#97 Emotional intelligence, Ego & Becoming Plant Powered with Dr Gemma Newman

Dr Gemma Newman: How do we have a way of living and eating that is not only healthful but is sustainable? That is something that we can thrive on, but that the planet can thrive on. Something that will allow us to reduce our long-term risk of antibiotic resistant diseases, something that can reduce our risk of future pandemics, something that can reduce the biodiversity loss, increase the quality of the soil that we grow our food in. All of these things are all linked to eating a more plant-based diet.

Dr Rupy: Gemma, I'm so excited that you're here on the podcast. It's a pleasure. We've been meaning to do this for a little while, so it's nice to actually find the time to do it with your busy schedule.

Dr Gemma Newman: Thank you. I'm absolutely thrilled and it's an honour and I've really been looking forward to this conversation too, so yeah, it's really good.

Dr Rupy: Why don't we start by how you are? You're an author now, your book just came out. A lot of people just see the publication date, right? They just see the book's out, smashing it in the charts, on all these different podcasts and stuff. But the journey started for you a while ago.

Dr Gemma Newman: Yes.

Dr Rupy: Perhaps why don't we start talking about your journey to becoming a published author?

Dr Gemma Newman: Well, it is a long road. Like you say, you know how much work it takes behind the scenes for you to do what you do. And for me, there was many, many years of research prior to writing the book, and then writing the book in the midst of the pandemic, which was challenging to say the least because I was doing more clinics, I had to cover colleagues, obviously the kids and the homeschooling, and writing a book as well. It was all quite difficult, but manageable, thankfully. I had some help at home. I don't think I could have coped up without that. But yeah, it's been a long road. And then it's not just writing the book, it's refining it and editing it and thinking about how it's going to look and thinking about all the recipes and making sure that the recipes look right and making sure that everything comes together. And I wanted it to be really accessible, so I thought it's got to be colour, got to have some illustrations and some photographs and different colour sections. So yeah, it's a lot to think about. And then of course you've got the publication date and you really want to promote it after that and you obviously work hard to do that, but it's been a bit of a whirlwind to be honest. It's been a nice whirlwind, but perhaps different from what you'd normally expect because I've never published a book before. There's no book signings or proper book launch as such. So it was just, ah, okay, it's out there now.

Dr Rupy: It's a strange time. I if I look back at my first two and compare it to the one that just came out, it's a drastically different scenario where you don't have that sort of that point where you're like, ah, I can celebrate now. But I remember when you told me that you were writing a book in the same breath as you telling me that you were increasing your clinics as well. And I remember when I was writing my first book, I was working pretty much full time as well. I couldn't imagine increasing my workload whilst going into a cycle where I had to publish a book. I mean, how on earth did you juggle that first off?

Dr Gemma Newman: Well, I have a nanny. That is how I juggled that. I have to be honest and serious about this. Women think that they can do it all and maybe, maybe some women can, but somebody has to be there to cook and clean and look after the kids and make sure their homework's done and do all the internet shopping and all the things that it takes to run a house, remember people's birthdays. There's a crazy amount of things to think about. And so I needed a little bit of help with that. And obviously my husband is there too, which helps too. He's not doing nothing. But no, it really helped to have her and she's been the main reason why I had the time to actually be able to sit down and write. So there was a lot of evenings, a lot of weekends. Unfortunately, I feel like sleep did take a back seat, which is a shame because I always talk about the importance of sleep.

Dr Rupy: Yeah, me too.

Dr Gemma Newman: But I wasn't really living it at that time because I had to spend my evenings writing. I had to spend a lot of time. I spent a lot of time with the kids compared to people who would work full time in clinic. So I do have a lot of gratitude for the fact that even though I was increasing my hours, I was still able to spend time with the kids during the week at certain times. But I found that my creativity was actually better in the morning, but that was the time when I was usually either in clinic or having to be with the boys, so it was challenging. But you just get on with it, you just do what you can. And I didn't watch telly, you know, it was basically that's another reason I was able to do it. I never wasn't watching TV or doing anything socially because of the pandemic. You don't go and see your friends, you don't go out. So I managed it and you know, that book is the result. So I am proud. It took a lot of work, but I'm really glad that it's out there now and people can hopefully enjoy it and feel inspired and make some changes. So that's what it's about.

Dr Rupy: Definitely. I'm so glad you mentioned that actually about the thought that it's possible to juggle so many different things. And I think when you look across, particularly in social media, and you see perhaps fellow doctors who are also mothers, juggling everything, there's almost like this expectation like, well, if they're able to do it, then I should be able to do it. And then you kind of push and push and push through the pain. But in reality, sometimes you do need help. And I think that side, we don't really show as much of on social media. We just, you know, post our positive reel. I think it's really important to show that sort of side that, I mean, I have down days, I have days when I eat sweets, I have days when, you know, I'm eating a delicious warm doughnut with jam in the middle, although I can't remember the last time I did that. Now I want to do that.

Dr Gemma Newman: Now you think about it.

Dr Rupy: Now I think about it, exactly. But you know, it's I think it's really important to to project that. You can't do everything.

Dr Gemma Newman: No, you can't. You can't do everything. And this is whenever anyone asks me the question, how do you do it all? How do you juggle it all? I say, I don't. I don't juggle it all. I have another human that I'm sharing that burden with. And yes, in most, especially in the pandemic, it's been such a strain on people. You know, husbands and wives and partners having to work full time, having to somehow juggle homeschooling, which is not possible. You can't do both well. You just can't. And you know, even before that, I think the idea is that women can do it all and have it all and it's not true. It's it's really, I think about my friends that that don't have partners and that are raising children. Oh, it's such a struggle. And having, you know, having to do that and work and think about how you're going to help create and, you know, sort of really nurture this human as well as your job. It's, I mean, hats off to people. It's so hard. I mean, I found it challenging and I've got lots more help. So yeah, it's I think it's something that is important to recognise that we do all need a little bit of a helping hand.

Dr Rupy: Yeah. I think, you know, I think back to 2016, 2017 when I was writing my first book, I essentially put myself in a little pandemic myself. Like I was a hermit. I didn't have a TV in my house. I would not go out at weekends after clinic. I'd be in the kitchen doing all the testing and recipe writing, all that kind of jazz. Again, the research and referencing and all that kind of stuff. So I was literally just doing that and not really doing anything else. And I don't think that's a healthy way to sustain your work balance. And I think, you know, us talking about sleep and us talking about the importance of sharing and time down and also being authentic to the fact that we're not always like that as well. I think it's quite comforting for people to to recognise.

Dr Gemma Newman: I think so. I think you're right. And it's interesting because a friend of mine said something, I can't remember the exact quote, but something like, you know, do something you love and you never work a day in your life. And she says, she said, no, no, do something you love and you end up working constantly every hour of the day and night. I was like, yeah.

Dr Rupy: That's a really good point. It's a really good point.

Dr Gemma Newman: Yeah, but I do enjoy it nonetheless. And so it has been worth it. But it's good. I'm glad to be able to sort of reflect back on that time and think, yes, that's done. And, you know, we'll see what this year has in store. So yeah, it's it's it's good to be able to reflect on it and be proud of it. But at the same time, as you say, I don't think it's healthy to be constantly working.

Dr Rupy: Yeah, totally. I I want to go back to what you're doing right now in terms of like your workload and and and how you're juggling and and future products as well. It's funny that we always talk about future products. What's what's next when you've just done something like of this magnitude, you're like, okay, now what what's next? It's just like, you know, you need a little bit of calm. But everyone has a story. I always joke that anyone in lifestyle medicine or practicing some element of food as medicine has a background, whether it be personal, whether it be their family. Why don't you indulge us in in how you got to whole food plant-based eating and and your yeah, exactly, your story.

Dr Gemma Newman: Okay, where do I begin? When I was a little girl, I always knew I wanted to do something to help people. I had this strong desire to be useful and I think I was always a kind of a listening ear for my mum and it gave me a sense of value and importance. So I look back on that now, I think it's really ironic that I chose a career where I have to listen to new people tell me their problems every 10 minutes throughout the day because that's what I gained value from in childhood, I think. So yeah, I I I had the urge to be a doctor from a very young age and and I always kind of also knew I wanted to be a GP because I love getting to know people. I love learning about what makes them tick. I've always been interested in things like religion and psychology, understanding what people need in order to feel whole. And I thought that being a GP would be great because I'd get to know families, I'd get to know people giving birth and then I'd get to see their kids grow up and make incremental changes throughout their lives. And as Dr Ian Panja says, saving lives in slow motion. So I had that concept in my mind long before I went to medical school. And then I thought that maybe going to medical school, that would be it and I would be able to save lives. So I was a young, enthusiastic doctor, but exhausted at the same time. I started my practice and I was just wiped out. I could sort of barely eat my dinner after my long shifts. I was so tired and I knew that I actually wasn't looking after myself at that time. And snacking on the wards and in the doctor's mess and just grabbing whatever I could whenever I could and just feeling really, really tired. And I thought, that's not right. I'm at the beginning of my career and I need to be able to have the energy to do this job well. So that's when I started to sort of think about ideas around, how do you look after your body so that you can do stuff that you want to do? And I took in the background hum of, oh, carbs are bad, you know. So you just cut the carbs and maybe do some calorie counting and move your body and stuff that people just assume.

Dr Rupy: It's amazing. Sorry to pause you there, but it's amazing how pervasive that message is actually. Like whenever I speak to friends and they they always tap me up for advice about whatever it is, as I'm sure they do with you as well, non-medic and medic friends as well. And they said, well, I've cut the carbs, but I'm still not like, I still need to improve all these things. I was like, what, where is this coming? Is it is it just like in every magazine all the time to just cut the carbs or?

Dr Gemma Newman: Well, I think probably back then it was, and maybe it still is. I'm not really one to buy magazines these days, but I think, yeah, you're right. It is pervasive. And so and I did get some results. I lost some weight and I got some energy and I felt good. And I was like, yes, okay, this has worked for me. And but then I checked my blood panel and I had a raised lipid profile. And I knew that I had a family history of heart disease. I also know it's our biggest killer here in the UK. And my grandfather died in his very early 60s. He was just playing a tennis game and then dropped dead. And so I knew that there was potential risk there in the family. And at that time, it hadn't yet happened, but my father also died of a sudden massive heart attack. He'd just had a minor car accident and nothing that would have actually really caused any sort of physical problem for him, but he got out of the car and and then the stress of it, he just collapsed and that was it.

Dr Rupy: Oh, God.

Dr Gemma Newman: And he was, yeah, 50, 59.

Dr Rupy: 59, yeah.

Dr Gemma Newman: So I, you know, I was really disappointed to find that after all my effort in the prime of life, I had raised lipid profiles.

Dr Rupy: And how how old were you when you had this?

Dr Gemma Newman: 23, 24, 25, yeah, something like that. So I just chalked it up to my genetic destiny. I just thought, well, I'm living healthily, I'm working out, you know, I'm doing everything I can, so I just have to accept that's my fate really. And then fast forward a few years and I was always searching for stuff that would help my patients. So I did education on cognitive behavioral therapies and solution focused brief therapeutic approaches in the clinic and really enjoying GP life, but also feeling somewhat jaded in the sense of thinking, I'm just doing a lot of tinkering with medications here and people are not getting better. People are gradually getting worse in fact, most of the time. And following guidance as I should, but just feeling that people weren't necessarily getting where they needed to get to. And then my husband ran the London marathon and he was getting a few injuries here and there. He was really struggling to get the times that he wanted. And he was frustrated. He looked into his running technique, he was changing his footwear and all this stuff. And he thought, well, hang on, maybe it's got something to do with what I'm putting in my body. And he said, if I'm struggling to run a marathon distance, how is it that these guys are doing double marathons, triple marathons without having any problems? So he read Rich Roll's book, Finding Ultra, and who else did he read? Scott Jurek, he's one of the greatest ultra runners of all time, Born to Run. Brendan Brazier, he helped Hugh Jackman get really ripped for his Wolverine role. He wrote the book Thrive. Richard was like reading all these books. He's not a medic. He's like, Gemma, look, I'm going to go plant-based. I was like, oh, really? Oh, no. I was really not into it.

Dr Rupy: What was your impression back then?

Dr Gemma Newman: My impression was it was awkward, it was inconvenient. We would be social pariahs. Nobody would ever want us over for dinner. It was all about the, you know, my preconceived ideas about what it meant to be more plant-based. I just thought, oh, God, it seems so pious, so boring. You know, I like a steak and a burger as much as the next person, you know. So I watched carefully as he continued to improve. And this was really interesting. So he no longer had the injuries and inflammation and he was able to run his next marathon an hour and 10 minutes faster than his previous marathon. And I couldn't believe that. It was jaw dropping to me that he'd been able to improve so much. And so, you know, people say to me, oh, you're a doctor, you should know, you know. I don't know if you ever get that as well. So I thought, okay, well, I better research this. Why was it that he was getting better results? And I realized that having a more plant predominant diet, and in his case, he went completely whole foods plant-based, he was able to have a really antioxidant, phytonutrient rich diet. It meant that his recovery times would be much quicker. And he achieved the results he wanted to. So I thought, okay, well, I'll do some more studying because I want to see what else this could help. Because for me, it was my patients always in the back of my mind. I'm not an athlete or somebody that's particularly into gains or anything. So I thought, well, you know, you see that on the on the internet. So I thought, no, I just want to know what about heart disease? What about diabetes? What about our biggest killers and causes of morbidity? And I realized that the truth was staring me in the face for as long as I could realize, but I just didn't know. So the American College of Cardiology tells us that a plant-based approach is one of the best ways to prevent heart disease and the American College of Clinical Endocrinology says that plant-based approaches are a tremendously useful for preventing type two diabetes. The World Cancer Research Fund tells us that fruits, vegetables, whole grains and legumes are the absolute cornerstone of a cancer preventing diet. And I was just thinking, my head's spinning and I'm thinking, why, why don't we talk about that? You know? So I I kind of, I'd already researched the environmental benefits. I knew that there were environmental benefits to being plant-based. It's pretty much the single biggest thing any one individual can do to help reduce environmental degradation. But again, I hadn't taken it on board myself at that point because I thought it just seemed a bit too hard. So when I read all about this, I thought, oh, maybe I'll give it a go. And so I did, and I tried a completely plant-based diet. I did it secretly because I didn't want my, I didn't want to lose face with my husband. Yeah, I just like, you know, I don't want to tell him, oh, look, I'm going plant-based and then not be able to do it.

Dr Rupy: And he's secretly wondering why there's so much broccoli in the shopping trolley.

Dr Gemma Newman: No, it was so funny because I was cooking the meals for the family anyway. So after about a month, I decided to check my blood and I was really thrilled to see that many years later, I was not, you know, exercising in the same way at all. I'd had a couple of kids, you know, life priorities had changed so much. And yet, I managed to finally normalize my blood lipid profile within just a month. And I thought, okay, I'm, yeah, this is this is good stuff. And clearly, that's an anecdote. That's my story. But, you know, having read the literature around these topics for a long time, I felt fairly confident that I was within guidelines to be able to talk to my patients about some of the benefits if they were open to it, if they were interested, if it's something that they felt compelled towards. And that's where the real magic happened, because that's when I could see the results for people that were so, well, it it did feel magical to me at the time, but it's obviously not magic, but, you know, people were able to stop their insulin if they were type two diabetic. People were able to reduce or stop their blood pressure medications. People who were feeling so much better with their IBS, hormonal health changes, people who had endometriosis, period pains, asthma. I mean, it was it was really quite broad the amount of different issues that could have been improved. And I was seeing this in my practice and I just felt this real strong sense that more people needed to have this information at their fingertips if they choose to use it, because it can change lives. It can change lives and prolong lives in a way that's provides so much vitality. And, you know, what family wouldn't want access to that kind of information for them and their loved ones? So that's what really fueled my passion from that point.

Dr Rupy: Yeah. And if you take me back to when you first started having those open, honest conversations with patients, because I think you're right, putting myself into the mindset of someone who didn't do that deep dive into the literature before, I would have been very skeptical, very dismissive of the idea that diet and lifestyle can have such dramatic effects. And I'd be honest, if it wasn't for my my personal experience and the battle with my mum who was telling me, I need to improve my diet last before I have a procedure to treat my atrial fibrillation, age 24, you know, I perhaps would have just carried on and had the ablation, probably had a curative effect because I was a very good candidate and just carried on being a normal medic and may have done surgery like I'd always wanted to at that point. But, you know, it's I think it kind of takes those little those experiences to to to want to talk about it a bit more openly. So, so when did you when did you start doing that in practice?

Dr Gemma Newman: It was a few years back and I mean, I've always had the kind of relationship, I hope, with my patients where the most important thing is really to listen and to figure out what's important to them, what they're suffering with, why it's important, how it affects their life. And when you begin to have those kinds of conversations, you see places where a difference can be made. You see things that they could perhaps start imagining that they can do or feel for a better life for themselves. And so when you start on those conversations, it can come in quite naturally if if it's something that they're open to, if they were interested, if it's something that they felt compelled towards. But you're right, it's something that perhaps uniquely to medics, you know, we are trained to have a skeptical mind. You know, we're trained to always sort of look at something as objectively as possible and look at confounding factors and make sure you've read the data and, you know, it seems ridiculous to say how much of an impact it can actually have because you don't necessarily see it that dramatically in practice. It's not something that you learn about in medical school. But when somebody takes it on, you know, the changes can be really profound. And the first time I mentioned it was when a chap, so I remember he came in to see me, he sat down, he slumped in the chair, he turned to me and he said, I'm in real trouble, doc. I was like, what's the matter? And he said, they've sent me home from work and I'm not allowed to go back. And I was like, okay, what have you done?

Dr Rupy: How old is he?

Dr Gemma Newman: I know. You know what it's like with patients, it could be any number of things that's happened. He was in his early 50s.

Dr Rupy: Okay. Yeah.

Dr Gemma Newman: And he is a truck driver and he had an on the spot medical and he has he had been shown to have a dramatically high blood pressure. And so high in fact that they said, right, we're revoking your license, you go home, you go to your doctor, you get this sorted and then you'll have to sit your license, your have your medical so you can get your license back. And he was devastated. He loved his job. He, you know, he found a lot of meaning in his work and he really wanted to go back to work. And I said, look, with a blood pressure this high, it's about 180 over 100 millimeters of mercury, we're going to need probably at least three agents to bring it down to normal levels at least. And we're going to start that process today. And that's what you can expect over the next few weeks that we'll gradually bring it down. He said, no, no, I don't want to be on medications for life. I was like, well, what do you want to do about this situation? He said, well, is there anything I can do? Anything I can do? I said, well, there is something you could try. And I explained to him a little bit about the science around why plant-based diets could be beneficial for helping to modulate your blood pressure and improve the suppleness of your blood vessels and how it all works. And I talked to him about the benefits of flax seeds, crushed up flax seeds. I've read a couple of studies on there and how they can open up the vessels. And I told him all about the plant foods that he could eat and and he was skeptical. And I said, I'm going to start you on these medications. He said, no, no, I don't want the medications. So I said, well, what do you want to do? He said, just give me a week. Give me two weeks. Just give me a week or two. I was like, right, you've got one week. Off he went and then he came back and I couldn't believe it because when he came back, his blood pressure had completely normalized. He'd gone down to 120 over 80 millimeters of mercury.

Dr Rupy: After two weeks?

Dr Gemma Newman: After less than two weeks. And I I was stunned. I really did not expect that. And so I asked him to come back again. He came back three times. On the fourth time, I think, I did his medical for him and each time his blood pressure was consistently normal. He was able to go back to work. He was absolutely thrilled. And he was of course waxing lyrical about how amazing this all was. And so, you know, that was the beginning of me realizing how powerful this could be. And of course, not everybody is going to go from 180 over 100 down to 120 over 80. But I've seen it consistently, even in people who've had, you know, remodeling of their vessels, you know, calcific plaques. It's hard to to make those changes when you've already got calcification. But people do manage it. And I had somebody who was in his 80s and he said to me, it's never too late, is it, doctor? It's never too late. And I said, no, it really isn't because he brought his blood pressure down too. He'd gone from dangerously high around about 200 systolic to around about 150. And obviously, we were using medications as well. This is never something that you would use instead of. It's important to think, well, we're just adding this into your toolbox. You're making sure that you're doing everything you can to maximize your chances of vitality. And yes, of course, medications and procedures will always have a part to play. But in his case, you know, he was thrilled that he managed to do that with his diet and with medication.

Dr Rupy: Yeah. I mean, it's incredible when you look at those cases and you realize that you suddenly find yourself creating a selection of them. You're like, okay, and time and time again, okay. And you're just you're just waiting for that for a couple of cases where it completely doesn't work or or they don't have a good effect or whatever. But when people follow diets that they enjoy and they can and they find it accessible and actually are motivated to do it every single day, it's profound what the effects can be. My question, I guess, is about behavior change with perhaps the lesser motivated patients. So that person in that example, you know, was was obviously motivated by the fact that he still wanted to work. You know, he loved his job. He was devastated that it could have been taken away from him because of something that he felt within the locus of his control to prevent. What about someone who is a skeptic or just going in there expecting pills? Because that's something I personally have to deal with quite a bit when doing general practice, but but especially in A&E as well. And they they're going there, they want the pills, they want this. How what's your what's your process?

Dr Gemma Newman: So it depends very much on the person. And what I find interesting is because I I'm very lucky. I'm a senior partner at an NHS GP surgery and in my role, I have the ability to build up relationships. And so quite often, if I'm seeing someone and they just want a medication, I've got the time to figure out why that is and what else they might be looking for. And because most of the time, I find if you get really down deep into it, they don't necessarily just want to take a tablet for the rest of their lives, actually. But they just don't know that they have the ability not to. And you know, that might be different with regard to things like a course of antibiotics for an infection, for example, we could perhaps talk about that. That's a very different issue, antibiotic resistance and all of that, but in terms of actually taking medications for chronic disease, people find that quite a daunting prospect on the whole and especially when you're starting out on that journey. And so to have something that you can do yourself that could potentially change the course or the trajectory of your illness and bring it to being something that is more in your control is really empowering because I see so many patients, people with autoimmune diseases, people with cancer, the control is taken away from them. And it's not the fault of the medical profession, it's no one's fault as such, but it's the idea that suddenly you have a diagnosis, we don't know why it's happened, your body has started to attack you, either your immune system is attacking you or it's not doing a good enough job and your cells are dividing too much and we are going to cut it away and give you medications and try to fix you and this is what's going to happen and you don't, you lose control, you completely lose control and it's really disempowering for people and it makes them feel like they can't trust themselves, they can't trust their bodies and it can be quite a journey from that perspective as well as everything else. So for me, it's really about spending that time to figure out what's important to them, how they feel about this illness and what they want to do next. And sometimes they don't want to do anything. Sometimes they need time just to process it all. And that's okay, whatever they need is fine. But it's just the idea of thinking if and when you're ready to go on this journey of self-discovery, to be able to think about ways that you might feel better in yourself, then then this is here for you and I am here for you whenever you need that. And that's that's the role I think that we can play when we're when we're seeing people with these long-term issues and when we've got the ability to see them again. That's a really special thing.

Dr Rupy: Yeah, because I think the limitations even if you are a senior practitioner at a at a surgery of the classic 10-minute appointment where you spend two minutes of that 10 minutes just sitting down, rapport, and then you might spend even more minutes trying to extract information from that person who's clinging on to critical information, you have to tease it out of them. But, you know, how even despite the fact that you can bring them back and you can develop a relationship, I I still struggle sometimes to emphasize the locus of control that they have through food and and all the other lifestyle factors. And I wonder if there are any nuggets of wisdom that you've come across in in your clinical career that have allowed you to perhaps open people up.

Dr Gemma Newman: Well, I have actually. In fact, I made a whole acronym. It's called blend it. And blend it. So this is this is my little acronym to help me remember how to help people make changes because like you say, it's really impossible and doctors are so tempted to boss people around.

Dr Rupy: Totally. Oh my god. It's just, you know, it's it's like one of those things in the back of your mind like, I can just give them this pill, I can just and then boom, they're out the door. It's honestly, it's a bad thing to say out loud, but it's it's always that you're get out of jail free card.

Dr Gemma Newman: Yes.

Dr Rupy: You don't want to use it.

Dr Gemma Newman: I know, I know. But I mean, to be fair, it is harder with telephone consults, I've found actually, because you don't have that same rapport and you don't have the physical body language that you normally would use. But let's assume that things have gone entirely back to normal and you are able to see your patients face to face. Blend it. So blend it stands for believe, listen, evoke, no bossing, desire, and then information and timed. So start with start with the B, believe, okay? So this is important. You have to believe that your your patient is capable of making changes in their lives. And they have to believe that it's possible. Okay? And that's important because it's hard to imbue someone with that sense of belief, but at least if you keep it in the back of your mind, it allows you to feel more open when you're in a consultation, when you've got a heart sink, you know, you've got someone coming and you're like, oh, okay. Just think, no, no, I I believe that these things can can change for this person. And you know, we are expecting our patients to go through all manner of things, you know, procedures, uncomfortable blood tests and, you know, operations, like we have to believe that they're going to make a difference for this person for them to want to go through that. And it's the same, I think, with behavior change. We have to believe that our patient is capable and then it helps them to believe it too. And L is listen. It is important to listen. And that means looking as well. So if if if you've got someone in a consultation room, take the time to look into their eyes. Don't tell them this, but you could even try and note like, what's your eye color? You know? As they sit down, because it reminds you that you have to look at them. Okay, because otherwise you're just looking at the computer. Yeah, yeah, yeah. And really listen to figure out what they're trying to tell you from their non-verbal cues as well as their verbal cues, because quite often you'll see, you know, frazzled mums or someone who's lonely and alone, like you can you can pick that up quite quickly when you're in a room with somebody if you're paying attention. E is evoke. And what that means is you have to ideally help them to imagine a better future. Because when you said earlier about making behavior changes, how do you do it? I think that it has to come from them. It really does. But sometimes you can plant a seed which allows them to begin to imagine a more positive future for themselves. And you can do that by reminding them about times in the past where they've been able to help themselves or even asking them, what did you do last time you felt this way? And it's a way of prompting them to think about the strategies that they already have that they can feel proud of, that they can remember. But also it can help them to imagine a more positive future self, a future self that can do the things that they're struggling to do at the moment. And it takes them out of that emotion that's in this moment of upset or, you know, misery around what they're going through. And that's really important as well. N is no bossing. I have to remind ourselves about this. Doctors like fixing things. The problem with bossing people around is that nobody likes to be told what to do. And it means that they're more likely to be resistant to what you're suggesting. And in fact, it also means that they are compelled to voice the reasons why they are currently doing things differently. And we tend to believe what we hear ourselves say. So you are basically forcing your patient to justify why they are behaving in ways that are not healthy. And that then potentially makes them behave in those ways more because they are reinforcing the negative elements of making a change. So that's really important. So don't boss them around. Instead, what you do is you build that desire. So D for desire, you build the desire in them to make a change. And you can do that in a number of ways, but generally it's with open questions. So you can ask them, what would you, how would you like this to look different? How would you like to feel different? What kind of things would you look forward to doing? And get them to open up about what they're going through or what they've noticed. That's another good question. What have you noticed? So let's take alcohol, for example. You might be seeing a patient and you can see from their notes that they've drunk heavily in the past. And you know, you ask them about what they're drinking and they say, oh no, I don't drink that much. I said, oh, you know, what, how much are you drinking? And they'll say, oh, I will have, you know, maybe five pints a night when I'm watching the TV every night and that's how I unwind, for example. And your head's thinking, oh no, that's way too much. You're going to get liver cirrhosis, you know. But you don't say any of that. You just say, so something as an open question, you might say, so how do you feel about drinking that much? And then they'll say, oh, I haven't really thought about it, you know, it's just what I do to relax. But it kind of opens up the question in their mind. And they could say something like, oh, well, actually, what I have noticed, I'm a bit sluggish in the morning. And then you could say, what have you noticed? It's a very open question. What have you noticed? And then they can then think, oh, what have I noticed? Oh, I felt a bit sluggish. Oh, I've been getting some reflux. Oh, I've been having more arguments with my spouse, or whatever it is. Oh, you know, so and so told me that they thought I was drinking too much and I got angry. Or you know, they can start to pick up those things. And then you realize that they are beginning to voice the reasons for change in that exchange. And that can be tremendously helpful. It doesn't always work that way. Sometimes, you know, if somebody is in a situation where they, you know, they are needing desperate medical attention or they've got ascites or whatever it might be that they need to go into hospital, then it's slightly different. But if you're planting those seeds of change, that's a really great way of doing it. And then the last part of my little acronym, it, information and timed. So basically, you then have the opportunity to give them information, ask them, would you like some information? Would you like to to know about this or that? And then they they say, yes, I would. So Yeah, that's fine. And I think that, you know, being okay with them essentially rejecting you is something that I I struggle with and I think a lot of other people in positions of authority, i.e. doctors would would struggle with as well, because the onus is kind of on us to to always want to help them. And there's two things I wanted to pick up there. Like one is totally understandable with the open questions, the motivational interviewing technique is so effective, even in even in just life, right? You people can't be, can't feel like they're being dictated to or they're being told to do something because you're less likely to keep it up as a habit or a behavior change. But if you feel like you've come up with that idea yourself, like the alcohol example, for example, you know, or, you know, the fact that you should go running every day or you should meditate, all that kind of stuff. You feel that you came up with that yourself, you're much more likely to to develop that as a behavior change. And the other thing is the the no bossing around. I I feel this is something that is more related to to the younger generation, because older patients that I've come across kind of expect the authoritarian vibe from me.

Dr Gemma Newman: They'll say, you're the doctor.

Dr Rupy: Exactly. You tell me what to do.

Dr Gemma Newman: Exactly.

Dr Rupy: That's the exact line I get that all the time. Like, how do you feel about this? What would you like to do? And they just look at you like, what on earth are you talking about? You look like 15 years old, you just came out of medical school.

Dr Gemma Newman: Yeah, it's interesting. You have to know your audience. You should add that to my little. I'll add that to my blend it. Blend it K, know your audience. No. It's true. And a lot of my elderly patients, bless them, you know, they call me Dr. Newman. They want to know my advice. They want to know, I will do what you tell me to do. And I sometimes find that quite difficult as well, actually. But at the same time, you go with it because you know that that's something that's important to them. And that's something that's, you know, built into their psyche and the way they think about going to the doctors. And that's okay too, as long as it helps them, that's fine. But the biggest and most important piece of advice that I have ever been given in my medical career is to let go of my ego in the consultation room. Really aim to leave that at the door because it's our ego that makes us want to fix people. And if we can let go of the outcome, if we can completely let go of the outcome, it doesn't mean that we don't care about our patients. It just means that we respect them enough to take the information and do with it what they wish. And that's okay. If we can let go of the outcome, it doesn't mean that they won't make changes. It doesn't mean that we don't care. It just means that actually you're doing them a service at the end of the day.

Dr Rupy: Honestly, that resonates with me so much because I I feel that it's my ego when that that gets hurt if I don't know the answer or I can't answer the questions about a diagnosis or what the best treatment pathway is or, you know, my thoughts on X, Y, Z. And sometimes appropriately showing vulnerability to your patient is perhaps the best thing that you can do. The very the very simple statement of I I don't know, but I'm going to try my best until I do or try my best to help you as much as I can, as much as we can as a team.

Dr Gemma Newman: Exactly. And it's also brings another point to mind for me, which is the fact that we actually can't know everything because people are very unique. And I learned this very early on after I finished medical school. I mean, I've been a doctor now for a long time. And you know, when I first became a doctor, I I naively assumed that most people would fit into certain boxes. And the the diseases that we learn about and and how that fits in with my patients. But I realized very early on that people don't fit into boxes and sometimes we can't explain their symptoms as much as we would love to be able to do so. And so yes, it's important to make sure that we've been thorough, make sure we've followed guidelines, make sure we know the best that we can based on current common practice. Ultimately, sometimes people don't always fit into those boxes. And that's something that we do have to accept. But also it is really important to do a service to our patients to know a little bit more about how they can help themselves. And that's where this nutrition aspect comes in and other lifestyle measures because if we don't know about these things and if they are interested to find out, then then that's a real shame. So yeah.

Dr Rupy: I I I honestly think that's the result of the traditional paradigm of medical curriculum at the moment in terms of fitting everyone into boxes and and and you know, brushing this particular patient age group, demographic, ethnicity as more likely as having because you come out of medical school feeling prejudiced and and you actually have like these racist kind of connotations about, okay, well this person's come in and they're in inner city London, they fit this group, I need to be thinking about X Y Z. And you're like, actually, not everyone fits that.

Dr Gemma Newman: You're a pattern recognition robot.

Dr Rupy: Pattern recognition robot. And I think we are currently developing AI algorithms to do that for us and we have to provide the human element. And I think that is kind of lacking. It's definitely better than it was.

Dr Gemma Newman: Oh yeah. And you're making it so, may I say as well, not to massage your ego too much, but that's that's some of the things that I think is probably really important to both of us.

Dr Rupy: Yeah, definitely. Absolutely. Put us into the perspective of a GP. I think GPs, general practice, I think has a a mixed reputation amongst both the public but also amongst medics as well. And I don't think people really appreciate the breadth that someone like yourself has to go through on a on a daily basis in terms of flip-flopping between patients every 10 minutes.

Dr Gemma Newman: Yes, it is a skill. It's a very specific skill. And it would be easy to be a GP that is not quite up to scratch, but it's also, yeah, it's it's a very, it's a very difficult job. And I think that this is probably something that people in the public and other doctors and even politicians actually don't quite appreciate. You know, they they're wanting to, I mean, they're wanting to train up sort of nurse practitioners to basically be GPs. And I've nothing against nurse practitioners, but nursing training is quite different from medical training. And medical training is also quite different from general practice training. And I think that where people don't quite understand is is you're having to deal with a tremendous amount of uncertainty and you're having to prioritize, you know, what's most important in that consultation, what's most important to that patient, what's most important in terms of guidelines, how you can actually fit all those things in in a cohesive way is a very difficult skill. And it's something that a computer wouldn't be able to do. It's something that you're not trained to do if you are trained in another field. And so I think other fields don't quite appreciate the amount of juggling that goes on in order to in your mind in order to be a GP that's actually thinking about guidelines, thinking about the patient, thinking about how it all fits in together, making it time efficient as well, and then coming up with a management plan within those 10 minutes that you are happy with and that you can sort of put your name on and say, yes, I'm completely happy with this and being comfortable with the level of uncertainty that that requires. Yes, it's a skill.

Dr Rupy: I think that last bit, I think is perhaps the most poignant for me. It's being comfortable with the level of uncertainty because when you allow someone to leave the door, leave the room and they're out the door and you've only spent 10 minutes with them, you've got to be pretty confident in what you said was safe and as true as possible. And that I think that for me is perhaps one of the worst aspects of of general practice. It's it's just the the niggling sensation that did I do this right? Was I was I exploratory enough in this story? Did I provide the right level of investigation? Did I over or under, you know, all these different things.

Dr Gemma Newman: This is it. Yes, this is exactly it. And it is hard. It is a really hard balance to strike. And I think younger GPs may probably be much more tempted to over investigate. Maybe much older GPs perhaps under investigate, rightly or wrongly. So yeah, it it it is a real challenge that we that we have to live with as general practitioners. And I remember when I was working in hospitals, my colleagues would be very scathing of GPs sometimes. And they'd say, oh, they didn't do this, they didn't do that. Can you believe they sent them in for this? And I'm thinking, you don't actually know what it's like to not have the bloods and the x-rays and the MRI scans and the CT scans and the ultrasounds at your fingertips and be expected to come up with this plan that is safe and effective and is able to couch the uncertainty also. So yeah, it's it is a skill, but it's something that I absolutely love. Perhaps it's something that not everybody thrives on. I think people really sometimes struggle with it. They go into GP thinking, oh, people say it's family friendly. It's not as hard as hospital medicine. I will do that. That's not the reason to be a GP.

Dr Rupy: I I I can hear those explanations. I recognize them. I remember those, yeah.

Dr Gemma Newman: Yeah. And I'd say, I'd say to anyone thinking that, just see how it feels, you know, when you do your hospital rotations first and and then go into the communities, really embrace it and see how it feels and you'll really begin to get more of a picture of, oh, maybe this is or isn't for me based on what you experience. And it's not just one GP practice. That's the interesting thing is when you're a GP, there's so many different kinds of places you can work, so many different fields that you can then actually go into from there. But yeah, I think it's definitely something you have to be passionate about and really love because it is a vocation, not just to be family friendly. And in fact, I've got friends that did GP training for that reason and then left it because it was so hard. They actually found being a GP really awfully hard, long hours and they had no idea how difficult that was going to be and then they went back into hospital medicine and retrained in other areas that they preferred. So don't do it just for that reason.

Dr Rupy: Totally. Yeah. I I see that like every at every level of specialty, you find them ragging on the one below, so to speak. So, you know, the tertiary specialists will be ragging on the general medics and the general medics will be complaining about A&E and A&E will be complaining about general practice. And maybe some GPs are complaining about the district nurses, you know, they should have done this. So, yeah, I think it's just that level of respect.

Dr Gemma Newman: Less judgment and we'll all be happy.

Dr Rupy: Exactly. Yeah. I think and I, you know, given how hard general practice is with the number of patients that you see on a daily basis, the number of stories you have to come across, is compassion fatigue something that you've come across before or experienced? Maybe we can define what we mean by compassion fatigue.

Dr Gemma Newman: Yeah, that's an interesting thing. And it's not something I've ever actually been asked before, so I'm quite, I'm glad to talk about it because it's, I mean, to to my mind, maybe you'll have a different definition, but to my mind, it's quite similar to being burnt out, like having a burnout. And when you are having burnout as a medic, then it's a quite a specific kind of situation because you are still expected to feel something for the for the situations people are facing, you know, people are going through real traumas. And we've always used kind of black humor perhaps to get through that and that camaraderie, sort of trying to make light of those situations so that we can process them. But when it comes to compassion fatigue, it's a situation where you just literally no longer feel like you can actually care at all about things that you used to care deeply about. And, you know, you see people in front of you that are going through things and you just feel completely detached from it, which is something that perhaps you didn't feel before. And I would suppose be quite similar to burnout, but I have seen it. I've seen it a lot in hospital medicine as well as general practice. And my personal experience of that is, I think that both burnout and compassion fatigue happened less when we were able to work more as a team, when we felt supported. Even if we had longer hours, even if we had, you know, crazy long shifts, if we had a team of supportive colleagues, then somehow it felt okay. Even going through the worst of things, you were able to talk about it, you were able to be there together through it. There was that continuity and there was that support. I think when that's gone, it's actually much more likely that you'd start to feel overwhelmed because you're feeling perhaps overworked, you've got no continuity, you've got no support, you're maybe saying yes to things that you don't feel like you're able to do right now. There's maybe nobody else there to do the things and you're overworked. So I think, yeah, it's an interesting one. It's not just about having to work hard, it's also about perhaps also having to work in a toxic environment or an environment that wasn't as supportive.

Dr Rupy: Yeah, yeah. I that's definitely been my experience of it as well. And it's occurred both in general practice and hospital medicine where you feel like you're seeing so many patients, you're being overworked and you're not giving yourself the time to decompress for want of a better word. But I feel sometimes you do need that decompression. It's like you're lifting yourself out of it. And if you're constantly in the thick of it, I think the word you use detachment is is very accurate for me anyway, is where you don't feel that you can show that level of empathy that you were actually able to do perhaps if you were well rested, perhaps if you, you know, you did have that more of a support network. I think the pandemic has been good in a way for both the public recognizing how hard medical practitioners and all key workers work in general, but also from a camaraderie point of view, because people are actually actively looking out for each other, which I think perhaps didn't happen as much pre-pandemic.

Dr Gemma Newman: Yeah, I think you may be right. It's been a long time since I worked in hospital medicine, but when I was, I was part of a team. And so I never actually felt unsupported. I really enjoyed my hospital jobs. I know that there's been a huge amount of change in hospital training since I did it, because I'm quite old now. You keep on saying that. It must be a plant-based diet because you look very young. Come on. Thanks. Well, yeah, I mean, I left hospital medicine a good few years before MTAS and all those changes happened. So for me, I think I haven't got first-hand experience of what that feels like in hospital medicine, but I know that in the pandemic, it's been tough. There's been a lot that people have seen and dealt with that they've never had to deal with before. But you're right, there's that feeling of collective camaraderie, which has been really helpful for people. And also just, as you say, that public recognition, which is great. But I think if if a medic is listening to this, because your podcast is aimed mostly at medics, isn't it?

Dr Rupy: Oh, it's at the general public actually.

Dr Gemma Newman: Oh, is it everybody? Okay, well, there's a good mixture, I feel, well, I hope so anyway. There's a good mixture of both, of both medics, people who are interested in medicine, and also obviously people who are interested in nutrition and helping, yeah.

Dr Gemma Newman: Okay, well, that's good to know. So I think, yeah, if if you're a medic or somebody who's working in healthcare and you are beginning to feel like, you know, you're quite cynical where you didn't used to be, you're sad a lot, you're dreading seeing the patient, you know, when you didn't used to dread seeing people, or you're hearing stories that that would normally have really upset you, but you're just kind of feeling numb, or you're getting sort of somatic pains, headaches, irritable bowel, you know, you're having these physical symptoms that you haven't had before. These are all signs that you might need to take a step back and really look after yourself and get some help. And I think that's important because we sometimes as medics, we don't necessarily prioritize ourselves.

Dr Rupy: Talking of the collective sort of mind there, at the start of the conversation, we we talked about how when you did your deep dive into nutrition and and how to help or a, how to explain your partner's experience with plant-based eating, but B, you know, your experience with with patients as well and anecdotally, you know, things that you've been able to achieve. Where do you think the resistance to using diet as a tool primarily and collaboratively with all the other conventional options that we have, where do you think that comes from given that the the institutions that you just reeled off, the American Heart Association, the endocrinology, is it endocrinology association or?

Dr Gemma Newman: The yes, so it's the I don't know the American one so well. The American College of Clinical Endocrinology. There you go, that one. That catchy.

Dr Rupy: But also, you know, yeah, there's there's a few in the UK too.

Dr Gemma Newman: I think where does the resistance come from? I think it's a mixture of things. I think, you know, we all kind of know that fruits and vegetables are healthy. Like we get that. But I just don't think we quite realize how much of a difference it can make. So I think you're right in saying that it does come from personal experience as well. But also it takes it takes a focus on that area to really understand the breadth of information that's there. And guidelines also take a few years to catch up with the evidence sometimes as well. And so now we are in a situation where we are in the midst of the sixth big mass extinction event on Earth caused by humans, the Anthropocene. That's what we are currently in. I don't understand why this is also not something that we talk more about because this affects the health of us and our children and our children's children forever. You know, we will not be able to exist on an unhealthy planet, let alone be healthy, let alone, you know, optimize our blood pressure. It's just really for me, it's it's about really bringing it all together. How do we have a way of living and eating that is not only healthful but is sustainable, that is something that we can thrive on, but that the planet can thrive on, something that will allow us to reduce our long-term risk of antibiotic resistant diseases, something that can reduce our risk of future pandemics, something that can, you know, reduce the biodiversity loss, increase the quality of the soil that we grow our food in. Like all of these things are all linked to eating a more plant-based diet. And you don't have to go 100%. I think that's another area of resistance is that people think, oh God, you know, being being vegan. Oh, it's so pious, so boring. No. Firstly, it's not, but even if you do feel that way, I think what's great is that if you can learn to be excited about new recipes and like different things that that your absolute favorites that you can make a bit more plant-based or add a few more veggies here and there. It's just a way of really improving your health while also feeling emotionally quite good about it as well, finding that why for you, which is different for everybody. But I think now that we've got these really big issues that we're facing as a species, it has to be on the table more for doctors to talk about. And interestingly, the Royal College of GPs are beginning to see that. We've got the Eat Lancet report that was written, you know, with the help of Professor Walter Willett, one of the most respected nutritional researchers in the world. He has said quite clearly that the UK has to reduce our meat consumption by a good, you know, 80, 90% if we're going to meet any of these targets that were laid down for us. That is big. Somebody has to do something to help people at least understand the importance of that. As I say, no bossing is important. But at the same time, these conversations are crucial if people are going to get any sense of an idea of, you know, what needs to be done.

Dr Rupy: Yeah. I I and the conversation that you you've sparked with your books and and social media and and stuff, I think they are so important because they're not being had at a medical school level. And I question why as well, given that we are in a sixth mass extinction event, which should be taught at medical school. If we are heading towards a time where antibiotics won't work and and a good deal of that is because of our current agricultural methods. And we have an environmental crisis which will also threaten things like water supply.

Dr Gemma Newman: Global wars.

Dr Rupy: Global wars.

Dr Gemma Newman: This is what we're going to be facing soon.

Dr Rupy: Exactly. Yeah.

Dr Gemma Newman: Over over resources, over resources like water.

Dr Rupy: Absolutely. Yeah. So, you know, all these all these things, what where do you think we we start? I mean, my small contribution to this is, you know, culinary medicine and and trying to at least engage the right stakeholders, not say you need to eat plant-based or you need to, you know, drastically just it's just like, let's get everyone in the room. Like first of all, the right people aren't in the right room. It has to be the registered dietitians, the nutrition specialists, it has to be the culinary expertise, and it has to be medical professionals, including nurses as well. Get them in the room. That's step one. But then it needs to evolve. Like what what are what are sort of the things that you you think we should be moving towards in that respect?

Dr Gemma Newman: Well, it's not a small task. I think on a personal level, we need to make it easy. We need to make it easy for people because, you know, being environmentally aware is hard. You have to make sacrifices. You know, people have to think about, oh, where am I going to drive a car? Am I going to get on an airplane? Oh, I've got to try and buy this or that at the supermarket. Like many people don't even have the mental bandwidth to think about that or even afford to think, oh, I'm going to buy solar panels for my roof, you know? It seems so out of touch for so many people. But at least, you know, if if it's possible for governments and institutions to make it easy to make simple switches and to make it cheap and accessible, that's that's what's going to drive change. And I think governments and companies do have a role to play. And you know, not everybody's going to want to eat a healthy plant-based diet. So I do think that it's important to have junk food alternatives as well for environmental purposes, not necessarily for human health purposes, but that is something that is part of the equation because people don't want to necessarily change what they're doing that much, but we do have to make changes in order to be able to survive as a species. So yeah, I think governments need to really embrace the idea of regenerative and conservation agriculture moving forwards. That is going to be a huge, huge benefit for the quality of our soil, our ability to make food ourselves for our population, to retain the top soil that we already have and to improve the quality of the top soil that we have. And I could talk for hours about that. But but yeah, I think on a government level, really allowing farmers, our agricultural superheroes, the opportunity to create healthier soil and be able to earn good money in the process because it's really hard to grow food. It's a really hard thing to do and it takes a lot of skill. And you know, I feel like for more than 70 years, farmers have been pushed and pressured to make agriculture and food production more and more intensified, using plows, using chemical fertilizers. It's all reducing biodiversity, it's increasing soil degradation, water pollution, erosion of the soil, flooding, you know, all this kind of stuff is what we're now facing because of our food systems. So that's something that we can't change on an individual level. People just want to buy what they need at the supermarket. But we have to think about those things on a much higher level for sure.

Dr Rupy: Absolutely. Yeah. And you know, something that's going on right now with the farming protests is something that I've I'm I'm privy to obviously because I come from a Punjabi background and my my dad grew up on a farm in very much the same way, in very much the same sort of situation that the current farmers are in right now, being pushed to the brink by bigger corporates and the inability to do anything about the the need to use ever more pesticides and agro-petrochemicals to produce crop, you know. So there's a whole bunch of issues in that respect. And I know you're super interested in this subject because I remember when I released a podcast on it, you sent me a voice note saying, you know, it's good that you're talking about this because, you know, we need to be engaging in these conversations as medics. You know, it's not this is not just for someone who's interested in in permaculture and and farming and and the environment. It's it's actually something that obviously everyone needs to engage in.

Dr Gemma Newman: Yeah, this is our food. You know, and if we have, I mean, it's an incredible, you know, our human existence relies on six inches of soil and the fact that it rains, you know? So we have to look after that soil and we have to think of ways that we can rebuild what we've lost and hopefully be able to feed us all in the future in a way that's actually really sustainable because a lot of the crop land that's now being used or the vast majority of it is being grown to feed animals and there's a real inefficiency there. You know, you give 100 calories of grain to a chicken, you get like 10% back. You give 100 calories of grain to a cow, you get 3% back. This is shocking. We can't sustain that. So we have to think about how do we farm in a way that we can sustain, not only sustain but actually thrive. I think that's a really interesting point as well is that you can actually thrive through different methods of farming over time as long as you've started to recreate the health of the soil. And you can do that through crop rotation and through making sure that you don't disturb the soil, no tillage of the soil, let the earthworms do their magic, you know, earthworms contain these amazing nitrogen fixing bacteria and then the casts that they produce is incredible, all that mulch, you know, it it helps to regrow the soil, all the fungal networks in the soil that are like a underground city with all the highways of information that help talk to the other plants, help them grow, help them transfer nutrients one to the other. This is an entire ecosystem. You know, you can pick up a healthy handful of soil and there's more microbes in that than there are humans on this planet if it's healthy. This is what we have to really focus on. And that's something that I am passionate about, but clearly I don't talk about that in my consultation room. But it's nice to have the chance to talk about it with you.

Dr Rupy: Yeah, I was going to say that's going to be a long 10 minutes otherwise. I know they'd be like, what is this doctor on about?

Dr Gemma Newman: I might be coming back for a second consult.

Dr Rupy: I think with that in mind, do you think given that we need to eat more plant-based, we it's clearly demonstrated in the Lancet report that had a number of different academics across it, a number of different organizations that bought into it as well. Do you think perhaps veganism might have a branding problem? When I say vegan to anyone off the street who doesn't understand exactly what veganism is, they just think, you know, hemp t-shirts, trying to jump into animal laboratories and protesting on the streets and that kind of that's the kind of and maybe I'm making a huge generalization there, probably am. But you know, with that in mind, do you think there are issues around the term and and how we should use language in that respect?

Dr Gemma Newman: I think it's a really interesting point. And I think it's also interesting how language and its use changes over time. And yeah, I think there is a branding problem. When I've spoken to patients in detail about certain things that they should eat, they've kind of put the dots together and they'll say, you don't want me to be vegan, do you? And I'll say, no. Because I don't, because veganism is in and of itself, it's a lifestyle that is defined by what you're not eating. And you're not eating animal products or putting them in your life in other ways because you have compassion for the animals or the environment and so that's really important to you. Whereas eating more whole foods plant-based is is an idea of actually thinking, well, these are all the things I'm going to put onto my plate in more abundance and they're going to be healthy for me, but also it has the side effect of being more compassionate to animals, yes, and being environmentally thoughtful, yes, but the main goal, obviously, in terms of my conversations is always about human health because that's what I care most about. That's why I went into medical school. I personally would define myself as vegan now. Um, just because I suppose it I do rather fit that definition. But it's not something I would ever tell anyone else that they had to do because it's sometimes it doesn't suit everybody and sometimes it's, you know, it's not something that people are interested in. They just want to get more healthy and that's great. You know, as long as they're eating more fruits and veggies and whole grains and pulses, herbs and spices, nuts and seeds or whatever it is that they're improving their health with, I'm happy with that. But I think you're right. I think it's the idea of, I mean, I spoke to a patient the other day and she said, I was really reluctant to try doing this because I thought it means I have to go vegan and that's not me. I said, I thought, I thought, wow, you know, what do you think it means to be vegan? And she said, oh, it's just not me. It's just not me. I don't know. I just, oh, it's so so awful. I was like, okay, well, that's really interesting. I think maybe it should be called something else to get people more into the idea of eating more plants. But to be honest, you don't have to even, you know, go all the way, so to speak. And we don't know exactly how what proportion you need to have in order for optimal health. We get an idea from looking at the epidemiological data and from looking at randomized control trials. And you know, the totality of the evidence suggests that there are multiple different ways of eating that can benefit you in terms of styles, you know, Mediterranean style, Thai, Asian, like cuisine, African cuisine, whatever it is, it can fit into any one of those cuisines. I think people feel like it's very restrictive. I think that's part of the issue as well. Sometimes, especially if you have a history of disordered eating or if you're only eating certain foods with the only reason being to lose weight, I think that can be problematic as well. And that's a whole other conversation. But in terms of just optimizing health, I think plant-based approaches are fantastic. And it just so happens that they're good for the environment as well, which is something that we have to start thinking about now more than ever. And you know, the BDA has talked about that, the British Dietetic Association, you know, they've got the one blue dot campaign, which is essentially talking about how the blue dot is Earth. I think that's that's the idea of looking at our planet from a from afar and thinking big thinking, like how do we help our planet from a, you know, day-to-day level. And you know, what they do emphasize is a more plant-based approach, even, you know, so so big institutions are talking about this, the Royal College of GPs, the sustainability, green impact scheme, plant-based diets are part of that. So it's it's kind of, it's about, it feels sometimes like pushing a monolith. But we have to start somewhere. And so, you know, if we can start with inspiring, educating, making people feel good, then that's fantastic. That's something that any doctor or any healthcare professional can do is is help people feel good, you know, help people understand some of the benefits. And that can make a huge impact, you know, even, I was looking at some of these stats yesterday, how many gallons of water are saved, you know, how many square feet of land are saved from eating a more plant-based diet is is fantastic. So, you know, it's uh, baby steps can sometimes work.

Dr Rupy: Definitely. Yeah. And I think this is why I like talking to you about it because you you're not one size fits all. By virtue of the fact that you are a general practitioner, you understand the nuance and the fact that there are a number of different dietary patterns that could be more suitable for different people. I think eating disorders is definitely something that needs to be taken into consideration, particularly when talking about these subjects on social media. And I feel that, you know, people need to be filters for their own digital landscape, but also we as people with a degree of influence have to take some responsibility of the kind of content that we put out there. And I think, you know, you you do that and you toe the line very, very well. Going back to veganism, I think sometimes it can feel like it's to use a religious term, it's proselytizing almost, like you have to go this way, you have to be like one of us, sort of thing. Whereas, maybe it won't require a different name or a term because you'll still get any, you'll get any number of people with different ideas about what people should be doing and how to try and coax them into that community, you know, whether it be scaring them into it or with the enticing them into it. But but really, the goal is to get eating, get people eating more plants.

Dr Gemma Newman: Yes, I mean, that's my goal. I I I'm not somebody to um, to push people into doing anything particular. Um, but I think if if they can understand some of the benefits for their health, then that's fantastic. Um, you're right. I think veganism can attract all different kinds of people and they do it for all different kinds of reasons. And we're human, so we like to feel part of a tribe. You know, we like to feel part of something greater than ourselves. We don't like being ostracized is psychologically and emotionally sometimes worse than death. You know, because you you feel as though you don't want to be out on a limb or by yourself. And I think sometimes social media is a way to make people feel part of a community, but it can make people feel quite separated as well. And we get caught on our own little silos of people that agree with us. And then we think therefore that we have the right then to judge other people who think differently because it seems so alien to our understanding of the world and what the world looks like. You know, having watched the social network whenever it came out, you know, I really did reflect on that and where society is going because in order to win people over in the consultation room, in life, with colleagues, we have to understand where they're coming from. We have to have empathy for where they have been. Otherwise, we just alienate people. And I think that that is true of veganism sometimes is that, you know, there is some negativity and people say, you should do this, you should do that. And that's tough because people don't react well to that. Just as, you know, we circle back to earlier in our conversation, how do you help somebody sitting in front of you that that to make a change? You don't tell them what to do. So it's the same thing, you know, you shouldn't be telling people what to do because they don't they don't like it. Nobody likes that. So yeah, I don't have all the answers, but I think that we have to lead with compassion. We have to lead with love. We have to lead with the emotions that understand other people have very different life experiences to you. And if you were them, if you grew up in their house, had their siblings, had their parents, had their life experiences, had all the things that they had up to that point, you could very well be them. And hopefully, I'm not quite sure how we're going to get that out there in the world, but I think conversations like this help. But yeah, I do worry about the future and and where that goes. But hopefully, I heard Barack Obama say once about, you know, the pendulum of change, it does go back and forward, but ultimately it will go hopefully in the right direction.

Dr Rupy: Yeah, yeah. It's like a statistical term, regression to the mean. Yes, yes. Or to take a Buddhist approach, it's the middle way, you know, it's we are generally trending towards that pattern. And I I feel that might be happening with our dietary patterns as well. More and more people are being attracted to the idea of all the things you talk about, whole food, plant-based, beans, nuts, pulses, etc, etc. Um, I did want to ask actually about things that you've changed your mind about. Since having all these revelations and, you know, introducing diet and doing more research around this, are there things that you perhaps did believe in but but now less inclined to?

Dr Gemma Newman: Yes. And I think it's good to change your mind. You know, when new information comes to light, then we, you know, it's it's good to be intellectually and emotionally flexible. Um, changed my mind. I think, yes, actually, um, I I was doing a lot of reading around conservation and regenerative agriculture. And one of the things that I kept hearing and and thought was true was that we need livestock to always be a part of that process. And I thought, yeah, that makes sense. You know, the manure is important, you use that as a fertilizer and then you don't have to use the chemical fertilizers. So that's something I've changed my mind on relatively recently because I spoke with a professor of um, um, ecology at the University of Reading, Professor Amir Kassam, and he was explaining to me that actually, um, livestock are included in farming primarily to make money. And biomass in the form of fodder crops and um, kind of like crop residues and things like that, pasture land, all of that can be recycled without having to pass it through the intestines of a mammal. And you do that using plant roots and biomass of the soil. And essentially what you do is you that makes a compost and then that can be incorporated into the soil via earthworms and microbes. And as long as you're not tilling the soil or breaking it up, then that does just as good a job, if not a better job, because you're not actually giving up the biomass for the animal to then eat and then poop out. Which I was really surprised by.

Dr Rupy: Yeah, yeah, that is surprising.

Dr Gemma Newman: Yeah. So so that's something that I sort of changed my mind on in the last few months, I suppose. Um, but yes, I think in terms of, I guess, just my practice in general, I think what this last year has taught me more than anything about humans is that we are all much more similar than we have things that divide us. And our pandemic situation has has really shown us that that it has brought out the best, it has brought out the worst. It's brought out all sorts. And I used to think that um, things were only kind of getting a lot worse in the world in terms of separation and and arguments on social media. And that could still be true in some quarters. But I think what this year has taught me is that, you know, as I say, there's so much more that we have in common. And all the bickering and infighting is completely useless, especially when we look at the future of the planet. You know, how connected we are to that. How everything else in some ways really pales into insignificance when you're looking at that bigger picture. So yeah.

Dr Rupy: Talking of arguments on social media, I hope you don't mind me bringing this up, but you've had some negative experience, many positive experiences, I'm sure, but some negative experiences on social media where you were unfairly vilified by not just your average troll, but people who should know better and have a degree of authority within nutrition, even medicine as well, some some doctors. What I don't we don't want to go into the specifics of it, but what I want to know is how you deal with the balance of using social media as a tool, but also dealing with that kind of negativity that no one should really experience.

Dr Gemma Newman: It's difficult, isn't it? And I found it very hard at the time. And what I reflected on at that time was thinking, you know, again, it comes kind of back down to ego a little bit, because I felt really bruised and I felt like my professional integrity was being questioned. And so sometimes, you know, when you are being criticized, perhaps unfairly, perhaps not, you know, your first instinct is then to feel naturally like you're being attacked. And sometimes you are being attacked. There's no question about it. But other times, you know, it's important to reflect, could you have done something differently? Could I have said things differently? But also, it made me reflect on what it's like for young people, because I'm somebody who is generally quite grounded in who I am and who quite likes who I am and knows who I am. And so I see young people now really struggling because they're yet to completely form or understand their identity. And they're on social media and getting all sorts of bullying that they can't escape from. And they feel like that's their entire world because they never even knew a world without it. That's something that I really have reflected on a lot since my experience, because I began to realize that that yes, professional shaming is particularly painful, but it doesn't define me or my mission or who I am. But that it can feel very defining for people who don't have that same sense of self. So, yeah, I it's made me a lot more compassionate and aware. What I've also noticed since that time is that the people, some of the people who have been negative at that time have experienced themselves negativity since that time from others and really seemed to struggle with it. And so I reflect on that thinking, you know, they hopefully now have also had that experience of feeling that human sense of, oh, you know, it's not just somebody behind a screen or somebody's profile, this is a person and they have feelings just as I do. And so, you know, I think these experiences can be quite helpful in a way because they help us to realize how important it is to be sensitive to others in the future too. So where someone might be tempted to, you know, be particularly, call out culture. They might think twice after then having experienced that themselves. It's something that I've never particularly indulged or I never indulged and I never do that. I never have done that. But it's something that is very common, this call out culture. And that's something that I have always struggled with even from being very young because I don't see how it helps actually. It creates false tribes. It creates a false sense of self-importance. And then your message becomes, what am I going to do next to make someone else feel bad? What am I going to do next to call out the next person? And then that's a quite a negative thing to have to live with in your own body and in your own self. So I guess my advice would be if that's tempting to have that tribe feeling around doing that, try not to, because then you will feel less good within yourself. You just do your own thing, spread positivity wherever you can. And of course, we're allowed to feel negative things. I think that's another thing that people don't realize is that, you know, I think it's quite toxic just to constantly think, oh, I have to think positive. I have to be positive all the time. No, it's it's recognizing that these feelings exist, but that you can work through them and just remember to be mindful of what you're putting out there for other people to have to work through.

Dr Rupy: Yeah. I I'm really, I'm really glad we talked about that because I think call out culture is a thing. It's almost like a badge of authoritarian honor, something that we should indulge in as people of knowledge, you know, to make sure that other people are being protected at the misinformation because it disagree, we disagree with it or that's not from our camp or whatever. And I think public shaming is something that is strangely something that has been pervasive throughout human history and human evolution. It's and I think it goes back to that sort of tribal and and community mentality where we shame other people to demonstrate solidarity within our community. And and social media is something that can absolutely, you know, accelerate that process. And it's interesting you said that about ego and and how because you identify your social media accounts or even your profession with you and and someone attacking that, of course your ego is going to be bruised. But if you can separate yourself from it, that's how you can work through it. And I know from from personal experience of of similar sort of bullying scenarios, I'm really grateful for that now to have had that experience because it's definitely made me a lot more vigilant about who I associate myself with both publicly and privately, but also, you know, again, heightening and and thickening that barrier between me and social media. I think that that's a super important theme that I think will be really important for for for younger generations as well.

Dr Gemma Newman: I think you're so right, Rupy. And sometimes we have to learn through experience and sometimes the experience is painful. And that's okay. It's okay to feel the pain of it as long as it doesn't define us. And I think that's the problem that a lot of people face is that it can feel so overwhelming and it can feel so important. But, you know, we shouldn't give that importance to people who don't have our best interests at heart. And, you know, for me, having a sense of self has been really useful. And yes, I'm glad that I had that experience as well for a number of reasons. And at the same time, I wouldn't wish it on anybody. And actually, I found it quite painful to see when some of the people who were negative towards me had something similar happen. Like, oh, it kind of it felt painful because you think, you know, why do we put ourselves through this? What is the point? When, you know, we all just want to be connected with other people. We all just want to feel loved. What is the point in all of this, you know? So, yeah, I think having that sense of self is great. And for young people, coming back to who who you are, what's important to you, keep that in your mind. It doesn't matter what, you know, people on the internet think. What matters is what you think. And that's that's what we should look at moving forward.