TRANSCRIPT: Vegetarian & Vegan Vs Nonveg Diet Debate With Sangeetha Aiyer

Now, that’s a far-fetched dream the way the way things are currently, to be very honest. But I at least tell them walk 45 minutes a day. Walking is a very underrated exercise. And we have studies that have shown that 15 minute walk or even a stroll after every meal. And if you can’t even do it after every meal, after two meals, or if you can do a long walk, that helps in bringing your glucose levels down.

So that is something that you start with. That is something I start with because people get very overwhelmed when you, too many changes, you will not start anywhere at the same time. The lowest hanging fruit is something that you do three times a day, every day versus 40 minutes in a day, three times a week, which is exercise. So you’re eating three times a day with a snack in between and doing that every day. If we attack nutrition first, chances are that, you know, they will have easy or early outcomes, which then they can kind of move the needle by saying, OK, now I’m walking. Now, maybe can I go to the gym once a week? Things like that.

Clinical Approach and Collaboration

DR. PAL: Beautiful, beautiful. So I absolutely love the approaches. So this is what I do in my practice as well. So, you know, we have a GI dietitians and then we both work as a team. So I say that, you know, this is what the protocol that we have and the dietitians will go deep in terms of what’s the diet chart and everything. And then we always start with the diet. And as you know, 80 percent, as we always believe, 80 percent is diet. 20 percent physical activity.

And if you do everything together, it’s good. But if you can’t do anything, at least start with the diet. So we’ll go one by one. The first thing that you said was the protein, protein. So in this patient, I will give you another patient as well. OK, so we can so that the audience can understand where is the clinical context of this.

Two Patient Scenarios

DR. PAL: So this is a patient. The first patient is a uncontrolled diabetes where he has a diabetes. He was on metformin and he was just taking metformin but not making any lifestyle changes. So the A1C slowly crept up and only when the A1C is more than 6.4, then the nerve supply damage was starting to appear slowly. So this guy was 8.5 and that level. So the nerve supply started getting damaged.

There is an — other common scenario is new onset diabetes. In your practice, you see it all the time.

SANGEETHA AIYER: Pre-diabetes.

DR. PAL: Pre-diabetes. Between 5.7 to 6.4.

SANGEETHA AIYER: 6.4. Yeah. They will not have nerve damage at that time.

DR. PAL: But the point is, if they don’t do all these four that you’re talking about.

SANGEETHA AIYER: You will get there. Unfortunately. It has to. It will. It will. That is how pathophysiology works.

Pathophysiology of Diabetes

DR. PAL: I’ll take one minute to explain the pathophysiology where we talk about insulin resistance. Just refreshing about our discussion as well, where there is a lot of insulin, but it’s not working. So you need to give rest to the insulin. So that’s why I promote time-assisted feeding where overnight you don’t eat anything. So your insulin sleeps. So your quality is better. That’s number one.

Number two is, when you go down on the carbohydrate intake, again, the work on the insulin is lower. Yes. So whatever the insulin is left, it is trying to come back and attach to you so they don’t divorce you. Yeah. OK. So these are all the two major points. Yeah. These two points have to be remembered in either of these two patient scenarios. For that to happen, all the four things that you said should happen.

Protein Intake Study

DR. PAL: So number one, protein. OK, let’s start with protein. So I have done some small research within my clinical scenario. I get a lot of Indian patients in California because of my social media reach. And I have had a small Excel sheet in terms of, OK, what is their protein intake? My dietician and me will work together and we have done a small study on that. The average protein intake in a vegetarian patient, the sample size is around 1000. OK. In 1000, average protein intake is only 40 grams per day.

SANGEETHA AIYER: You have topped my sample size of almost 600 vegetarians. I had once done a free calling. My sample size showed 30 grams. So yours is slightly better.

DR. PAL: 30 grams. Yeah. It’s abysmal. But you are there. You’re probably right. Yes. 30 to 40. Yeah. You’re right. But all of these people, the body mass index, the measurement, body weight is around 70. Correct? So BMI is OK.

SANGEETHA AIYER: BMI is normal. That’s the thing. That’s the trick with Indians.

DR. PAL: Exactly. BMI is normal. Again, as you know, BMI is also tricky with Indian community. Usually it should be lower. BMI of 23.

SANGEETHA AIYER: The lower end of the spectrum, Indians should be.

DR. PAL: Should be. And the 24.9 is for the Western people and not for us. So if you look at the research paper, BMI is 23 around that for Indian community. So these people are around 23.5 and they don’t look obese. They look normal. So protein is 70 grams is needed, but they only reach 40. OK.

The first problem that I am facing is the weekly follow up that they come to see me. I say, what is happening in protein intake? They say, I don’t know what is protein, which amount is there. How do you start with them? How do you teach them?

Educating Clients on Protein Sources

SANGEETHA AIYER: So, doctor, my consultation calls last anywhere from 30 minutes if it’s a slightly evolved patient to almost an hour if it’s vegetarian. Not a patient, I should say clients. So the first education exercise that I do after basically a KYC on the client, knowing their history, family history, health condition, evaluating their blood markers. I am equipped to read some basic blood markers. And then when I take a dietary call, what’s your average day of eating?

So the first thing that I do, I don’t even like I said, for me, carbohydrate reduction comes later because that’s an easy thing to do. The biggest education exercise that happens on every consultation call is to explain to vegetarians what a class one protein is and what a class two protein is. So what are your primary protein sources and what are your secondary protein sources? And there is a lot of myth busting there.

OK, now I am born in a South Indian family. I was a vegetarian for the first 30 years. My mom raised me, giving me one cup of sambar rice every day, thinking I’m getting protein. No fault of hers, but you have tamarind rice as well. Yeah, but right up there, there is this misconception that that dal is protein. Don’t get me wrong. Or similarly, chole is protein, chana is protein or rajma is protein. The right definition of these foods is complex carbohydrates with protein.

OK, and there is a primary difference between class one protein, which tend to be animal based protein, which are meat, all red meat, poultry, eggs and chicken, seafood, fish, prawns, etc. Dairy. OK, so these are your class. Anything that comes out of an animal is actually what we call class one protein. There are two reasons for it. The amino acid profile is complete without getting very technical. They are not only complete, but they are there in the right balance that is needed for the human body, which people miss out.

In plant protein, one, the amino acid profile is incomplete. And second, yes, on paper, you can combine dal rice, you can combine rajma rice and complete the amino acid profile. So if one amino acid is missing in rajma, for example, that amino acid is present in rice. Yes, your nine is complete, but you do not get it in the right amount that is needed per meal for your body to absorb. That’s number one. And carbs to protein ratio in plant protein is three to one or four to one. OK, I’ll explain the carbs to protein ratio a little bit.

Carbs to Protein Ratio

DR. PAL: You know it, but I’m just for the audience. Carbs to protein ratio is, for example, one gram of protein. You don’t want too many carbs. Yes.

SANGEETHA AIYER: So for one gram of protein, let’s say you have only like two or three grams of carbs, it’s good. Yeah. No, actually, you were actually explaining one is to three. So for one, usually if you want a protein source, you don’t want carbs. You ideally want fat in it because that is how protein and fat are designed in nature. An egg has no carbs. Chicken has no carbs. Fish has no carbs. Paneer has no carbs. OK, the only exception being curd and milk. They have certain carbs in it because milk is for children. So you have all three macronutrients.

So ideally you want a protein where if the protein is one, you want the carb to be at least 0.5 or equal at worst case scenario. OK, so let’s say 100 grams of let’s say cooked moong dal or we can take raw. People go and search raw. If you have 100 grams of raw moong on an average 22 to 24 grams of protein, depending upon the moong, that same 100 grams will have about 70 plus grams of carbs.

And then when you add rice to complete the protein, 100 grams of rice will give you probably two, three grams of protein. But you are taking 35 grams of carbs. So basically for a very small amount of protein, you’ve taken excessive amount of carbs, which calorically is not value for money for you, because to just complete that protein requirement, you’re taking too many calories. And if you don’t use those carb calories, you’re going to store it.

Complex Carbs and Fiber

DR. PAL: So coming back. OK, I completely agree with you. This is my thought process as well. But there was a guest that we discussed, the same topic we discussed. The point of angle was complex carbs because it has a fiber. The carbs count is not the same. So technically speaking, even if it is, let’s say she also agreed that the carbs to protein ratio is very high. So 20 grams of protein, even if you have like 150 grams of carbs, those carbs are complex carbs with fiber, which will not affect the insulin levels that much.

SANGEETHA AIYER: I’ll tell you my thought process. Partially true. That’s what I’m saying. I think it depends upon the overall clinical profile of the patient. One, and if you’re going to have only plants, only plants, OK, whole food plant based.

DR. PAL: WFPB.

SANGEETHA AIYER: Exactly. Whole food plant based and what vegans do, even dairy is not there. Remove dairy because dairy is an animal protein. Indian vegetarians have a strange confusion with that. But we leave that apart. If you’re going to a whole food plant based and let’s say you want to hit a protein target of 70 grams to hit that protein target, you and let’s say your standard calorie intake per day for you to lose some weight or whatever it is, maintenance is 1800 calories.

You will have to one, you will automatically go to up to 2000, 2500 calories. Number one, one caloric intake will go high. Two, you have to probably count for more plant protein because it is less bioavailable. There are two challenges, which is why, so which is why if you look at people who are vegetarian and let me take some common examples, you know, vegan bodybuilders, vegan athletes, vegetarian bodybuilders, vegetarian gym trainers, they are not, they are not going whole hog on rajma and dal.

They supplement with a whey protein because that little bit of whey protein or processed plant protein, even whether it is pea protein or soy protein in smaller number of calories gives you the complete nutrition. More protein, more protein and more bioavailable because it is an isolate form. OK, so on paper, a lot of things sound great talk. Yes, rajma rice, yes, chana and whatever.

But and if we, if we add another layer as to how sedentary we are — while the carb component of the complex carb will not spike insulin as much as probably rice or wheat or bread, but the total caloric intake has gone high and unless you count for activity level to that extent, you’re going to store energy and gain weight.

DR. PAL: I think that was the discussion that we had that if let’s say the patient is physically active, lots of muscle mass, the metabolic rate is very high.

SANGEETHA AIYER: High. So in that particular profile, maybe the complex carbs doesn’t matter a lot. But that is not the patient that we usually see in my clinical practice or in your practice.

DR. PAL: Not in mine and neither is a layman that physically active, even like to be very honest, I consider myself physically active. I probably go to the gym three to four times a week, 45 minute to one hour session. I try and do 8000 steps a day.

SANGEETHA AIYER: Even this kind of activity, which, you know, from your practice is not not common.

DR. PAL: Even for you, it’s very difficult.

SANGEETHA AIYER: Yeah, even for me, it is very difficult. That’s exactly what I’m trying to say. If I don’t control for the quantity of my calories by focusing on quality of calories, that is where. So coming back to I think your point is very true that that’s not the common patient you see. That’s not the common client that I see. So coming back to what I do in the practice.

Protein Sources for Vegetarians

SANGEETHA AIYER: So therefore, if it’s a meat eater or a non-vegetarian, very easy for me. OK, relatively, because they don’t have eggs, chicken and the more variety in their nutrition, the far easier it becomes. But if you’re a vegetarian, the major counseling goes to say that you have to figure out within. This is not about converting anybody, not about forcing choices. I have to figure a way to work with the person depending upon their way of eating, cultural practices, beliefs, all of that. A lot of noise goes on social media that I’m here to convert people. No, no, no, not at all. For 35 percent of my clientele are not even egg eating vegetarians.

DR. PAL: I speak to a lot of so. So vegans.

SANGEETHA AIYER: No, no, they don’t eat egg. They’re Indian vegetarian, basically non-egg eating vegetarians. What we call lacto-vegetarian.

DR. PAL: Lacto-vegetarian. Yeah. Some are over lacto-vegetarian. They drink milk. Dairy is there.

SANGEETHA AIYER: So there I have to explain that. Listen, paneer, a little bit of milk, if you’re able to tolerate it. That’s, again, very different. A lot of South Indians after the age of 30, 35 don’t tolerate milk. But if they can, yes. So paneer.

Lactose Intolerance

DR. PAL: Just a point on that. We’ll come back to the thought process. I just wanted to add this point that this lactase deficiency, we are seeing a lot in my practice because they come with bloating. I’ll tell you my close friend. He had bloating. OK. And he called me. He’s a cardiologist. He said, dude, I have bloating. What do I do? I said, first stop the filter coffee in the morning. Right. He could not stop the filter coffee. But he went on low FODMAP diet, which is a diet for bloating. OK. Irritable Bowel Syndrome.

In that low FODMAP will include dairy. Except for dairy, he included everything else. But the bloating was still there. I said, at least now we remove the bloating. So as soon as he stopped, he got better. Yeah. So then we both started doing some research on his cardiology practice and also in my practice as well. And then for some reason, I don’t know, immigrant population in the United States. He’s in Minnesota. I’m in California. Lactose intolerance is almost rampant. It’s almost I would say like one and two or even even more than that. Have lactose intolerance in South Asian community, South Indian community.

SANGEETHA AIYER: Yes. I also think that it’s because the Indo-Gangetic Plain descendants and the Deccan descendants have been raised on very different topography, ancestry, which is why I feel that I have never seen South Indian, even in my own family, people being able to pound lassi and paneer and whatever. We do better with fermented dairy. So curd and buttermilk and all of that.

Protein Options for Lacto-Vegetarians

SANGEETHA AIYER: So coming back. So you talked about being lacto-vegetarian. Lacto-vegetarian for the audience is basically vegetarians who consume dairy. OK. So first option is I have to bring paneer and somehow paneer is a form of cheese which even South Indians can handle. They do. They may not handle tons of milk, but they can handle paneer. So paneer, curd. OK. If you can hang the curd, like basically drain the curd off the watery part, it becomes a little more protein efficient. OK.

DR. PAL: Can you explain a little more how do you do that exactly?

SANGEETHA AIYER: It’s actually very simple. Make curd at home. OK. You get muslin cloth. OK. A muslin cloth is everybody knows what a muslin cloth is. It’s a white color drain. It has small holes in it. So you put your entire curd in it and you drain it. OK. And you leave it for an hour or two. So the drip, drip, drip, drip, the buttermilk in it or the thing in it will drain. Then you will get a really thick curd. Now that has a little better protein quality. OK.

Now, if you don’t want to do all of that, I understand we’re all time sensitive. Now, India and abroad, you have Greek yogurt. India, we have now two, three brands. So Greek yogurt is a great option. I think in the US, Chobani is a great favorite. If you are in UK, the diaspora, I think the spelling is F-A-G-E. Fage or Fage. That’s a brand. In India, there are a couple of brands that are there. Two, three, two brands we have which are doing good work.

So Greek yogurt is a very good option for you. Also, Greek yogurt tends to have two strains of bacteria. That’s better for your gut health. One point for Greek yogurt is Greek yogurt gives you 10 grams of protein, 10 to 12 grams of protein.

DR. PAL: Depending upon the brand. Yes. Chobani, I use Chobani all the time. Please don’t use flavored Greek yogurt.

SANGEETHA AIYER: Let me just come to that. I was about to say that.

DR. PAL: No. Classic. Yeah, yeah. This is not sponsored by Chobani.

SANGEETHA AIYER: No, no. Neither is it sponsored by any. So there’s a point in the probiotics where, exact point that you mentioned, when you add flavors to it, you have invariably added sugar. Yes. So then the probiotic effect is blunted. That’s what I’m saying. You’ve damaged it by adding, if you have a mango Greek yogurt or a vanilla or a blueberry Greek yogurt. It’s better to put real blueberries on your Greek yogurt. That’s my favorite snack or real strawberries on your Greek yogurt than to have a flavor and sugar in it.

DR. PAL: So, yeah, slightly more nuanced option. Practical option is that when I was in the journey, I knew that additional sugar is going to blunt the fermented effect of yogurt. But at the same time, I couldn’t eat the plain yogurt by myself. So I added blueberries, strawberries, similar to what you said. It is still better than plain yogurt, but not as good as the flavored yogurt. Right. So what I did was I started with the flavor. At least I’ll get the protein. Right. Then I got used to the taste. And the reason is I wanted to introduce my gut bacteria to this new thing. And usually in my practice, I will say six weeks. Anything new, the new lining, usually three months, but at least six weeks, there’ll be some change. Then you’ll be able to handle the taste better. That’s what happened with me. Then I went to plain yogurt with strawberries, which was much better.

SANGEETHA AIYER: Yeah. Yeah. No fair point. Everybody has a way to transition. Like ultimately, you know, I know we say food is for fuel and food is energy, but it has to go via the mouth. If it doesn’t solve for taste, there is nothing we can do.

DR. PAL: Of course.

Protein Supplementation

SANGEETHA AIYER: Coming back to the Greek yogurt. Greek yogurt. Now, I would urge people not to fear supplementing with some whey protein. Yes, I’m sure you’ve been aware that this protein powder and processed protein powder has been a lot in news for adulteration and wrong claims and things like that. These things will continue to happen. That doesn’t mean that that product itself is bad. Please be a discerning customer. Talk to some experts, your doctor, certified nutritionist. They will point you towards the right sources. So do supplement.

And nothing happens with that whey protein or even if you’re taking, if your preference is not whey, some people are better suited to plant protein, isolate, whey protein, soy protein. If it suits you, please take that. Now, if you’re very worried, like you said, we need our gut to get used to it. Don’t have a whole scoop. Start with half a scoop every other day. Slowly introduce a new thing and you will get it.

Soy-Based Protein Sources

SANGEETHA AIYER: And finally, there are two more sources, but India doesn’t like them a lot. Tofu and tempeh. Very popular outside India. A lot of my Indian clients in Germany, Europe, London, US, they all like tofu and tempeh. It’s plant protein, soy based protein, fermented soy. I’m not a big fan of the soya chunk, doctor. I will tell you.

DR. PAL: Why is that?

SANGEETHA AIYER: I’ll come to that. So these are your two options. The reason is this. That form of soy is highly processed, one. Two, that particular form of soy, because of the lack of fermentation, which protects natto, tempeh, tofu, because of the anti-nutrients, which we know, soy is one of the top eight allergens in the world. Right. If you have eight allergens in the world, there are top eight. Soy is one of the top eight that people are allergic to.

What makes soy easy to digest without a lot of side effects of bloating is the fermentation process. That Southeast Asians, Far East and all of them do. This soy protein lacks that. And I have seen that after a couple of weeks of consumption, there is invariably some gastric issue, bloating, gas coming up and things like that.

Now, that’s one. Second, that’s the one form of soy is highly processed, further processed in the name of soy chap. So India has a product called soy chap, which a lot of vegetarians eat, thinking it is the tandoori chicken equivalent. But it is a lot of vegetable oil mixed with maida. So it is junk. And then more oil brushed on it in a tandoor. Completely ultra processed. And a lot of vegetarians eat that thinking they’re getting some high protein option like a tandoori chicken outside.

So that form of soy is avoidable as much as possible. So coming back, if vegetarians are able to get all this in their diet.

DR. PAL: Let me just add a point on soy. Soy is one of the complete protein. Plant based complete protein.

SANGEETHA AIYER: Absolutely. Yes. And you were just talking about the soy chunks. I’m saying only that which India largely consumes. It’s not found. No soy milk. Soy milk for the entire, in terms of 100 ml, you won’t get a lot. 7-8 grams. So you’re better off eating tempeh, which is 19 grams.

DR. PAL: Why tofu? Tofu is very tasty.

SANGEETHA AIYER: I’ll tell you what happens with tofu. So every time I go to Indian vegetarians, right? And they get fed up with paneer. Obviously, because I say that these are standard. These have to be there every time. See, tofu doesn’t have, soy itself doesn’t have a indigenous dish in India. If you see, if you spoke to your mom or your grandmom, I don’t think they’ve ever made soy. Nobody’s grandmom has made soy.

Challenges with Tofu and Tempeh

SANGEETHA AIYER: The problem with tofu, which I get is they don’t. It has a slippery, slimy kind of a taste and texture, which 90% of my Indian vegetarian clients don’t eat. But the saviour has been tempeh. And there are one or two brands that have launched tempeh in India, which are more crunchy and they have come with some schezwan, this, that, little bit of flavour.

DR. PAL: Which is great. But for me, I’ve tried both. You’ve tried both? But I absolutely love tofu.

SANGEETHA AIYER: Tempeh taste is not that good for me.

DR. PAL: Very individual.

SANGEETHA AIYER: Very individual. But tofu, I’ve seen many people.

DR. PAL: Yes. Younger people like it, who are exposed to, so a lot of vegetarians, if you’ve travelled to Southeast Asia, you know, it can be a challenge to, everything is meat based. So younger people who’ve travelled, who’ve experimented, oh, some people, I recommend to do a paneer tofu mix, which then the taste, each taste balances each other. And what happens is you cut down the fat content of the paneer.

If you’re watching your calories that carefully, you’ll cut down the fat content of paneer, you’ll raise the protein content by adding tofu and the texture gets better.

SANGEETHA AIYER: Wonderful. So I do a combined, one of the recipes that I give is a tofu this combined and you’re able to have it like a bhurji or whatever. Right.

Protein Sources for Vegetarians

SANGEETHA AIYER: So, so this is what I tell most vegetarians. And then I tell them, what are your support protein? Now comes your support protein, all forms of moong, soya bean, the whole bean. You have edamame, then you have your chole, chana, rajma, all of that.

I said, use them as support protein. Now, after that, please focus on fiber, vegetables and fruits, then the grain. So when I structure and explain in a counseling chart and then I do that, when I prepare my nutrition this way and I tell them, you cannot negotiate on the primary protein. One or two forms of that has to come.

Either you do paneer and whey protein in two different meals or you do Greek yogurt and whey protein or you do paneer and whey protein. I need the quality protein to come in. One more thing I want to tell you, doctor, this is may not be in studies and research. People don’t digest this legume variety that well.

OK, this pulses and legumes, right? Every day, if you tell them to have chole and chana and rajma and all of these things, no matter how much it is soaked and boiled intrinsically, I think because of the nature of that food, you know, they do complain about digestion issues. That is where I again say mix and match. So this is how I educate vegetarians, egg eating vegetarians again to the top.

DR. PAL: Yeah. So overlap to vegetarians. I say, OK, to the top layer of dairy, add the eggs. OK, then you use your support protein.

SANGEETHA AIYER: Right. And then it becomes relatively easier. You must have seen this. You say, OK, increase your protein content vegetarian. They increase the legume, chana, dal, lentil. And right away the next day you say, I feel bloated. I have pain. I can’t do this.

DR. PAL: The reason is that they, most of them, most of them have poor small intestinal motility.

SANGEETHA AIYER: Probably. And the reason is that overall, you know, lack of sleep, stress, physical activity, everything.

DR. PAL: Overall eating pattern and lifestyle.

SANGEETHA AIYER: Lifestyle. Yeah.

Small Intestinal Bacterial Overgrowth (SIBO)

DR. PAL: Have slowed down the motility of the GI tract. So and then small intestine is supposed to contract and only then your food, digestive food goes into the large intestine. Yeah. And then large intestine absorbs the water, stool is formed and comes out of the anal canal. When the motility is low, what happens is the food doesn’t get passed very easily. So it’s like a stagnant pipe with secretions are getting stagnant.

So what happens is you, our bacteria love stagnant. OK, so similar to like how we know mosquitoes are in a stagnant water, in a stagnant secretion in small intestine, bacteria comes in. How do we know is when we do the endoscopy, we take something called small bowel aspirate. When we look into the microscope, we count the number of bacteria.

And usually in, as you know, there are 100 trillion bacteria in the colon. There will be only 1 million bacteria in the small intestine. 1 million, 100 trillion. So the diversity.

SANGEETHA AIYER: Significantly different because large intestine is the main.

DR. PAL: Right. Small intestine, suppose, should not have bacteria. Not more than 1 million.

SANGEETHA AIYER: Very minimal. Because it’s very active. All the bacteria is pushed into the colon.

DR. PAL: So what is happening now because of slow intestinal motility, when you look at this small bowel aspirate, you are seeing like billions of bacteria in small intestine. Because all these large intestine bacteria are slowly coming back into the small intestine.

SANGEETHA AIYER: It’s getting backed up.

DR. PAL: Yeah, because their food is right there because it is stagnant. So when it is there, they absolutely loves carbs. Doesn’t matter whether it is healthy carb, unhealthy carb, doesn’t matter. So complex carbs are healthy and you ask the patient to take, they take and they are not eating it. The bacteria eats it and the byproduct of CO2 is the abdominal bloating.

SANGEETHA AIYER: Yeah, correct.

DR. PAL: This is what we call it a SIBO. SI stands for small intestine, BO stands for bacterial overgrowth. So the point that you are saying when we are adding legumes and lentils, maybe not the inherent nature of the food, maybe a little bit, partly contributing, but other part to this is the inherent SIBO that is being associated even without any GI symptoms.

SANGEETHA AIYER: Yeah, yeah. And on top of that, sometimes you cannot blame. I do understand that legumes, there is this narrative that legumes have a lot of anti-nutrients, plants have a lot of anti-nutrients, legumes have phytates and this and that. But sometimes I feel that a single food cannot be vilified so much unless you take a look at the context of the entire individual and what they are consuming. What is leading to that?

It can’t be that one food alone, because I work with a lot of people on a spectrum of IBD and IBS and I’m sure we’ll come to that. It is the overall abuse of the system, largely the gut, which then the gut starts rejecting almost everything. And that is where elimination diets start to come into play.

DR. PAL: Right, right. So, yeah, I get your point. I’ll tell you a beautiful example, Sangeetha. This is mind blowing. The treatment of irritable bowel syndrome is what is low FODMAP diet. That is a treatment. People who want to see, check low FODMAP diet will check out, put that in the description. What does low FODMAP diet contain? Lentils, legumes, dals, all good foods and dairy.

It’s not like something very bad, oh, avoid chips. Low FODMAP diet is not chips. Low FODMAP diet is your regular food. And I am a gastroenterologist. I’m telling you, don’t eat it.

SANGEETHA AIYER: Yes, very difficult. I was about to say that. I thought you will stop the podcast, because that’s the first thing I do.

DR. PAL: Don’t eat that first.

SANGEETHA AIYER: No, no. The reason is these patients will not be able to handle it.

DR. PAL: Yes, because they don’t have the gut back there to handle it. If you circle back, it’s absolutely mind blowing that if you would have taken all this FODMAP diet, high FODMAP diet to start with, you will not be in this situation at all. Because you didn’t take that, you are developing IBS. Now, the good food that you are supposed to take, you’re not able to take for a short period of time.

SANGEETHA AIYER: I think that’s what I said that in the growing up years or when you’re post-puberty, if you don’t develop your gut microbiome and get bacteria, and at that time you’re thumping cokes and pizzas, and you have changed your gut bacteria, and then outside food, and if there is alcohol and smoking, if there is sleep deprivation, all of this is fairly common, doctor.

DR. PAL: Or you’re going every day out, every third day having biryani and coke. Ordering on all the apps.

SANGEETHA AIYER: So, this is where the gut comes to a problem. It starts with a mild, I’ve seen it in my practice, starts with a mild acid reflux, mild heartburn, then food backing up, then palpitation, then diarrhea 7-8 times, then eating food, and then within half an hour having cramps, cramps and wanting to go to the loo.

So, when they come to this stage, then there is a very narrow scope to work with, then every elimination and slow introduction begins. That’s what I do.

DR. PAL: The one that you mentioned, having food, you have cramps, you go to the bathroom, you feel better. Very common. Very characteristic of IBS. That is what IBS is. And when we say irritable bowel syndrome, basically, it is high time that you repopulate your gut bacteria by changing your lifestyle. So, that is what you were discussing, that legumes will have some difficulty initially, similar to the whey protein that you said.

Initially, you need to figure out whether it is whey protein concentrate, isolate. It happens even with something as wholesome as eggs, doctor.

SANGEETHA AIYER: Eggs? When somebody is consuming one egg a day, I cannot take them to 6 eggs a day immediately. They are not going to be able to handle that food because they don’t have the requisite ability to handle that food. It is the same thing with fiber. If you are like 3 grams and 5 grams of fiber, in a day if I take you to 30 grams, you will have a lot of gut distress. So, even protein, when bodybuilders etc., not bodybuilders, people who are into aesthetic fitness, they come to me and they say, I am able to do only 70 grams, I want to go to 1.6 grams.

Can we start tomorrow? I say, you cannot start like that. If you are at 1, 1.2, you go to 1.3, few weeks, 1.4, you know. So, I think everything is like that. But sure, there are some people who cannot tolerate certain kinds of food. Then, okay, you can keep that away.

DR. PAL: Of course, of course. In my practice, I say this to the patients, two things will happen. One, the patient will come back next in 6 weeks for follow-up. Sometimes, they may not come back. Because either the problem got solved or they went to different doctors.

SANGEETHA AIYER: That is forward, ya.

DR. PAL: But the person who is coming back in 6 weeks, invariably, they say that my symptoms are 50% better. Invariably, invariably. And it all takes time.

SANGEETHA AIYER: It all takes time. Because all the damages happen overnight.

DR. PAL: Exactly. I always say this.

SANGEETHA AIYER: You do?

DR. PAL: Ya. People want to do one month trials with me. I am like, this is not a car you can test drive for 2 kilometers today and then say, I will buy this car. I know we have had analogies of the human body with the car. But you have taken 5 years, 8 years. One month of trial, even the gut does not change, right? You are saying minimum 6 weeks.

SANGEETHA AIYER: Minimum 6 weeks. So, patience is definitely needed. Re-learning eating behaviors need to be evaluated. Your understanding of what real food is has to be changed. So, yes, those things are important.

Practical Challenges in Implementing Protein-Rich Diets

DR. PAL: Right, right. So, coming back to the protein thing that you said. So, pretty much we have analyzed everything in the first point. In the protein thing, right? What are the practical problems that you are facing in your practice while you are trying to implement this?

SANGEETHA AIYER: So, invariably after 8 to 10 days of following a adequate, I am not even talking high protein, okay? I am saying adequate protein anywhere between 1 to 1.1 gram. The first thing that I will hear is, there is something going on. I am not hungry. I am worried that I am not getting enough food.

DR. PAL: Misconception. Actually, it is a good thing.

SANGEETHA AIYER: Because you are not eating that much.

DR. PAL: Ya, you are not eating that much.

SANGEETHA AIYER: And there is a concept called protein leverage, okay? And it was by two scientists, Robbenheimer and Simpson, founded in the late 80s, that human beings have a unique appetite to search for protein in their nutrition. And they will eat until they complete that requirement. Therefore, when you eat low protein diets, your energy consumption via other macronutrients go by and possibly this is one of the reasons that is driving obesity. In an environment where protein is expensive and everything around you is either carbs, refined carbs, fat and salt, which is basically ultra processed food, okay? Or refined carbs, right?

So, I go back to them and tell them, this is actually a good sign, okay? Instead of you using willpower, white knuckling, motivation to kind of reduce your hunger, it is happening automatically because you are taking protein. Now, this takes a lot of explaining because people are coming from the habit of three big meals, two snacks in between, sometimes late night snacking. You know how we eat.

So, one challenge is this, which they then get and understand. Second very practical challenge that happens is very unique Indian challenge. Carbohydrate delivers every other food into our mouth.

DR. PAL: Every other food has carbs.

SANGEETHA AIYER: No, no, no, I don’t mean that. If I want to eat, let’s take an example of vegetable. If I want to eat a vegetable in the Indian spectrum, wherever you come from, I don’t know how to eat that vegetable on its own unless there is a roti with it. I don’t know how to eat dal on its own unless there is rice.

DR. PAL: Channa needs a puri.

SANGEETHA AIYER: Channa needs a puri. So, I call it that we have simple carbohydrates which act as a delivery vehicle of other nutrients into our mouth.

DR. PAL: Wow, that’s absolutely true.

SANGEETHA AIYER: So, there is no concept of just eating channa alone. Why can’t you eat a lentil salad?

DR. PAL: Lentil salad. Sorry.

SANGEETHA AIYER: Or just a lentil soup.

DR. PAL: Or a lentil soup. I mean just a sambar alone.

SANGEETHA AIYER: Sambar alone.

DR. PAL: Exactly. Why can’t your moong dal which is what you go out is called a lentil soup with less masala? Or why do you have to eat naan and butter chicken? Why can’t it be chicken grill or butter chicken alone?

SANGEETHA AIYER: Okay, so I have found out in my… I know, of course. This insight that we need to relearn our way of eating. And then we are told chole bhature is the combination.

DR. PAL: Yes.

SANGEETHA AIYER: Okay. Appam kadala is the combination. Malabar, parota and beef is the combination.

DR. PAL: Idli, sambar is the…

SANGEETHA AIYER: Two sambar, idli, chutney. Idli, sambar, dosa, chutney. So, the first thing I have to teach them is you don’t need the carbohydrate to do the delivery.

DR. PAL: Okay.

SANGEETHA AIYER: And because of that, the carbohydrate becomes the maximum portion of your meal. How many times have you noticed that if a sabji or a vegetable is there in the plate, the person will ask one more roti or some more rice to finish that vegetable. Or if the sambar is remaining or something is remaining.

Yeah, of course. You add more idli. You add more idli or chutney is remaining, one more idli. Eat the chutney on its own.

Challenges in Changing Eating Habits

SANGEETHA AIYER: No problem. So, we have developed and it is a tough one to break. This is by far my toughest one. See, reimagine you are again in the breakfast. Even if you are eating an egg, where is my toast? Okay. So, when I am trying, especially with diabetic patients. See, if it is somebody with obesity, I can still introduce. I will say four idlis. Eat two idlis. Add one boiled egg or add 100 grams of paneer. Add a salad.

DR. PAL: They are like breakfast salad? Breakfast you want me to eat a sabji?

SANGEETHA AIYER: No. So, that concept is gone. So, this reintroduction that if you are doing a dosa, eat an egg dosa. Like how the Sri Lankans eat. What is it called?

DR. PAL: Hoppers.

SANGEETHA AIYER: Hoppers. I love that concept. Or make a moong dosa and put egg over it. The profile of the food has changed completely. Or if you are a vegetarian, have 100 grams of tofu or paneer on the side with salt and pepper. And eat one idli or two idlis. And do have a salad. It does not have to be complicated. It can be a raita. Okay. This is one. So, realigning that you do not need carbohydrate to do the delivery of everything. Learn to enjoy food on its own.

Experience at Saravana Bhavan

SANGEETHA AIYER: I did a video in Saravana Bhavan. I went there. And I said, hey, look at this.

DR. PAL: Not a paid promotion. Saravana Bhavan does not need pay promotion.

SANGEETHA AIYER: Exactly. From anybody.

DR. PAL: It is in Canada.

SANGEETHA AIYER: Yeah. Maybe that one will need. Because taste was not there. So, I went there. And then the concept was okay. So, I am going to get protein 25 grams on this meal. So, I always say.

DR. PAL: It is a vegetarian place.

SANGEETHA AIYER: Vegetarian place. No hardcore. Hardcore vegetarian. So, my advice to my followers is 20 grams of protein per meal. So, that you try to achieve that. Somehow.

DR. PAL: Yes.

SANGEETHA AIYER: It is a good starting point.

DR. PAL: Good starting point.

SANGEETHA AIYER: Somehow 20 grams of protein. And I always say.

DR. PAL: So, 20 grams of protein and 10 grams of fiber.

SANGEETHA AIYER: In every meal.

DR. PAL: In every meal. Yes.

SANGEETHA AIYER: You are big on plant points.

DR. PAL: Plant points. Yes. So, let us say you have 3.

SANGEETHA AIYER: Hopefully, you will get 30 grams of fiber. And 60 grams of protein. I am happy. I am happy.

DR. PAL: Your cat will be happy. That is what my. Actually, you can try starting there. Okay. 20, 10 is better.

SANGEETHA AIYER: So, the purpose of the video was. I am going to go there. And then I am going to show. I am going to get 20 and 10. I go there. And then I order Idli. Okay. And then I order. They came with Idli and Sambar.

DR. PAL: Correct. That is the combination.

SANGEETHA AIYER: That is the combination. So, Idli. Correct. That is the combination. That is the combination. So, Idli has what? 2, 3 grams of protein. Very minimal. 2 Idlis. Only 4 grams of protein. Max.

DR. PAL: Max.

SANGEETHA AIYER: Okay. Not more than that.

DR. PAL: Yes.

SANGEETHA AIYER: Then I said. Okay. There is nothing else over here. And I asked them to see. Can you give me eggs? Or anything like that.

DR. PAL: Yes. Yes. No. Do not even mention them.

SANGEETHA AIYER: Okay. Then I said. Okay. Milk. You have milk?

DR. PAL: They had milk.

SANGEETHA AIYER: Yes. They brought milk.

DR. PAL: Chocolate milk.

SANGEETHA AIYER: With sugar?

DR. PAL: Already chocolate milk.

SANGEETHA AIYER: Yes. And they are giving sugar as well.

DR. PAL: Then I said. Did you succeed?

SANGEETHA AIYER: Then I said. Only pure milk.

DR. PAL: Pure milk. Who gets pure milk?

SANGEETHA AIYER: Filter coffee.

DR. PAL: Yes. Filter coffee is already sugar added.

SANGEETHA AIYER: Yes. Then I said. Okay. That is okay. At least. It is okay.

DR. PAL: Okay.

SANGEETHA AIYER: Then I drank the milk. And the filter coffee box was so small.

DR. PAL: Okay. So, it is not even 8 ounces.

SANGEETHA AIYER: I have to get. The tumbler.

DR. PAL: Tumbler. The tumbler. The South Indian tumbler is that much only.

SANGEETHA AIYER: So, I said. Okay. Give me one more tumbler. So, I got like 8-9 grams of protein in that little thing.

DR. PAL: Okay.

SANGEETHA AIYER: So, total is 12. And then only idli. Sambar is another thing. And I already am full.

DR. PAL: Yes. I was about to ask. What happened to the tummy? How did you eat after this?

SANGEETHA AIYER: After this. And I am also. I am not hungry anyways. In the morning. That much. Because of the fasting. I am not hungry anyways. So, I said. Okay. So, what do I do? I asked them to bring chana.

DR. PAL: Okay.

SANGEETHA AIYER: I asked them to bring channa. You know what they did? They brought chana. But there was puri right next to it.

DR. PAL: See, this insight that I am telling you.

SANGEETHA AIYER: Exactly. The delivery mechanism of everything else on our plate is via a cup. It is like. Forget the spoon. We use puri, roti, rice as the spoon. And the food is the spoon. And the food is the cup. And the food is the spoon. So, this is the situation. The delivery mechanism of everything else on our plate is via a cup. It is like. Forget the spoon. We use puri, roti, rice as the spoon. And we don’t know. It is. We don’t know how to eat without that.

Challenges with Vegetable Consumption

SANGEETHA AIYER: I will give you another example, doctor. I mandate that there need to be 300 grams of vegetables in your meal. 100. Within a week. I will get frantic messages. Can’t eat so much vegetables. And this is from vegetarian.

DR. PAL: You are a vegetarian. For how long do you do this job? We need to do it. You are a vegetarian. You are a vegetarian. You are a vegan. I am not vegetarian. You are a vegan. I am not a vegetarian. I am a vegetarian. I am a vegan. I am a vegetarian. I am a vegan. I am a vegan. I am a vegan. I am a vegan. So, you are a vegetarian. If you can’t eat vegetables, what are you eating?

SANGEETHA AIYER: Why can’t they eat vegetables?

DR. PAL: Because it is bloating.

SANGEETHA AIYER: No. Oh, they don’t include. Indian vegetarian, if you look at the diet, it is a mountain of rice or three rotis, one dal, one little sabji. The hero of the meal is always grain. They are always grain maxing. Unfortunately, it should be the other way around. If you actually want to eat properly, you have to not have more than 80 grams of cooked rice or one roti in your plate, two sabjis at least.

I mean, how does, where is the nutrition coming from? Like you said that you did the case study, right, with your GI dietitian, 30 grams of protein. I also did one more thing. I said, in a person who calls themselves strict vegetarian, what is the, one is 30 to 40 grams of protein, 70 grams of carbohydrate.

DR. PAL: For what?

SANGEETHA AIYER: For the total caloric composition in a day, if they are eating 30 to 40, 30 grams of protein, in my calculation, it is 60 to 70 grams of carbohydrate. So you’re, you’re maxing so much and out of that carbohydrate, the largest portion is refined carbohydrate, which is grain. Now we are assuming they’re all eating clean.

Now let us add the khakra, the biscuit, the sweet, the bhujiya, the farsan, the murukku, the taste, all of that when they come, that carbohydrate consumption in a day goes to almost on an average 300 grams. Obviously, you will fall ill because that is energy, toxicity in your body. So this is the problem. Next challenge is how do I teach people and that is where the entire counseling happens.

And every time I will get, when do we go to normal way of eating? I say, what you are doing is abnormal way of eating. This is normal way of eating.

DR. PAL: Okay. So that might be the patient when I asked, how are you in the hospital? He said, if I was better, I will not be here.

SANGEETHA AIYER: Every time I get this, when do I go to normal? I said, your normalcy has brought you to me, there is something abnormal about it.

Health Issues Beyond Weight

SANGEETHA AIYER: And of course, one more thing happens, doctor, because people don’t come to me only for, I don’t just run a weight loss. I’m sure you know, even in your practice, in your clinic, along with, and in Indians even without a lot of obesity, there are issues of fatty liver, there is a high insulin, high fasting insulin. First thing I see is a dyslipidemia, basically, the lipid profile is not optimized, high triglycerides. People think they’re eating, people think here that, you know, they’re worried about saturated fat.

The LDL is not high because of the saturated fat coming from one or two spoons of ghee. It is coming from all the fried nonsense that you eat in the name of food.

DR. PAL: Absolutely. One or two spoons of ghee, people are making saturated fat into this coconut oil tadka that you put in, or the coconut chutney that you eat, or even the coconut milk fish curry that you’re making at home, or you’re cooking your one egg or two eggs in butter, that is not the saturated fat problem.

Sorry, very important point to discuss, where the previous discussion that we had, we talked about ghee. And the discussion was, oh, ghee is okay, I don’t know, and she said ghee is not okay. Ghee is completely not okay, because it is saturated fat and rich in calories. But I said, you know, I think one to two tablespoons of ghee per day is completely okay, as long as you don’t overdo it.

But the point she was mentioning was people always overdo it. They, you’re saying they’re putting the ghee on the roti. And then when they do tadka, they do ghee over there as well. And then they use ghee for cooking or the sambar or…

SANGEETHA AIYER: Not my experience at all.

DR. PAL: I see. In fact, there is so much fear of saturated fat in the last 30-40 years. Everybody I know has moved to peanut oil, mustard oil, sesame oil, and worst case all the saffola, sunflower oil, whatever, that’s a completely different podcast we can do.

There is a lot of awareness about ghee. Okay. When we think of oils, first and foremost, we should think of how we are consuming it. The first way there is excess oil in your diet is when you take ultra processed food. There is palm oil, there is this oil, there is that oil. Also, ghee is really expensive. Nobody is using it that much, really. And there is so much fear of ghee and cholesterol.

Ghee is expensive. A good, decent brand is 1000 rupees. I’m not even getting into that Bilona method and all, which is now, it’s almost priced as gold. 1000 rupees for an Indian household for a litre of ghee, let’s remember, it’s a four member family. It’s very expensive. The problem is not the ghee, it is the overall consumption of, in what all ways fat is coming into your diet. Just like in what all ways carbs are coming into your diet. When you eat the tatte, the murukku, when you’re eating, people don’t even think about the oil that they’re eating in a biscuit, in a…

DR. PAL: You are right. If you are overall mindful about the quantity of oil, another big culprit is that outside food ordering, they are designed to put more oil, make it tasty. You make grilled chicken at home, I make it in 6-10 grams of butter, you order grilled chicken from outside or tandoori chicken, even if they are writing, they will tell you it has 28 grams fat, that is their job.

SANGEETHA AIYER: So, you don’t have to fear, yes, do not have these highly refined, hydrogenated oils. Traditional oils including ghee are fine. The overall, see what your overall diet is comprising, that one ghee that you put in sambar or even that your mom will put that chammach in the katori and put a little bit on, that is not the one that is, it is the ice cream. It is all of that that you do on a daily basis is problematic.

So, fat be, rotate your fat, don’t worry about saturated, you have different kinds of fat and Indian cultural wisdom, we are from the south, so we use sesame oil for certain things, we use peanut oil for certain things, if you are from Kerala, you didn’t use peanut oil, you use coconut oil for certain things, ghee was for certain things, we always rotated our oil.

So, depending upon which part of the country you are, rotate your oil so that your omega 369 is in, the problem today is the ratio between omega 3 and 6 has become 1 is to 22, which is highly inflammatory and that is coming because of, again and again we can say this, your bad food, your junk food consumption, your fried food, eating all these other things, so that is where it is, there is no need to fear ghee and butter.

DR. PAL: When you are talking about fried foods like samosas, pakoras, kachori, look at what gets served in a regular corporate office between 4 and 6, vada pav, samosa, bread pakora, kachori, meetha bhel, all the bajji, if you go down south, bonda, bajji, bhujiya is that, is that haldiram thingy, that sev, but that is deep fried as well. Now they have baked version of it, it’s just that they are adding everything but instead of deep frying, the oil is pre-added, they are only baking it. We have baked version of the sev now, but it’s just that in the dough itself the oil is added, so they don’t have to fry it, they bake it, so that is the oil part of it.

Omega-3 and Omega-6 Ratio

DR. PAL: So educate us about this omega 3, omega 6 ratio and everything.

SANGEETHA AIYER: Okay, so in human beings, the ideal omega 3 to omega 6 ratio should be 1 is to 2, so 1 part omega 3, 2 parts is acceptable of omega 6. If you push it a little, modernization, 1 is to 4 can also be okay, but you will be shocked to know that this omega 3 to omega 6 right now is 1 is to 22, in some populations even 1 is to 30.

So this omega 6, if it crosses the, omega 3 I am sure you are aware, it’s very good, brain health, omega 3, HDL, lowers your triglycerides, plays a very important role, brain development, children, okay, aging, omega 3 has a lot of roles to play, you get it via seafood, largely fish, right.

Omega-6 and Seed Oils

SANGEETHA AIYER: Omega 6 is where it is highly inflammatory and the research is currently pointing out to what we call vegetable oils or seed oil usage has become way more than, very pervasive, commercial oils.

DR. PAL: So educate the audience about seed oil, what is seed oil?

SANGEETHA AIYER: Okay, it is marketed as vegetable oils, but they don’t really come from a vegetable, they are also, so you have plant fat and you have animal fat, okay, so let’s start there. Animal fat is your ghee, your butter, even white makhan, the white butter that the North Indians use, lard, pork lard, you have goat tallow, you have beef tallow, you have all of that, so that is animal fat, which is considered a very natural source because A is attached to the protein, okay, and yes, it is high in saturated fat, but we can discuss, that’s a completely different discussion as to how much of it is good. So these are good for us, okay, now there is plant fat and even in plant fat, there are certain plant oils that are good, olive oil is very good, coconut oil, high in saturated fat, but very good, avocado oil, very good.

Now, in the recent 60 years, we have seen oils made out of things that are not necessarily source of oil, so if you look at rice bran oil, the name itself tells you that you are crushing bran to an extent and processing it to an extent to derive oil out of it, soybean oil, that’s the second one, rapeseed oil, canola oil, safflower oil, sunflower oil, so these are basically coming out of seeds, or outer structures of a plant that are not supposed to be oil. It’s very simple, you crush an olive, you can feel the olive in your hand, you may not be able to do that with a peanut, but you lightly blend peanut, you are getting peanut butter out of it.

There are — these kind of plants that we are, or seeds that we have to use thousands and million tons of them and they have to go through a highly industrialized process of bleaching etc., which is now being used and marketed worldwide, which is one of the theories is that they are high, it’s not a theory, yes they are high in omega 6, and one of the reasons of co-factor of insulin resistance, high inflammatory markers, raising risks of obesity is the usage of seed oils.

Now India is a bit of an exception, we have used 2-3 other kinds of oils in our mix, peanut oil, sesame oil, depending upon where you come from, we have also used mustard oil, mustard oil, I am sure you are aware it’s banned in the US, and in the European Union. So there are certain regulations outside the country because of a certain kind of an acid, I won’t get technical, but it’s banned for that, because it’s supposed to be not good for humans. But in India, these 2 oils, sesame oil and mustard oil, mustard oil is common in North India, yes, even Bengal, Bengal, fish, certain fish, correct, then sarson ka saag, that’s made, again it comes to how we were using it, sesame oil, nallanna that we call in Tamil, very common.

But both these are not used to high smoke points, and they are not regular features in our diet traditionally, they are flavoring agents, they are used in certain seasons for certain cuisine. So they were not mainstay of Indian traditional cooking, even the sesame oil in the south, it was used for either idli podi or a certain kind of a sambar that was made, it was not, it was not the universal oil. You were not cooking day in day out in it, neither were you cooking day in day out in mustard oil.

Practical Approach to Oils

SANGEETHA AIYER: So I get a lot of question on what about sesame oil and mustard oil, it’s been used, use it the way it is meant to be used, as a tadka, as a flavoring agent, in a certain recipe, in a certain season, you are alright, your mainstay will always be the other combination.

Now, because of the, now, obviously there has been large scale production of seed oil, soya bean, yeast and canola, every commercial kitchen you can be sure it is that, every, not even peanut oil, it’s not even peanut oil, okay, so, commercial kitchen you are talking about, hotels, restaurants, when you do, because that’s cheapest, cheapest, shelf life, shelf life is longer, much longer, you can buy soya bean oil and it will stay for 5 years. So it’s been bleached, so these are the oils, obviously they are cheaper, like we just discussed the cost of ghee, let’s talk the cost of olive oil in India, first and foremost you won’t get olive oil that’s not blended with something, it’s not suited for Indian cooking, any, minimum is 800 rupees, avocado oil, forget it.

Avocado only we can’t afford in India, even in US this avocado oil is expensive, very expensive, now, cold pressed oil, expensive, so these are the oils that are available depending upon which sale and which big basket, whatever you go into it, from 80 rupees to 150, versus if you look at cold pressed all the other oils, start, a good cold pressed coconut oil is probably 300 to 500 rupees minimum, ghee is 1000 rupees. So, clearly 5 to 10 times more, at bare minimum 3 times even in low, in tier 1, tier 2, because of this and of course all of this commercial usage are, these ratios have tilted, and omega 6 is one of the very clear reasons for having an inflammatory effect, CRP or SSCRP levels, cytokine storms, all ultimately come and fall into the gut, right, so, yeah.

DR. PAL: One additional point I was going to say is, I was under the impression that you know, if you look at any influencer, any Instagram thing, they will say, oh, this chip’s packet has seed oil, oh, I can’t believe that they are having this, and this is going to, if you eat this, you are going to get cancer and all those things, right.

I was under the impression that, you see, you cannot say that don’t have chips, it is just about the amount, so I was always focused on the amount of the oil, you know, you just be mindful of how this is included, if that includes within your calorie limits, and if seed oils are coming in, you should be reasonably okay, if you can completely avoid it, yes, that is the best thing to do.

SANGEETHA AIYER: Not practical, what I told you, so, for example, see, 80-20 rules follows everywhere, doctor, right, now, in your home, even if you are going to have a mix of peanut oil, ghee, olive oil, whatever you can afford, you use a mix, like I said, rotate your oils, someday you will go out and eat, okay, someday one from outside some murukku packet will come, not necessarily it is made in ghee. Okay, so, if it is far and few, okay, it is okay, correct, correct, like, if I go to a, I am travelling, I am going to a dhaba, he is probably using some oil, so, the thing is, there I will avoid, for example, fried food, be intelligent, because I don’t know, first and foremost, what oil he is using, and then, generally fried food, how many times that oil is being reused and reheated, that is where it gets even worse for us.

DR. PAL: So, if you remember, there was this outlet called hot chips, everywhere, in the south, everywhere, it was very popular, because, I didn’t see it in Hyderabad, so, I hope people have understood that it is not healthy, at one point, because he would start in the afternoon and the batch would end, people thought it was fresh, because he was frying, but the same oil, the same oil, the same oil.

SANGEETHA AIYER: So, if you have, let’s talk about hierarchy, because we have to give practical solutions for people, okay, so, if you want to look at the hierarchy, regular usage, stick to the facts, that cooking fat and oil, that we have always grown up with, I have mentioned, what all, depending upon which part of the country you come, once in a while, if you go to a restaurant, there is no point in fighting with that guy, why he is using soybean oil.

He is going to, you come and run the restaurant, or worst, he might do something else to your food, which you don’t want the waiter to do, correct, right, so, get bacteria, yeah, problematic, right. So, if you are a family that eats out every Saturday, every Sunday, cut that eating out to probably first only one meal in a week, how do you minimize all of this, okay, so, cut that, when you go to a restaurant, don’t, very clearly don’t order deep fried dishes, because you know that’s a commercial fryer. He is not changing that batch of oil with every French fry or every poori or every kachori, gobi 65, yeah, gobi 65, he is not changing it.

Okay, so, avoid the ordering of fried foods, okay, if you ever want to eat fried food, eat it once a month in your own home, you know what your oil you are using, and then like my mother, please don’t reuse that oil for one month.

DR. PAL: My mom used to do that, poor thing, she didn’t know, it’s out of ignorance, no, I was in Madurai recently, my mom was using the oil, and then I said, what are you doing, and this is for you, she is re-eating the oil, for the paniyaram that she is doing. And she is having a separate fresh of oil, another dish, another vessel on the second stove, what is that, that is for my grandkids, that’s fresh oil, for the grandkids, fresh oil, yeah, so, parents have their own logic.

Reducing Oil Intake

SANGEETHA AIYER: So, I am saying, reduce the, I will tell you where your oil intake is going completely wrong, see, younger people, okay, your app deliveries, every, the amount people order is not funny. So, reduce those orders, okay, so, when you do all of this, in your practice, how often like a young software professional in Hyderabad or in Mumbai, every single day, doctor, they order every single day, sometimes even two meals, two meals they are ordering, every single day, software professionals working, you know, night shift, US timelines, a lot of high pressure job, where they don’t wake up before 11. But they are working till 4, may be one meal when the mother is around, she will give something, or if they have a wife or whatever, and if both husband and wife are working, all, one meal a day is outside, that is a lot.

And I, so, I specialize in the, there are 100 million, no, no, there are 100 million clubs and 100 million films and 100 crore, I specialize in the 100 plus kg category, hate to say it, it’s very sad, a lot of, lot of my clients are 100 plus kgs, age group being 25 to 45, so, it is everywhere, younger, older, older people have different issues, but younger audience is indiscipline of, I am very concerned about the 25 year old.

DR. PAL: Me too, me too, 45 at least, the damage is still going to take longer, this 25 year old, I am very concerned.

SANGEETHA AIYER: So, it’s, this high pressure job of, you know, being there, wanting some, you know, the taste is also great, convenience of ordering, let’s say some project delivery needs to happen at 1 in the night, after eating at 9, ordering again something at 11.30, that’s a big one. So, if you stop doing all of this, then doesn’t matter what oil you use, exactly, by mistake one seed oil meal is not going to hurt you, or if you go to somebody’s house and by mistake they are using saffola, whatever is not going to hurt you, don’t measure in the micro, right.

DR. PAL: Yeah, I think that is the problem, I think that is where the context is being missed, yes, yes, yes, see my son, when there are tournaments, he is an aspiring cricketer, yes, yes, yes, when there are tournaments and he plays matches for 15 days together or one week together, there are multiple matches, he is in a restaurant, he is in a hotel, like a 3 star.

If there is enough sponsors, it is a better hotel, otherwise it can be some dorm, okay, where one dhaba will be there in some outskirts, where is he going to get clean food, but the only thing, and I can’t tell him, don’t go play that match, he will disown me, see your nutrition fundas you keep to yourself, I have to play the match, that is more important, so the rest of the time when he is there, we try and clean up, obviously his diet, keep it all very nice and whatever, that compensation is not happening, that is what the problem is.

SANGEETHA AIYER: Yes, and you have to be practical also and give practical solutions, that is the thing, with seed oils, minimize the instances, don’t have to get all crazy about it, so that is why I tell my patients is that, doesn’t matter where the oil is coming from, but the amount is important, so 2 liters for a family of 4 per month, so 500 ml per person, so how it translates doctor is 1.5 tablespoon of fat per person per meal, if you are looking, if you are watching your weight, trying to be healthy, I am not saying you will have to fear everything, you can go one or day a little more or back, but largely that is the quantity of fat we can healthily use in our diet.

DR. PAL: I am so glad, I know a lot about nutrition more than any of my gastroenterology colleagues, very very happy to know that, no obviously, they don’t teach all this in the curriculum, so unless we learn by ourselves.

SANGEETHA AIYER: So once you do that, the amount is limited, so then your ratios become better, and then once you start recognizing what are omega 3 foods, now difficult if you are a vegetarian to get it, or if you are somebody who doesn’t like seafood and fish, supplement a little bit, there are some plant sources, but they don’t convert very well, like flax seeds, so we don’t convert the ALA very well, so again, we have to look at some amount of supplementation and you are taken care of, the problem is minimize that ratio which is causing the inflammation by all of these methods.

Role of Nuts and Seeds

DR. PAL: In your dietary plan, what do you say, nuts and seeds play a role?

SANGEETHA AIYER: 100%, so there are two ways to look at it, I give it almost like plant points or fiber points, and healthy fat points. So nuts, depending upon the objective, if sometimes people have the — nuts are not very satiating, you can eat 200-250 grams in a go, that is the nature of, without knowing. So if somebody’s objective is weight loss, somebody’s objective, then I tell them, watch the quantity very carefully, because nuts can be over eaten. Otherwise, I like to do combinations, like I will say, take your seed mix, toast it and sprinkle it like a thing on your vegetable, pumpkin, watermelon, all the good seed mix where you get all your micronutrients.

Now if you want to eat almond, walnut, yes, eat it, you can also like saute it and coarsely grind it and put it on top of your Greek yogurt, it has a nice nutty flavor. So I do these things for healthy snacking option between 4 and 6, instead of going and reaching out to some biscuit or some save or something like that. So 1 to 2 tablespoons of a seed mix and probably a fistful, anybody’s fist, fistful of nuts in a day, give you your decent amount of healthy fat that is needed. Only thing I tell people is, don’t go crazy over this nut and jaggery ladoo, that is where now you are changing the profile of that.

Healthier Alternatives and Marketing Issues

SANGEETHA AIYER: So they do a lot of these, they will crush a lot of seeds and nuts, add jaggery to it and make it into a powder, it will turn into a healthier ladoo, like as if it is healthier than a motichoor ladoo or a besan ladoo. So don’t do things like that, once in a while may be okay, than eating a jalebi.

DR. PAL: So then that is a marketing problem.

SANGEETHA AIYER: Yeah, it’s a marketing problem or it is a, what you see on Instagram, this is a healthier ladoo because it doesn’t have sugar and it has whatever, caloric value of that is high and you don’t need to eat it in that form. So it is part, nuts and seeds are always part of a plan but I make like I said combinations or if you are somebody, drink whey protein and follow it by a handful of nuts and one fruit, it’s a great meal on its own, it has healthy carb, you have got your protein, you have got your fiber and fruit in it.

Challenges with Snacking and Fasting

SANGEETHA AIYER: So I have, this is a third challenge, people need healthier snacking option. Yes, I will always say don’t snack but I think if you are coming from a practice of fasting, it takes a very long time to get to that period like I don’t snack at all.

DR. PAL: Just an additional point on this is that I am big on circadian rhythm, time-restricted feeding and I am not saying fasting is the holy grail, it’s not. I am saying that fasting is one of the sustainable option for a busy professional, that’s how I usually put it for my patients. And if you want to maximize the fasting, you start with 12 hours of fasting and then you maximize to 16 based on whatever you are.

And studies have shown that the less disturbance that you are giving to the insulin, the more rest that you give to insulin, it is better. So I do, I eat snacks but I eat, in that window, I eat along with lunch, I eat say whatever, I don’t avoid, I don’t avoid any food at all. But I take it in very limited portions but I add it to the dinner, so my insulin stimulation, in that one meal and then you are done with it, instead of stimulating the insulin every 2 hours by going on, I call it grazing, intermittent eating.

SANGEETHA AIYER: Yeah, intermittent eating, correct, so initial problem when I did this was I was extremely hungry, I thought initially at 4 p.m. but I was not hungry, I was thirst.

DR. PAL: Thirst, yes, so I drank water.

SANGEETHA AIYER: Yeah, okay, it just extended and black coffee.

DR. PAL: Yeah, extended around, yeah, then drinking black coffee at 4, 5 p.m. disturbed my sleep, so then I just drank water.

SANGEETHA AIYER: Yeah, then I realized one of the most important hack that absolutely helped me was having that water bottle right next to me.

DR. PAL: Yeah, it’s a wonderful thing, I know it’s a very simple thing but what has happened is like I know at 4 p.m. I am hungry, we missed the signals also, there are confusing signals.

SANGEETHA AIYER: Confusing signals, yeah, confusing signals, so let’s say the water bottle is right next to me, I keep sipping, I don’t feel hungry at all. But let’s say that there is no water bottle right next to me, I am busy at some work, then my hunger, I missed the window, then I am not going to drink water to extend my hunger, I am going to eat something. So point to that is yes, 2 meals as much as possible, avoiding snacks is the ideal thing to do.

DR. PAL: Yeah, but difficult.

Challenges with Work Schedules and Meal Timing

SANGEETHA AIYER: Difficult, I will tell you why doctor, because if you look at how Indian people work, urban places, right, 7 o’clock they are still at work, the dinner if they do at 9, I am happy, let’s say you have done your lunch between 1 and 2. Let’s say you are in Bombay or Bangalore, by the time you have clocked out, very optimistically you are clocking out of work at 6.30, you have one hour commute, you come home, by the time you sat to the table, 8, look at the gap, that 4 to, I call it the witch’s hour, 4 to 6, that is when everything goes for a toss, most of these people also when they don’t bring adequate protein in the first 2 meals, which we discussed as a problem.

If you don’t have protein driven calories in the earlier part of the day, this is proven, your propensity to junk on junk calories in the later half of the day is very high because hunger catches up, so it is very logical.

So when you, when I say let’s say 30 grams of protein in the first 2 meals and that snack, I give them one of these options, then they are able to go home, large protein centric dinner, no carbs, they are fine, now few of them obviously, fasting is something that I do in my practice. I am an intermittent faster myself, 7 years now, 2 and a half meals is what I have in the same window. But when people come into fasting, I do the same thing, like push like 9 to 10, 10 to 11, in the morning, they are not willing to cut down the night time.

I will tell you why, Indian work system again, that is the only family meal, dinner, if you have kids in the morning, you are taking them to this one, somebody is grabbing a breakfast, somebody is eating breakfast in the car, in the train, wherever you are. So family is not there, afternoon you are doing office lunch, night is the, that dinner is a reward, one, all socializing, going to somebody’s house, whatever is evening, all going out is evening.

So I know every research points out that end it at 7, right, and if you have to skip, skip night, maximum, people have a very strange thing, if I don’t eat in the night, I can’t sleep, it is very common. They say okay, Sangeetha, I know, but I say 8.30 and then at least give me a 2 hour break, how often 8.30 is practical you think, I say 8.30, they will go to 9.30, but 9, people who come on my program, if they are very serious and then they do whatever — they will ensure that they do, if they know it is going to be a late night, then they will make some arrangement at work or something like that.

DR. PAL: And work usually gets over by 6.30, work in general, it is supposed to, I mean, I’ve worked a corporate career myself.

SANGEETHA AIYER: Very, there is no timing, no, if you work in software, if you work, you know software, if you work in the media industry, if you are an editor, if you work in entertainment industry, if you are, if even banking, which is supposed to close on time, if you are going by month-end schedules and quarter-ending schedules, plus commute is very difficult, that is where the life goes, one hour is very, very conservative, so very difficult for people to end 7 o’clock.

Strategies for Extending Fasting Periods

SANGEETHA AIYER: So I extend the breakfast and to take people through a breakfast, I do many tricks, black coffee is one, some people like black coffee, some people don’t, I say, okay, not technically a fast, try with buttermilk, like watery buttermilk, do 200, 300 ml, if it can help you push, fresh lime soda with salt, especially when you are getting into a fast, one of the first things people will complain, I am feeling light-headed, I am feeling dizzy. I feel like a headache is coming, it is basically electrolyte withdrawal, if you do a little bit of fresh lime soda with salt, works, so over a period of time.

DR. PAL: The only concern about the buttermilk is, we did a research about what is stimulating this insulin, right, I mean basically insulin is like Rajamata, if it works, it is good, insulin is so powerful, extremely powerful, so it is even secreted when you are tasting, while you are preparing for, the cephalic phase of insulin rise, which is called.

SANGEETHA AIYER: Yes, cephalic phase is even when you wash it, looking, like an ad or smelling, your gastric acid secretion, insulin doesn’t come that much in cephalic phase, insulin is only when you put anything in, so when you are tasting something, all it needs is 5 micro calories of carbs in the blood, okay, how are you tasting, it needs to go to the blood, okay, so insulin is stimulating, so many people ask me, okay, so can I taste, I said, when you are starting, it is totally okay, this is what I do, so I will tell them, don’t do a lassi, do the South Indian, very watery moru, very watery with salt in it, okay, the other option that I do is, you would better off doing ghee coffee, butter in.

DR. PAL: Yeah, because fat doesn’t.

SANGEETHA AIYER: Yes, absolutely, that doesn’t stimulate insulin that much, I do that as well, yes, that’s the other idea, like if you like coconut oil, depending on what your taste is, ghee coffee, butter coffee, it gives you that energy.

DR. PAL: So I am going to tell you a trick in terms of what I do, I have realized that to extend the fasting in the morning, so we have finally come to an agreement that, okay, it is not that easy to decrease from 9 p.m to 7 p.m.

SANGEETHA AIYER: Yes, very difficult after practical modern world issues.

DR. PAL: So in that case, I think that 12 hour window should be at 9 a.m, 9 p.m, so let’s say you are waking up in the morning and you are craving for that filter coffee in the morning, what I did to get that craving out was, I had a black coffee initially, I said for this, I will just drink the filter coffee, I absolutely hated it, so then, I had it with milk, filter coffee with milk, and no sugar.

SANGEETHA AIYER: Or you had it sugar, no, no, no, no sugar, but doesn’t matter, I broke my fast.

DR. PAL: Yeah, you said, okay, no, the minimum I can do is 6.30 to 9 p.m, I was like, I can’t do this black coffee.

SANGEETHA AIYER: Yeah, it’s not happening, it’s not happening, okay, so then, I realized that, okay, see, insulin is essentially drawn into cups, not that much of fat, and you have fat, insulin is also secreted, but not to a level as a cup.

DR. PAL: Yeah, so that’s why I said, you know, the drip coffee, there is this pod that you put it on, K pod, and then the Keurig maker makes a black coffee, then I add creamer to it, creamer is your butter version of the.

SANGEETHA AIYER: Yes, I got it, it comes in those little pods, and they are hardly 5 grams of creamer in it.

DR. PAL: Yeah, it is high fat, high fat, only fat, it is fat.

SANGEETHA AIYER: Yeah, only fat, there is no cup.

DR. PAL: Yeah, so you add that, and I realized that I was able to sustain that 3 hours or 4 hours, so then, I started noticing changes in the taste, to a point that I am able to do black coffee now, so the point I am trying to say is that, you need to figure out the way, what works for you, somebody said bullet coffee is good, it does not mean it is good for you.

SANGEETHA AIYER: Correct, also, there is a lot of chatter, doctor, like on the internet, saying that, oh, like for example, you had filter coffee with milk initially, at least you just only had filter coffee, you did not eat a meal, you were trying to push it, right, so allow yourself smaller things that you can do to be a work in progress than to be a non-starter, very important when you are having any new practice, if I cannot go, 16 hours is the Bible of a fast, no, for you, if you are somebody who has achieved 12 and you are going to 13, that is progress.

Okay, if you have managed to take out sugar and just have 50 ml of milk and coffee, that is an achievement, eventually, you will take out that milk, add butter, so every day, and that is where even in my practice, slow steps and do not let people tell you, this is the right way of fasting. This is technically, am I in a fast, not in a fast, no, you are progressing, so that is very important. And that is how you also, I have always believed that when a person has come to a point and they come to you to change their health, whether as a doctor, as a nutritionist, as a wellness coach, you have to give them small wins. Otherwise, they are not coming back, they will change the doctor, they will change the nutritionist.

Worse still, they will go back to doubly doing what they are doing, which is even worse, I am happy even if they change, but people, they just said, they give up, they think this is too hard.

DR. PAL: So I think, yeah, there are tricks like this that you can do to take it forward, my buttermilk trick is diluted buttermilk, I know you are technically not doing a fast, but at least you have dropped your calories to an extent where you are getting used to hunger a little bit and you are moving the needle a little bit.

SANGEETHA AIYER: There is a point on the getting used to the hunger, experiencing that discomfort is a good thing, not, I am not talking even in a fasting world, I am just talking in a philosophical world, where we are so comfortable at multiple levels, where whenever there is a stressful factor that is coming in, either it is fasting or a pressure at work or a mental health issue, where there is a stressful factor that is coming, I am saying my patients are not able to handle at all, completely and that is very visible.

Mental Health and Gut-Brain Axis

DR. PAL: Why I am talking about mental health a lot, this one in two patients walking into my gastroenterology service have mental health problems, but there is the gut brain axis, which is very proven. So in my practice, I say fasting and everything, I know they are not going to do it, but at least they will try because I said, I told them to do. So when they are doing that discomfort, they are creating that neuronal plasticity and new neuron that is being developing, handling that discomfort. So I think it is one thing that everybody should get. Okay, it is okay to have, it is okay to feel hunger, it is not the end of the world and everybody knows that we are not going to die because of the hunger of that one or two hours.

SANGEETHA AIYER: Yeah, doctor, I have often compared fasting to meditation, always, I said meditation is not the loss of thought, you will never be able to meditate if you want to, it is not not having thoughts, it is when you are starting the practice, even for that 10 minutes, it is being comfortable with all the thoughts that are coming and going, knowing that over a period of time, all these thoughts will pass.

Fasting is the same, it is not starvation, it is just knowing that this ghrelin, which is going to the horron, which is coming up and down or which is affecting me, wanting me to be hungry, I am just watching that come and go for a period of time till I get used to it. Yes, you will not succeed the first day, it takes time, but like you said, that good stress or that good discomfort is helpful also because it has happened with me. I do not know if it has happened with you, you start to recognize what real hunger is versus what snacking out of boredom is versus what is eating out of stress is or coping mechanism is, it resets your relationship with hunger.

You will no more be hangry, like next half an hour is my meal time, if I do not get that meal and let us have to wait another hour and a half, it is not like my moods are going all over the place, so while people, I get a little on the back foot when people say it is just a way to restrict calories, sure it is, but it is much more than that mentally, resilience, resilience, mental resilience is one of the main thing.

Dr. Pal’s Approach to Patient Care

DR. PAL: I, you may or may not believe what I am going to say, in all my jay patients walking into my office, I do not prescribe any medications at all, I prescribe only one or two or three things, one is I do fasting, which is overnight, because I strongly believe that when they have rest overnight, hormones itself will take care of the problems and as you know it is neuro hormonal thing most of the times.

The second thing what I say is, you need to experience the discomfort somehow, you have to, there is no other option, you are anyways experiencing it and it is the worst kind of thing you know, where you are unable to lie, you have to lie in this position. You are burping, you are having flat, there is a discomfort either way, choose the better one, choose the better one, they say no doctor, choose your heart, everything is hard. So my prescription is first is eat by 7 pm and when I say 7 pm, they will at least eat by 9 pm or whatever it is, I always go hard, so that at least if I get 50 percent of it, I am okay.

So eat by 7 pm and then 7 hours of sleep, so I say okay, you should not go to bed 3 hours after your last intake, intake that is very key difference, because let us say you start your dinner at 7, you are not going to finish by dinner 7, you are going to finish your dinner only at 7.20, I always ask my patient to start the timer clock, end of the intake, after washing the hands.

SANGEETHA AIYER: After washing the hands, I know it is only 15-20 minutes, but it makes a huge difference, in fact, I think doctor, sorry to interject, it was Satchin Panda on the Huberman episode who said, it is not until almost 2-2.5 hours after your last intake, that the actual fasting begins, correct me if I am wrong, because you are still digesting.

DR. PAL: 3 hours, yeah, 90 minutes, so your actual, if you have to count fasting, no, that is why it is called deep fasted state, where you start your sleep in a deep fasted state, so you sleep better, and you get the benefits as well. So let me tell you 2 examples, 9 pm you are eating, 10 pm you are sleeping, 9 pm you start eating, 9.20 you are finishing, 40 minutes, let us say 2 hours, the thing is 90 minutes to 3 hours, so let us say an average 2 hours, 9.20, 2 hours, 11.20, your digestive hormones are done, but you are sleeping at 10, 1 hour and 40 minutes, your body is confused, whether you want me to shut down, or work the digesting, that work needs to be done. So it will compromise on probably your sleep quality, while doing that, sleep initiation is a huge problem, maintenance is maybe okay, correct, initiation is a huge problem.

SANGEETHA AIYER: So if you do this, yeah, I have clients who tell me, I have counted 1000 sheep, you remember we have that technique, look up and count the sheep, 300 sheep and you will say, I have 1000 sheep, I am not falling asleep.

DR. PAL: So these are 3 things I usually say, eat by 7, sleep for 7 hours, and then 3 hours definitely should not eat, should not go to bed after your last meal, I said should not sleep, right, my patient, send me a picture, you know you can communicate through inbox messages, send me a picture, doctor as you said, I am not sleeping, but he is lying down on the bed, you have to be specific doctor, it’s your fault, then I changed my wording, I said okay, 3 hours before you go to bed.

SANGEETHA AIYER: I’m not making it up, I can imagine, I can sure imagine how all these things come up, but I was curious about something you said, you said you don’t prescribe medication, but there are certain urgencies, right, like when you have to do NSAIDs and PPIs and temporary handling of symptoms.

DR. PAL: Yeah, yeah, I am talking about GI symptoms in young patients with bloating and abdominal pain, if there are no red flags, I know what is the problem, the brain contactors are not working, they must be changing the doctor because you are not giving medication, no, my approach is longer, yeah, and they don’t like it, right, so they want, so let’s say I give an antispasmodic, it’s very easy for me, right, to give antispasmodic, correct, and they get used to it, then they will not change, they will not do, yeah, I said you know you do this, you come back after 2 weeks and then see, let’s see how it goes, I don’t know whether it goes or not, the patient goes.

SANGEETHA AIYER: Because we have this, there is, unfortunately, so we have a very pill popping, let us fix this issue in the temporary quick fix with everything and with this also, you know, there is an effort, you have to eat at a certain time and do at a certain time, no, just give me something that I will sort it, you know, sustaining the pain.

DR. PAL: Yeah, yeah, that will apply to physical activity as well, initially, it’s going to be painful, and I went to a gym, all the guys, I got so scared, you know what they did, they lift the weights and then they said, no pain, no gain, no pain, no gain, I said I am not coming to the gym, I don’t want the game, you don’t have to do that, really, I don’t want, I would just be coming to check how much was the price, but anyways, wonderful discussion, thank you, Xavier, I’ve had a great time and I hope it’s been, of course, I’m sure, you know, there are, we talked about a lot, I’m sure if I was listening to this podcast, I will at least write down the points physically, so that it gets registered in the mind, so that at least 25 to 50 percent, you try to implement in something.

SANGEETHA AIYER: Yeah, I’d like to offer another solution, if there is something that you haven’t understood, let audiences post it in your comment section, of course, I am happy to clarify or if it’s related to your expertise, obviously, clinical experience, you can clarify, happy to do that, because it’s been, there’s been a lot of back and forth in this conversation, but if there’s something that you haven’t understood and how to go about it, right, happy to do that.

DR. PAL: Of course, that’s so nice of you, thank you so much for being here, thank you, Dr. Pal, you’re right, as usual, I’m so glad that we could do this, thank you, thank you.

Closing Remarks

DR. PAL: Thank you, that was a wonderful episode, I learned a lot, I’m sure you learned a lot as well, I really want you to make sure that the discussion that we had, if at all there are some points that you have noted, I really want you to take some time, understand what those points are, see whether that is applicable to your life and if it is, please write down in the comment section, in terms of what you learn as usual, so that that gets registered in the mind, the more you put writing and writing in words, that thought process gets registered a lot more and there are multiple reasons to prove that as well, so I’m hoping that the techniques that we discussed will be implemented in your daily lifestyle as well, thank you so much for all your support, the whole goal is to make this podcast a real health podcast with credible information coming out, so that you can pick and choose your lifestyle based on the recommendation that is discussed.

We have two new YouTube channels, Gut Feeling with Dr. Pal Shorts and Gut Feeling with Dr. Pal Clips, these are all shorter versions of the hour-long podcast episodes to highlight the salient futures, these are all 8 to 10 minute long or sometimes 1 minute long for the reel, please consider subscribing and extend your support, we will make sure that we’ll provide the high quality content to you by giving you a wide variety of input from multiple medical experts, in case if you want to listen this in audio format while you’re commuting or while you’re driving, please check us out in Spotify with the name Gut Feeling with Dr. Pal and please consider extending your support by subscribing to that channel as well, as usual it is one belly at a time, it is absolutely important, I’ll see you next video.

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