Join Dr. Michelle Woolhouse as she talks with gastroenterologist Dr. Pran Yoganathan about supporting clients through diet and lifestyle changes for better metabolic and digestive health.
Understanding that current discourse around gut health, optimal diet and wellness is a complex, and confusing space, Dr. Pran Yoganathan focusses on simplifying dietary guidance to focus on the intake of dietary protein and fats, while working with individual patients to lower metabolic risk and imbalances. Dr. Pran and Dr. Michelle discuss the benefits of referring to our ancestral diet and lifestyle practices to simplify our own diets in a world when we are overwhelmed with conflicting dietary advice. Importantly, Dr. Pran focuses on the need to tailor dietary advice to the individual, based on their health status rather than their microbiome to ensure that they are able to get the best from the foods that they are eating and prevent disease.
Covered in this episode
[00:31] Welcoming Dr. Pran Yoganathan
[01:44] What is a carnivore diet?
[04:27] Maximising nutrient density to optimise metabolic health
[07:56] Feeding the microbiome versus feeding ourselves
[10:49] Why some people feel better when removing plant-based foods
[14:55] The thermagenics of protein
[17:59] The power of personalised diets
[21:04] The diversity of traditional diets
[24:33] Not all fats are created equal
[27:08] The omnivore diet and insulin response
[31:48] Exercise and increasing metabolic rate
[35:21] The benefits of a low fibre diet in Crohn’s and ulcerative colitis
[40:13] Should we “weed, seed and feed?”
[43:48] Thanking Pran and closing remarks
Key Takeaways
- A diet that contains adequate protein and fat from grass-fed animals will provide greater satiety and has a high thermic effect which may support weight loss.
- To break down proteins properly, fats must be consumed at the same time.
- A high fibre diet does not necessarily suit all people, particularly those who have diverticulitis or Crohn’s disease.
- Nutritional advice is convoluted and features many blanket guidelines that are not tailored to the individual. Personalising nutritional advice to the person will ensure that their diet can provide them with the health they need.
- Looking to ancestral diets can provide us with key insights into how to eat to support our bodies.
- It is important to simplify nutritional advice to micro and macronutrient levels to ensure that these basic requirements are met.
- Fibre provides fuel for the microbiome and does not support the health of the human.
- “There is no essential food, only essential nutrients.”
- When we are thinking about diet we need to think about maximising nutrient density to optomise metabolic health.
Resources Discussed in this episode
Transcript
Michelle: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr. Michelle Woolhouse.
The world of diet and gut health is ever-changing, full of opinion, research, emotion, passion, and with the scientific landscape evolving by the day. Naturopaths and traditional medicine practitioners have espoused the connection between gut health and its impact on whole-body health for centuries. But despite an extensive amount of scientific research that backs up this connection, Western medicine is lagging in getting up to speed, incorporating this into practice, and training for new doctors. But there are some who have been championing the role of food and nutrition in not only gut health, but in the prevention of disease and part of Whole Person Care.
Today’s guest, Dr. Pran Yoganathan, is one of those rare doctors. He's a gastroenterologist who uses food and lifestyle changes to optimise his patients' gastrointestinal and metabolic health and empowers them to embark on a journey of self-healing. Welcome to FX Medicine, Dr. Pran.
Pran: Thank you, Michelle. I appreciate you having me on. It'll be a pleasure to catch up on these topics.
Michelle: So one of the interesting aspects of your work is your open-mindedness and willingness to explore new and ancient ways, really, to support people's long-term health. And today, we're going to focus on discussing a very old nutritional concept, one that's baffled modern day's nutritionists, and that is the carnivore diet. So Dr. Pran, how did you become interested in this? And what do you exactly mean by the carnivore diet?
Pran: Thanks, Michelle. Look, I think there's a lot of wisdom in looking at our evolutionary past. I think you've always got to view biology through evolutionary lenses, and something as ancient as nutrition, I mean, our species is three and a half to four million years old, so we've certainly adapted to consume nutrients or food in a specific way. So I started looking at it more from a gastrointestinal perspective, like, what...almost like reverse-engineering the gut, what is our gastrointestinal tract supposed to do?
And it really opened up my eyes in terms of what we're supposed to eat and how we are supposed to consume food, which leads us to the paradox or the dichotomy, which is that some of the foods that are evolutionary, from an evolutionary perspective, that we're best adapted to, are some of the foods that are demonised by the nutritional sector and, in fact, the healthcare sector. And I think this is where I had to stand at a crossroads and make my decision as to how do we progress from there?
And the concept that I've really embraced is individuality, which is that we've got to tailor diets according to the preference of the person and what best suits the person, at what stage of life they're at, their activity levels, their ethical beliefs, all this sort of stuff, rather than just preach a pyramid, which clearly, for the last 40 years, hasn't really worked, because we're seeing disease, chronic disease, at levels that are really unprecedented. So when you asked me...
Michelle: Unbelievable.
Pran: ...the question of, well, what does a carnivore diet mean? I've never preached the idea of eating exclusively meat. I think some balance is required. But at the same time, I'm irritated by the fact that meats have gotten such a bad name in the health care and nutritional sector, and in particular, red meat. And these are some of the myths that I'm hoping to dispel. That, in fact, a whole food, red meat-based diet can be one that is very nutritious, but also very, very beneficial, especially in the states of disease, which is where most adult Australians find themselves.
Michelle: One of the things that I look at modern medicine and when we have so much technological advances like the MRI machines are incredible, and some of our testing. But yet, we're really seeing disease at astronomical levels, obesity and type 2 diabetes, heart disease, cancer. It's just extraordinary what we're putting up with.
But one of the things I was reading over the weekend in preparation for this, and it's really opened my mind, and I know that you are really strong on this evolutionary nutrition, but I was reading an article written by an Inuit woman from Northwestern Alaska. And just reading about that particular diet, which has always been quite baffling for me, how did these people survive with virtually no plants and vegetables at all? For a couple of months of the year, they might have had some things growing through the ice. And it was associated with longevity and good health. And so I think that looking at those diets can give us such inspiration. Like, we think about food per se, but there's really no essential food, there's only really essential nutrients. Would you agree with that?
Pran: Absolutely right. Absolutely right. That's exactly right. And you've hit the nail on the head there, Michelle. We've overcomplicated diet and it's especially in the medical sector and I think also in the nutritional sector. We've overcomplicated. Really, it's about eating to achieve nutrients and maximising nutrient density to optimise metabolic health. That's what fundamentally all of this is about. And the Inuits were well known for this. There's other tribes all around the world, the Maasai of the African plains. They're the cow herders that survived purely on animal source foods or largely on animal source foods, and they enjoy good health.
I think human species is very adaptable. We just adapt to the environment that we're in. And for the most part of the Northern European history where these people existed in very similar environments to Alaska actually, with a very cold environment faced by the frozen tundra, there was very little in the way of plant-based food. And we've got to remember, like, agrarian societies, or agricultural society’s really only 10,000 to 12,000 years old. Our species is 3.5 to 4 million years old. So the question is, what are we consuming? What's our gut really adapted to?
I think we've overcomplicated it. You talk to most doctors, medical doctors, or even nutritionists, you say what's an ideal diet? A lot of them will tell you it's a high fibre diet, which really, to me, lacks any sort of insight. Not saying the fibre is not beneficial, we can touch on that later. But fibre is not a nutrient. It's not something that human beings can utilise. It's food for the microbiome or the gut bacteria. They ferment the fibre if it's soluble and they produce a beneficial component called short-chain fatty acid, which is a ketone which our body can utilise.
But the physiological limit to what the gut or the human body can utilise in terms of fibre is actually very, very limited. So it leads me to the conclusion that doctors and these so-called nutritional gurus, in particular, the cardiologists who really espouse or preach a low fat, low meat diet, have very little idea what they're talking about.
Michelle: That's really interesting, I think. I like looking at these kinds of extremes. I mean, the Eskimo Inuit diet is a diet of extreme compared to what we're doing now. So it obviously wasn't extreme, I mean, they lived in an extreme environment, let's face it. But it can teach us so much to actually drill down and look at what humans need. So, what is going on with the gut biome on a predominantly meat-based diet? What's happening with the gut biome in that regard in your mind?
Pran: Yeah. I think we get too nuanced about the gut microbiome. I mean, I can tell you right now, Michelle, without any debate, I don't think there can be any debate on this, that fundamentally what's stuffing our human microbiome, or the gut microbiome, is ultra-processed food. And that's what's doing it. And the vast majority of ultra-processed food is plant-based calories.
Whether that comes from sugar or refined carbohydrates such as breads and pasta, these are plant-based foods. And of course, refined meat falls into that category but there's actually, the vast majority of refined food is plant-based. And so if you look at it from that context, it becomes relatively simple.
In terms of the gut microbiome, the gut microbiome, the vast population of your gastrointestinal microbiome exists in the hindgut, which is the colon. And what makes it to the colon is a protein that's not absorbed and carbohydrates that are not absorbed. Fat as well, I suppose, if you've got issues with fat malabsorption or you're overeating fat. Very difficult to malabsorb protein unless there is pathology or concurrent drug use, which might be impairing it.
Michelle: Yeah.
Pran: So really, when you think about it, the vast majority of things that end up in the colon are undigested carbohydrates, which can be the FODMAP-type carbohydrates, the fructans and the lactose and the fructose and etc. Or fibre, which as I pointed out before, is a carbohydrate that humans cannot utilise per se. Their gut microbiome does.
So really, when you think about it, the microbiome exists on those things. So people have become obsessed with feeding the gut and the gut microbiome. Really, we've got to learn to feed ourselves. We've got a population of people that are under muscled, they've got terrible skeletal health with poor bones. And we've got kids with under-muscling. We were not even feeding ourselves. So I think we've got to learn to feed the human body before we worry about the microbiome. I think that's the basic principles of the diet we espouse that, really, we need to be focusing on the priorities.
Michelle: So, over the weekend too, I was reading this recent 2021 study, which was published on behalf of the American Society for Nutrition, and it was an observational survey. So they surveyed 2,029 people, and they didn't have a control group and they're obviously willing participants within this. And they had to have been on a carnivore diet for greater than 6 months and over the age of 18.
So with that, they specifically were eating less than 10% vegetables more than monthly. But what I thought was really staggering about this observation is 50% of the participants that were surveyed had started the diet because of an allergy or autoimmunity. And they were finding quite staggering benefits from going on this purely meat-based diet. So in your mind, what do you think is going on for people who feel better when removing plant-based foods?
Pran: Just to clarify, okay, let's take a person that's carrying significant amounts of body fat, and we put them on a diet that is pure water, some minerals, with no calories in. I think there was an Italian gentleman, Angus Barbieri, I can't remember what...it might have been in the '40s. But he did a 365 day fast. He was morbidly obese. At the end of it, he was perfectly healthy, much healthier than when he started the journey. And additionally, he had lost a lot of his fat, additionally lost muscle as well, which is not ideal.
So the whole point is if you're consuming a diet that is ultra-processed, and let's be honest, the vast majority of Australians are, the vast majority of their calories come from ultra-processed food, going on an elimination diet such as that is super beneficial because you're just removing rubbish. Now, you could do the same with fasting, although I don't advocate that at all. Or you could do the same with, say, a diet that is full of monotony, say, with something like broccoli or potatoes. You would still lose weight. You would still see the same benefits that these people on the carnivore diet have seen.
However, is it sustainable long-term? The answer is no. One, due to palatability factors. And secondly, a plant-based monotonous diet is unlikely to fulfil all your essential amino acid needs. And additionally, you won't get the fats that go along with these meats. And we know fat is an essential macronutrient as also it can be very nutrient-dense, depending on how the animal was raised, and so forth. And particularly, the omega fats are essential fats.
So this is the thing with this meat-based diet. They're fundamentally providing their body with elimination, number one. And number two, all the essential amino acids. Because let's be honest, red meat pretty much contains all the essential elements required for the building blocks of life, which is protein. And it's an animal source protein, so it's easily absorbed, broken down, and assimilated. So it really isn't that surprising that a monotonous diet such as this achieves it.
Now, you could, as I said, just to repeat and reiterate the point, you could achieve the same with a diet that is just pure white potatoes and water and salt. You'll still get the benefits in terms of improvement in metabolic health, but you can't sustain that. You can't sustain it. You'll very quickly run into some sort of protein or energy-based deficiency depending on how much body fat you carry. Whereas the red meat diet, it provides satiety and all these essentials for life really. So you're basically stripping it down to what are the essentials of survival, and as we well know, carbohydrate is not an essential macronutrient.
Michelle: Yeah, that's right.
Pran: Your body can make it out of protein. I think there are benefits to consuming certain carbohydrates and certain soluble fibres, but that's a different story. So that is my summary of that study.
Michelle: Yeah. I mean, I know that you really talk about protein a lot. And I thought what was really interesting about reading about that in your diet over the weekend was that they would actually, even though towards the end of those deepest, darkest winters and they saw maybe a moose or caribou on the ice. But the moose and the caribou that they were seeing were so deficient in fat. They were just so sinewy and so unwell because of the long winter, that the traditional people wouldn't eat these meats because they were so low in fat that if they ate protein only with no fat, they would actually get sick. And so there was, like, they called it the “protein ceiling." And I know you talk so much about the importance of protein from a satiety and also amino acid building block level. But the addition of essential fats seems to be the magic of having both a really good level of fat alongside the protein intake. Would you agree?
Pran: Yeah, absolutely. It's primarily just an energy deficiency. So I mean, protein, as we know, has a really high thermic effect. So to consume protein, you need energy to break it down. So this is why a lot of people lose weight on a high protein diet, not only is it satiety-related factors, but also the dietary thermic effect, which is that by consuming protein, you require energy to actually break it down. So you actually consume energy.
Michelle: I kind of think that that is missing out in the general knowledge area of how much you actually require energy to break down protein. So from a weight loss perspective, there's still that controversy of should we go on low carbohydrates? Is that okay? Has that got evidence-based? But if you're stripping it back to actually understanding how nutrition works, it's actually a really good thing to understand the thermic basis of eating a high protein diet or adequate protein diet.
Pran: Yeah, correct. Yeah, exactly right. But you can imagine, like these people consuming these lean proteins with very little body fat. And let's be honest here, Michelle, someone consuming lean protein in the absence of fat or carbohydrate, with a very high body fat percentage, is not going to run into those same issues with protein.
Michelle: Yeah, that's right. That's true. Yeah, they've got some resources to use up.
Pran: 100%. 100%. So we had these really lean people consuming lean protein, and you're going to very quickly run into protein toxicity in that context. So that's very unlikely to happen in the modern world. And, in fact, I'd say for people carrying a lot of body fat, the leaner proteins are probably the way to go. So I think there's no doubt there are many nuances when it comes to these higher-protein diets.
Michelle: I think what I'm hearing from you, Pran, is that it's just so important to look at the person in front of you. If you've got a person in front of you that, yeah, they might have irritable bowel syndrome, but they are actually carrying 30, 40 kilos extra, to look at their diet and shape it to what is actually going on in their metabolism right now. And that obviously changes as time goes by. If they start to lose 10 or 15 kilos, then you start to adapt as things go by. Is that how you shape your dietary, I guess, nuances?
Pran: Yeah, absolutely. And just to clarify, Michelle, I don't specifically give out dietary advice. I mean, I understand it, but I am very cognisant of the fact that we've got a regulatory body that sits above me, which is APRA, that can very quickly create issues for us, which is, this is the ridiculous aspect of it all, that doctors aren't...we're not supposed to give dietary advice. This is how ridiculous the whole situation is so I...
Michelle: Even as a gastroenterologist? Is that...?
Pran: I think there are nuances. I think gastroenterologists can, and I believe endocrinologists can as well. But I've really surrounded myself with a fantastic team of dieticians, led by Jessica Turton and a team at Ellipse Health that work concurrently with my own service. And so we individualise these diets for people. And we're the only species that has to have dietary guidelines. We don't know what to eat now. We're surrounded...
Michelle: We're really confused.
Pran: We're really confused and we're surrounded by rubbish. And our concepts are very basic. It's introducing whole foods back to the person and just making sure that they're meeting their nutrient needs. And some people need supplementation. If we've chosen, if people have chosen a vegetarian or vegan lifestyle, we don't judge that. We simply help them to make sure that they are meeting all the nutritional needs.
It's more difficult to do so because animal-based foods are so powerful in the nutrient adequacy that eliminating them completely makes things difficult. But we personalise it for people. A lot of people don't eat meat simply because, and I see this in practice, in particular, with female patients, there's huge levels of empathy that go along with it. Like, they don't want to consume things that have had to die to help them along. And some of them know that it adversely impacts their health but they choose not to do anything.
You can't judge people like that. I mean, these sort of people, I admire them. But at the same time, as a doctor, I've got to find a way to help them to make sure that they don't run into nutritional issues. So we'll often see them with B12 deficiencies, iron deficiencies, sarcopenia, or gut-based issues, and it's like, "Well, what can we do to help them?" And our team of dieticians do so very well.
Michelle: Yeah. So I mean, I'm going to go back to that traditional diet in that way because, I mean, I think we can learn so much about that. But food diversity is one thing that I've always spoken about. And it was interesting, listening to their diet, which was so diverse, much more diverse than I thought. And I think diversity of different types of animal products, but also they were eating things like seal brain and fermented whale and caribou livers. And it was their use of the organ meats as well that helped them to get their nutrition.
And I think, also, in many ways, we don't tend to focus on those really super nutrient-dense foods like livers and kidneys and brains, etc., from various different animals in which to get things like vitamin A, vitamin K, and vitamin D, even.
So, they were getting all of their nutrients from this diet. And they were even, because they were eating frozen or raw foods, they were also getting small amounts of vitamin C, which was enough to stave off scurvy. But obviously, seal brains and caribou livers are not found in the local butchers. For somebody looking towards really increasing the quality of animal products within their diet, how do you go about advising them how to get that kind of diversity and that kind of sources that they can get things like vitamin A and vitamin K from, for example?
Pran: Yeah, absolutely. I think a lot of these cultures that have survived on mainly animal-based foods and, kind of, eaten the whole animal. And I think it is important to get that eating, I think, if you're going to do a predominantly meat-based diet. We don't advocate that by any stretch of the imagination. We're more about that meat is an important part of the diet.
But if one chooses to consume liver to get some vitamin C or vitamin D and all the other vitamins that go with it, including vitamin A and so much more. Liver is some of the most nutrient-dense foods you can get, well, that's fantastic. I think even up until 40, 50 years ago in Europe, liver was a massively valued foodstuff. And that can be chicken or ruminant livers. So I think a person getting a combination of muscle meat with the fats that accompany it, and liver, is getting pretty much all the requirements for life. Although, the vitamin C in the liver can be destroyed by excessive heat like if you overcook it, so…
Michelle: Yeah.
Pran: I think these cultures often would eat the liver raw as soon as the animal was killed because it tends to spoil or oxidise very quickly and makes it not all that palatable. So there's a lot of wisdom to the ancient traditions that we utilise. It's very difficult to do that in this modern world, of course...
Michelle: Yeah, totally.
Pran: …we’re not butchering our own animals.
Michelle: Yeah. And we don't really want to ferment whale flippers, I think they were eating. I mean, respectfully, I'm sure. But yeah, tricky.
Pran: Yeah, that's it. That's it exactly. You might run into trouble with the law, I think you if you...
Michelle: I know.
Pran: Yeah, so...
Michelle: And that empathy would go next level. But I mean, I want to also hone in on the fact that not all fats are made equal. Often, sometimes, when we're talking about our meat supply, let's take, for example, beef, we've often got an issue with we've got grain-fed beef. And so grain-fed beef have got a different level of omega-3 to omega-6 ratios that can be problematic as well. I know you're really passionate about… there's a big difference between, say, domesticated farmed meats compared to, say, wild meats. Talk to us about fats and how important they are in terms of overall health with regards to, I guess, the animal husbandry of the animal before it is killed for meat.
Pran: Yeah. Absolutely. I don't think grain is particularly natural for animals to consume in large amounts. And the vast majority of Australian beef is now grain supplemented. Do you know what I mean? And there's many reasons for that. Part of the reason is it makes the animal more palatable when it's got the marbling and the fat through it. So that's a desired trait.
But I don't think it's particularly healthy for the animal, I think the nutrient value drops. There's been plenty of studies to suggest this. And the omega-6 content increases and the omega-3 drops. Omega-6, as we know, is… I think society's got an issue with too much omega-6 fats versus omega-3, not enough omega-3.
And in addition, it drops the protein content because the animal's muscle becomes more marbled with fat. And as we've spoken about before, the priority really has to be protein. And the beauty with fat and protein, in particular, when you're consuming it with animal-based foods, they tend to provide a high level of satiety. I think fat, in its unrefined form, tends to provide a high level of satiety.
Whereas in a lot of these low carbohydrate diets, people over-consume things like butter and so forth, where these, I would consider them refined fats, not in the natural matrix. So these fats are very, very easy to over consume. And so you end up with a surplus of calories. Whereas, it's very difficult to over-consume marbled meat or lamb chops, for instance. Like, that combination of protein and fat tends to provide a high level of satiety, which must have some sort of neurohormonal basis in the gut with leptin and ghrelin, and these sorts of mediators, you know?
Michelle: That's really interesting. I want to take, I mean, it leads me into my next question about the omnivore diet, which I know that I think you're much more, I guess, akin to. But one of the things about reading about these carnivore diets, and also the research that was done and the observational research. But before insulin was invented, people with type 1 diabetes were often put on an ultra-low or no carbohydrate diet, and were just fed protein and fat. And there was some reports back in the 1700s that that was actually an effective treatment modality. Not advocating that now, obviously, because we have insulin to deal with things better. But what struck me when I was looking at that is that isn't this a very low or no carbohydrate diet part of that reversal of that metabolic impact that we're seeing in something like a metabolic syndrome or when we combine the omnivore diet and plants, is that upsetting that ability to reverse that metabolic dysfunction, for example?
Pran: I don't think so. I think that diet, which you were looking at, I can't remember the physician that advocated it, but we were looking at type 1 diabetes.
Michelle: I think I've got his name here.
Pran: Have you? We were looking at type 1 diabetics generally. And so, that was beta islet cell failure, and so too little insulin, so it was a replacement. Whereas now, with type 2 diabetes being the predominant form of metabolic dysfunction, we've got an excess of insulin. And you don't even have to be diabetic, type 2 diabetic, to have an excess of insulin. I'd say the vast majority of young adults walking around the world now have hyperinsulinemia and just don't know it. Without the type 2 manifestations as yet, you just have to measure it. Although we don't do fasting insulin, right? Like, because that's not advocated by the Australian diabetic guidelines, which is a travesty.
So most of this stuff, we don't know about. But this is the reality of the situation. Like, we're dealing with too much insulin, too much energy, fundamentally energy toxicity. So really, rather than making it specifically about the macronutrient, what it is, is we need to get people into an energy deficit. And I don't like using energy deficit because it implies the calorie in calorie out model, but calories are still king.
Michelle: Yeah.
Pran: So the question is, how do we bring insulin down? Well, we've got to reduce calorie intake. Okay? We can do that either through willpower… you could put someone on an 800 calorie diet, which is just macaronis and potatoes and they'll lose weight, but they'll be miserable. They'll be hungry because these things don't have very high satiety.
Now, the key is to do this through foods that have a very high thermic effect, which can be the fibrous greens. Or my favourite approach to it would be nutrient-dense meats that they tend to have very, very high thermic effects and also very, very high satiety levels. So we can push people into a caloric deficit using these means.
Now, additionally, these sort of high protein diets generally tend to promote good muscle health, good hormonal function. So hopefully, it motivates the people to get out there and exercise as well. So you'll find that people that do these sorts of diets often, at the same time, will exercise. Any sort of diets, they tend to exercise. But try exercising on a calorie-restricted low protein diet, you'd feel absolutely shocking. It's not sustainable. And these are the sort of people on these hype diets that you see in the cardio section of the gym just really struggling and fundamentally just having blowouts on the weekend where, because they're starving, they are just driven to eat. And they overeat and they feel guilty and the cycle begins again.
Whereas getting into a diet that is higher in protein, higher in animal source foods, you're provided with so much satiety, you automatically fall into a caloric deficit, the high thermic effect. Additionally, that willingness to exercise, the sex hormones work better. So you get better muscle health, better motivation, hopefully, less mood-based dysfunction. It really all goes together.
Michelle: Yeah. And also, I mean, just as you were saying, I was thinking we get better liver detoxification as well. Because you need all your amino acids to make sure that you detoxify your liver effectively. So you almost… you’re making the cog work in that different way. Like, slowly but surely, returning to a state of metabolic health. You can see it in the early days. But it's even before the weight drops, you're starting to reverse those internal cycles.
Pran: Yeah, absolutely. I agree.
Michelle: Yeah, which is exciting. And it'd be really great to sort of shape that for patients too. Like, I'll often say it's really not about weight loss in that early times, it's all about energy levels. So if you're feeling more energy and you're able to go to the gym. Or I know that the gyms these days are really aiming for that huge strength increase even for women, you know? Like, the best exercise at the moment is deadlifts. It's the new everything for everything apparently, everyone says.
Pran: Yes. Yes.
Michelle: And rightly so. But that high protein diet helps to build that muscle so that you can then exercise and turn the whole metabolic dysfunction process around.
Pran: Absolutely. And I think anyone who says exercise isn't critical is really missing the whole picture. And people get so ideological about their diet, but really, just find a diet that allows you exercise. And that's always been my point.
Michelle: Yeah. And there's evolutionary nutrition. We'll see that the Hunza people from Pakistan, or the Eskimos, they're only eating once or twice a day. A, because they had to hunt for their foods. So that's a good indication that it'd be great if we actually walked to get our food, not just to the fridge. That could be something we could think about. But they used to be out in nature all the time exercising up to 14 kilometres a day walking, hunting. So we really have to bring that into the whole, I guess, evolutionary nutrition perspective. Because not just sitting down sedentary like we often do at our computers and things like that.
Pran: Yeah, there's no doubt. I mean, we've become increasingly sedentary. And that's a huge part of the equation there. But before we push people towards exercise, we have to direct them with the right sort of exercise. And I think a brisk walk for 45 minutes, whilst it's beneficial, it's unlikely to achieve anything meaningful in terms of falling into that caloric deficit. And additionally, just having a bigger musculature and not being sarcopenic, you're going to have a higher resting metabolic rate.
So anything that allows you to be anabolic and build muscle would be beneficial and I think that plays into both nutrition and exercise. I'm a big fan of weightlifting and, in particular, increasing the muscle mass for your lower body and big muscles like back and so forth is so beneficial because you're just building your metabolic rate. So you're burning energy in your sleep, fundamentally, you know?
Michelle: Yeah. Absolutely.
Pran: Yeah. So I like to see a lot of older individuals that are metabolically unwell get into that type of thing. But it's an uphill challenge because a lot of people feel intimidated by gym environments and often go there... And a lot of fit people, they're working out and you don't want to impose and take the machine. So they find it very intimidating. And most people tend to gravitate towards the cardio section where they could just do their own thing on a treadmill and not be disturbed.
Michelle: Yeah. That's true.
Pran: So it's about changing perspective and changing their mindset. And it's a challenge.
Michelle: Yeah. And knowledge, I think, really just helps. Even the fact that they know they can burn calories when they're sleep is pretty seductive for most female patients anyway. Put it that way.
But I wanted to talk to you about a really damaged gut. Sometimes, I'll see patients with Crohn's disease or ulcerative colitis and often, what's happening is they're put on low fibre diets, and that tends to really help them.
Going back to this kind of carnivore looking diet...and I'm not saying that we're necessarily espousing it, because it's very difficult to go back to a traditional Inuit diet that was so diverse and incredible. But what's happening in things like Crohn's disease and ulcerative colitis? Is this something that we need to look at? Like, why does low fibre diets help them? And what do we need to look at from a dietary perspective for such a damaged gut where the gut wall and gut biome is skewiff? And what's your advice for that?
Pran: Yeah, I think we got to look at autoimmunity, in general, and Crohn's and ulcerative colitis is just part of that continuum or spectrum. I think autoimmunity arises in the setting of genetic predisposition in the presence of probably a damaged gut environment or gut lining. I think the internet colloquially calls it “leaky gut syndrome.” But I think what we're seeing here is the introduction of things never before seen in systemic human circulation, which are now freely circulating or entering past the gut barrier and freely binding tissue. And this can be bacterial toxins, environmental toxins, pesticides, food components. And I think this speaks to this issue of intestinal permeability, which I think is driving a lot of autoimmunity.
The question is, what are the factors driving intestinal permeability? And it's one of these chicken and the egg type arguments. And I think that's a complicated question. I think the lack of good mucosal health drives it. And some of the factors contributing to it are the high volumes of gluten, high volumes of fructose that we're consuming, potentially. And this is theoretical at the moment, but I think I'm in favour that it's problematic as the high use of glyphosate, which is now found in a lot of our food products, which I think adversely affects our gut barrier.
And you just have to look at the trend for autoimmunity in the last 50 years to know that it's just exploded up. So that's not our genetics changing. That's something very real in our environment that's occurring. And I think what we're putting in our gut is fundamentally damaging our gut and then driving up autoimmunity. Now, ulcerative colitis and Crohn's, that's just a version of it.
The reason why a lot of people respond to low fibre diets is because fibre produces bulk. If you've got a colon, for instance, that's terribly diseased with ulcerative colitis, it's been known for years that you've put them on low residue diets, low fibre diets because you don't want bulk and stretch in a colon that's damaged.
Michelle: Same with diverticulosis, diverticular disease.
Pran: Yeah, same with diverticular disease. And this is what I find funny about diverticular disease is what's preached as a high fibre diet, high fibre diet. Some of the worst diverticular diseases I've seen anecdotally, and it's even been reported in the literature, is in people with really high fibre diets. I don't think we're designed for these extremely high fibre loads because I think that provides a problem. And I think a lot of diverticular disease is just overall metabolic health of the colon deteriorating more than anything else. It kind of speaks to systemic health rather than just local health. And so, low fibre diets certainly have their role.
And some people just don't tolerate fibre well. You don't have to have ulcerative colitis or Crohn's disease. They've got a physiological limit to how much fibre they can tolerate. So that needs to be slowly introduced, titrated up to culture their microbiome, foster it, allow that to proliferate, and then you could have them consuming some soluble fibre. I think insoluble fibre is less ideal for a lot of people with gut distress, and most people feel better off. And so this is, again, goes back to this individualisation of these diets and personalisation of the diets really.
Michelle: Yeah. No, totally. It really makes sense actually, like, just to, I guess, to understand. I mean, to be honest, it's been something that's eluded me for a long time. Like, why, with diverticular disease, but now what you've just said makes complete sense, which is great.
So I just wanted to finish up and really talk to you from your gastrointestinal hat on. Because the naturopaths and traditional healers have long used this kind of “weed, seed, and feed,” those kinds of things. Do you use that kind of philosophy of that weed, seed, and feed? And if so, what do you weed, seed, and feed with basically?
Pran: Yeah, I'm not huge on that, to be quite honest, Michelle. I think my priority has always been if the issue is metabolic health, and I think it is for the most part of it, I think we've just got to learn to restore that first, just introduce good healthy eating behaviours, which allow people to eat the building blocks of life.
Most of these components that are used, the phytochemicals and so on, most of them don't actually leave the lower gut. They don't leave the colon. They're mainly utilised by the microbiome. And that's fine. They've got their benefits. But I think we're talking one-percenters there. So we just try and reach the...try and hit all the broad categories, which is, let's get this person who is chronically under consuming protein to eat more protein. Chronically under-consuming things like iron and B12 and choline, to introduce those factors before we start worrying about the one-percenters, I suppose.
Michelle: Yeah.
Pran: And I think the Inuit and some of these more ancestral groups have proven that you really don't need too much of that stuff as a human being to survive. So we just try and hit the broad topics first.
Michelle: That's great. I mean, I think what I love about your approach, Pran, is how simple it is. I was reading in this article over the weekend is that literally, no one knows what to eat anymore, which is just so ridiculous. As a human society with so much science and so much research, we've researched ourselves into confusion. And that's why these evolutionary nutrition concepts just allow us to sort of sit back and just see what our forefathers and foremothers have done before and really look to them for wisdom that transcends all of this bulky research.
But it's fascinating to really focus on protein and fats and just coming back to that basic nutritional concepts of macro and micronutrients and utilising how the patient is individualised. Where are they in terms of their metabolic shape? And how can we build that through exercise and movement as well as nutrition?
Pran: Absolutely. I think you hit the nail on the head. Really, it's about the micro- and macronutrients. Let's get that right before we worry about the one-percenters. And the human body, it's complicated, but you can simplify it as well to an extent. It's a machine and it needs the right fuel to run, and we've just got to get the fuel and the building blocks right and optimise people that way. And just I think the simple approach is far more beneficial to the person sitting in front of you, which is your client. But whether as a naturopath or as a doctor or as a nutritionist, that rather than over-complicating the situation. And that's what we aim to do.
Michelle: Thank you so much, Pran, for taking us through your views on gut health and evolutionary nutrition and helping us to simplify these things so we can really incorporate these into our practices. I think a lot of practitioners will now just have a broader viewpoint of what a carnivore diet means and just understanding how we can learn from our ancestors to bring health and well-being into a whole new light. So it's really interesting to hear, just the way that you think is so helpful to help us think in a much more simplistic but rich and deep way.
So thanks again for joining us on FX Medicine today.
Pran: No problem. It's an absolute pleasure, Michelle, and happy to do it again sometime.
Michelle: Thanks, everyone, for listening today. And don't forget you can find all of the show notes, transcripts, and other resources from today's episode on the FX Medicine website. I'm Dr. Michelle Woolhouse. Thanks for joining us. We'll see you next time.
About Dr. Pran Yoganathan
Dr. Pran Yoganathan is a Gastroenterologist and Gastrointestinal endoscopist based in Sydney. He aims to empower his patients to embark on a journey of self-healing using the philosophy of “let food be thy medicine”. Dr. Yoganathan believes the current model of medicine is problematic and he aims to empower patients to improve their own health so that they may seek independence from the pharmaceutical-medical-big food complex
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