Dr Rupy: Confused about supplements? Do you struggle to understand nutrition science? Are you constantly bombarded by conflicting headlines about which diet is better than another? And how do you make sense of all of this information when the noise to signal ratio is so disproportionate? Well today, I have the pleasure of speaking with someone I regard as a mini hero of mine, Kamal Patel. He is the co-founder and director of examine.com. And if you haven't come across examine.com in the past, you really should go check out this website. It is the world's largest unbiased internet site that peer reviews academic literature on diet, supplements and nutrition, all with the aim of giving the most uncoerced, unbiased information you can find anywhere. And it's a site that I've personally used during my masters and also supported me throughout my nutrition journey as well, very, very early on. Kamal holds two master's degrees from John Hopkins University in business and in public health. He's published peer reviewed articles on vitamin D and calcium, as well as on a variety of other clinical research topics. He's been involved in research on fructose and liver health, on nutrition in low income areas and on mindfulness meditation. There are so many things that we talk about in this podcast that I've actually decided to split it up into two parts. The amount of information that we actually talk about is quite overwhelming to listen to, but trust me, it's worth a good listen and there are so many insights that I picked up from Kamal's wealth of knowledge. Here are just a few of them. We talk about circadian zeitgebers and what those are, non-diet paleolithic perspectives, how misinformation and bias starts from the research labs, multivitamins, fish oils, vitamin D, supplements for lifestyle, stress, sleep, anxiety, nootropics, the placebo effect. I could go on, but I would highly encourage you to check out the show notes, check out examine.com, subscribe for free and get that information so you are better informed as to how to deal with the influx of media headlines that bombard our media outlets, both digitally and in press as well. I think you're going to really enjoy this podcast episode. Do give us a review online as well. And if you want me to talk about specific supplements in the supplementation realm, I'm sure I'm going to have to speak to Kamal again at some point in the future. Without further ado, do listen to the podcast right to the end and part two will be coming up soon as well. Before we get started, I'd love to know a bit more about how the pandemic and COVID has impacted you personally.
Kamal Patel: Sure. So for the business, that first week, I actually, I don't know what the first week was for you guys over there, but the first big week over here was when Tom Hanks got COVID. You know, that day it was like all that, those three things happened at the same time and everybody said, oh, if Tom Hanks has it, you know, we're all screwed. So that week, we weren't sure what to do financially because we were, our traffic was going up steadily, we were getting some more sales, but we don't make a ton of money because we don't sell supplements and we don't have ads and all that kind of stuff. So a couple of years ago, we got dinged by Google and our traffic plummeted, so we were like making our way back up. And then COVID happened, so we made contingency plans, cutting salary and worst case, cutting jobs, which we didn't want to do because we have a very small team of mostly researchers. And then it ended up being okay, but the first thing we did is we made a COVID page and we spent two weeks just reading all the studies that existed at that point. And it was tough because everything was changing so quick. Then we made a page about masks. And now the mask evidence is changing really quick again, so it's hard to keep up. And for myself, I was with my girlfriend in San Francisco and we moved down to be with their parents in LA. And we've been there since, since the spring and I don't really go anywhere, so it hasn't affected me too much, but we do have conversations about Thanksgiving, for example. Like today is Thanksgiving in the US, so should we have anybody over? Should we not? What kind of precautions should we take? So I haven't been as affected as many people have. A lot of our four of our employees are in New York City, so they had to kind of, you know, the first two months be really, really careful. But yeah, I think it's heavily geographically based, heavily income based, and then also just people who live paycheck to paycheck have different considerations. And that's what makes it so complicated in the US where it's just so scattered, the messaging. I know that there's controversy in the UK too, but here it's, you know, I don't like swearing, but it's a shit show.
Dr Rupy: Yeah, yeah, no, absolutely. I would agree with that. I think if there's ever a time to swear, it's now. And throughout the whole year, the strategy has just changed so reactively. There hasn't been a core sort of understanding of the, of the impact of it initially in terms of how the gravity of the situation. I think it was taken quite lightly by our political leaders, but even now, like seven, eight months into it, we still haven't learned the lessons of clear direction to the public and, and we've definitely lost a lot of confidence in our politicians based, I don't know if you've heard of some of the, the, the issues with some politicians breaking the law and not apologising for it and stuff. And that's, that just undermines the whole messaging system.
Kamal Patel: Yeah, we had that recently in California. And it's, you know, as an observer trying not to read too much news, you still read enough that that you get frustrated. And everybody's frustrated, I think, to a certain extent. And hopefully come next spring, vaccines will eliminate some of that frustration.
Dr Rupy: Yeah, absolutely. When it comes to the quality of the evidence that was coming out actually this year about COVID, supplementation in particular, but even masks, like you, like you just mentioned, was there a lot of frustration on your part? Because from what I saw, the quality of evidence that was actually being permitted into journals, quite established journals was, was quite shaky at times.
Kamal Patel: Yeah, there were and are a lot of preprints. So not peer reviewed, pre-peer reviewed studies, which is fine. You know, you have to have that in a quickly evolving epidemic, pandemic, but the lay person doesn't understand the difference between a preprint, a peer reviewed randomized trial, a meta analysis, a poster at a conference, or even just somebody who appears to have credentials who's talking about their opinion. And in the US, there's a variety of opinions from medical professionals. And, you know, somebody could be an infectious disease doctor and have an opinion, but they don't have a large social media following. And then if you're, for example, a neuroradiologist, let's say, and you happen to have an opinion, then that can trump other people's opinions, no pun intended. So it's a really difficult situation and people don't really know who to trust. I don't, you know, I know very little about most issues, but I try to know a little bit about everything given my role. And when we were doing research for our first COVID page, we had a large section on supplements because that's what people ask us about. They wanted to know starting in March what supplements to take that might help prevent infection or reduce symptoms when you have infection, and there weren't any studies. So there were some speculative studies, mechanistic studies, in silico studies, and we decided to not report on that, but we did include a section at first about evidence for previous coronaviruses. And there were a lot of pros and cons to doing that. Like at first I wanted to do that so that people realised at that point the flu from that year was still going on. And people still got flu and cold. So I said, well, you know, flu and cold season is still happening. If you have something that's most likely not COVID in March, it's probably these other things and here's the studies for those. And then people got upset, somewhat justifiably that that could confuse people messaging wise, like they might just buy all those supplements. So then we took that off the page. And then I wondered, oh, am I just caving to this? You know, should I just put everything out there and people can handle it, you know, if they understand it? And I don't really know the answer.
Dr Rupy: Yeah, I want to come back to that point actually about putting the information out there and just allowing people to make whatever they make of it. And depending on their educational background, their ability, their time to to to read more than just the abstract, people will take away different things. And I think examine.com, and I've been an avid follower for a number of years now, has really changed the way in which you portray information. There's obviously the digest and there's the subscription product now. But how has the company evolved over the last, I think you started in 2012, so the last eight years. How has the company evolved from its initial sort of start to to what it is currently and where it's going to evolve later on?
Kamal Patel: So at first we were tiny, sort of a passion project, and it came out of Reddit. There were a lot of people talking about evidence for supplements and nutrition. And there's always been these mostly bodybuilding websites in the early 2000s that had articles about food and nutrition. And they were mostly about gaining muscle and losing fat. So bodybuilding.com, T Nation or T Mag, I'm not sure what it's called nowadays, and then a couple other ones. And that's all good, but one person can only read so much evidence. So if one person writes an article, then that's already limiting. And then in order to run a large website, you need to make money, so you have to sell supplements. So examine came about based on the idea that it's always better to get information from people who don't sell something. Granted, we now do sell extra information, but we don't sell supplements, we don't sell diet plans, we don't sell coaching and that kind of thing. And we don't have any affiliations with any organizations. The one that kind of snuck in there before we finalized our policy was like the European something association for lifestyle medicine. But after that, we said, you know, not even professional organizations. We just try to be as Switzerland as possible. But then over the years, we had more costs from website hosting and hiring researchers, and we just couldn't afford it. So we had to figure out what to do to make enough money, yet still obtain, retain objectivity. So that's when we started coming out with products. And the products are extra information. I personally think they're really unique and cool, but of course, I'm biased. And we're never going to make a ton of money because we never say this is exactly what you should do. You know, we always say this is the level of evidence for this option. This is the level of evidence for the next best option, and these are things that we know we don't know, which is like a not really easy to understand thing for the average person. So we're trying to make it a little bit easier for people to understand, but it's not really easy. And I think you would know better than I because I've never been a clinician. You know, in my brief time, there was three months that I interned at a weight loss clinic that was a mindfulness based weight loss clinic at Mass General Hospital in the like mindfulness program at at Harvard. And I didn't know what to do. Like it didn't matter how much I knew, it only mattered how much people understood that they could practically do in an easy fashion. So it would, I would always fail. You know, I'd be like, well, you know, what are your triggers for overeating? And somebody would say, peanut butter. And I'd say like, oh, well, maybe for next month, you can work on, you know, eating less or no peanut butter. And then when you feel stressed, then, you know, doing this instead. And then then they would just switch to almond butter and eat more of that. You know, so it's it's tough. And it's not like it's no fault of anybody because especially now, like how does one deal with stress? You can't just be like, well, I'm going to download this mindfulness app and it's going to like solve everything. Everybody wants to sell things that they think are easy fixes, but I don't think there really is any.
Dr Rupy: Yeah, yeah. I I I and I definitely want to talk about that because I I feel like now we are living in a huge paradox, which is, you know, we've never before had so much information readily available to us. Examine.com is a very good example of that. But yet we live in a society where the biggest issues that we're dealing with are supposedly those that are preventable. And if you look at the NHS budget, for example, a huge proportion is spent on preventable diseases like type two diabetes, obesity, etc. So why is that the case in today's atmosphere and environment? And what is the cause of that? Like is is it because we have created a culture which is apathetic? Are we all lazy? Do we forget that wellness is a long journey rather than something that can be, you know, instantly gratifying like taking a supplement? What what are your opinions on that?
Kamal Patel: It's funny, I actually first started thinking about this seriously when I was working at a hospital. I was working on the vitamin D guidelines changed in the US about 12 years ago, and they needed just warm bodies to help, you know, data extract from studies. So I was around. I think they just like pulled me from the street. So I was doing data extraction for these vitamin D studies. And then they pulled me into another project, which was there was a visiting scholar from the NHS. For all its good and bad is at least a cohesive system that we don't have here. But in the US, everybody makes their own decision, which comes with pros and cons. The pro is that if you're a rationally acting person with enough time to do research, you can really like figure stuff out and you can lessen costs for yourself much more so than a centralized body could do. But the truth of it is that most people don't have that time or expertise, you know, even scientific literacy is pretty low. So there's a lot of people who believe they know. And that's where maybe a little bit more centralization could help. But in my humble opinion, the reason why this information discrepancy has started harming people a lot is that there's there's sort of like a medicalization and like a, you know, a proliferation of terms that sound exciting, but the important things sound boring. And you know, sleep and stress management and stuff sound boring, but I think it only sounds boring because most people don't introduce this ancestral element. And some of this kind of started being talked about when Paleo became popular 15 years ago or so. But nobody has to eat a paleo diet. You know, it's not, that's not necessary for health. The more interesting parts of Paleo are probably not the nutrition parts, but the non-nutrition parts. So like things that entrain a circadian rhythm are very underrated probably for health. So there's seven or so, what's called zeitgebers. I think it's the German word for factors that influence your circadian rhythm. And the main one is light, but there's other ones such as movement. And even small things such as seeing faces during the day can help entrain your circadian rhythm. And, you know, being around kids or babies can help that too, right? But a lot of that is lost. Now it's like, how much protein should I eat? How much protein should I eat in one meal? Should I have casein before I go to bed because it's slow digesting? But there isn't like, should I take a long break during the day if that makes me happier, even if that makes it so I can't do my side hustle, just so that, you know, I'm happier and it, you know, I can get some blue light outside like a normal human. Um, you know, should I expand my friend circles? It's a little bit harder to do now during COVID, but should I wear like super looking blue light blocking glasses at night to make sure that I'm not incentivized to use an iPad? Like those kind of hacks that more emulate our great grandparents, even if not necessarily our our paleolithic ancestors, I think are underrated and the nutrition and supplement side is overrated in my opinion. And that's why I think people get really confused.
Dr Rupy: Honestly, coming from the co-founder of one of the biggest supplement sites in the world, I think that is really telling the fact that, you know, supplementation is overrated, whereas the perspective of paleolithic lifestyles is something that we really need to get a more comforting relationship with, a closer relationship with. And I love the way you described that because I like to think of things through the evolutionary lens, which is why I'm so obsessed with food. Because when we think about food, everything that we now label as lifestyle medicine, mindfulness, movement, sleep, would have been centered around seeking food. Your exercise is going to be walking across planes, hunting, stalking. Your mindfulness is just a pure focus on trying to forage or hunt or just being quiet so you can hear any predators coming along. Your sleep is there because you want to make sure that you're up crack of dawn so you can go and hunt and forage. And the community aspect, the sense of purpose, everything is around food because you're going to be communally eating as well. So just to hear that that sort of, um, the description of of how you you describe Paleo, I think it it really does speak speak volumes.
Kamal Patel: That's a really good point. I haven't quite thought of it that way, but we have sort of severed the cord between us and food, which is not severed anywhere else. Even the smallest microorganism, you know, slowly amoebas its way over to something else to engulf it. And now we don't have to do that. We don't have to move towards food, we don't have to like plan or prep. We don't have to store food. It's all gone. And by an example that maybe is too close to home right now is, um, so we're having Thanksgiving here and, uh, my girlfriend's parents retired and they, uh, don't have to do things that they don't like anymore, like cooking. You know, which is great. But the opposite of that is like traditional cultures, like my grandparents, um, my grandma spent all day in the kitchen, not because she loved it necessarily, but it was cheaper. You know, and sometimes it was the only way to make stuff. You know, of course, you you would make yogurt using a cloth and milk and stuff. That that was the only way. So when I was growing up, then I'd hold the cloth and she she'd make it and and that sense, it doesn't matter whether you're keto or carnivore or vegan or omnivore. Um, if anybody watches those terrible survival shows on TV, I used to watch a lot of them just as like mindless entertainment, but I think the main reason I liked watching is because I like to see how they got food. Like occasionally there were vegans, um, there were often hunters from the bayou in Louisiana, but they would all survive because they would try to get enough protein, right? And it didn't matter how much plants or animals you ate, you had to get enough protein. And it's not protein as a macronutrient and getting a certain amount or 40, 40, 20. It was more so like you felt weak if you didn't get enough protein. And then if you got some protein, all of a sudden you'd be like, wow, I've never felt this before in my life. You know, I'm I'm a superhero. So we don't have that now. We just like go to the grocery store and get our shrink wrapped protein or a powder and then and then we all know protein is good. So now protein has snuck its way into cereals and and all that, which is really weird.
Dr Rupy: Oh my god. It's one of my, yeah, it's one of my pet peeves about how everything including water is now fortified with protein.
Kamal Patel: I know that that protein water, it's water fortified with protein and electrolytes, which yeah. Weird.
Dr Rupy: Well, this is why I think examine is is a really important organization and more than just a website because there is so much noise and the noise to signal ratio is completely out of whack. And the noise has exponentially risen not just because of the, um, increase in nutrition literature, but also because of armchair experts sort of using social media as as a tool, as a microphone. So my question to you is, how do you create an unbiased company that's going to thrive on the internet? Because even reputable company or reputable sounding companies like WebMD or Mayo clinic or Cleveland, you know, all these definitely have ties. So, so how, how are you creating such an unbiased organization? And I wonder if examine has a mission statement surrounding that.
Kamal Patel: We do have a mission statement. Um, and honestly, I I always forget the specific words. It's like demystifying something using meticulous analysis, but um, that's one thing I got from business school. Like business frameworks and mission statements and values, whatever, I just like I've had enough of that in my life. But um, the way to to start and grow a company like this is probably the best way honestly is to get venture capital funding and we've rejected that. And the reason why that's the best way is because the struggles we've had, you don't have to have if you accept, let's say 10 or 20 million dollars in venture capital because then you have enough money that you can afford to be unbiased. Um, the other way is what we're doing, which sometimes feels like, you know, Sisyphus pushing the rock because we push it up a little bit, we got it up far and then two years ago we got looped in or roped in with a lot of alternative health websites and we got our traffic chopped by like 30, 40% by Google, which affected our revenue quite a bit. So, you know, that was not good for us and you can't just like call Google and say, hey, we swear we're not one of those, we're not selling crystals, you know. Um, but it didn't work. It took us a couple years and we got some of that back. But what we started as is the same exact thing I did for like vitamin D, data extraction from human randomized control trials and assessing the strength of evidence is what we did for examine, but we did it for a wider variety of supplements and diets, so we couldn't do it quite as thoroughly, but it's still it's like 90%. Um, and as we started going that route, we've just gone the incremental angle where we try to be unbiased by getting employees who don't demand massive salaries, but are still pretty smart. Um, and iteratively updating our pages that are important, like creatine, cannabis, vitamin D, fish oil, like we know people read those pages a lot, so we try to make them really accurate. And then our hope is is that in the next few years, um, we get a big enough cushion, uh, that we can automate that that process better. So we have sort of a bare bones technical staff, but really this requires a lot of technical expertise because we can't just make a WordPress site. We have a back end system that has like matrices and all these different things that I don't understand at all. Um, so if we can afford to to get enough people working on that, I think it'll be a lot easier and we can just have a feed forward mechanism that makes us bigger automatically.
Dr Rupy: You you mentioned hierarchy of evidence there. I wanted to double click on that because, um, the the expectation is that, you know, you have your meta analysis as the the gold standard of of of research and then everything else sits underneath it, your your anecdotes all the way to your systematic reviews. What is your personal perspective on the hierarchy of evidence as it pertains to not just supplements, but but also dietary patterns? And how do you guys provide a variety of different angles to to provide sort of nuance and context to to what can be treated like quite a binary question?
Kamal Patel: Well, we've actually considered recently doing our own informal meta analysis because currently on the web page, there's a matrix that has a level of evidence and notes about studies, but you can see in general if the studies agree, but a meta analysis is fairly powerful because it it includes things that you can't just judge by an eyeball test. Um, the problem is that there's two problems. One is that people don't really understand meta analysis, you know, you have to at least take a minute to explain it. But the second thing is a meta analysis can hide truths. Um, so for example, if a meta analysis on five studies shows something, then that's a good indicator, but not a great indicator because there could be one high quality study in that five that is better than all the rest. Or there can be two studies by the same study group that have the same biases. So that level of subtlety is not something you get from just looking at the forest plot or the end result of the meta analysis. So, you know, I try to think what's the best way to go about this and I don't know yet. Um, I actively try to find out. There's different options. Like for example, on the clinician side, um, an old roommate of mine made a website, uh, called the NNT.com, NNT stands for number needed to treat. And uh, and that presents information in a way that for clinicians they can see if you suggest fish oil or statins or something to your patient, then you would have to treat, you know, 130 people to prevent one case of cardiac arrest or something. So there's different ways to present the information and we just keep noodling over those and at some point we'll figure out a better way to do it than we currently do.
Dr Rupy: For the for the listener who who is privy to, you know, some character restricted social media platforms where you just get the headline or a tabloid that promotes fish oil as like a cure all for everything and then the next day it's like, well, no, it's it's going to give you prostate cancer. How how what what strategies do you suggest for people trying to actually pick apart where the where the real truths lie in in the headlines?
Kamal Patel: Um, it's tough because the sometimes the headlines are accurate if the reporter works hard and has some background knowledge, but you know, nobody will have any idea if they are. And then there's actually a study in the BMJ, British Medical Journal about six years ago that tried to look at where the misinformation started. So if there was misinformation in a press release, um, or rather in a in a media article, where did that come from? Was it the writer? Um, was it some other source? And what they found is a lot of it actually started at the university or the research center. So they looked at three factors. One was subtly indicating causation whereas the study probably indicated correlation. Another one was overstating animal trials and I don't remember what the third one was, but they looked at a bunch of studies and they saw that the communications department, the PR department often was too vague or too aggressive about the write-ups. And I saw this on occasion at the medical center I worked at, but it's not a huge problem. It's only a problem in as much as you're introducing uncertainty or you're introducing some bias early on. You know if you introduce bias early on, then the reporter is going to pick up on and amplify that. So really at the level of the researcher, you have to be as unbiased as possible so that the PR department can be unbiased, so that the writer can be unbiased, that the person who interprets it can be unbiased. So there's several levels and that even excludes the copy editor and the reviewer and the person in charge who changes the headline, you know, even if you don't want them to. So we have that at examine as well. Like the researcher will write something and then the copy editor copy edits it and then sometimes they'll loop me in or another reviewer if they think something is wrong and sometimes they won't, but we don't have an unlimited amount of money. So we'll include external reviewers if we don't have enough expertise, but, you know, we have some cushion but not a lot. Ideally, we'd have a bunch of reviewers so we'd say like, hey, you over there, like, do you have time right now? Do you have two hours free? But you can't do that. So for somebody just reading the media, it sounds bad, but you sort of have no chance to evaluate it yourself. You can look at certain indicators, like, um, if they were measured with their language, the website in general, a very, I shouldn't use this indicator, but if the website doesn't have a lot of ads or if it looks clean, then I trust it more. You know, like certain websites do that and certain websites don't. And if they don't, then it's like, come on, they didn't like even work hard enough to get a web designer. So yeah.
Dr Rupy: I mean, one of the things that I, uh, I wanted to ask you about actually on this is, um, you must have had millions of questions asked, um, either through emails or through the search bar on on examine. What have you found the most robust answers for for the most commonly asked questions? So in terms of like the the the biggest interest, where you've actually got some information that you can stand by. And I must say, like, I really do respect the level of transparency that you you put on the site and and what you've just talked about there about how, you know, even the content that you put out may be, um, privy to bias, but but yeah.
Kamal Patel: Well, uh, there are themes of questions and, you know, whether somebody is a a personal trainer or just somebody interested in nutrition and their family has some questions, you all get these questions, I'm sure. So probably one of the most common is should I take a multivitamin? And, um, there's a somewhat clear answer to that. I'd say the answer to that is more clear than should I take fish oil. So I'll just tackle multivitamin first. So multivitamin is if somebody doesn't eat very well and we're entering the third wave here in the US or the second wave, maybe in other parts of the world of COVID, it might be a good idea to take a multivitamin because there's fairly strong evidence about immunity and multivitamins, especially in older people. So that one is somewhat cut and dry. But if somebody eats well and especially if you've tracked your micronutrients, there's only a couple ways to track micronutrients. I can't say this in my official capacity as examine guy, but as a private person, chronometer or chronometer or something, um, is one of the only ways it's an app and a website to test your micronutrients. And if you do that on a weekday and a weekend day, um, so it's kind of representative of your diet and you see that you hit a green amount, like a pretty good amount in most nutrients, you should not take a multivitamin because there's instances where specific nutrients have been tested and the researchers thought something would happen and the opposite happened. So for example, the carrot study was the most famous study where beta carotene was tested and vitamin A was tested and it was found to increase mortality in certain subgroups, but still that's pretty bad. And then, um, when I was a student in public health, I had a physician at the student health clinic who also happened to be a nutrition researcher, just randomly. And, uh, I won't name names because, um, this is like kind of sort of gossipy, but, um, years later I was like, I was looking at a meta analysis and I was like, hey, this was my doctor when I was a student. So that doctor, I know for sure was not an expert in in stuff in general because, um, I used to lift weights more then, um, and then I had a bunch of surgeries because I have a connective tissue disorder, so now I haven't lifted weights in a long time. But, um, I gained a lot of muscle then and I was a want to be powerlifter and I went in one time to the clinic and he said, oh, your blood test results are good, but your, um, creatinine is sort of high. So you shouldn't eat meat or something. And I was like, hold on, what? So, you know, I did not go to medical school. I was not a clinician, but I knew that creatinine went up if you had a decent amount of muscle turnover. So I was like, well, that doesn't make sense. And I said, you know, could it be that I've, you know, gained a lot of weight in the past few months because I was doing a a bulking cycle followed very quickly by a cutting cycle. And and he said, no, you know, for example, I I'm I'm around 230 pounds and you're like 180 pounds. So my creatinine should be higher than yours. And I was like, hold on, isn't when doesn't that not apply because, you know, body weight, you know, muscle adjustment, but so anyway, this guy was an author of meta analysis on vitamin E and it showed that vitamin E might have slight detriments if supplemented high enough for certain populations. And it wasn't as bad as the vitamin A study, but it was still not great, right? So people don't know the mechanisms behind these things and the meta analyzer does not know either because it's interesting for hypothesis generation, but you can never really understand the mechanisms of something that is involved in so many antioxidant pathways. So that's where sort of that ancestral eating comes into play. So like, what is vitamin E for? It's to it's to serve as an antioxidant, especially regarding lipids. So do you need as much vitamin E if you're eating a decent, uh, balance of lipids? Probably not. Um, similarly with vitamin A, um, like its roles might warrant consideration depending on your context. And in those studies, it was people who smoke cigarettes that had higher mortality if you gave them vitamin A. So for somebody who eats a a decent diet, I'd say targeted nutrient supplementation is much better than a multivitamin, especially because nowadays there's an arms race to make higher and higher potency vitamins. So it's not good enough to have one basic vitamin. Now there's packets that have four or five pills in them. So the odds of you finding a basic one that has good forms is very, very low because it's either going to have very high amounts of certain things or it's going to add in random stuff. You know, like, here's lycopene, you know, here's some probiotic, you know, just in case you want it, here's some random mushroom. So better than that, uh, get the nutrients that you're more likely to be low in. So right now it's going to be vitamin D. The evidence is very promising for vitamin D and COVID. So vitamin D first and foremost, um, minerals often tend to be low in diets because our soil is relatively low in minerals compared to our parents' parents. So things like magnesium, selenium and stuff like that. Um, and then look at your context. So some some men are high in iron, uh, because of either genetic reasons like hemochromatosis, probably pronouncing that wrong. Or some women are low in in, uh, iron because of either athletics or, um, something to do with their periods. So there's only a handful of nutrients that somebody has to consider supplementing. The other ones, you don't need to get a multi.
Dr Rupy: And you were going to talk about fish oils as well in terms of the promise.
Kamal Patel: Yeah, so fish oil is a tough one and it basically changes every two years. So, um, one of the first times a a bigger media outlet reached out to us was maybe four years ago about fish oil. The New York Times, um, was asking us about it. So I had like an hour call with the reporter there. And, um, probably because I was just so uncertain, you know, it it didn't really get, it didn't get published. It didn't say like examine said something. But rightfully so, they asked the people who actually conducted the studies. And my conclusion at that point was that the evidence was not good enough to heavily consider it for most people. But then all of a sudden the evidence changed and all of a sudden there was EPA showing benefit. So I was like, hmm, okay, yeah, maybe EPA, especially if you've had a family history of heart disease or if you yourself have had an infarct or something. And that more or less is where it stands now, more or less. So I think the best thing to do is to talk to your clinician about which if any fish oil pill might be worthy of consideration. In the US, I don't know how it goes in the UK. In the US, it's like some physicians will say, go to your local store and get a fish oil pill or they'll even like recommend a brand. Or they'll recommend like Lovaza or some variety of fish oil pill that's prescription, but depending on your insurance, it might or might not pay for it. And I know it's different in the UK. I don't know how you deal with it.
Dr Rupy: Oh, so generally supplements in the UK are not paid for by the NHS unless you're severely deficient in things like, uh, vitamin B12 for which we can give injections. Um, there's vitamin D3 that's advised across the board actually, um, during, uh, winter months, but during the year, if you're of darker complexion, um, there's very few vitamins. There there are some exceptions with with kids under the age of five, I believe, um, where we give a multivitamin actually. But, uh, there's very few exceptions where vitamins would be, um, promoted or offered at least on the NHS. Um, but I think that kind of speaks to the differences in the sort of healthcare systems. Um, we certainly wouldn't recommend a brand for sure. And and actually that speaks to a question I wanted to ask you about, which is, are there strategies to choosing a legitimate supplement? Um, and any recommendations because at the moment, people will either rely on influencers or hearsay of what they've heard or or perhaps even promotional, um, uh, packages from from the company themselves.
Kamal Patel: Yeah, there are, uh, there's a couple of sources on the internet and we have no affiliations with them, um, and they cost money or depending on the amount of information you get. But there's like labdoor.com, consumer lab. Um, and then depending on the type of supplement, occasionally there's either industry or or quasi industry organizations that evaluate the supplements on a batch basis. So for example, this might be the only example actually, for fish oil, there's International Fish Oil standards, IFOS. And, um, a colleague of mine from back when, um, recently asked me for himself. It's funny, um, of the people I've worked with at hospitals, uh, like they won't really ask until it's for themselves often. Like for patients, they'll be like, yeah, you know, you should try to be healthy, you should lose weight. But then if they gain a lot of weight, they're like, hey, you know, what can I do to lose like, should I do a protein modified sparing fast? Should I do keto? Should I? But anyway, um, this guy was asking what fish oil brand he should take. And I said, I can't tell you what brand to take, but there's a lot that have entries on that international fish oil standards page. And because it's free, you know, I recommend not, it's good to not pay money unless you have to, including with us really, but, um, that page happens to have batch testing to see if there's heavy metals, um, if there's auto or oxidation and that kind of thing. Um, but in general for brands, there's certain tells. Um, the claims are a good tell. If there's too many health claims, it's almost always not great. Um, if they use a standardized extract, um, often times with herbal supplements, then that's usually pretty good if they can say like we use this, you know, like trademarked extract. And sometimes it's really, really important because, um, for example, for lavender, you can take lavender as a pill or you can, uh, take it as sort of an aromatherapy and it can help some people with relaxation or even falling asleep. And there is a branded extract. And we say on examine, you don't have to take the branded extract because it's not like people 200 years ago like smelled only branded lavender extract, you know, so it's not necessary, but if you're worried or if you're deciding between two things, there's one called Silexan, I think, and, you know, that's branded. So at least you know that it's a certain amount of substance. Um, and then there's other things just like, um, it's better to use one ingredient before you use five. And that comes into play in things like probiotics because for probiotics, it's sort of the wild west right now where, um, the more, uh, living bacteria the better. And in a certain sense, it it does make sense because the way I like to think of it is like if there's something going on in in your tummy, uh, either you have a problem or it's just not optimal, then, uh, a way to think about it is is like a party, you know, and now the party's kind of gone overboard and somebody's causing problems. So when you bring in the probiotics, then you're you're basically calling the police. So when you call the police, do you want a police officer to come to knock on the door, meaning like, do you want one probiotic strain? Or do you want 10 in one capsule, in which case it's like a SWAT team, you know, probably one because there's two problems. When you choose the SWAT team and something happens, who do you blame? Do you blame like this guy in the SWAT team, that guy in the SWAT team, or your response to the SWAT team? Like, oh, the SWAT team was too much, so we just went crazy and we threw the bottles out the window and they all like smashed on the ground and somebody got hit on the head. So nobody knows who's at fault. At least if you have one, you know who's at fault. And the other thing is you can titrate it up. If you have one officer, they can knock on the door, then they can come in. If you have a SWAT team, they're all in at the same time. So there's certain, uh, it's not strategies that everybody should take, but I think if you have GI problems, it might be worth considering, um, titrating your dose even less than the suggested dose. Like you can even take a capsule apart usually, especially with the probiotic because it's not, uh, gel encoded, and take like a quarter of it or a half of it. Um, and then test it out a few days and then go up, you know, it's not going to kill you and and sometimes they're enteric coated so that they survive, um, your stomach acid, but if they're not, go ahead, you know, take take the capsule apart and take a little bit of powder. It's okay. And then you can build up and maybe take a a multi-strain probiotic later, but it's usually better safe than sorry.
Dr Rupy: Yeah, I've never heard that analogy before, but I do definitely understand it and I appreciate the, uh, the parallel there. And I think it's very important because like you said, it it really is like an arms race as for as many different types of, uh, probiotic strains you can get into one capsule, the different formulations, the claims as to whether it survives the gastric acid or not or, you know, which one is more effective. And it really is the wild wild west. And when it comes to probiotics, I'm not a, I'm not actually a fan of of people trying them unless they really have, uh, gut issues. And really, the root cause of gut issues can be completely unrelated to, um, your supplementation regime and actually might be related to more things like stress, like poor sleep or not exercising or other changes to your diet that perhaps, you know, you've let slip because of all these other things that I've mentioned before. So I I think it's really important to to get context. And with probiotics, um, it's definitely something that I would recommend people, you know, speak to a practitioner about and actually say, you know, these are the issues with my gut, could it be something else? Um, and I'm privy to, you know, a whole bunch of very mild vague symptoms being something super serious later down the line and we've missed it because people have like, you know, started supplementing or taking probiotics when they should have just come and spoken to someone like myself or a colleague.
Kamal Patel: Yeah, self-medicating on those grounds is not a good idea, especially because, um, like the areas that probiotics work best in, they're very clear clinical scenarios. So C. diff, for example, that's when you want to take probiotics and if that doesn't work, then even consider like fecal transplant. And the reason why those scenarios work with probiotics is because very few probiotics, um, if any, really colonize in the gut. So it's a bandaid solution to something else that is happening. And if there's an imbalance in flora, then the gut is almost always the canary in the coal mine. You know, it could be something to do with your environment, it could be something to do with your diet. You can't outrun a bad diet using probiotics. Um, and then there's also a situation where people take probiotics, but the issue doesn't even have to be bacteria, it could be yeast, or, you know, it could be virus or something. So you really, really need somebody who knows what they're talking about there.
Dr Rupy: Definitely. Um, now I'm going to ask you about obviously supplements for insert condition or insert, uh, scenario, but there's so much information on the website, so I don't really want you to just regurgitate, you know, everything that people can can go and look up on examine.com after listening to this. But there are a couple that I wanted to to to, um, just just ask you about. Um, supplements for stress and mood. Now, obviously, mental health is a hugely complex subject. It's something that I wouldn't recommend trying to, you know, fix, quote unquote, with diet and supplements and all the other things. And it's definitely something that I would always want people to speak to someone like myself before they start doing these things. But are there any sort of nuggets of information or certain with the with the interest in mental health these days, any sort of supplements and and dietary changes that you've come across that could potentially alleviate these issues?
Kamal Patel: Yeah, so, um, stress and mood is possibly the most interesting area to talk about that. And it's because there's two different sorts of supplements. There's stress and mood supplements that have some evidence, lemon balm, lavender, um, stuff like that. And then there's a bunch of supplements that have very little evidence and it's a heavy overlap with the term nootropics. So, um, adaptogens is sort of a classification within nootropics. Nootropics are usually supplements that, um, don't have much obvious detriment. Um, and a lot of them were studied for other conditions, um, often in small trials in Europe from like decades ago. And then adaptogens typically are herbs, um, and that often have an Eastern medicine bent. So those, it's really tough to know. And usually I advise not going directly to that route because, yeah, there are people who say, you know, like, I took ashwagandha, for example, and it like cured all my whatever, or rhodiola or whatever. But, um, there's also like tainted herbal supplements. There's, um, studies that are poorly done on some of those supplements that make you think that they might be effective. And then you take it for a month and then you think it works, but don't underestimate the power of your own placebo effect. And it's so powerful that when I started experimenting with nootropics, um, it was shortly after college, so almost 20 years ago, but I realised very quickly that I had no idea. It's such a subtle difference. If the difference was so strong, um, and sustainable without detriment, then it would be a miracle drug, right? So usually it's not that. So instead, I figured out I can't really discern the difference, so I'm going to make my own capsules. So I got a capsule making machine, one of those little things. I would stick in 50 gelatin capsules, and I would split up the pills between maltodextrin and the substance, and I would have somebody give them to me. I've become less crazy over the years, so I don't do that anymore, but, um, I found out that most of the time I cannot predict what the substance was. Maybe like 20% of the time I could. So as far as supplements to help mood and sleep and stuff like that, or sorry, I I gave away my answer. The supplements to help mood and stress, it's usually supplements that help with sleep. That's the indirect way to help mood and stress because, you know, if your problem is energy, drinking a five-hour energy is not the way to go about it. It's like what are the proximal factors that affect energy? Similarly for mood and stress, it's not what kind of supplement you can address it with, it's what other things impact stress. And number one is usually sleep. So in that case, the first supplement people look to is melatonin. And melatonin is a good supplement for sleep. Um, so it's something you could definitely take. However, sometimes people will take melatonin and then wake up in the middle of the night and then they can't fall back asleep. Sometimes people will get poor quality sleep from melatonin. Sometimes sustained release melatonin helps that. But the the easy way out of that is to not get blue light exposure at night. So that's where the blue light blocking glasses, they're actually very cheap, you know, they look really dorky, but that's fine, um, if you're not living with judgmental people. And then the other thing is, if you don't want to wear those, there's free things you can do. Um, Apple and Amazon Kindles, I think, have blue light, um, lowering, you know, uh, synchronous things that sync up at certain times. If you don't have that, you can download the program Flux or f.lux or whatever it's called. Um, and there's a bunch of different things you can do on that count. You can get a, uh, e-reader that uses e-ink so that you're not getting any any back light. Um, you can use candles unless that's going to cause fires. There's a bunch of things you can do that don't involve bright light at night. And it'll hurt over the first, um, week or two, not because your eyes are like, oh, I want that blue light, but more so your eyes will be like, I want that internet. You know, I want access to all the information humanity has ever put out. So it's going to take a week or two, but after that, it should go a little bit better. That I think I recommend way more than supplements. Um, but in terms of sleep supplements, there are things that help certain people. The best thing is to take things that are sustainable because there's things that might help at first, but then they're terrible over the long run. And it's not just supplements, it's even things, um, at the pharmacy. So, uh, ZzzQuil is a supplement made by, um, Vicks or whatever that, um, might work in the short run, but evidence shows it's really bad in the long run. Like you become tolerant really quickly to it and they market it so heavily and it's it's really a terrible product. I don't, um, the thing that I used to have or still kind of have sleep issues, I had much worse sleep issues in the past. Um, there was a time when for like a year or two, I slept very poorly and it was because of very extended opioid withdrawal because of these joint problems. I had some failed surgeries and, you know, long story short, I had a year or two where I kept trying to get off like fairly heavy opioids and if you're on longer term opioids like methadone or, you know, Suboxone, that kind of thing, um, it's a slog getting off and you're going to have, you know, hundreds or thousands of hours of sleep lost. And then at night you end up researching sleep supplements like way too much. So I would find things that are a little bit better on the cost benefit side. And one is glycine. For some people it helps. It's a very benign amino acid. Um, it's a sort of conditionally essential amino acid. Um, lavender was one of those. Um, for some people, very simple things help, especially if you're on a low carb diet, like a little bit of honey or milk sometimes before sleep can help. Um, it it really depends on your context. And then there's other things that are not supplements, like recently, we run across all these crazy studies in our, um, personalized product. This isn't really a pitch, but we we try to cover, we try to read all the studies that come out every month. And one of them that came out a couple months ago was on weighted blankets. And, um, weighted blankets actually do help certain people a lot. So it's basically just heavy blankets that give you a sense of comfort. And for some people, that's the missing link. Um, which is sort of ironic because sometimes it's, uh, links of metal chain, um, in the blanket that make it heavy. But, um, there's hacks like that that help some people, whether it's a weighted blanket or a prop you put under or between your legs or a certain type of pillow or if you have more money, a certain type of bed. Like some people, um, you know, spent a lot of money in the past for a memory foam bed and the reason they can't fall asleep is because it retains heat. So then the way out is maybe considering a latex bed or something. So there are a lot of things you can do for sleep. It's just you have to do a lot of your research. I'm not, I'm only sort of a, for myself expert. I I can't recommend other people do stuff, but self-experimentation for sleep, trying things that don't have detriment is really, really useful.
Dr Rupy: Yeah, absolutely. I this is what the podcast is about. It's not to give direct advice to people. It's actually to inspire them to become experts of their own health and actually, you know, whether that be through diet, whether it's through personal, um, supplementation or even just looking at investigations that might give them an insight into why they might be, uh, struggling with sleep or or stress and the other things. I I wonder about, um, it's funny you said the weighted blanket because, uh, we're we've actually just got a blanket for my puppy and and the weighted blankets are meant to help dogs sleep better as well. So maybe there's something there as well. I'm not too sure. I can see that actually. I didn't think about that. Yeah. Um, but I yeah, and and the honey, particularly if you're on a low carb, um, diet, is is that because of the soporific effect of of carbohydrates in general, like, uh, after you've eaten them?
Kamal Patel: There's a lot of, um, purported mechanisms, but at least for me, the reason why like honey might help when I'm on a low carb diet has nothing to do with pathways. It's literally just having that taste. You know, like, um, one benefit to a low carb diet is that you're no longer, um, like a optionless victim to sweets. And I have a huge sweet tooth. So that's a big benefit. But there's lactose in milk and there's, um, free fructose and glucose in honey. And your mouth senses those. You know, like we have certain tastes because those things, you know, would have helped us thousands of years ago. So sugar helps us. And, um, that's why at least for me when I'm on a low carb diet, I think it helps. It's having something, like I don't want to have jerky before bed. I don't think that's going to help me for sleep. Um, but a little bit of, you know, a touch of honey could help. But again, that's highly personal.
Dr Rupy: Yeah, yeah, it's again, it's highly individual. And just when you said that, it just reminded me of when I was a kid and my mom used to make dude for me with a little bit of Oh, yeah, now we're speaking the same language. Exactly. Yeah. Exactly. Uh, but it's almost like you read my mind because you talked about sleep, uh, you talked about stress, um, and you mentioned nootropics. Uh, is there anything else for for brain performance? I think everyone's asking me these days about supplementation and different ways to improve brain health. And I always obviously go down to the the the foundations. You have to try and get yourself a rock, um, a foundational rock in in good rest. Uh, you've got to exercise, you've got to make sure your your diet is is plentiful and then so you can get lots of different minerals. Um, but are there any sort of like cherry on top supplements or nootropics that could be beneficial for cognitive well-being?
Kamal Patel: Um, there's several that have some evidence. The the one with the least potential for detriment is probably dark berries. Um, so blueberries have a decent amount of evidence and there's several different ways you can take it. You know, you can have blueberries every day or blueberry juice or blueberry powder. And that's usually studied in older people. Um, and then there's other things that maybe sort of help a variety of either cognitive aspects or memory, um, or kind of stress and memory. And green tea is one, um, probably because of the theanine in it. Um, and then there's a a different class of supplements altogether that includes different types of choline. Um, and choline is typically found in eggs, but you can also take it as a supplement like CDP choline and stuff like that. Um, and those all support brain function. And then there's supplements that have, um, evidence mostly because people study them a lot. And that's like fish oil and stuff like that. Um, but as far as brain stuff in general, I think usually the more important thing is, uh, everybody knows like keeping the brain active, but there can be randomized long-term randomized trials per se on these things, but, um, having a sustainable thinking related hobby is probably good. And language learning is the one thing that has evidence, um, because it, you know, makes those neural connections. Uh, and I also think just anecdotally that something that gives you some, um, like path to improvement is good, whether it's language learning or playing an instrument or something like that or painting or whatever. Um, because it sort of keeps your brain going and making those connections sustainably and more over time. Um, whereas something that either, you know, you could say like, oh, my hobby is my side hustle, but that's not really a hobby. That's something it's like, yeah, I can see the benefit in that I'll have this much more money and I can afford this later. But really the pleasure thing, I think if people could do studies on a hobby that produces pleasure but also works your brain in a certain way, I'm sure that would show better benefit than like, you know, CDP choline or blueberries, but, um, you can't do randomized trials on a lot of these things that we both know are really important. So that doesn't really make the news a lot, unfortunately.
Dr Rupy: Yeah, and I think that's the wider issue I guess with, um, nutritional science in general. It's very hard to do these high quality studies. Um, as you're experiencing yourself, there isn't a lot of money out there to to establish what those links are. Um, and unless we get to that that model which pharma is I guess looking at, uh, looking at nootropics and and direct supplementation, there isn't much you can you can do in that. Um, you mentioned freeze dried berries. What what do you meant, what do you make of freeze dried products in general? Do you think there there are benefits in having those as a convenient option over fresh or would you always, um, sort of go for for fresh where possible?
Kamal Patel: Um, I think freeze dried is pretty much fine for most cases. And like where it fits in in terms of the amount of processed is frozen has almost no detriment. Um, and often it has a higher level of micronutrients because it's, you know, fresher than the stuff that gets shipped from Bolivia to, you know, Europe. But then, um, I guess below that would be like fresh and then canned, I guess, and freeze dried would be in there somewhere. But freeze dried is good in as much as it's very convenient and can be studied. So, um, when we first started our research digest years ago, one of our first studies was on mango for blood sugar. And it used freeze dried mango. And, um, and that was interesting because the notion was like, well, of course you can't help blood sugar by eating something with sugar, right? But the thing is you can because like polyphenols and and stuff like that. So, um, food is medicine at times. You know, that doesn't mean you have to take freeze dried mango. Like obviously not. Um, like a better way for for blood sugar control is just to eat a diet that helps you with blood sugar. But, um, these sorts of things can help. And also, I like freeze dried as a snack just personally. Um, like I don't know if you guys have, I know a little bit about your grocery stores from my memory, but I don't know if you guys have certain things like we do. Like what's it, you guys have Tesco or something? Yeah, we've got Tesco. But do you have a thing that's like, we have Trader Joe's here that has like cool snacks. Do you have something like that?
Dr Rupy: Yeah, yeah, we've got we've got whole foods here, um, and Waitrose as well, which is like a higher end supermarket, which is introducing a lot of like the cool like trendy healthy snacks.
Kamal Patel: Okay. So like, you know, if you go to those places, then much more often they'll have these rows of freeze dried bags, right? And along with like, um, dehydrated coconut and stuff like that. The reason I like that is that it's a good way to reduce temptation, um, because I have a huge sweet tooth. So I was trying not to eat too much sugar. So I would throw together some chocolate chips and freeze dried berries and something else and it actually tasted really good and it never went bad. Whereas if you have like raspberries in the fridge, I feel like they go bad as soon as they're like out of the grocery store. It's almost like a car. Like you take the car off the lot and it depreciates. It's like raspberries, like they don't give a shit. Like you can try to put them in the the special like, you know, stays fresh wrap and they don't care. They just go bad right away. But freeze dried raspberries, they stay good forever. So I like freeze dried. It's overpriced. That's the main thing. But if you have a dehydrator or something, you can make them yourself.
Dr Rupy: Yeah, exactly. There's loads of like thrifty ways in which you can make these things yourself. It's just time, I guess. Um, but yeah, those those snacks are like, uh, popping up everywhere. And I I try and use some like little hacks of dehydrating my fruit and stuff. But the the way I see like all these different elements that could have medicinal value is through the perspective of recipe creating. And so I've started using dried mango in curries and I'm just raiding my mom's drawer. And actually a tip for for any listeners out there is is to go to like ethnic stores, Indian stores, Turkish stores. They have a lot of these like trendy, uh, dried fruits that are actually so much cheaper than if you were to go to, you know, a whole food store or whatever. I mean, every every supermarket has got its its benefits and downfalls.
Kamal Patel: Yeah, not everybody has infinite money. So here, what I suggest is, um, like sometimes people ask about ways to get collagen and things around collagen. And I say, well, if you happen to eat a lot of meat, but then you also like exploring, we have a lot of Chinatowns around here in LA and San Francisco and New York. And they just sell tendon. You know, like there's no more direct way to get it than like you can have sliced up tendon in like pho and soup. But then our Indian stores, yeah, they have much cheaper mango. And I was just, um, thinking about that last night I was watching, I don't know if there's a cool way to say it, but bake off, Great British Bake Off. I don't know if you guys have seen it.
Dr Rupy: Bake off. Yeah, yeah, you say bake off. Yeah, yeah.
Kamal Patel: Hermine in the latest season was, she puts mango in everything and I'm like, man, she knows what's up. Like she's because if you have mango in storage, you can basically put it in whatever and it tastes awesome. It's the king of fruits.
Dr Rupy: It really is. I love the fact that Americans are getting into bake off over here. It's brilliant because it's literally like the most quintessential British show.
Kamal Patel: Yeah, I that's actually the reason I watch it. It's so aesthetically pleasing and also I have this sort of not fantasy, but like, um, just I the time I was in England, just people were on average a little bit nicer. And in in, uh, in baking show, I always call it bake off, but it's not called that. In baking show, like the contestants are just less rambunctious than on the American baking shows. Yeah. Like they're not like cut throat and they all seem nice. And then they show their little hobbies and they're like, oh, here's this guy gardening with his daughter. Oh, they they do upholstery on the weekends. And here in the US, I've brought this up before in the same podcast, but I feel like the people I know it's like weekend, side hustle or something. And I'm like, oh my god, like can you just try to be quaint to like do some kind of something that's not trying to make extra money, but
Dr Rupy: That's because you live in West Coast, mate. Everyone's got a side hustle they're trying to make some extra dollar bills.
Kamal Patel: Yeah, I should get a side hustle.
Dr Rupy: No, no, stick to it. Honestly, you're doing great stuff. You you need a break. I think everyone needs to learn how to bake. I can't imagine what your your cake would be though. It would probably be like, you know, jacked up with like green tea and theanines and
Kamal Patel: You know, the funny thing is like, um, like when I snack or binge, I I hate that stuff. Like matcha ice cream and whatever is really popular, but I think it kind of tastes like dirt. I mean, like a grassy sort of not terrible dirt, but like when I want something good, if I'll get like a cheesecake with everything that's ever been invented in it, pretzels, chocolate, white chocolate, caramel, nougat. I don't even know what nougat is, but you know, the healthy stuff, whatever.
Dr Rupy: I'm so glad you said that because like most people think like I live a really clean lifestyle, but you know, I regularly post images, um, when I'm working at at work and you know, there's chocolates and sweets around and that's the kind of stuff that I like to have when I'm having a day off or when I don't feel like eating 80 to 90% of my diet is like really good. But, you know, when I when I snack or when I have a day off, it's like, no, I'm going to go for the stuff that tastes incredible and reminds me of my childhood and you know, have a Snickers bar or whatever.
Kamal Patel: So do you when you go for those options, then do you eat British chocolates? Because I know a little bit about British chocolates because my family's from South Africa. So they always had stuff coming in, flake, uh, etc, etc. But I don't have access to that anymore. So I'm curious what you
Dr Rupy: Uh, well, well, you you've got a connection here in the UK if you ever need, uh, to smuggle some chocolates in. But yeah, no, we're we're like the British chocolates we have like flake, galaxy. Um, in fact, one of my best friends who lives in Chicago, he gets his mom to send him over like blocks of galaxy. I don't even know if that's legal actually. I'm not going to write him out. But definitely gets Cut that out. Cut that out of the podcast. Cut that out.
