. And then of course, as I do the research, I see that there are many substances that are produced during fasting. And one of them is bdnf, which is a big word for brain derived neurotrophic factor. What that really basically means is, look, when you are fasting, does nature want you to just crawl into your cave and fall asleep and just die? No. Nature wants you to go out there, find your kill or your prey or find your berries or something. So it actually makes your brain more alert, rejuvenates your brain and you actually now there's data to show that you can actually grow new cells as well in prolonged fasting. So what happens is that you actually become more wide eyed and bushy tailed. And that's what I saw with the patients too. They were so happy when they walked into my office. They were walking to cardiologist's office, laughing and joking. This is fantastic. And then. So that's something. And then I found that their energy levels, they just not only felt better mentally and the mood was better, but they said that they moved around better. So I said, what does that mean? They said, well, look, my aches and pains went away. I said, come on. I said, yes, I only lost £15 so far, but my joint pains are all gone now. Wait a second, why is that? Why did the joint pains go away? You don't take off that much weight to take them off your knee. Well, there's inflammation. And I found that inflammation went down in these patients. So I said, okay, so how do I measure inflammation? So I looked at the CRP levels on these patients and I found that the CRP is a blood test. And your audience would know that this is a test that we do to look for inflammation, micro inflammation in your blood vessels. And I found that they were coming down. Now, you know how hard it was for me to bring these inflammatory markers down. You know, we give patients statins and that does bring down crp. But I found that these patients who were fasting, the CRP levels came down and perhaps a lot of the inflammation in the joints was getting better because the inflammation went down. So I said, okay, that's fine. What else are you feeling? I said, well, you know what, my stomach feels good too. Wait a second. Come on, guys. I mean, you're fasting and how can this be happening to you? I said, yeah, less bloating, my bowel movements are better. I'm not getting so gassy and I don't get that fatigue after eating. You know, I just, I just feel so down. Of course they're not eating it, but when they do eat after the meal, they feel so much better. So they are eating after when they break the fast, but they're feeling better, their guts are better, their joints are better, their minds are better. I just said, oh, God, this is crazy. This is crazy. So that's what really, I got so excited about fasting, as you can tell. I just. It is an amazing journey.

Dr. Rangan Chatterjee (34:18)

Yeah, it's. You know what's incredible is hearing you talk about this with this incredible passion. You know, you have seen really, really sick patients. You've been inside their body. You're obviously, you know, there was, there was clearly a frustration at some point. You know, why am I keep doing this with all these patients, they keep coming in, what else can I do? But what you're talking about with fasting, it's not giving more things to someone. Oh, you've got to add this into your life. You've got to take more medications, take more supplements, go to the gym more. Right. Because most of the things we advise, we're asking them to do more, add more things in. Actually this is very, very simple at its core. We're asking them to do less. We're saying actually that don't cook. We'll get into the specifics, but I'm just saying sort of 30,000 foot view is, it's kind of like, well, I'm going to save you some money, you can eat less, I'm going to save some time, you don't have to cook. This is going to help improve your sleep, your cognitive function. It's kind of, it's very interesting. It's something so simple that pretty much every religion has as part of its kind of culture and tradition. Yet it's so alien to us in the way that we currently live or as doctors, the way we currently practice, isn't it?

Dr. Pradeep Jammadas (35:41)

Absolutely, absolutely. And you know, on this journey they find out something about themselves. I'm talking about what they find out. They find out that they are not the hunger, they are not the craving, that they are something. I'm just going to say in first terms, I am something beyond my hunger. I am beyond my body, I'm beyond my habits. I've suddenly realized that I am in charge, that I don't have to have breakfast if I'm not hungry, I don't have to have breakfast. And now Doc tells me that's good for me. Lunch comes around. Are you hungry or have you been a victim of just. It's 1:00 so I have to eat. So when the patients suddenly realize that, gosh, I don't have to eat because I'm not hungry, of course, if you're not hungry. And now they're empowering themselves. They realize that there's another part of themselves, a real inner amnes my awareness, the real me, which is beyond my body, beyond my feelings, beyond my sensations and I have control over it now I found that that seems to empower patients more because you start them out first doing this dietary stuff, okay, learn how to just skip meals. Then all of a sudden it roller coasters and they themselves become so empowered they say, whoa, whoa, whoa, whoa, what have you done? He says, well you know Doc, you, me to Fast. I haven't eaten for 48 hours. I said, yeah, but I didn't tell you 48 hours. So what I'm saying is that it empowers them even more because they realize, yes, I have control. I've regained my control over my eating habits. I don't have to eat because it's 1 o'clock in the afternoon. I have to go downstairs to the cafeteria to eat. I don't have to do that if I'm not hungry. And when I am hungry, my ghrelin levels have gone up. They'll stay up for about an hour, Doc told me, and then it'll come right back down and my hunger will be gone. So now I'm empowering myself that yep, I can do it. I'm going to wait it out for one hour. I drink a glass of water, Doc told me to drink a glass of water. And yeah, sure enough, my hunger went away. I moved on. Doc told me to keep my mind busy. Go and do your chores at 1:00, go do your shopping at 1:00 or pay your bills at 1:00 and your time will pass. And before you know it, you'll be back to work at 2:00 and you'll have no problems till the evening. So I think that self empowering the patients this way, they're taking control and they're looking back and they're getting positive feedback. Oh yeah, I have regained control.

Dr. Rangan Chatterjee (38:16)

Yeah.

Dr. Pradeep Jammadas (38:17)

So you know, because compliance is such a big problem. So when I did that, the compliance with medications also improved because the patients just, they took control, they took control. Giving back control to the patients.

Dr. Rangan Chatterjee (38:31)

Yeah, I mean there's so many things to kind of follow up on there. You mentioned that actually when people fast they often get more energy and more mental clarity. And this is very alien to, as you say, how most of us have been brought up and I think kids are still being brought up. You have to eat regularly. And I give an example from my own life, which is my son is 11 years old currently and every Saturday morning we try and do something called Parkrun, which is a five kilometer run in the local town. Now just to be clear, I am not giving anyone medical advice with their children at the moment. So this doesn't get misinterpreted. But I know my son, I know his health well, I know what he's capable of. And we run at 9 o'clock and my son loves food. Right, he loves foods, but actually he's realized that actually he runs better and feels better when he runs at nine, if he doesn't eat. So he said, daddy, you don't want to eat to eat? I said, no, no, if you don't want to eat, that's fine, right? Which is not what I would have been told at that age, I can tell you. What do we know? You're going to need to eat so you've got energy for your run. So on a Saturday morning, he gets up, let's say at 7, he'll probably have, you know, I'll probably keep reminding him, stroke nudging him to have two glasses of water. But then we'll go and do a run together at nine, let's say nine till half nine, then we nip to the supermarket, we come back and what I've started doing with him is I say to him, gentlemen, how do you feel now? You know you missed breakfast. And he'll say often, daddy, actually feel really good. Like I could think really clearly. So first of all, kids get this stuff, right? And I'm delighted that my son is actually showcasing some of the stuff that you are talking about. At the age of 11, I tell you, I certainly was not. I was very much eat from the minute you get up, go downstairs and have your bowl of cereal and still be eating. Last thing at night, I remember just going to my room with big bowls of muesli and milk and just I was eating all the time. So that was one thing I wanted to say. But the second thing I wanted to talk about was what you said about I am not the hunger. I thought that was so powerful. Dr. Jam, that s because I think many people these days have forgotten what real hunger is. And then if they ever experience hunger, it's like, I need to eat now because I'm hungry. It's like, well, you could just sit with your hunger and see what happens. So just a couple of points there and yeah, I'd love you to share your sort of view on that.

Dr. Pradeep Jammadas (41:03)

Absolutely. Now, the experience with the sun is so empowering. So he and all of us have realized that we are a hybrid engine. So you have your metabolism that's based on glucose and everyone needs to understand it's sugar and glucose that is the ultimate currency that we use to produce ATP. But there's another currency in the body and that currency is ketones. So when everything's put into storage and you've depleted the glycogen in your liver because you've been exercising now, then you need your fat stores. That's another source of energy. So when the fats kick in and your ketones start going up. You will feel different when the ketones are in your body. So that feeling of euphoria, that feeling that the patients feel empowered and your sound feels so good after running on an empty stomach. Of course, partly because of endorphins that are produced through exercise, which is very good. But the other product is this. Ketones. We all make ketones. We are supposed to make ketones. The trouble is, when you eat so frequently, you turn ketones off. We must all experience some degree of ketogenesis in our life, in our day to day, maybe at least two to three times a week. You should become significantly ketotic. That does not really mean that you need to fast for three days or four days. No, look, when we cut down on the amount of carbohydrates, simple sugars, and we will go into ketogenesis sooner and sooner in a fast. So that's adaptation. You're adapting your metabolism. If you're eating a lot of carbs and sugars all the time, then stop eating. You will stop producing ketones maybe at 24, 36 hours. But if you're already on a diet that cuts out processed foods, sugars, simple starches, all the refined products, now your body will start making ketones at a much earlier state. So maybe by about 15, 16 hours, also some people start making substantial amounts of ketones. Now, those ketones, when they are being used in your metabolism, you will experience what your son experienced. I feel great. My exercise sounds better, my thinking's better. So it's a different chemistry you're using in your body. And I think all of us, all of us need to go into some degree of ketone production because it has multiple other benefits to being ketone production. And in ketone production, there's a whole new biochemistry that's going on in the body, which we need because one is anabolic, what putting on, on, on all the time. When you in the ketosis, now the body's cleaning up and becoming efficient. So it's another metabolism that we need to engage and we just don't engage enough of it. And now on the fasting program is when I'm seeing that the reparative processes all kick in. Now, I'm going to say this again. The reparative process in your body is kicking in at a higher level when you are doing your fasting. How do I say that? Oh, I told you. Blood pressure comes down, joints seem to get better, bowel symptoms seem to get better, patients look better. But now there's data showing that these patients live longer, less cancer as well. And we know about the chemistry that is induced, which one of them is called autophagy, where the cells actually recycle all the inner parts to become more efficient. And mitochondria recycle as well, which is called mitophagy. So these autophagy and mitophagy, which is recycling your biochemistry of your cells, does not occur in a fed state. It occurs much more when you in a fasting state. So we're supposed to have that. We're supposed to do it. That's what our life cycle was supposed to be.

Dr. Rangan Chatterjee (44:57)

Yeah, yeah. It's interesting, as you speak, you remind me very much of a conversation I had with Dr. William Lee very, very recently on the podcast, who's done a lot of research into comparing food as medicine compared to drugs. And Dr. Lee talks about these defense systems that we have inside our body. He's got these five. He talks about these five defense systems and he talks about using food as medicine to support these defense systems. And you know, there are things like, you know, inflammation, the immune system, the gut microbiome, stem cells, DNA. And it's interesting, he talks about what particular foods have been shown to support those various defense processes. But also what you're talking about is the withdrawal of food at prescribed set intervals also activates these natural defense processes that the body have got. And I find that really, really fascinating that actually what we're trying to do is support the body's natural defenses. We're trying to support that body's own natural resilience that's there. If we and modern life kind of gets out of the way, we're getting in the way and actually stopping this stuff from working. But what you're talking about is let's get out the way and we're gonna naturally kick all of these kind of different systems into gear.

Dr. Pradeep Jammadas (46:28)

So right now, Dr. Li Amazing. So he talks about the foods that you want to consumes to bring about these beneficial changes. Right. And the mechanisms are immunity, of course, and stem cells, as you mentioned, and your gut microbiome, which we know now plays a huge role in your day to day health. Now fasting impacts on all of them.

Dr. Rangan Chatterjee (46:51)

Yeah, exactly.

Dr. Pradeep Jammadas (46:52)

After you finish your fast and then when you have your meal, you get stem cell mobilization. So after a fast, you're getting more stem cells mobilized from your bone marrow. Now what are stem cells? Stem cells will go into the circulation, go to the parts of the body, and they already have messages on them, tagging them where to go, what to do. The body has immense internal signals. So these stem cells go exactly and hone in exactly where they need to go and create the new cells and repair the body. Because maybe those cells that were senescent died, maybe certain organs, dysfunctional cells died and these stem cells move in. And we know that, we know this is stem cell mobilization. It occurs with fasting. You talk about growth hormone, growth hormone, you want to increase your growth hormone. Growth hormone, as you know, goes down after the age of 30, plummets, really goes down. Growth hormone is responsible for muscle building health, and growth hormone production skyrockets when you're fasting because your body makes much more growth more than taking shots. So if you exercise in a fasting state, you'll actually put on more muscle mass, which is what your son is going to come back and tell you that, dad, I'm putting on more muscle in my fasting state when I exercise it then than if I exercise, it's because of growth hormone. So there's another immunity. Your immunity gets better when you're fasting. During your fast, your body is developing mechanisms to strengthen itself and immunity does go up. And we know that certain foods will do the same thing. But there you go. Now imagine the power if we joined all this together. So eat the right foods, eat the foods to improve your immunity as well, and do the fasting as well. This is just, I think that the future is so exciting in this area where people like you and Dr. Lee come together and we're going to change things and say, look, we need to change what we're eating. We need to change the sourcing of our foods and we need to broaden our outlook. Look at the microbiome. I didn't even talk about the microbiome just now. So fasting does affect the microbiome. It does. And when we know that, that's a whole new area that's so dynamic and the half life of in the gut changes. So we know that when we're fasting, certain bacteria are gone. And we know that the types of foods that we eat affect our microbiome. But fasting itself also affects the microbiome. So I love fasting because it does have positive effects on the microbiome. And we know that that's huge. I never believed about the microbiome stuff until about five years ago, but the data now coming out is so compelling for me as a cardiologist. In fact, I just saw a patient yesterday and I advised him that he needs to be eating probiotic foods and fermented foods. And he's like, but doc, I'm here for my coronary calcium score, which was so high. So it's just fascinating stuff.

Dr. Rangan Chatterjee (50:05)

Yeah, it really is. And again, it's that one thing, fasting, that's hitting so many different things, isn't it? It's reducing your insulin, it's encouraging autophagy. You know, we've not mentioned where the apoptosis yet. It's encouraging apoptosis, stem cell production, growth hormone. So many different things are being activated. And actually if we could get a drug to do any one of those, we'd be sort of shouting about it. But, but this one thing does all of them, which is, which is incredibly fascinating. Look, I really want to understand because I want to talk more about the science a bit later on in this conversation. But in terms of getting really practical for people, like if we compare fasting to, let's say, movements, right? So people, if they want to move more, they know they could start off with a 15 minute walk around the block, you know, they want to do a bit more, they make it 30, 40 minutes around the block, then they might start jogging. Some people might want to do a 5k walk or even a run, a 10k. Some people want to do a marathon, right? So there's different grades of movement. And so what are the different grades of fasting? You know, where can people start? You know, super, super simple. What are the benefits of that level? And then how can people progress up depending on their state of health, depending on their goals? You know, I think that would be quite a useful way at looking at fasting and making it really practical for people?

Dr. Rangan Chatterjee (51:37)

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Dr. Pradeep Jammadas (52:48)

My general advice in my office and all my nurse practitioners do the same thing with our patients is, look, first thing you need to do is cut out all the sugars. Because if you go into a fasting with your regular diet pattern, you're going to have a very nasty experience. You're going to feel very hungry, you're going to go through withdrawal from sugar, you're going to feel terribly hungry, sweaty, you may even actually have worse symptoms. So the first thing we got to do is, look, we explain to the patients that your body is not supposed to consume so much sugar. You know, we consume about more than 20 teaspoons of sugar a day in one form or the other. So the first thing I tell my patients is, look, you need to get rid of all artificial foods. Sugar is manufactured, sugar is artificial, sugar is a poison for the body. You need to cut out all sugar, all processed foods, Processed foods. Anything that is made in a factory, anything that has a barcode on it is suspect. Anything that's been pulverized, anything that has been made into a powder, get rid of everything. You need to eat foods in their natural whole form. And that's the first thing you do. So forget fasting right now. The first thing you're going to do is just change your diet. I want you to eat whole foods. So I have a chart in my office that's an anti inflammatory diet and it contains all the whole foods. I said, when you look at the food in your plate, you need to be able to recognize it. Yes, this is what this is, this is what it is. And they said, what about meat and chicken and fish? I said, no problem, as long as it is grass, finished meat, organic chicken, organic eggs, and you can have some turkey, but you must have vegetables in their normal natural state. And first thing you need to do is do that. So get rid of all the bread, all the bagels, pastries, all the things that are coming in a box, spaghetti included, pasta included. I said, look, right now just get rid of all those things. I want you to eat a natural diet, so eat as much as you want, but of the right food. And I want you to do that for approximately two to three weeks. No fasting right now. No, no fasting right now. So that way they get used to that idea that I'm going to first just change my diet and then after two to three weeks, then I bring them back inside and I say, okay, so now that you've been doing this, how do you feel they said dark. I really feel much better now. I say now you're going to learn to skip meals. So step number two is skip meals. Wake up in the morning, I'm not hungry for breakfast, skip it. Come around to lunch, have your lunch, have your dinner. Next day, have breakfast, but skip your lunch. The next day, skip your dinner. So learn to just skip meals. And look, you felt fine, nothing bad happened, you were perhaps a little hungry. You got overeat by drinking a glass of water. Drink lots of water during the daytime. So I do that for another two weeks or so. See I'm doing it gradually. Just like your athlete, you can't go to your 5k right now. You first need to build into it. So for a couple of weeks I make them just skip meals randomly. Then I sit down with them and say now this week, five days a week, I should have only two meals. And these two meals are going to be within six hours of each other. So that you're going to have 18 hours that you're not going to eat at all and only drink water. No calories in those 18 hours whatsoever. You can have water, black tea, black coffee, but no calories whatsoever. And they say oh gosh, that's great. And they do that for about two weeks. So for two weeks, Monday to Friday, two meals within a six hour window period. So they're 18 hours, they are fasting, they do that for two weeks. Weekends I let them have fun because they're with their families. So I say you can have breakfast, you can have lunch, dinner, but no snacks in between. So most you're going to have on weekends is three meals on the weekends. Then they do that for another two weeks. Then I say okay, now is when you're really going to start your fasting. Monday, Wednesday and Friday I want you to skip that second meal. Also now you're only going to eat one meal on Monday, Wednesday and Friday. That's it the rest of the days. During the week you're going to have your two meals. Weekends you can still have your three meals. So I gradually get them into that and most of the time patients are able to do it this way. When I go there, when I try to make them go to once a day eating or time restricted feeding within a six hour window. From the get go my failure rate is much higher. So I make them do it gradually and then, then they self empower themselves and then eventually I come to a three day water fast. Which we can talk about the biochemistry of that.

Dr. Rangan Chatterjee (57:28)

Yeah, yeah, I mean I love that. And I love chatting to fellow clinicians, I love chatting to researchers as well, I must be honest. But clinicians like yourself, you've got the real life experience, not just. What does the laboratory study say, what happens in the lab now that you're dealing with real patients who are probably quite scared. And you know, that sort of protocol you just took us through, just to make it really clear for people, you know, what types of patients are you recommending this in? You're a cardiologist, of course, you know, you practice in America. I don't know the exact differences on who gets referred to a cardiologist in America compared to here in the uk. So my guess would be that people are, you know, sick on some level. You know, they've either got angina already, maybe they've already got ischemic heart disease, maybe they have already had a heart attack. You know, you're obviously seeing those kinds of patients. But then we could take it one step further, which is that we know in America there was a recent study, wasn't there? Well, not that recent, a few years ago now, that showing that maybe over 80% of Americans are not in good metabolic health, which is really quite incredible. So I'm imagining pretty much all of your patients who come to see a cardiologist are already metabolically unhealthy, are already having a degree of insulin resistance and therefore problems with their health and wellbeing. So, you know, maybe help us through that a little bit, because what I want to be really clear on someone who feels that they're in good health, they're of, you know, a decent weight, they don't have any health problems. Is that the approach they should be doing as well, or are you specifically talking about patients who are already a little bit sick?

Dr. Pradeep Jammadas (59:15)

No, no, no, no. You're so right. No. What I'm talking about here applies to just about everybody. In fact, it's more than 80%. I think it applies to more than 90% of the patients. Now, of course, the cohort that I see in my office are patients who already have coronary artery disease or they already have had a heart attack. So those patients are kind of easy for me to convince that, hey, listen, you already had a heart attack, now you want another one. You already have had two stents, and then you're going to get the third one. So you need to do this, and I'm going to put you on this program. Okay, that's fine. But then there's another cohort of patients who come to me and I do a Coronary calcium score, and it's high, but they're asymptomatic and they've passed their stress test. So let me just tell everybody who doesn't know about coronary calcium score, because this is so important. And I'll tell you why. Really, it's important. So. So it's a CT scan, low level radiation of the heart, and it looks at the amount of calcium buildup in your coronary arteries. So it tells you you already have atherosclerosis. So there's no guessing that. Oh, yeah, your cholesterol, your blood pressure, your weight, and therefore your risk of having a heart attack in the next 10 years is such and such. Except plug into a formula. No, this is. Do you have the disease? Yes or no? Do the scan. Yes, you have disease. Do the stress test. Pass my stress test. Why? Why did I pass my stress test when I had calcium in my arteries? Well, you pass the stress test because your blockage in your artery caused by the calcium is less than 70%, because it takes a blockage more than 70% to reduce the blood flow in it. And then you may have symptoms or you may pass, I mean, failure stress test.

Dr. Rangan Chatterjee (60:59)

Could we just back it up a second? For people like, what is ischemic heart disease? What is atherosclerosis? What is a stress test? Because I think there'll be some people listening who probably may not be familiar with those terms. And I think it would be quite useful to sort of set that foundation, if you don't mind.

Dr. Pradeep Jammadas (61:14)

Yeah, yeah, they're very important. So atherosclerosis is the buildup of plaque in the walls of the arteries, and they occur everywhere. In your neck, in your brain, in your legs, but most importantly in your heart. So when the artery, the walls of the arteries, develop calcium in them, it's atherosclerosis. You cannot get atherosclerosis without calcium. Actually, you can, but very little. Most of the time, there's a lot of calcium with it. So the calcium is a surrogate for the plaque buildup in the walls of the arteries and that calcium buildup. The atherosclerosis can cause two problems. It can narrow your artery down on the inside, so the pipe becomes narrowed, and therefore that causes ischemic heart disease. Ischemic heart disease. Lack of circulation, lack of blood flow going down that artery. Therefore, the muscle is deprived of blood, and the patient may experience pressure, tightness, heaviness in the chest, particularly on exertion. That's called angina. So angina chest pain is because of lack of circulation due to the plaque which is picked up by the calcium. And a positive stress test. Now, a positive stress test, stress test is where you exercise you, or we use chemicals to simulate an exercise and it can tell us the consequences. The consequences of the blockage. Is my blockage more than 70% or less than 70%. If it is more than 70, it may reduce the blood flow in the muscle. And we'll pick that up on the stress test. The stress test can be a nuclear stress test or an EKG stress test. But now if your blockage is more than 70, you are more likely to experience chest pain and the effects of the lack of circulation in the heart muscle. And depending on the location of that blockage and how much muscle is getting the effects of the lack of circulation, your cardiologist may opt to either put your medicines or if you're having very bad symptoms, maybe even put a stent inside, which we can talk about. But what I really want to stress here is that you can have a blockage atherosclerotic calcium laden blockage that is less than 70%. You pass your stress test, you have no chest pain. And those are the patients that I'm seeing in my office now, because they're coming in, they're getting the colon cancer score, which they would not have otherwise, because you go to your primary care physician's office and they say, oh, yeah, your stress test is good, your cholesterol's fine, your blood pressure's okay. Yep, keep going. And the guy gets a heart attack within a year or two years. And so what happened to me? Well, because you already had the plaque, you just didn't know it. So the coronary CT scan that we do, low level looking for the calcium, picks up the calcium in the walls of the arteries and quantitates it on a score that goes from like 0 to 4000. Over 100 is significant. Between 100 and 400 is very significant, but over 400 is critical. That means you really have a lot of calcium in the walls of the arteries. So these are the patients who coming in, they do the scan and I see that they have all this calcium in the walls of it. Now I turn around to them and say, did you know that you already have atherosclerosis? You already got it. And we have studies that show that that coronary calcium is going to predict whether you're going to have a heart attack or a coronary event or a stroke, or even total mortality. More accurately than all the other blood tests put Together. So now I say, now do I have your attention? You already have. See, you've got to motivate the patient. And this is my carrot. Look, you have atherosclerosis. Now I want you to do my program. Now I'm going to look for some parameters on your blood test. I'm going to see what's causing this calcium buildup. And the patient said, but I'm fine. I said, yeah, but you didn't just build this up. Something is making your coronary calcium build up, so let's find out what it is. So I do a craft test. I do a full physical examination. I'll do tests. Advanced lipid panel. These are tests that I do in the office to see. And then I might even inquire into the gastrointestinal health. I'll do a whole evaluation to see why this patient's building up this atherosclerosis. And part of the treatment program is going to be my fasting program, which I think is the number one program for this. So those patients are very happily motivated because I show them the chronic calcium score. I said, look. Look at your picture. This is it. Check it out. You got this calcium. Another group of patients, they come in the 80% that you're referring to have metabolic syndrome. So for the. For the sake of the audience, I'm just going to tell everyone what metabolic syndrome is. This is a derangement of your metabolism, and basically, it means that you're overweight. Your body mass index is greater than 25, and you have an increased abdominal girth. All the weight is around the belly, and there's actually a ratio that you can do between the waist and the belly. The belly is increased, and then the hdl, the cholesterol is low, the triglycerides are high, and they have borderline high blood pressure. Now, when you look at all these numbers, what's the common theme that comes to mind from everything I've already said is insulin. It's all about insulin. Lowers your hdl, increases your triglycerides, increases your abdominal girth, because all the fat is down there. Remember what insulin does. Insulin puts all your calories, excess calories and frequent calories, and because of the high insulin levels, puts it where? Into the liver, pancreas, and visceral gut. And that fat is totally different from the fat that you put on all over your body when you overeat. When I overeat, just eating a lot of fats and okay, that's different. But the fats that are produced under the Influence of insulin by the liver de novo lipogenesis. The new fats that are created, the glucose has to be converted into storage product. The storage product is that fat. Fat. That fat in the liver gets deposited in the liver, pancreas. Visceral gut is very inflammatory. Composition is totally different. You do a biopsy of it, you'll find inflammatory cells in it that are producing tons and tons of interleukin 6 and tumor necrosis. Bad stuff. So metabolic syndrome, although you have these basic features, when you do additional biochemistry on them, you will find that they have increased CRP level, which is a blood test for inflammation. And if you can do even further testing, you will find that they have very high interleukin 6 tumor necrosis factors, and they have small, dense LDL particles indicative of inflammation. So these patients come into the office for prevention or they sent to me because they have a low hdl. And these are the patients that also do the fasting program. So some patients are motivated to go into my fasting program and lose the weight that way. Because see the weight, by the way, I got to tell everybody, the weight is a side effect of the metabolism that's gone wrong. You fix the metabolism, the weight comes down as a side effect. It's not really a weight loss program. It's a metabolic program in which one of the side effects is that your weight comes back down to the way it's supposed to be. Comes back the way it was supposed to be. So these patients come in and they get referred to me. So I almost invariably do a coronary calcium score on them. But. But even if their coronary calcium score is not very high, the metabolic derangements are going to make coronary calcium in the future and motivate these patients to start making the lifestyle changes by showing them that their metabolism is off. Now, these metabolic tests are not being offered by every doctor's office and nobody because it takes a lot of effort. And the insurance companies sometimes don't want to pay for it, like the advanced lipid panel. Sometimes they pay for it, sometimes they don't. So what I did in my office is I developed a program where it's a cash paying if the insurance doesn't pay for it, okay, this is how much it's going to cost you. But get the test done. It's a good investment. And I have to show them that it's going to change their life. But you're absolutely right that this metabolic derangement is not 80%. It's probably more than that. And it's very. Because I'm seeing it in children. I mean, just the other day I saw a mother bring in her 16 year old and I'm like, you know, and I said, you, I'm not a pediatric cardiologist, but there you go. She had all the derangements already at the age of 16.

Dr. Rangan Chatterjee (69:51)

Yeah, this is so, it's so fascinating. And I think, you know, I think I've read a study where they're saying nowadays atherosclerosis starts in some children even under the age of 10. I believe you can see in some kids, which is, you know, clearly no one wants to be hearing that. No parent wants that for their child. We don't really want that across society. What I find really interesting is that the different groups of patients who come in to see you, the proper, the ones who've already got established heart disease and obviously, hopefully a lot of them will be motivated to go, okay doc, tell me what to do and I'll do it. But you've also got some who are probably coming in for prevention. You know, what's the state of my heart, what's the state of my bloods? You know, is there anything I need to do? And the approach I can see is, is very similar. But you also, you know, you're sort of encouraging them to go all out and cut out all of the highly processed foods. You know, you're saying all breads, all pastas, which, which for many people is very difficult. Now some people in the UK at least would call that quite extreme. Okay. Now I also have used that approach successfully with my patients. So I can, I've absolutely seen the value off that, but I think it's worth talking about that does everyone need to go to that extreme? And I know a lot of breads these days are highly processed. They've got about 10, 15 different ingredients and they have a high glycemic index, they spike our blood sugar. Whereas I know some of the kind of German breads like the rye bread sometimes, and some of the like this in the UK at least the square shaped German breads often can have a much lower sugar response. So I guess what I'm trying to get at is all patients presumably say, look, I'm going to try it, but they can't do the whole thing the way you would ideally want them to. You know, are there some common obstacles, Are there some sort of common compromises you have to make with people when they can't go the whole way?

Dr. Pradeep Jammadas (71:58)

No, no, you're absolutely right. I mean if you Grew up on toast and white bread. And it's going to be very hard to do. So it just depends on their stats. Now, if they're coming purely for prevention, they're not overweight, but they do have some family history. It might be difficult for me to convince them that, hey, listen, you need to cut out all the bread. But clearly if they're overweight, it's basically convincing the patient that, look, you're overweight, you have metabolic disease, I can see some parameters here on the blood tests. Or you already have coronary calcium in your arteries and then explain to the consequences of that. That is not just that you're going to get a heart attack, okay? You also at risk of getting dementia when you got older, you're going to get peripheral vascular disease, you're going to get renal failure. Such a big link between kidney disease and heart disease. I said, so take a peek. What do you want? What do you want? And cancers. Obesity is also related to cancer. So sitting down between myself and my staff, explaining to the patients that, listen, this is not just about your heart, this is also about your whole life. This is really a holistic approach. This is going to affect everything. This is going to affect the way you're going to retire and what your retirement going to be like. And are you going to be aware of your own retirement and you'll be able to think, because Alzheimer's is going off the roof too. I mean, we have a huge increase in the amount of dementia that's going on. And I'm one of those who believes that much of that is also vascular. It's all vascular. I think everything. You're as old as your arteries, so what's your arterial age? Let's look at that. So I think that making these dietary changes and cutting out the bread, yes, you're absolutely right, is a difficult one to sell. But at least even if they cut down or move to pumpernickel bread or even sourdough bread is better because at least it has some benefit on the microbiome, but at least make some compromises and start, start, at least do something. And I think that that's the key thing is motivating the patient to think more long term also and not just think coronary artery disease. Everything that I tell the patients to do for their heart, I tell them straight up front, this is going to keep your eyesight, this is going to keep you from getting dementia, your renal disease, this is going to help you from, hopefully also decrease your risk of cancer, joint disease, back problems. I mean, name it. It really has so many ramifications. So, yeah, so again, it comes down to what we said right in the beginning of this talk. We have to motivate the patient. I need to get into your brain, make a change in you so that you know that this is the right thing to do. And then it resonates with you. Yes, this is right. And then see the practical results of it. And it's a slow process, gradual process. But, you know, we've done this. We've gotten patients off blood pressure medication, got them off insulin. You know, the biggest achievements I've had in the last few years now is getting patients off insulin. And it makes me feel so good when I do that. And all through this program, they come in and they're already taking 25 units of insulin twice a day. Now they're on nothing. And the A1Cs are so good.

Dr. Rangan Chatterjee (75:04)

Yeah, you love it. And I bet the patients love it as well, don't they?

Dr. Pradeep Jammadas (75:08)

Oh, gosh. Coming off insulin, coming off blood pressure medications, coming off cholesterol medications. Do you know how many patients walk into my office and they're on tons of statins and I do a coronary study on them and the score is zero. Score is zero. They have no coronary calcium and they're taking all these statins and they're hobbling around with all these muscle aches and pains and I'll just stop the statin. So that's another thing, you know, empower patients to know that, you know, there's no one treatment for all that. Yes, your cholesterol level is a little high and therefore you have to be on a statin. I try to individualize the treatment for the patients based on what's doing to your body. You know, you have a decent advanced lipid panel and we can make some dietary changes here so that you don't get any more coronary calcium, but you don't have to be on a statin. Empowering the patients to do that as well. Yeah.

Dr. Rangan Chatterjee (76:03)

Thinking about your approach, because I've been using similar approaches with my patients for a number of years now, and I think we see a different subset because I'm a general practitioner and you're a cardiologist. Of course, there's a huge crossover given how common type 2 diabetes is, how common metabolic syndrome is. But it's interesting. So you go before you approach any form of fasting, you have a three week period where you, you know, in inverted commerce, try and clean up the diets, you try and reduce the processed foods. That they're going to consume, increase the whole natural foods which is just going to put them in a much better state for when you then bring in your 18 hour fast.

Dr. Pradeep Jammadas (76:49)

Right.

Dr. Rangan Chatterjee (76:50)

So which I, which is really interesting, I, I take quite a softly, softly approach. I guess I always start with a 12 hour fast which some people wouldn't even call a fast. But I think pretty much every human being should be able to go for 12 hours and every 24 hours without eating food. And if you can't currently that's okay, but it would indicate that you are, you know, you have some sort of dysfunction, some metabolic dysfunction somewhere, otherwise you would be able to. Because some people, you know, say I really struggle with that. And I say, okay, it doesn't mean that that's not a good thing for you. It just means at the moment your biochemistry and physiology is not able to support that. So let's work on that and get you to a point where you can. And then yeah, for the right patient I also increase it up gradually. So I find that super interesting as kind of just to notice a difference because there's no right or wrong, is there? There's just we're all trying to empower our patients and, and we're all kind of biased I guess by our own experiences as to what we have found working with patients. So I found that really interesting also. Are most of your patients men? And the reason I ask that is because of course heart disease, we hear a lot about killing men. Of course it affects women as well. But also there is this question mark that many people have over fasting as okay, kind of works for men, but maybe it's not so good for women. I have my own view on that, but I wonder if you could share some of your thoughts on that.

Dr. Pradeep Jammadas (78:22)

Yeah, so the first part was 12 hours versus 18 hours. You know, there's two things that I'm concerned about when patients start fasting. One is the withdrawal. And I think that withdrawal comes in two shapes. There's mental withdrawal, that it's, I'm a Pavlovian reflex. I have to eat at 8 o'clock in the morning. I've done that for so many years. The other one is a true biochemical addiction at the level of the brain. So that really concerns me. That's why I do this period to come in. Because that gets them rid of the addiction. Because I think addiction is a real issue. They're addicted Pavlovian wise, but they're also biochemically in the brain and some of them really do go through withdrawal symptoms. And they said, you know, I felt terrible, I started sweating and I had these intense cravings. And I said, God, this sounds like heroin withdrawal. And I think it's real. So that's why I do this. Just skipping meals and gradually getting into it. But once. How long does that take? That's the question. How long does that take? And in my experience, I've been doing this, it takes three weeks. At the end of three weeks, I can pretty confidently say that the patients have gone through their withdrawals and they're going to be now okay to take on the 18 hours. And that's why I do it that way. And the withdrawals are very real because the foods have addictive properties. Sugar is definitely addictive. We know that. We know dairy products have caseomorphine, which actually are addictive. So you crave those things that Doc has told you to skip the meals on and all that. But I think that after three weeks, they're done. And I tell patients it's not going to be easy. For the first three weeks, you're going to get a lot of cravings. You need social support. You need to structure your life. You need to do your shopping during the times that you're going to be eating that meal. Otherwise you keep your mind busy and you got to get your seven hours of sleep. So the withdrawal issue is very important. That's why I do this gradual stuff. And then the answer to the second part, the women, definitely women are not exempt from CAD and heart disease. And something that applies to you and me is Asian women, too. Did you know that the incidence of coronary artery disease in Indian women is actually higher than Indian men? But it's just that they don't get diagnosed and they don't seem to complain that much, so they don't come to the doctor's office. But actually, I've seen worse coronary artery disease in Indian women in my office than in Indian men. And in Indians in general, they have far more coronary artery disease than Caucasians. So it's a huge problem. So I think that women are certainly a population that is not exempt from coronary artery disease. Now, the fasting programs in women, there are some data to suggest that they may not benefit as much as men. But overall, I think that what I've seen is that they also seem to benefit just as much. So I don't make much distinction between men and women. They come in here, I work them up the same way. I'm very aggressive with women as well, especially women from South Asia. When they walk in, they've got my antennas. In fact, any South Asian that walks into my office, my antennas are up. Because they are what I call tofis. You know, they're thin on the outside, they fat on the inside, and they're metabolically very deranged. And there are specific things that I tell them about fasting and dietary recommendations for their diet. And the reasons have to do with vitamin K2 as well, which I'm finding absolutely fascinating these days.

Dr. Rangan Chatterjee (82:17)

I very much appreciate that perspective. Thank you first of all, for sharing that you're seeing lots of coronary artery disease potentially worse in South Asian women than South Asian men. I don't think that is commonly known. I did not know that. And actually I'm now thinking of people and women in my family. I'm thinking, right, okay, maybe instead of thinking about the men, we need to start thinking about the women as well in terms of prevention, in terms of getting early screening done, blood tests, maybe coronary calcium score, or whatever might be available to people. My experience of fasting in inverted commas because fasting can mean so many different things to so many different people, is, yeah, I have seen some women with hormonal problems. I'm not talking about necessarily insulin hormonal problems. I'm talking more about kind of around the menopause, let's say, or estrogen progesterone sort of imbalance issues. I found with some women it can be a bit challenging for fasting and some women don't do so well. But I've also found many women who thrive on it. So I think a lot of the time people, I've noticed this on social media. A lot people try, oh, it doesn't work for women. It's like, well, what do you mean, 100% of women all the time? It's like, you know, and this is why I love talking to real life clinicians. It's like, well, we see that not everything works for everyone all of the time, and we have to tweak our view depending on what we see. And, and when we make these kind of gross generalizations that, oh, fasting doesn't work for women. It's like, well, we put like, let's say there's that subsection of women who thrive on fasting. Well, they get put off. They think, oh, it's not for me. And it's kind of like, well, there's no one size fits all in anything. And you see enough patients, you kind of realize that there's very few. Although fasting might be one of them, I guess you might argue, but do you know what I mean? I kind of feel these days we get too polarized on these things and we just miss the kind of nuance that's actually there.

Dr. Pradeep Jammadas (84:15)

You're absolutely right. And this is the new medicine. We're going to become more individual. Okay. Why is this lady not able to enter into my fasting program? She really needs to. Her BMI is 42 and she has all this stuff going on. There may be other reasons. She may have so much stress in her life. She may have financial problems that she can't buy the right kinds of foods that I want her to buy. She may be in a very dysfunctional relationship and that may be causing so many problems for her. She may not be sleeping at night, a simple thing. She may have undiagnosed obstructive sleep apnea, which is why during the daytime she has so much fatigue, tiredness, and she's never going to develop enough willpower to enter into my program until I get her a good night's sleep. So maybe put a CPAP on her for the time being and, and then see that, oh yeah, now she can abide by the principles of the fasting. So, you know, it just means looking deeper into the. Why weren't you able to do this? There are obvious factors why you cannot. Where's your willpower? Why don't you have the willpower? Let's look into this. We don't always find the answers to everything, but I think that looking at them overall. So the sleep apnea is a huge issue, by the way. I mean, massive problem that I find so oftentimes temporarily I do put them on a CPAP mask and say that you're going to have more energy, mental energy and clarity and less neurodisfunctional during the daytime. And therefore you will be able to abide by the diet. But the goal is really to lose the weight so that we can get you off the CPAP eventually.

Dr. Rangan Chatterjee (85:47)

So batsi, batsi the kind of therapeutic use of fasting. So you do this kind of three week program where they unprocess their diet. Then you put them on this kind of 18 hour fast. So they're having two meals a day over six hours and then for 18 hours are not consuming anything. We must talk about any contraindications like insulin or blood sugar medications at some point just to make sure that, you know, people who are listening, who want to try stuff that we've, we've covered that. But also I Want to go a bit further because I know you have used 24 hour fasting with patients, I know you have used three day fasts. And you have also shared in previous conversations some very powerful statistics. One in particular I remember on a seven day fast you shared a statistic, a bit of research from Boston in terms of what that does to your lifetime cancer risk. So maybe you could talk about some of these longer fasts and then practically, how do people start going about that?

Dr. Pradeep Jammadas (86:47)

Yes, yes. So absolutely. So at all times they are supposed to take their blood pressures twice a day, make sure that the blood pressure not going down too because they do not stop the blood pressure medications right off the bat. So the blood pressure medication reduction will be done depending on your blood pressure readings. As far as blood sugar is concerned. If they are on oral agents, I'll continue those oral agents while they're doing the 18 hour fast periods, even the 24 hour fast, I'll keep them on it and I will ask them to monitor their blood sugars. Now, continuous glucose monitoring, the little devices. I only advise those on patients who are on insulin when I'm fasting them because I want to make sure that their insulins don't drop off. But when a patient is taking insulin and he does the 24 hour fasts, I drop the insulin levels by half first, I mean insulin dosage by half. And I monitor the blood sugars and then when they go beyond 24 hour fasts, I stop insulin completely. Completely, Completely. I stop it completely because I don't want them to become hypoglycemic. So oral agents, I will continue insulin, I will discontinue if I'm doing more than 24 hours. But I monitor the blood sugars very closely. And then that brings me to a little longer fast. Before I go to longer fasts, I make them do a 36 hour fast. So I'll make them do that once a week. Once a week means that evening rolls around, skip that meal also and then have yourself a breakfast, treat yourself with a breakfast the next day and that brings it to 36 hours. So I make them do at least one 36 hour fast for maybe two consecutive weeks and then I'll take them to higher levels.

Dr. Rangan Chatterjee (88:35)

Can I just clarify that? So the 36 hour fast, the way you have found it most beneficial for most of your patients is what you skip one evening meal to the next evening meal. When does that fasting time? I know you can do it any way you want, but what have you found to work? Can we just Clarify that.

Dr. Pradeep Jammadas (88:52)

Yeah. So the patients already are used to having only one meal a day. So then I'll say skip that one meal and then have the next meal when you're supposed to have, then that'll bring it to 36 hours. So for most patients these days, they're having the evening meals because it's more social. They're having it with the family. Okay, so they'll skip breakfast, they'll skip lunch. Evening comes down, they're supposed to eat and I tell them skip it and go and have breakfast the next day. That brings them to 36 hours.

Dr. Rangan Chatterjee (89:18)

I guess if they're already used to having one meal a day, then actually skipping that evening meal is kind of, I don't know, go to, go to bed early as well. You know, sort of, you know, it's. Yeah, I like that. So what stage do you take the. From this two meal a day, which is this, you know, the six hour eating window, you know, you, you do that initially for the 18 hour fast, then you take them to 24 hours to you with just one meal a day. Is that how you do it?

Dr. Pradeep Jammadas (89:46)

That's exactly how I do it. And then they're doing one meal a day, five days a week. Weekends, they're going to have two meals. They do that for two weeks. And then I say, okay, you've been doing this for two weeks now. You've been having only one meal a day. Next few weeks, one day a week, you're going to go to 36. And the way you're going to do it is you're going to skip that one meal also and then have a breakfast the next day. So that'll bring you to the. And I want to see how you feel. And most of them come back saying, I just missed the meal in the evening, I watched a movie and went to bed. So why am I going from 24 to 36? Because I want to get them ready for longer fasts, especially if they tremendously overweight and they're metabolically deranged. What's the biochemical advantage between 24 and 36? By 36 hours, almost all of them will be in some degree of ketogenesis. So it's hard to know who's going to start spilling ketones at 18 hours, 24 hours, 30 or 32 hours, it's hard to know that. So when I prime them, then I'm finding that there's longer and longer periods of ketogenesis. That means they go into ketone production at 16 hours hours. So long as they Made their dietary changes gradually, got into this. The ketogenesis phase starts a little bit Sooner at about 16 hours. And the most motivated patients say that, oh, I want to know. I said, okay, if you want to know, then go to the pharmacy and pick up some keto sticks and just test your urine and tell me when you started spilling the ketones. So after 24 hour fast, almost all of them are spilling ketones. And when they're spilling ketones, I know what's going on with their physiology at that point. I know that they're getting the benefits of some degree of autophagy, growth hormone, BDNF production and mitophagy. I know that's happening because they're spilling ketones. Spilling ketones. So that's another motivating thing in the patient who's showing me the interest and the ones I really want them to. Yes, give them the tool, take this home, check your ketones. That's what I find so fascinating. So by 36 hours they're making the ketones. So they'll do that for a couple of weeks. Where they now went to 36 hour fasts once a week for two weeks. Now, at that point, depending on how motivated they feel and how well they are doing now, I'll go to more prolonged fasts. And my favorite fast is the three day water fast. And most of them, I'm telling you, greater than 95% of them, when they've graduated to this point where they've gradually gone and done all this, they're able to do the three day water fast with no difficulty whatsoever. And if they get cramps, then I tell them, okay, take a glass of water and put a pinch of salt in it and just down it and you'll feel better. But most of them don't because they've adapted themselves. If you go into a three day water fast too quickly, you're going to get more cramps, but more importantly, you're going to go through what is known as keto flu and you just feel terrible and achy and you just feel really bad. So I do it gradually, but I must make them go to a three day water fast. I use it in that case. I also use it in patients who are able to lose weight, but then they reach a plateau. So now they're weighing 230 pounds and I want them to have more weight loss. So they've been doing this now for a month and they said, look doc, I just can't shed any more weight now. I've done everything you're saying, and I'll put them on a three day water fast and lo and behold, they'll start losing weight again. So I use that in patients who've reached a plateau going to the three day water fast.

Dr. Rangan Chatterjee (93:28)

Yeah, thank you for sharing that. I think something I did want to bring up today because I know a lot of people and again, we're all influenced by the online world or the patients that we've seen or the online world that we inhabit. And you know, I spoke to David Sinclair, this Harvard professor who talks about aging in a very, very profound and novel way. And you know, when I put out that episode with David, a lot of people were saying, look, asking people to skip meals is very triggering for people with eating disorders. And I know eating disorders are on the rise massively all over the world, certainly here in the UK and in America. So I think we need to be careful about that. I think it's worth me just flagging that here that potentially this advice is not for people with eating disorders. That's a sort of separate issue. Well, I'd welcome your perspective on that. But also, you know, is it possible that we take these things to extremes? I guess it would be some people. We mentioned Anna Lembke's book before Dopamine Nation and that we are all, we're living in a world of addicts now and that, you know, she mentions that the smartphone is the modern day hypodermic needle, which I thought was a very provocative way, but I actually completely agree with her of talking about it. There's health, there's physical, biochemical health, but there's also this kind of emotional health and our mental well being. Do you think as much as you love fasting, do you think some people, they can sort of overdo it and get so addicted to kind of that feeling of fasting and actually go to an extreme which potentially could become problematic.

Dr. Pradeep Jammadas (95:20)

I think you're right, it can happen. Fortunately, I haven't seen it here with somebody. I tell them, stop now, stop, stop, this is enough now you should be eating two meals a day. And you know, I think that the pattern you need to settle down in is for you. I think that two meals a day in a six or eight hour window period may be a nice thing for you to do chronically to maintain what you've gained, the benefits that you've already gained then. I haven't seen any patients who ignored that and continued to do the three day water fast on a weekly basis or whatever, or two weekly basis. I haven't seen that. But. But you are absolutely right that there are some patients who clearly have an eating disorder and they clearly have a type of addiction. And they're going up at night and they creep downstairs and they're eating away five bars of chocolates and all this kinds of stuff. And those patients clearly do need help. And I will not deal with those on my own. I will supervise it, But I'll send them to a psychologist that actually specializes in addictions, because they have to really spend time with that patient about addiction behavior. And it's not just behavior about the food. There may be other issues that are actually triggering because, see, you slide from one addiction to the other, to the other to the other. So you can't take up this alone on its own until you also take care of the sugar and maybe the cell phone and other digital gadgets that give you the instant gratifications. And there may even be other issues he may be a gambler for or have other type of deviant behavior addictions. So, no, you're absolutely right. So. So recognizing those with the biggest problems. And addiction is a huge problem. And it's becoming more known now that the addiction is to not only sugar, but it's also addicted to processed food content. Processed foods and the content of processed foods are very addictive. And I think that that's why you want to change the type of food that you see. Getting rid of all the addictive substances in the food, the addictive sugar in the food, and addictive behaviors in other aspects of your life as well.

Dr. Rangan Chatterjee (97:26)

Yeah.

Dr. Pradeep Jammadas (97:26)

So it's really looking at the whole thing. It's a huge problem. It's a huge problem. And yes, we are an addicted nation. And that's why it's making it so easier for us to become addicted to food later on in life, because it starts at a very young age already getting addicted to gadgets and instant gratification.

Dr. Rangan Chatterjee (97:46)

I want to move on to the mental benefits shortly of fasting, because I think there's a real important piece there that we touched on a couple of times in the conversation already before I do. I sort of feel that there's so much divisiveness and, you know, frankly, fighting about different diets that I think sometimes gets so unhelpful for the general public. They see doctors who they admire saying, this diet has got this evidence. This is really good. And they see another doctor who they admire say, this diet's really good. It has all this evidence. And I think. And I know this from talking to patients and talking to the public that many people find this incredibly confusing. I really like fasting for the right person in the right state of health. I kind of see it as the great unifier in many ways because as long as you are metabolically able to do that fast, you know, whether you choose to eat meat and fish or whether you choose to be vegan, if you are whole food primarily and not having much processed food at all in your diet, then you're still going to get benefits from fasting, right? Whether you're low carb or whether you're vegan. And you know, it's interesting that video that you did on fasting, fasting for survival on YouTube, which is, you know, had millions of views. I was reading through the comments just before this conversation, Dr. Jammadas, and the top comment was really, I think encompasses everything that you stand for. He, I think said he was mostly plant based and he started off following your advice with a whole food, mostly plant based diet. I think he started off with 18 hour fast. He moved up to 24 hour ones, I can't quite remember. Then he moved to maybe one three day one every six months. And he's documented his health journey over two years. And it is utterly remarkable that you put out a video on YouTube and you have completely empowered that guy to transform his life. So first of all, just I want to acknowledge you for that. That's just one of millions of people who've seen that video and changed their lives. So that's just incredible work that you're doing. But what do you think about this concept that fasting could be the great unifier? No matter what tribe you belong to, you can still get involved with fasting and yield and reap many of those benefits.

Dr. Pradeep Jammadas (100:20)

You're absolutely right. The various dietary programs that have come out have confused the public. It's confused the physicians as well. I mean, my patients come and say that I'm following this diet, that diet, and nothing happened. And this one's too hard for me and this one's too restrictive for me and it doesn't fit with my lifestyle. Understand that. I understand that fasting forgives you. Fasting in a sense forgives you for certain foods that you may then consume. And actually think about it this way. Also, you eat that slice of bread after a fast. Your insulin response is totally different in the fasting state than in a fed state. You're going to make less insulin for the same slice of bread in a fasting state. So it's and the type of food that they consume. So when I First started out, I was years and years and years ago, I'd say, you got to be a vegetarian, you got to drop all meats. And being here in the United States, how many patients are going to become vegetarian? Right? So, and then as the data came out and I started studying more and more, I changed. I decided that, hey, there's something wrong with this. You know, people should be able to eat ancestral foods and what they grew up with. But the problem was processed foods. When we take the foods and we process them, we change them, and all the additives that we put into and the way we grow our food or way we get our meats has changed. So I said, no, no, no, no, this is not right. When I studied non vegetarian diets around the world, how come there is low incidence of heart disease? There are populations that eat only meat and only drink milk and blood, or the population that only eat starches and a lot of it, and they also live long. What's the commonality? What was the commonality in all of them? The commonality was no processed foods, no additives, right? No, no sugar. So they all had simple diets. So then I came up with my own plan and I said, listen, what do you like to eat? What do you like to eat? So you want to eat red meat, okay. Then eat grass, finished meat, because that'll have more nutrients in it. The fats will be the right kind of fats. You will not have all those Omega 6s in there. You'll have more natural fats in there. And if you want to eat eggs, chicken. So I let them do that. And I said, but you got to also introduce plants in your diet because you need the plants, not for you. And you're going to get some, some water soluble vitamins, et cetera, et cetera into your system and eat plants and all, but it's really for your gut bacteria. So again, I had to read a lot about the microbiome to understand that the fiber is hugely important, very important. And so I tell them, eat your vegetables as well. So this is my diet plan. It's not so restrictive. Just stay away from anything that your great great grandfather wouldn't eat. And no processed foods, anything in a packet box, barcode, stay away from anything made into a flour. And that's been a hard one. The flour one.

Dr. Rangan Chatterjee (103:28)

Yeah, it's everywhere. It's everywhere, isn't it?

Dr. Pradeep Jammadas (103:32)

It's a huge, huge, huge problem.

Dr. Rangan Chatterjee (103:34)

Yeah.

Dr. Pradeep Jammadas (103:34)

But I can't do it without it.

Dr. Rangan Chatterjee (103:36)

I love this. I'm so enjoying speaking to you. There's a real kind of. There's just a beautiful energy. There's also this kind of real life practicalness that you know what it's like when these patients come in and you've got in your head the ideal thing. But you got to work with people and their tastes and their preferences and their culture and what they want. And I really do strongly feel that too many people these days on social media, commentate, they look at the science and go, oh, this is what everyone needs to do. It's like, it's just not how it works in real life. In my experience, you know, people are different. They've got different desires, they've got different cultures, different preferences. So I really like that you've mentioned all the kind of physical benefits, the biochemical benefits when we have a period of not taking in food, a period of fasting. But there's also something really powerful, isn't there, like you have touched on several times, but what it does for you when you know, oh, I can go 12 hours without food. I can go 18 hours. Wow. Actually, I can go 24 hours and I don't actually need to put something in my mouth. I think we shouldn't undervalue just what that does for someone. You know, I think it's freedom. It's freedom from a dependency on food, addictive foods, processed foods, sugar. It means that you can go about, you're out on the train station or the airport and there's no good food to have. Cool. Just don't eat, Take the flight, don't eat. There's a real freedom which many people feel, that they're in chains, I guess, to the food industry and to their hunger and their stomach. So, you know, can you speak a little bit about that and why you feel that's so important?

Dr. Pradeep Jammadas (105:25)

Yeah, I love the fact that you use that word, freedom, because, you know, I said, okay, it empowers the patient, but it is a real freedom. It's a freedom that they know that their behavior resulted in no adverse effect and that they were able to overcome this, which they never thought they could overcome. So these little hurdles that they're overcoming in their diet actually has huge repercussions in other aspects of their life. And really, honestly, it percolates into their workplace, into their family life, in their social interactions with their friends. And I've seen that these people, they just become more self confident. And I think it's because we introduce terms to them like that's who you are, the real you. So it opens up a new aspect of Their existence. That there is a part of me that's separate and apart from my body and from my mind and my cravings and my stomach and my feelings and all these things. And that's the real me. And of course, you know, this gets into some of that part that I have a huge interest in, which is, who are you? Yeah, who are you really? Where is the you? And why can't you that you change your behavior? Of course you can, because you need to change your identification. So this is an identification change that I see the patients doing. They realize that they are in charge that them inside them, not the body, not the mind. There's actually an awareness, an amnes. And I am. And that is huge, Huge. And I found that people who have done this program over the last few years, they actually get work promotions. They actually become better supervisors, they become just better family members and caregivers. It's miraculous how one thing, because it's showing them that yes, you are in charge, look, you can do it, you can do it. And they just self empower themselves. It feels so good. Self confidence just goes off the roof. And I think that's. That I'm learning more about this. But I think it does boil down to. Because that also brings me to stress management. Because one of the things we do tell our patients is that if you start getting stressed out during these periods where you're getting into the fasting period, you need to go out and do some meditation. We tell them and we show them how to meditate. And I have a very simple meditation technique where I just basically ask the patients to, okay, just close your eyes and just concentrate on your breathing only. And when a thought comes, let the thought go. Don't follow up on it because then another thought will come in a few minutes. Don't follow up on it. Wait, just come back to your breathing. Concentrate on your breathing as the breath goes in and out. And you will find that there'll be gaps in between your thoughts that get longer and longer and longer. And my patients have all said, yes, you're absolutely right, there's blankness. I said, well, that blankness when you don't have a thought or when you're not thinking of something, that's you, that's the real you. And when you come out of this for 15, 20 minutes, you will realize that there is that you in you. And you can make up your mind about anything, you can do anything. It'll empower you and you'll feel less stressed out, you'll feel less compelled you're less automatic. You will become, as you said that word that you used, you'll have freedom. You'll have freedom. And I find that fascinating. So you see this whole thing, I said this in the beginning, that fasting seems to open up that onion into all different parts of your life. It's just amazing stuff.

Dr. Rangan Chatterjee (109:27)

I mean, I love it. I just love it. And if and when we have our second conversation, I could see us going deep into who we are, spiritual spirituality. And I, I really do feel that's a missing piece in medicine. Like, it's not just about telling someone what they should do for their health. I mean, people don't really do what other people say in the long term. In my experience, they might do initially to get them going, but at some point it has to change from being the doctor's plan to being my plan. At some point it needs to be like, they go on your three week unprocess, your diet, sort of regime. They start fasting at some point. Maybe after a month, two months, three months. You want that self empowerment piece where it's like, yeah, okay, the doctor's guided me, but I know what I'm doing now. I want to eat this way. I want to fast like this because I feel good when I do it. So I'm now doing it not because he told me to, but because I want to. And I think that, you know, like you, I teach doctors, I always talk to them about this. This is a really important piece of the puzzle. Another thought I had is fasting is, you know, initially at least a difficult thing for many people to do. And we kind of know that when humans do difficult things, whether it's fasting for 24 hours when you find it hard, or whether it's completing a half marathon when, and six months ago, you couldn't walk around the block. What it does for us in terms of who we are and our self esteem and our confidence, it's very, very powerful, isn't it? So I really love that you are bringing that up. Also in the context of fasting, we.

Dr. Pradeep Jammadas (111:12)

Have to, you know that there's a huge, in health, there's a huge component of your mental being and your understanding of who you are and your role in your life and the people around you. So one of my interests, and maybe we can talk about this in other occasions, is what are your relationships like, especially with your mother, because that's going to tell you how long you're going to really live. It's amazing. Or when my patients are in the Hospital, how many people come visit them after open heart surgery determines how quickly they're going to recover from open heart surgery, same surgery, what's going on here. So we can, you know, there's huge repercussions on how patients health is depending on their social and then how do they view themselves in society and their role and the hierarchy in society. And that seems to also dictate outcomes in health, irrespective of how much healthcare provide facilities are available to them. So there's all these other social determinants of health that are extremely important and I think that we don't talk about that enough and I think that that's something that we need to talk about because in cardiology, besides my fasting, my other aspect is I do want to get into all that with my patients to see that health is defined by you basically metabolize your psychosocial being, you metabolize it into your body. So be careful about your thoughts about who you are and how you're interacting with the world and everything that's going around you. Because in an instantaneous state, this moment, you're actually metabolizing it into physiology in your body. So it's fascinating stuff and I have lots of data on that. Lots of it.

Dr. Rangan Chatterjee (112:58)

Well, we are definitely going to have a second conversation because I think we've not even scratched the surface of that. Just to finish off this conversation, Dr. Jamnadas, firstly, thank you for your time. I know you're a super busy cardiologist. This podcast is called Feel Better, Live More. When we feel better, we get more out of our lives. And I wonder if we're at the end of this conversation, you could share with your decades of experience as a cardiologist, with all the patients you've seen, can you share with my listeners, with my viewers, some of your very top tips that they can think about applying into their lives immediately after this conversation finishes?

Dr. Pradeep Jammadas (113:43)

Number one, eat only natural foods in its natural state. Two, eat infrequently only when you are hungry. Three, sleep at least seven hours a day. Number four, find pleasure in your life and activities so that you don't metabolize bad physiology from bad habits. Find happiness, find pleasure in your life. And if you do these four things, you'll find your health will turn around completely.

Dr. Rangan Chatterjee (114:26)

Well, thank you so much for your time. Where can people learn more about you if they want to sort of follow you on social media or on your website? You know, where, where should people go?

Dr. Pradeep Jammadas (114:36)

Yeah, well, on the YouTubes I have a channel called Cardiovascular interventions with my name, Preet Gymnadis. And I also have Galen Foundation. Now, Galen foundation is a foundation that I set up about 12 years ago for educational purposes, and I do give talks all over town. And of course because of COVID we did not do that. I go all over Florida to do it. But it's called Galen Foundation. It's also on YouTube and my website is orlando cvi.com and even if they just google my name, it'll show up. And on my website I have a lot of educational materials that people can use, videos, but a lot of that has to do with real cardiology, like how to put a stent in or what's a pacemaker and what's an ICD and all that kind of stuff. But that's also still very important. But I think that the most important new things that are on the websites that you can see is the diet and the coronary calcium, which I think is a huge advancement in motivating patients to make the changes that they need to change catching disease before it actually becomes a problem.

Dr. Rangan Chatterjee (115:36)

Dr. Jammath, you're an incredible man. You're doing incredible work. Thank you for joining me on the show and I'll see you very soon.

Dr. Rangan Chatterjee (115:46)

Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life.

Dr. Rangan Chatterjee (115:54)

And also have a think about one.

Dr. Rangan Chatterjee (115:56)

Thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and how happiness. In that email I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free@drchatterjee.com Friday 5 Now if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world covering all kinds of different topics. Happiness, Food, Stress, Sleep, behavior change and movements, weight loss, loss and so much more. So please do take a moment to check them out. They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And before you go, I just want to let you know about an exclusive January offer. If you want to listen to every episode without having to hear any of the adverts, you can do so with an Apple subscription. We're extending the free trial from seven.

Dr. Rangan Chatterjee (117:48)

Days to 30 days.

Dr. Rangan Chatterjee (117:50)

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