Five Steps to improve Heart Health, Avoid Diabetes, and Feel Great

[MUSIC PLAYING] SPEAKER: Good afternoon, and welcome We are hosting Dr. Ronish Sinha, author of the book, “The South Asian Health Solution.” Dr. Ronish Sinha is a doctor at the Palo Alto Medical Foundation But more importantly, he has had this principal mission of trying to address a set of preventable diseases that human beings can address by taking care of themselves– taking care of themselves and making choices about what we eat, how we move our bodies in terms of exercise, and understanding specific cultural factors that might be affecting issues like diabetes, heart attack, excess weight Early on in his career, Dr. Sinha was noticing that while he worked in this part of the world, that employees in certain industries and from certain ethnicities seemed to have the exact same problem For example, the incidence of diabetes or certain kind of heart conditions among South Asian populations, or the Pacific Islanders were susceptible to certain diseases And he started studying it And he started seeing patients coming from tech companies, in particular, with implications on lifestyle also having these sort of issues So when he started researching it, he found that there were cultural factors For example, what we eat or what traditionally, certain cultures have eaten has had a huge impact And he started educating these populations And that has become his mission in teaching groups of people from certain backgrounds on what to eat, how to exercise, and how you can be the CEO of your own body and your own peak performance and productivity Dr. Sinha is a well-known speaker, blogger, author, and I would consider himself as almost like a missionary in this area He’s got a sense of purpose more than just being a doctor at the Palo Alto Medical Foundation So it’s my honor to welcome to the stage, Dr. Sinha [APPLAUSE] RONISH SINHA: All right, so let’s jump in I’ll warn you ahead of time, my talks are pretty information-packed So sit back and get ready for a ride I thought you’d appreciate that But you have access to a lot of this content I will make a handout version of this and send this out to you I’ve got talks online So, I’m really here not to really tell you the what I think most of you know what you’re supposed to eat We will definitely talk about that I’m armed with an amazing dietitian to talk to you about that But I want to talk also about the why Like, how did we arrive here? Why do patients of mine that have all the right knowledge still refuse to make the changes that they need to make themselves healthier and their families healthier? So it is going to be part information It’s also going to be part motivation as well And then, when Prerna and I are finished, we’ll have a lot of time to answer questions as well, too So hopefully, we can accomplish quite a bit here So, how did we get here? What’s your risk type? So one of the things that I’m passionate about in the clinic is identifying what your risk type is so you can personalize your diet appropriately The right job for me might be the absolutely wrong diet for you, and vice versa And if we don’t understand that, we might be doing things that we think are making us healthier, but actually might be leading to more damage We’ll talk about some key lifestyle changes to implement And then we’re going to transition to Prerna for the nutrition practical tips So this is one slide I like to show Because many of my patients who are Asian in background tell me, how can you take away my rice? Oh, let’s get back, here And they ask me, this is a lifestyle that I led before I was eating all these foods How can we take that away? And I’m never there to take away people’s cultural foods at all But I do remind them that we have a significant difference from our ancestors or people who are living back in Asia So a typical rickshaw puller– so, I’m obsessed with rickshaw pullers When I grew up in Calcutta, I’d go to India every summer And we had a house that was right in front of a rickshaw stand So I used to check these guys out I probably saw more than I should have But I saw every part of their life But basically, an average rickshaw puller will walk about 40,000 steps, walk and run 40,000 steps in a day My average engineers– because I track their steps like a vital sign– about 2,000 to 3,000 steps So they’re 20 times less active than a rickshaw puller They obviously have a strong leg and core because they’re carting around lots of loads, including heavier families as well too, because in India, obesity is becoming an issue So they definitely a strong leg and core But we have a weak leg and core because we’re sitting in front of a computer all day Normal vitamin D levels because they’re out in the sun with minimal clothing exposure So they’re getting that natural sunlight-driven vitamin D, whereas here, we have an epidemic of vitamin D deficiency And vitamin D effects and metabolism, inflammation, and other parts of our health So for somebody with this sort of lifestyle,

moderate to high amounts of rice, awesome, great It’s going to fuel this engine so he can do his work during the day But if we’re sitting in front of a computer all day, that same sort of diet can lead to early onset diabetes, heart disease, and even cancer and Alzheimer’s disease as well So I’m not saying that you’re going to drop your jobs and become rickshaw pullers, pulling rickshaws down the 101 But there’s a happy medium where we can come to some sort of compromise So there’s a concept called ancestral drift And what that basically means is, how much have we deviated from our native lifestyle? So microbiome is basically the composition of the bacteria inside of our gut and digestive tract, which you might be aware of A lot of us that have migrated from a different country like India or China have come here We had a certain type of bacteria that inhabited our digestive tracts And that abruptly dramatically shifts within the first year, when you first start eating at a high tech cafeteria, et cetera And that could have dramatic implications If you’ve been raised in a Western lifestyle, your gut has had an opportunity to adapt It’s still not healthy, but the impact may not be as dramatic The second thing is this caloric mismatch So, for a lot of us of Asian background, you might see us walking around We might be slender arms and legs and we got a nice little pot belly here Because really, genetically, we’ve been programmed to store more fat around our stomach because we lived through periods of feast and famine And during situations of famine, your body stores more body fat And this is our Tupperware container We store it right here, so during the winter and limited access to calorie, we can actually break that down for energy But what do we do here in the wintertime? We feast even more, right? So we don’t empty our Tupperware, and we store more and more fat around that area So that’s caloric mismatch We call that the thrifty gene Now, elimination of traditional rituals So, the thing I find in my console practice, I probably see 60%, 70% patients from Indian/Asian background The rest are Western Europeans One of the questions I ask all of them is, what do you do for stress reduction? Do you meditate? Do you do mindfulness practices? Do you do yoga? And it’s unbelievable I find my Westerners are meditating much more than my patients that come from the land of yoga Most of my engineers are doing absolutely no meditation or mindfulness practices at all And that was a part of their traditional, their familial ritual And they’ve disconnected from that completely All of us can use that regardless of cultural background But if you come from a culture, your genes are from that land and you ditch that altogether, it’s going to have a more dramatic impact on our emotional and physical health And then the social structure is a mismatch, because many of us come from communities where there’s more, what we call, a village– extended family members living Neighbors knew each other You know the person at the local market And then, we get pulled out of that into a very isolated environment And that can have profound impacts on metabolic, physical, and emotional health So this is what I refer to as ancestral drift So the key is, how to bridge the gap, right? We can’t go all the way this way But how are some of the ways that we can really bring in some of these ancestral habits? So the first step is to understand, what is your particular risk type? So let’s talk about this And there’s a lot of variations in what our risk types are These are three categories I tend to focus on Number 1– do you have an insulin-resistant type risk profile? Number 2– are you somebody who is more susceptible to inflammation and autoimmunity? And we’ll talk about that concept in detail And the third one is a simpler one, but are you somebody who tends to have a type of cholesterol called LDL, elevated levels of that? So we’re going to talk about each of these categories And I’m going to explain to you how we can tailor our lifestyle to address those individually And this covers the vast majority of people that we see in the clinic So the first thing is insulin resistance You probably heard of the term This is the root cause for type 2 diabetes, for most heart disease, for most obesity, and also, we’re finding for cancer and conditions like Alzheimer’s disease also So this is an image from my book And I want to spend a little time so you understand this I tell people that insulin resistance is a carbohydrate parking problem So let’s call excess carbs in the diet– let’s call that a car in the middle of the diagram We have three parking lots We have our muscle, liver, and fat And the ideal destination for the carbohydrates is we want the carb car drive to muscle, so your muscle can burn that for energy The way the carbs get inside the muscle is by using a hormone called insulin That’s a parking pass It’s the key that gets the carbs through the muscle door When we say we have insulin resistance, all that means is your body is producing the parking pass, but the muscle is resistant It’s not responding to the signal As a result of that, we have all this overflow carb traffic And that flows to various other sites It can go to the fat parking lot When he goes to the fat parking lot, often, it gets stored in the stomach That leads to weight gain, inflammation, and worsening insulin resistance, fatigue, and other issues It might go to the liver And the liver would predominantly take the carbs and make dangerous cholesterol particles out of it like triglycerides And then, in a lot of people, it stays in the bloodstream So they might have high blood sugar, pre-diabetes, or diabetes So when I see insulin resistance in people in the clinic, it depends on each person So, for example, I saw three couples today, actually, in my clinic

And one of the common things we see is we see the man and the woman The male was often very slender But he’s got very high triglycerides, cholesterol, and very high heart disease risk So in his case, his cars tend to flow more through the liver where you can’t see it, but it’s accumulating in his bloodstream But he’s skinny, he’s walking around going, hey, I can eat all the carbs I want Look at me His mom is like, you’ve got to eat more food But they don’t realize it, the problems getting worse The spouse, on the other hand, often, the traffic is not going to the liver So her numbers look amazing, but she’s 30 to 40 pounds overweight because most of her traffic is going towards fat storage– very common pattern But then, as women reach perimenopause and menopause, it starts to go in this direction All of a sudden, heart disease risk escalates tremendously So this is the distribution that varies in each person But now you understand how insulin resistance functions in our body So what are some clues that you might have a parking problem– in other words, insulin resistance? You look at a type of cholesterol test called the triglycerides Most labs will say greater than 150 is abnormal But I tell people, aim for 100 or less That’s really what you should be looking at because that can really bring down a lot of the visceral abdominal fat HDL is the healthy cholesterol The target for male is less than 40, for females, less than 50 I’m sorry, these are not the targets, these are the risks If you’re less than 40 or less than 50, that shows you might have a carbohydrate traffic problem as well So you want to get above those levels And these two tend to be tied hand-in-hand The higher your triglycerides are, it pushes during your healthy cholesterol Body habitus, people that carry more fat around the stomach, elevated waist circumference, that’s a sign you probably have insulin resistance Then, blood sugar markers like the glucose or a test called the A1C, those are indicators– and also, the blood pressure as well So a lot of our folks, we see, unfortunately, have all or most of these, or even if you have a couple of these, those are early, early indicators Other insulin type clues could be your ethnic background So certain ethnicities, we talked about how we have that caloric mismatch, the thrifty gene So Asian Indians, East Asians, Hispanics, Pacific Islanders, there can be some what I call nonspecific overlap symptoms So men and women who are having difficulty losing weight, having a lot of fatigue, a lot of sugar cravings, they can be insulin-resistant or insulin type And then, if you have other existing conditions, they tell us that you probably have insulin resistance– so diabetes or pre-diabetes, a condition called polycystic ovarian syndrome, which is becoming an epidemic in young women, gestational diabetes, fatty liver, et cetera So these are some conditions Yes? AUDIENCE: Just a quick question Will you address– RONISH SINHA: So, I’m sorry Yes So, the question is why people with insulin resistance have sugar cravings And the whole issue of that is when your muscles are resistant to insulin, your body actually responds by producing more insulin And the insulin, what it does is it drops your sugar down So it’s not a perfect system It’d be ideal if it just brought it to a certain level But when you’re constantly flooding insulin to push the glucose into the muscle parking lot, often, it bottoms out So during the day, your brain goes between high sugar, normal, to low sugar And those fluctuations– we call it the carb roller coaster, or the sugar roller coaster So that’s how hunger gets generated All right? Great So this is a sample example So one of the reasons we have a parking problem– many of us have a parking problem– is when you flood the muscles with a consistent amount of high carbohydrates, the muscle gets tired It’s like, I cannot take on any more carbohydrates So here’s a typical example from my book I tell people that normally, for most of our sedentary workers, if we consume more than 100 to 150 grams of net carbohydrates– so net carbohydrates is your total carbs minus to fiber That usually promotes a lot of fat storage in the body But most people are not mindful of what that looks like So here’s a typical patient And she’s having a chapati, that’s 24 grams of net carb 1 cup of cooked lentils, great source of protein but you do have three times more carb per unit protein And then, 1 cup of cooked aloo sabzi, which is a potato curry So this, in one meal, sounds pretty innocent There’s no fat, nothing Turns out to be almost 100 grams of carb, which is what I’d consume over maybe a 1 to 1 and 1/2 day period total, right? This is one meal So in this particular scenario, the muscles are completely flooded on a regular basis And they cannot respond to the insulin signal And that’s why we’re having all of these issues, so just to give you a snapshot of what that looks like So this is one mnemonic I use in my South Asian patients And I’m not saying you have to eliminate these foods We have to pay attention to it So carbs, right? C is for chapatis, which represents flatbreads, Indian flatbreads or any breads A is aloo for potatoes or starchy vegetables R is for rice for rice-like grains B is for beans and lentils And S is for sugar and sweets So if we do the right combination and moderate the intake of those foods, we can reverse or significantly impact that metabolic traffic problem So, I’m by no means, telling people you have to eliminate these, but this is what we’re thinking about So net carbs, NC is your total grams of carb minus fiber

So in my work, I tell people, bargain foods are foods that we want to consume Bargain friends are foods that have a low net carb and maximal nutrients from return So things like vegetables, nuts, and seeds Expensive foods that cause more health damage are foods that have high net carbs and little to no nutrients like white rice, noodles, flour, et cetera So that’s how you sort of think about this So the other thing I want to bring up is in terms– so I told you, a lot of insulin resistance is coming from the types of foods that we’re eating But it’s also rooted in the types of pregnancies our moms, even our grandparents had It has a genetic effect So what we see in a lot of Asians, for example, is there’s a lot of traditions around pregnancy When my Indian patients get pregnant, what happens? Mom or mother-in-law flies out They tell them, please, don’t move too much Just stay in bed, and I’ll make you these foods that will make your kid smarter and healthier, OK? So I’ll make you these rolls, these laddus, and all those types of things And so, woman ends up getting a lot of weight And then what happens is, her body is already producing a lot of insulin We have epidemic gestational diabetes in Asian and Indian pregnancies And when there’s a lot of insulin, what that does is it robs nutrients away from the child, from the baby So often, we see very undernourished, underweight Asian and Indian babies and kids And then what happens? Oh my god, your kid’s too skinny So let’s overfeed the heck out of them so they can come to their normal curve Because when Indian families look at growth curves in the pediatrician’s office, they treat them like academic curves My kid can’t be at the 60th percentile 60th percentile? I’ve got to take them to 90 or 100th percentile So that wife, who’s a pediatrician, sees this And the thing is, if you take an underweight child and you rapidly accelerate them to 80, 90th percentile, guess what’s happening? You’ve turned on the thrifty gene They’re programmed for life to store more fat around their stomach now So a lot of what we’re doing is becoming programmed in utero, and also, early in childhood And the good news is, you can still reverse that at any stage of life But why start that problem in the first place? So fetal malnutrition leads to low birthweight babies, which lead to over-eating modern lifestyles, and that perpetuates the cycle of multi-generational diabetes and chronic health conditions I wanted to highlight real quick that there is a direct correlation Now, this is no longer theoretical Insulin resistance, we used to think of just being pre-diabetes linked to heart disease, directly linked to Alzheimer’s disease– undoubtedly I’ve talked to Alzheimer’s researchers Now they’re calling Alzheimer’s disease type 3 diabetes because of the strong correlation I want to spend a couple of moments here– and one of the things that happens, a hallmark of Alzheimer’s disease is you get these plaques in the brain called amyloid When your body is insulin resistant, you produce excess insulin and that prevents your brain from clearing that chemical So you can’t clear the amyloid, and your risk of Alzheimer’s goes up The hippocampus, a central structure that’s your GPS navigator, your memory storage unit is shrunken in people that have insulin resistance It’s smaller, it shrinks Diabetics– this one’s stunning– are 50% more likely to develop Alzheimer’s than non-diabetics Now, I’m not telling all diabetics Obviously, there’s other lifestyle factors There are some genetics But now, we’re calling pre-diabetes pre-Alzheimer’s So something to be aware of, because I feel like a lot of our community is desensitized Many patients tell me, oh, every Indian gets diabetes What can I do? I’m going to enjoy life and do whatever But listen, diabetes doesn’t scare you, Alzheimer’s better Because the rates are going up like crazy and we’re seeing a lot of dementia at earlier ages So I did a dedicated blog post on this if you want to learn more But it does definitely have implications for brain health Polycystic ovarian syndrome, really briefly This is an insulin-resistant condition in young women, teens These are a lot of the common signs and symptoms that we see from this I also did a blog post here But a lot of this is lifestyle focused, so we have to be really aware of this condition A lot of young women are having this And when they have polycystic ovarian syndrome early on, it can lead to a lot of issues with infertility and gestational diabetes and diabetes later on in life So what is inflammation? So basically, when we talk about the inflammation body type, so if you were to twist your ankle, that’s visible inflammation Your ankle’s swollen, it’s painful, and it’s red And that’s protective, because if your ankle wasn’t swollen and painful, you might do something to tear the ligament So that’s a good thing We need inflammation in the body But unfortunately, when people actually activate their immune system on a chronic basis, it can lead to other types of symptoms So this is a very long list here But these are the types of symptoms that might indicate inflammation This varies for each person For a lot of people, the inflammation comes from their skin They’re developing rashes, eczema, it can come from their muscles and joints like arthritis aches and pains A lot of inflammation is in the digestive system because that’s for most of our immune system sits So Prerna and I see a lot of patients with a lot of chronic bloating, acidity, constipation, loose stools Brain-type symptoms can be headaches, migraines, memory, brain fog-type symptoms Overlap symptoms are the same symptoms we saw with insulin resistance like fatigue and difficulty losing weight And then, there’s a whole host of autoimmune conditions We’re seeing a lot of thyroid disease That’s when your immune system actually attacks your thyroid

gland and then you have to take thyroid medications, rheumatoid, et cetera So lots of issues And inflammation just has such an adverse effect on all parts of life, but most of this is really lifestyle-induced Now the third type is the high LDL And I just wanted to bring this up because a lot of my patients, for example, might be on low carb, ketogenic, high fat-type diets But be aware that some people are very LDL-sensitive That’s a type of cholesterol in your bloodstream And some of our patients have very high LDL cholesterols And we have to manage it through diet But a lot of it’s also coming from disrupted gut health, so they have to eat more gut-friendly foods, which we’ll talk about They have to really consider a significant reduction in animal meat, dairy, and shift to more plants So, again, a lot of people eating low carb or ketogenic-type diets might be eating a lot of meat, a lot of butter, a lot of ghee, a lot of coconut oil and saturated fat That can really raise up the LDL And then, genes obviously can play a role So later on, I’ll talk about a case study But definitely, there are cases where we get concerned about the high LDL risk type So I kind of likened this– so I tell people, when it comes to your genes, think of them as being light switches or apps on your phone Many of us have inherited a type 2 diabetes app, maybe obesity app or an Alzheimer’s disease app But the thing is, when my patients see me that tell me all of my siblings, my parents have been diabetic, I’m probably getting diabetes, too, what I tell them is, yes, you have the same app, but your parents were eating a type of diet or leading a lifestyle that turned that app on You can leave it off And the things– the inputs that can turn those apps on or off are things like food, specific micronutrient deficiencies like vitamin D magnesium, inactivity, stress, sleep deprivation, toxin exposure So we clearly see when our patients make the right changes, they’re the first generation that does not develop diabetes Now, the converse is true, too Many of our patients, no family history of diabetes, heart disease, cancers, nothing And here, they’re the first one to develop diabetes, the first one to develop heart disease, or breast cancer, et cetera Because again, they have the have app Their traditional ancestors didn’t turn the app on because they led a healthier life But now, with their high stress lifestyle, their diet, they’ve turned on the apps for health conditions And we’re seeing this also in young kids A lot of families, parents, no type 2 diabetes Kids at age 9 or 10 developing adult onset type 2 diabetes has become an epidemic in our community So with heart disease specifically, we know now about insulin resistance We know about inflammation When those two converge, it leads to a plaque formation– the plaque that blocks off the blood vessels And that process can come– it starts in the first decade of life So already, if you’ve got young kids, if we don’t address these conditions early on, we’re already starting that cycle of plaque formation So really, keep that in mind So a quick example here This is not a real guide, but just a sample These numbers are a little bit changed for you But let’s take this guy Sam, he’s a 30-year-old software engineer, eats a vegetarian diet, has a body mass index of 24, which should be considered normal by general standards Normal blood pressure and blood sugar, total cholesterol level of 190 which might sound good because it’s less than 200 Goes to the gym, but he’s otherwise sedentary, and work stress is high Does this sound like anybody here? Yeah? A few people connect to this So Sam unfortunately had a massive heart attack while jogging in Rancho San Antonio He’s a runner He trains for half marathons And this ended up happening So now let’s understand his numbers a little bit better here Let’s look at his total cholesterol His results are 190 So most doctors might look at that and say, hey, that looks pretty good I tell most people total cholesterol is a very misleading number in most cases I don’t tend to focus on that Let’s look at the components, the subcomponents LDL cholesterol is 108 Most people would say target level less than 100 or less than 130 So a lot of people would say that’s OK 108 is a pretty good number HDL– H stands for the healthy, remember? So HDL for this guy, we’d want it above 40 But his is low, it’s a 32 Triglycerides is a number we’re really focused on I say less than 100 is ideal This guy’s number was 250 So I’m telling you, a lot of traditional doctors but look at these numbers and say, hey, total cholesterol is not bad LDL is OK Hey, he’s exercising, his body weight’s not too bad He’s all right But the numbers I want you to focus on are the ratios, not the absolutes So the first one is a triglyceride ratio This is not on your lab reports, usually You take the triglycerides You divide by the healthy cholesterol You want it to be less than 3.0, his number was almost at 8 The total cholesterol divided by HDL should be less than 4 Less than 3 and 1/2 would be even better His ratio came back at 5.9 So if I had seen this guy before this, I would have said, he’s very high risk But standard doctors and standard approaches would not flag this But these ratios are critical And then, this test is a marker for inflammation This number should be low, and his inflammation level came back high So these two things tell me– especially this–

he’s got a parking problem He’s insulin resistant And this number happens to tell me he’s got inflammation These two elements came together, it led to plaque formation, it led to his heart attack while he was running And I summarize some of these changes here One thing I want to tell you about this too, after protein, a lot of people have inflammation in the body and the CRP tests will be normal Because many people rush out and tell their doc, let me get a CRP But most people that have a lot of inflammation, this test may not capture When it’s high, I’m concerned But if it’s normal, it doesn’t give me false protection that there’s no inflammation in the body AUDIENCE: Question RONISH SINHA: Yes? AUDIENCE: Can you tell me what the last test was? I have typically not seen that one before RONISH SINHA: Yeah, so this is a separate test And I don’t recommend everyone gets it But when I see people that already have insulin resistance and other risk factors, I order that separately But yeah, thanks for asking that It’s not part of a normal profile, but it’s a very easy test to order, if the risk factors are there So now, based on this, which types of meals you think spike insulin inflammation more? The Indian sort of vegetarian diet, right? So this is not a token traditional meal I always tell people the cucumbers and tomatoes are decorative We don’t really eat those They just sit on the plate And then, everything else under, those four golf balls are Indian sweets You’ve got flatbreads You’ve got all these round mounds of carbohydrates, right? But hey, it’s a vegan/vegetarian type diet It should be fine, right? But now we know how much this can spike insulin inflammation Here in the Bay Area, we do a lot of diverse-type dishes So a lot of my vegetarian are eating foods like this But obviously, if you can’t eat fish, we have to find other proteins And Prerna will talk about that But these are the meals that are triggering a lot of the health conditions that we end up seeing So at a high level, we want to remove foods that increase insulin, that increase inflammation, that are turning on the wrong apps on our genes Those are foods like sugar and fructose, dangerous fats, trans fats in most vegetable oils Artificial sweeteners, which are popping up in a lot of different foods, extra carbohydrates, even good carbs So in my practice in Los Altos, people are not getting heart disease off pizza and Coke Most of the exact same patient that I see are getting heart disease and diabetes from eating too much quinoa, too much whole wheat bread, too much steel cut oats So even those healthy carbs in abundance will trigger a parking problem Not as badly as if they’re having sugars and sweets, but really keep that in mind Healthy carbs can get in trouble We have limited capacity in our muscle parking lot Then, other potential culprits for many might be gluten and dairy, which can trigger inflammation So keep these sort of categories of foods in mind So, oils are a big issue So I don’t want to underwhelm this I know I’ve talked a lot about carbs and sugar But the types of oils in our diet that we should be eating more of are the Omega 3s because they’re anti-inflammatory, they lower inflammation, they’re heart protective But unfortunately, a lot of us are consuming too much of a different type of oil called the Omega 6 So in the old days, if you were to look at our ancestral diet and how much Omega 6 to how much Omega 3 we’re eating, it was about a 1 to 2 ratio– I’m sorry, one part of Omega 3 to about two parts Omega 6 But now we’re eating at a ratio of about 20– 1 to 20 So we’re eating about 60 to 20 times more Omega 6 and Omega 3 Why is that important? Because when we’re eating the foods that raise Omega 6s, those oils get trapped inside our cell membrane Our cells physiologically change And the effects of that, when you talk to lab scientists, biochemists, they say it’s like nuclear radiation When those cell membranes change from these types of oils, it can promote cancer, diabetes, a lot of these health conditions And the thing is, once your cell membranes change, it could take 9 months to 12 months to reverse that So I’m telling you this because a lot of the health foods out there have the Omega 6 oils in it And it’s tremendously impacting our cell membrane health The Omega 3s were simply– without measuring this by an advanced lab test– if we’re getting rid of a lot of the processed foods– Prerna will talk about that– that have the Omega 6 and boost the O3s that have these natural food sources, you’re going to optimize that ratio And many people, after 6 to 9 months, feel completely great They feel like their memory’s back, their brain fog is gone, their health has gotten significantly better just by modifying that ratio Now, again, to highlight– yes, question? AUDIENCE: What source was Omega 6? RONISH SINHA: So the Omega 6 is basically– so it’s coming mostly from vegetables, right? So whether you’re cooking with vegetable oils like canola, or safflower, or any of these oils, or if you’re eating any processed foods or snacks We have pictures of mayonnaise or a lot of packaged foods If you look at the back, if it says canola, soybean oil, which is commonly used, those are of Omega 6s So it’s not going to say Omega 6 on the package, you’re looking for those specific oils That’s the key thing And Prerna, you’ll be talking about this as well, too, right? Yeah Great So dangerous of diet foods Keep in mind, now, with the low carb movement, many low carb or gluten-free packaged foods have tons of Omega 6s which will alter your cell membranes Many low carb or guten free packaged foods have artificial sweeteners, which, yes, they will not cause an elevation in your blood sugar But they feed the wrong gut bacteria And that leads to more inflammation So again, you’re going to stick to eating the most

natural foods possible and be diligent about scanning those nutrition labels, or you’re going to miss some of these foods So again, foods that lower inflammation, foods that prevent insulin resistance, foods with the greatest nutrient density So let’s talk about a few of these So these are some categories And again, sorry, vegetarians and vegans, I’m putting this up here But organ meats, liver, et cetera, incredibly nutrient dense Shellfish, very nutrient dense as well, sardines including the bones and organs, herbs and spices unbelievable anti-inflammatory, especially turmeric As you know, bone broth has become very popular as well And now, it’s very easy You can buy jarred bone broths, you can order them But they’re rich in cartilage and other anti-inflammatory substances that are great for overall health Egg yolks, you know, so don’t throw the yolks away, a lot of B vitamins and antioxidants in that And sprouts, especially broccoli sprouts, are some great nutrient dense power foods you can include in your diet So when we talk about gut health, there’s two different types And this clearly makes a big difference in our clinic So prebiotic foods are foods that you eat that will feed the right healthy bacteria in your gut So I put the categories up here, things like onions and leeks and dandelion greens, garlic, asparagus These all feed the healthy bacteria in our intestines Just by eating the right bacteria, you can lower inflammation in the body So these are prebiotics So we call this fertilizer We’re fertilizing the right bacteria Now, probiotic foods are foods that actually have the bacteria So it’s not the food for the bacteria, it’s the bacteria itself And dairy, yogurt, kefir, lassi, cheese, East Asian foods, a lot of traditional foods like kimchi, natural miso, kombucha, Indian food, so pickled chutneys, idli, dosa, uttapam in moderation, dhokla, lassi, as long as it’s not the sweetened type Those are fermented foods and others pickled in sauerkraut-type foods Now, do keep in mind, that many of the probiotic foods now on the market are high in sugar So you might be consuming carbs from that I’ve seen box cereals that actually now have probiotics I think they’re putting probiotics in Oreo cookies now So don’t get fooled by this Again, the food industry will always be able to take a health trend and turn it poisonous So be careful Read those labels But these are natural traditional foods that can really change our gut bacteria in a positive way So one question I get from families is, I’m too busy I can’t cook three or four different types of meals for the whole family, right? Anybody in that category? We can’t do that So what do you do? So this is one approach that my wife and I use when we give talks on family health And I tell people here’s the at-risk family members So I’ll take our family, for example I’ve had a tendency toward insulin resistance before, which is why I’m so passionate about this But I’ve got 14-year-old twin boys They’re 6 feet tall and they play basketball And they’re very physically active There’s no way they’re going to be on the same diet as me So if we have pasta night, maybe I’ll do spaghetti squash or zucchini individuals The kids can have whole wheat pasta or whatever But then, the entire family is going to have the salad, the same sauce that we make together, and then we’ll have fresh fruit We just switched out the starches For Indian night, I might have cauliflower rice, which Prerna will talk to you about and which was on your menu today as well, too The coconut chapatis or other types of flatbreads are lower in carbs My kids, they can have rice, quinoa, they can have regular flatbreads if they want to No problems with that at all The same vegetable curry, the same meat curry, the same salad for all of us Mexican nights, I might do more burrito bowls or lettuce wrap-type foods They can have tortilla, they can have some rice, no issues Again, the same filling, guacamole, some sour cream, cheese, those things are OK for us And Asian nights, you get the picture We’re just switching out the starch part, which is easy to do But we want to keep the other foods– no matter what type you are, if you’re inflammation, insulin resistant, LDL type– everybody should be eating healthy salads, fresh fruit, and natural ingredients That should be the common core for all of our families And just switch out a few of the things that people have issues with So if we have patients that are gluten intolerant, they’re not going to have that flatbreads They might have a little bit of rice or quinoa Somebody who can handle some gluten, they might have the whole wheat bread So those are the things that you can modify around the edges So fasting has become very popular We abbreviate intermittent fasting, IF And we can see tremendous impact When people fast in a very healthy manner, we can reverse diabetes We can cause a game-changing improvements in health So time restricted eating is another way to think about fasting, where you take eight hours in your day where you eat all of your calories So let’s say you eat from 12:00 PM to 8:00 PM, or from 10:00 to 6:00, or whatever Pick your eight hour window, eat all your foods– hopefully, mostly healthy foods then– and then you fast for the rest of the time So that means non-caloric beverages, herbal teas, water all that stuff’s OK, but you avoid other foods Now, if you do this the right way, there are studies, we’ve seen increased longevity in animal studies, definitely reduced insulin resistance, inflammation goes down, lower cancer recurrence, especially in breast cancer Studies have shown that intermittent fasting reduces breast cancer recurrence, so significant impact there Now, tips– breakfast skipping, people sometimes fasting might be a bit scary, the concept

But for a lot of people, if you skip breakfast or push it out and you have an earlier dinner the night before, that’s fasting Because sleeping counts as fasting, right? So try to end eating by 6:00 PM or 7:00 PM Again, consume non-caloric beverages during that time And it is really more successful if you’re eating healthy Sometimes it gets busy, so they come in and tell me, I’m fasting already I’m too busy to eat breakfast I skip lunch, and then I just eat dinner But then, they eat a really unhealthy dinner And they’re under chronic stress the whole time That’s really not healthy fasting You want to make sure your recovery meal is really good And make sure you’re eating the right quality foods here But basically, if you’ve finished eating your dinner by 7:00 PM and you have a late breakfast at 11:00 AM, you’re already fasting for well over 16 hours, / so that’s a major intermittent fast So I talk about safe ways to do it, and some of the myths about fasting in a dedicated blog post here So moving onto exercise, a couple of things with exercise So, why do we need to exercise? So a couple of goals, here Number one, when our muscles are active, they have a demand for energy They have a demand for more carbs So I tell people often in my lectures, you need to squat for your rice Because when you are engaging large muscle groups and then you eat rice after that, more of the rice traffic is going to go to the muscle If you’ve been monitoring your activity throughout the day, you’ve been in meetings all day, your muscles don’t have much demand for energy, so then you have to be very careful with the amount of carbs you’re taking in So creating muscle parking space is one thing The other things is regular physical activity lowers glucose, cholesterol, and it lowers inflammation levels, assuming you’re not overexercising If you’re overexercising, inflammation levels might be high So there’s a delicate balance Some of my type A patients, I have to scale back their exercise because it is triggering more inflammation in their body So total body type exercises So when my patients go into the weight room, if you have 15 to 20 minutes, warm up first and go straight to the legs because nobody wants to work their legs out They’ll do their upper body first, and like, I’ll just skip the legs Go straight for the legs, or do total body Again, my rickshaw theme is pervasive here But lifting-type activities that engage all your major muscle groups, if you even took dumbbells or grocery bags and did this 10, 15 times throughout the day, it’s going to activate a lot of those large muscle groups which can lower inflammation and really help with the insulin resistance issues So work on those types of exercises HIIT training or interval training is another way So if you walk at a steady pace for 20 minutes, you’re not going to clear much parking space But if you walk fast for a minute, slow for 30 seconds, whenever you alternate any type of physical activity in a spiked form fashion, you create more parking space Even for seniors, they show that seniors that walk, if they walk a little bit fast and then slow, fast and then slow, their glucose levels were better They clear more parking space Multiple ways to do it Tabata is one of the ways to do it So there are some apps I recommend The Tabata app is one I used to use I’ve been using Seconds You can incorporate any type of exercise into this– your yoga, your surya namaskar, whatever you want to do, do it in an interval fashion, you’ll see better results from that So real quickly, a lot of numbers here But I just want to show you a case example This is a patient that followed a lot of her guidelines, triglycerides, HDL, everything got better But this number right here, here’s the C reactive protein We want that to be less than 3 Less than 1 is even better It was 10.6, we made dietary changes, it went to 3.6 And then, something magical happened between 3.6 and 0.6 There’s only one single change he made, started meditating That’s it So meditation alone lowered inflammation levels I know Gopi’s loving this part of the talk He did not pay me to put this slide in there, right? But really, it is an anti-inflammatory For many patients who are not getting to their goal levels, this is it The mindfulness, the slow practices, the sleep, all these things make a difference with inflammation So again, you have so many resources here at Google– mindfulness practices, gratitude Many of our patients need psychotherapy They’ve had early childhood trauma It’s something we need to address There is a technology for people that need tech motivation, HRV technology I have dedicated videos on my side of how to use apps and devices to actually help you regulate mindfulness using HRV technology It can be pretty powerful So you check out some of those videos as more of a reference Women’s health challenges So the key thing I want to make is emotional obesity We call this emotional obesity because many of our women are eating the right foods, they’re doing the right exercises, but they’re not losing a single ounce And a lot of it is becoming because they’re not managing chronic stress Stress for women causes more fat storage Because for a woman’s body, even if you decide not to have kids, it’s programmed to protect you for lactation, for pregnancy So whenever there’s chronic stress from workouts and from work, the body will hold onto fat Many women, when they actually cut back that intensity, and they’re actually exercising less and less intense, they actually end up losing weight over the next several months This is something we see over and over It’s a very tough sell to make but we’ve seen quite a bit of it And the reason is because of some of these Chronic stress disrupts hormones and gut health It can overactivate the immune system

Aggressive dieting exercise can backfire in these cases So please keep that in mind I’m going to push across some of this because I want Prerna to get some time Real quickly, the sleep connection I want to make for you is sleep and blood glucose This is a major connection Deep phase sleep usually reduces glucose, it produces more growth hormone, which helps us hold on to more muscle And deep phase sleep primarily happens between 10:00 PM to 2:00 AM So when patients tell me that they’ve slept eight hours, sleeping from 1:00 AM to 9:00 AM is totally different than 10:00 to 6:00 because 10:00 PM is the golden window I used to be a late nighter But after looking at the studies, I had work to do, I’ll get up at 4:30 or 5:00 and do it But I’m not going to go to bed past 10 hardly ever So really keep that in mind, because it can impact the way the glucose is managed in the body So earlier bedtime is really critical So let me just finish off with a few last points here So this is the main point I made to you Parents are the ultimate genetic engineers Our behaviors, our emotions, now with epigenetic studies, we find that trauma in your grandparents actually affected your genes So a lot of times, if you have a kid and you’re thinking, why are they so anxious? It may not be your predisposition, it could have been trauma they experienced from the grandparents, or the grandmother, basically So it’s important that as we make these lifestyle changes, we’re affecting the health of not our children, but actually, our grandchildren as well So these are all practices we need to incorporate into our daily lives And this is a picture I want to show you That’s not my dad, by the way So, who is this? So I just want to make the example, my father’s an MD-PhD scientist He passed away over a decade ago But I thank God, because what he used to do during his medical training is every day, he used to go visit this guy to learn yoga and weight training So literally, without even knowing about epigenetics, he was already shaping like a healthier future for me and my brother And this is actually the first and only Mr. Universe in India His name was Monotosh Roy And he trained Bikram yoga, a famous Bikram anthology But I’m just telling you that now we have this knowledge, we should be able to make these changes so we can make our lives better, and the lives of future generations much healthier, too And this is my example Why am I so passionate? So now that you guys know all this knowledge, I’m sharing my own data with you guys I’m violating HIPAA here, but let me just show you real quickly In 2009, look at my numbers, a perfect example My total cholesterol you might think was really good, 154 But look at my triglycerides, way above at 314 My healthy cholesterol was 28 My ratio, does anybody remember what should your ratio would be? Less than 3, less than 3 I was at 11.2 in 2009, right? And I was exercising almost every day And I was eating steel cut oats and everything So now, let’s look at my numbers here So typical breakfast was a banana and steel cut oats I know from tracking my numbers when I exceed 100 grams of carb per day, my parking problem begins Steel cut oats and banana together, 47 grams of net carb, right? That’s already half my day’s allowance If we switch over to Mediterranean omelette with veggies and cheese, 3 grams of net carbs So just by changing breakfast and making a few other changes, you can see how my ratio improved It went from 11.2 to 1.6, triglycerides dropped, HDL went up almost 20 points People always think HDL, I need to drink red wine, exercise more No, it’s coming from high triglycerides You can see the inverse correlation right here As triglycerides went down, HCL went up So these are the powerful changes we make in the clinic that can reverse these sorts of conditions OK, Prerna, I went a little bit over Come on up PRERNA UPPAL: All right, I’m Prerna Uppal, and I’m a clinical dietician and a certified diabetes educator I work primarily with Dr. Ron Sinha at the Los Altos Clinic, seeing patients as well as doing corporate wellness talks I have over 20 plus years experience seeing patients with diabetes, obesity, heart disease, mostly at PAMF Los Altos I’m a Bollywood dance instructor, and an aerobics instructor, and a longtime practitioner of meditation I’ve been meditating my entire life I also co-host the Bay Area radio show on Southasian health with Dr. Sinha So I’m going to really present a lot of the practical parts to all the scientific information that Dr. Ron has given We are what we eat So I want to highlight for you where the pitfalls are as you try to live a very practically healthy life Are we the chemicals we eat? Some kind of chemical, either an additive, preservative, pesticide, herbicide, they’re in all the foods we eat You’ve probably been eating this yesterday, today because it’s on all the packaged foods that we purchase These chemical compounds that are added to the foods are harmful And several animal experiments have confirmed that they can cause cancer, birth defects, and harm our nervous system It’s for this reason that I do tell most of my patients to go organic whenever possible because that’s the one way

to circumvent getting these chemicals in our diets So what I want you to do is really focus on going chemical-free This is a wonderful website, EWG.org It stands for Environmental Working Group.org I think you’re going to get a copy of the slides, but you can definitely take a picture of this website And it has a listing of what we call the Clean 15 and the Dirty 12, which tells you the most pesticide and herbicide contaminated produce, and the ones that don’t have them So it’s a great resource AUDIENCE: I have a question PRERNA UPPAL: Good question If the food is organic, is it necessarily chemical free? For the most part, it is Now, if you feel that it’s out of your budget and you don’t want to buy organic, I would suggest getting local produce at the farmer’s market Get to know the farmers and just buy stuff that doesn’t have chemicals sprayed When you look at this resource, it really does amazing stuff It highlights nutrition concerns in the food, ingredient concerns, and processing concerns So it has a little bar code that it scans if you have it on your phone, and it can give you a rating from 1 to 10, with 10 being the worst score, and 1 being the best And what I like about it is once you get the rating– for instance, the KIND bar has a rating of 6– it will also give you some other alternative foods that are healthier A big part of my practical suggestions to you really comes down to reading the food label We all know how to check the food label for fat, sugar, calories, and carbohydrates However, it’s important to do advanced label reading And what do I mean by that? You need to take a look at all the harmful chemicals that are in all the foods that we are buying, such as growth hormones The US is one of the only countries where we’re still using growth hormones in our animals to increase milk production High fructose corn syrup Now, high fructose corn syrup, along with MSG is what we call them are the obesogenic chemicals So they actually increase fat storage High fructose corn syrup actually impacts to different hormones in the body One is insulin, it raises insulin levels, which is a fat promoting hormone And it also decreases your leptin level Leptin is your appetite regulating hormone So when you have less leptin, you’re going to be more hungry Artificial sweeteners, we do know that they’re, again, chemicals And we’re not necessarily seeing the benefit or the marketing sort of claim that they had made They were invented or made because we thought we were going to ward off diabetes They were going to be sugar substitutes There are a lot of studies showing that these artificial sweeteners increase your metabolic syndrome risk, which is insulin resistance risk, to almost 67% So they’re not really helping the diabetes epidemic Trans fats These are hydrogenated fats, which we know are very detrimental to health I will allude to it a little later in the presentation Food dyes Believe it or not, if you look at food products in Europe, for instance, you will notice that they use natural food coloring from plants and vegetables as food dyes Whereas we, here in the US, are using carcinogenic chemicals So when you look at colors like blue number one, blue number two, or yellow number five, number six, red number two, number 40, read the research on them They raise the risk for cancer Red 40 is linked to breast cancer So again, watch out for these food dyes Carrageenan Carrageenan is used as an emulsifier It comes from a seaweed and it’s used in dairy products and non-dairy products So not just milk and yogurt to emulsify and thicken and give it the creamy consistency, but it’s also used in other non-dairy milks, whether it’s soy milk, hemp milk, they do have Carrageenan used as an emulsifier MSG is also called an excitotoxin, so it really gets you to crave more food Dough conditioners– so dough conditioners are also used in a lot of breads Look for this word when you see breads There’s one specific one that caught our attention a few years ago, it’s called azodicarbonamide And it’s the same chemical that’s used in yoga mats to give it the spongy effect

So that’s what was being used in a lot of the breads that we eat– brands like Pillsbury, Sara Lee Subway was a chain that got a lot of pressure then to start to take azodicarbonamide out of their products Preservatives like BHA and BHT, they’re used in a lot of fats and oils to extend their shelf life Again, these are banned all over the world but we’re still using them in the US And they they’re known also to be carcinogenic Bisphenol A, BPA, is used in food packaging and also the lining of cans Again, carcinogenic and unhealthy I want you to start familiarizing yourself with this So here, I have an example for you Do any of you recognize this food? Look at all the ingredients I always tell my patients, you want to get foods that have five or less ingredients because that’s as close to natural as possible Any guesses? AUDIENCE: Cereal PRERNA UPPAL: Sorry? AUDIENCE: Cereal? PRERNA UPPAL: Cereal? That’s close It’s a breakfast item AUDIENCE: A muffin? PRERNA UPPAL: It’s not a muffin AUDIENCE: Pancakes? AUDIENCE: A bagel PRERNA UPPAL: So it’s really interesting It’s a breakfast item, and you’re all seeing that it’s got the wheat flour so it has to be some sort of a grain food Here we go You know, the one thing I want to point out before I show you what it is, look at dried blueberries I highlighted that because this is, again, a marketing gimmick They’re going to fool you by sort of just dangling a carrot in front of you and saying, hey, guess what? We’ve got some dried blueberries in here If you look at dried blueberries, they’re laden with sugar And so, again, a smattering of those dried blueberries doesn’t necessarily make the product healthy These are Eggo waffles And they call it blueberry flavored, just because they’ve thrown in a few blueberries Now, this is something that you and I would probably give our kids for breakfast Keep in mind, you saw the number of ingredients on there So as we’re looking at these ingredients, Dr. Sinha talked about the Omega 6 fats That’s the canola oil, soybean oil Those are the Omega 6 fats These are industrialized seed oils, which are processed with hexane and petroleum-based products And they have been shown in scientific experiments to cause inflammation Then, of course, we’ve got the sugars We’ve got modified cornstarch You’ve seen the food coloring, the blue number two, red number 40 So just really watch out for these ingredients that I’ve been talking about Another one for you guys Any guesses for this product? And don’t miss the number of ingredients– 43 ingredients When you see what product it is, keep that in mind Again, you will see a whole lot of Omega 6 inflammatory oils, partially hydrogenated oil which is a source of trans fat You’ve got monosodium glutamate, the excitotoxin chemical which is going to make you crave more food and eat more Coloring– the food coloring, safflower oil again, which is the inflammatory Omega 6 Any guesses? AUDIENCE: Mashed potato? AUDIENCE: Oh, somebody said Pringles PRERNA UPPAL: Who’s said Pringles? Yeah, very good That is pretty impressive So it’s interesting how they’re calling it baked So again, it’s a marketing stint, right? But it’s Pringles loaded baked potato 43 ingredients I make French fries for my kids at home And it’s three ingredients I have salt, I’ve got the potato, and I have a little bit of oil And I bake it So you don’t need to have that many ingredients How about identifying this food? Look at the ingredient list AUDIENCE: Mixed organic greens from [INAUDIBLE] PRERNA UPPAL: Absolutely See how easy that is? Was that easy to guess versus the other two slides I showed you? So you want to look for this sort of stuff when you read your food labels Look at those ingredients You want to have a real food Foods that are real do not usually have an ingredient list So when I go to the farmer’s market and I pick up my vegetables and fruit, there’s no food label there It doesn’t need one However, if fresh food has an ingredient list, most likely, you will not find any additives or preservatives or food dyes, just fresh produce So we have a new food label coming up this year And one of the differences from the old label and the new label is we’re probably going to see no trans fat because there’s a lot of lobbying going on FDA wants to remove them from the foods

But the biggest change over here is you’re going to see added sugars, which is something we dietitians have gotten very excited about Because when you look at the total sugar, you have no idea if this is natural or added And it’s really nice for us to know that So you’re going to know the added sugars And also, look at the different micronutrient profiles at the very bottom If you look at the old label, it did not have vitamin D And so it’s highlighting some of these nutrients that we should be paying a little more attention to So where do we start with all this practical information? You need to make sure that your environment is very supportive Out of sight, out of mind If I start to cook and I don’t have all the right ingredients, I’m not going to be able to prepare what I’m planning to do So you need to secure your environment And it takes place in two steps One is the pantry purge, the other one is restocking the pantry with the right foods So what are some of the things I would advise you to remove from your pantry? Start by taking everything out of your pantry shelf by shelf I know it sounds cumbersome, but I’m going to share a case study with you at the end and tell you how even a simple change– which doesn’t seem to sort of factor in in a big way– does really have the positive impact Discard refined highly processed whites– white bread, white pasta, white sugar, empty calories, sugary foods, sweetened cereals, pastries, sodas, sweetened drinks, high fructose corn syrup, agave, highlighting all of the things you need to watch out for in the ingredient list of those packages, and discard them Choose real foods, not chemicals And so avoid the additives, preservatives like BHA, BHT, sulphites, the dyes, the emulsifiers, dough conditioners, all stuff that I just talked about Luncheon meats tend to contain nitrates and nitrites They, by themselves, may not be a problem But when they’re heated, they turn into a compound called nitrosamines which is a known carcinogen So Dr. Ron and I have a lot of patients who are now on this gluten-free bandwagon You don’t need to go gluten-free unless you really have a need, unless you’ve got celiac disease And it’s really 1% of the population that has that condition But what about the ingredients in these gluten-free foods? A lot of people think they’re healthy So this is one gluten-free item, it’s tortillas And I want you to look at the ingredient list here Again, I’m always emphasizing that for the food to be as close to nature as possible, you want to go for five ingredients or less You’ve got tapioca starch This is the primary starch that acts as a wheat replacer in gluten-free foods It has no fiber It has no micronutrients It has a very high glycemic index, which means that spikes your blood sugar very rapidly Sweet rice flour, tapioca syrup, cane syrup, corn syrup, just look at all the sugar and carbohydrates that are coming into this food So read those food labels carefully because just because it’s gluten-free, it doesn’t mean that it’s a healthy product So when I talked about trans fats earlier, and I said I will allude to it later in the presentation, this is one of the things I hear practically every time I’m doing a diet history or a food recall for my patients, especially the Southasian community They’re having a lot of these snacks with their afternoon chai, or they’re having it at night And just keep in mind, that not only are they high in carbohydrates, but they’re a source of trans fat Now, it’s true that we’re trying to get trans fat out of our diet But if you look at the FDA guidelines currently, it says that it’s OK to have 0.5 grams of trans fat per serving of food Now, we don’t usually have just one serving of snacks like this That would be 1/2 a cup So let’s say that from different foods you’ve had 0.5 grams, or from a single food, you had more than one serving If you come up to two servings, you’ve crossed your safe limit for the 2 grams of trans fat You’ve crossed your safe limit for the day Other things to purge from the pantry, the Omega 6 industrialized seed oils that Ron had alluded to Canola oil, corn oil, Gopi wanted to know which ones they were So soybean oil, cottonseed oil, sunflower, safflower, all the vegetable oils, mixed vegetable oils Again, when you look at those crispy Indian snacks, the slide that I showed you, and you look at the label, it says edible vegetable oil You don’t know what oil they’re using, but it’s most likely an Omega 6 AUDIENCE: Question– PRERNA UPPAL: So, very good question What oils should we be replacing this with? What are the healthy oils? The healthy oils would be–

so in terms of high temperature cooking, you want an oil that has a higher smoking point, that would be avocado oil That’s what I would use Coconut oil is also a healthy saturated fat Sometimes, you can use grass fed ghee, that also has a very high smoke point Now, I don’t really recommend my patients do a lot of frying But if you wanted to use an oil for high temperature cooking, those would be the oils to use If you’re not doing high temperature cooking, extra virgin olive oil cold pressed would be my go-to, a lot of studies showing that it’s a wonderful oil I hope that answers your question So now that we’ve purged a lot of stuff from our pantry, what are some of the things we’re restocking? What are we bringing in? Minimally processed, unprocessed carbohydrates We’re looking for whole grain Now, again, watch out You might see labels that say whole grain, it doesn’t mean it’s whole grain You’ve got to look on the label for the fiber content If it has 4 grams of fiber per serving, the food is classified as a high fiber containing food These are some of the products that I recommend to my patients In terms of bread, it would be Ezekial bread, or the sprouted grain whole wheat bread from Alvarado bakery And these breads are available in the health food frozen section of most stores and Whole Foods You can find this there Pasta, again, you want to look for quinoa pasta, Ancient Grains is another, True Roots is another company that has a really good pasta and some other good unprocessed products Late July, if I want to serve some tortilla chips, I get Late July chips Ryvita makes crackers, multigrain crackers, and Mary’s Gone crackers Keep in mind, again, they all have carbohydrates So fit them into your carb intake for the day All carbs are not created equal The glycemic index is a way for you to know how fast your blood sugar level spikes from a given carbohydrate You want to pick carbohydrates that are low GI, low glycemic index And one sort of example I wanted to point out here was instant oatmeal versus steel cut oats Look at the difference in the glycemic index I had a patient, and I presented his case study at one of my previous talks And that was one of the changes we made in his diet And we brought a lot of his numbers down just making changes like this So we all know to eat more fruits and vegetables I’ve told you to try and get them organic Protein, somebody here had a question on protein Some of the protein sources for vegetarians would be nuts, legumes, and lentils I also recommend dairy products So, for instance, Greek yogurt, it has half the carbs and twice the protein Those would be some of the sources Soy products, like tempe, which is fermented soy tofu Paneer would be some good sources of protein We are bombarded with a lot of choices, as we all know So make sure you choose the right foods I do recommend to my patients when they’re looking for dairy, to get grass fed dairy products You don’t have to They are pricey You can go with products like Straus or Organic Valley But Organic Valley does make a grass milk, and I love the Maple Hill Creamery grass fed products Nutrition I want to point out that you cannot take one ingredient and say, well, I’m going to take this in a pill form, because this is what’s going to really help me It’s a synergistic effect The nutrients work in harmony together and give us the health benefits that we see A perfect match is black pepper with turmeric So I’m sure you’ve heard a lot about how turmeric has all these wonderful properties, anti-inflammatory, anti-microbial It contains a compound called curcumin And black pepper contains a compound called piperine And when combined, piperine increases the absorption of curcumin 2,000% When you add fat to that equation, again, it enhances absorption Another really good combination for vegetarians is when you have green, leafy vegetables, which are high in iron, adding vitamin C increases absorption Because red meat is much easily absorbed But we need the vitamin C for vegetarian foods So I picked these recipes that I had submitted today for your menu This is the baked salmon, and I wanted to highlight how I brought in these synergistic herbs to give you those anti-inflammatory benefits There was turmeric and pepper in them Another recipe that was in your cafeteria today was the fat with the turmeric and black pepper because that’s really how you’re getting turmeric’s full potential Cruciferous vegetables we know have anti-cancer benefits Kale, broccoli, Brussels sprouts, arugula, all of them, they’re micronutrient dense

When you’re talking about nutrient dense foods, these are high on our list Again, look at all the different nutrients they contain because that’s what’s going to really give you that benefit Sulforaphane is the compound that really gives us the anti-cancer property I’ll end with a case study And again, I’ve never done a case study that was so simplistic It’s usually a lot of biometrics But this is a patient of mine who came in, and as Ron mentioned, one of the inflammatory markers is gastric symptoms And that’s what she presented with, a lot of gastric acidity, bloating Some of the things that I recommended to her were all the things that I’ve discussed here today But she jumped into action She said she had tried losing weight for years She’d tried every possible program on the market Nothing had worked, and she said, I’m not sure you can help me But you’re my last resort We discussed all the things I talked about today She was very motivated She actually went and did the pantry purge She did the pantry restock And she called it my clean eating refrigerator And here were pictures that she mailed to me of her healthy kitchen And she said, I haven’t brought in the grass fed dairy yet, but I’ve started really getting in a lot of the micronutrients, lots of produce She was bringing in healthier oils and healthier fats, and shopping at health places, farmers markets She got a really healthy oil from Whole Foods So she was really reading food labels and bringing in all the right foods She lost– I don’t know if I had it in here, no– 14 and 1/2 pounds in two months And she said she has even more energy than she ever did She doesn’t feel she’s on a diet There’s no calorie counting It’s just making healthy changes So this is what the healthy plate should look like Half your plate should be vegetables, and the other half should have three segments– proteins, carbohydrates, and healthy fats [APPLAUSE] RONISH SINHA: We told you it was going to be information-packed right? So moving along I’ve got a lot of resources on my blog as well So I write on all these topics Prerna has co-written a lot of topics here too So we’re out there for you And this is our PAMF resource right here So I know we have a little time left, and we still have enough people in here So we can open up to any questions you guys have Prerna, do you want to come on up, too? AUDIENCE: People are very busy And one of the things that’s coming up a lot, and this is especially for kids, especially college going kids, is things like soylent as a breakfast substitute It’s supposed to be very good And I just wanted to ask what your recommendations are about that PRERNA UPPAL: So my take with anything, as I said, was minimally processed I want us to go back to our ancestral way of eating And our ancestors never had food from packages So my recommendation would be to go down to the basics Just give the kids as minimally processed foods as possible AUDIENCE: So this was more about college kids who are not at home, who instead, they’re just grabbing a bagel or something So this is my daughter PRERNA UPPAL: Right AUDIENCE: She was asking me about that And she was like, can I have this instead of grabbing a bagel? PRERNA UPPAL: So you know, I have a kid at Berkeley right now And so she battles with her diet as well because I’ve programmed her to do things a certain way And so, once in a while, it’s not going to sort of really hurt them But on a regular basis, every other weekend– I don’t know if that’s a possibility for you– go and do some grocery shopping and stock her refrigerator So get them some health things I get her Greek yogurt I get her a lot of berries Tell her to put flax seed or chia seeds on it Doing stuff like that Or if they can access eggs, right? I mean, at the dining hall, they can do eggs So like Ron pointed out, with his meal change RONISH SINHA: The food combinations you brought up this key They’ve shown studies of meat If you have a burger patty and you put avocado on it, it lowers inflammation up to 40% So sometimes, you’re in an environment where the main protein might be not that healthy But you try to surround it with the right foods One day I’m going to take a picture of my office shelves and you’ll see I’ve got olive oil I’ve got avocado oil I’ve got turmeric and pepper And sometimes, we’ll have catered lunches And I’d completely modify the lunch that I’m eating by adding those to sort of bulletproof it against some of the inflammation that can happen So there’s a lot of tips and tricks you can do for that Thanks, yeah AUDIENCE: Amazing information I like that you have very specific examples I think that’s what helps us kind of adopt change So thank you My question is about intermittent fasting Thank you for bringing that up Smoothies, if you want to skip breakfast, what are your thoughts on doing an avocado smoothie with spinach and all that stuff before noon? PRERNA UPPAL: So, smoothies, again, if they’re vegetable-based and you’re using a lot of greens– not using added sugars– avocado is fabulous to add Sometimes, when the smoothie’s ready, I’ll add some chia seeds But absolutely, you can have them

I usually will recommend patients do it if they’ve worked out Because I would rather you eat your greens than drink your greens But as long as blenders like VitaMix keep the fibers intact, sure RONISH SINHA: And then, also, people that have a lot of digestive issues Sometimes, soups and smoothies is what they have to do because they cannot absorb the nutrients at all So that’s another situation where those types of foods might be OK Great question, thank you Yeah? AUDIENCE: Hi I’m curious why the start and end times of sleep matter, not just the duration I’ve never heard that before RONISH SINHA: So the start and end times So I’ll give you an example So basically, what happens, typically, after sundown, our body’s digestive hormones shut down I tell people, our digestive hormones are like a shop And when the sun goes down, they shut down because of the release of melatonin So nighttime, when the sun goes down, our brain produces more melatonin And one of the things melatonin does, it prevents the pancreas from producing digestive hormones and insulin What that means is if I have white rice at 12:00 noon versus 9:00 PM, the blood sugar spike from that same rice will be much more dramatic So a lot of it, that’s why compressing that food– so there is a researcher down in Southern California in La Jolla And he’s shown that even if you don’t change people’s diets, even if they’re eating the same garbage, if you at least tell them to finish eating the garbage by 6:00 PM, they do tremendously well Not ideal, but they still have profound benefits Because between 6:00 PM and their breakfast the next day, maybe at 8:00 AM, the liver is doing detox The brain is doing detox as well too But the liver is at least able to process It’s the back-to-back eating So when you eat later, you go to bed later, a lot of those anti-inflammatory hormones and digestive processes just can’t be activated So that’s why that has become key is really, that earlier time So, yeah AUDIENCE: So you were mentioning that for women, high intensity exercises is not as effective And so, is that a broad brush approach? What is the theory around that? RONISH SINHA: So let me tell you at a high level So I literally saw a patient this morning in clinic And she’s the one that’s been sort of running, training for a half marathon And she’s 30 pounds overweight And what I identified, I looked at her workout schedule And she runs about 30, 40 miles a week And four days a week, she’s doing running, basically I actually looked at her heart rate because she had an Apple Watch And I realized based on her heart rate, that she’s exercising anaerobically, which means her heart rate is at a high level while she’s running And one quick equation you can think of is if you were to measure heart rate while exercising like on a machine or using a watch or whatever, 180 minus your age If you take a 180 subtract your age, whatever value you have there, if you’re exceeding that during your workouts, you’re constantly in anaerobic zone And anaerobic workouts to some degree, are helpful But if that’s all you’re doing, what happens is and when you exercise at the anaerobic high intensity level, you’re burning predominantly sugar So that’s good news if you’re trying to clear parking space But the bad news is your body’s constantly craving sugar And it’s very difficult to manage your diet if most of your workouts are at that level So I did a recent blog post, just to make it simple And I talk about how to exercise in the proper way But you need to have enough base aerobic foundation That’s going to be lower intensity But that actually burns more fat and it doesn’t generate that hunger Now, if you’re doing high intensity and your metabolism is adapted for it, you’re losing weight, you feel energetic, you’re not craving junk all the time, that’s the right exercise for you But for many women, they’re doing way too much anaerobic and their diet is off the charts And I call this practice compensatory eating People that will go to the gym for an hour and then they refill their bodies and overfill their bodies because they think, hey, I’m training for a half marathon I can eat what I want But the equation is kind of messed up So it really depends So that’s why we do like to personalize the exercise depending on the risks and behaviors PRERNA UPPAL: I just want to add to that, that I’ve never really tried to lose weight, per se I just want to exercise to stay fit And HIIT is the only thing that actually made me lose like 30 pounds in a year or so without trying RONISH SINHA: When it works, it can be very effective for people who do it the right way And actually, after HIIT, if you walk, that’s even better If you can do walking after HIIT, you actually unlock even more fat burning So great question Yeah? SPEAKER: So one last question, and then we’ll wrap it up So all this is incredible So clearly, the science is now available Our forefathers didn’t have access to it But the bad news is, it also seems extremely complicated understanding all this and incorporating into your life, combined with packaged food industry with all its global marketing that can pull you in the opposite direction So what is your recommendation in the most simple and easy and effective way we can make this a regular daily living habit? RONISH SINHA: Great point You want to give some feedback? PRERNA UPPAL: Sure So one of the things is, go natural Just buy as few processed and packaged foods as you can I try to always remember how my grandmother ate Because she used to spend a lot of time with us And there was no packaged food So I go and I buy real ingredients– whether it’s lentils–

I’m a vegetarian So whether it’s lentils, garbanzo beans, or it’s the produce at the farmer’s market Source it from the right place I’ll make sure it’s organic I’d rather cut corners there than someplace else And I barely have any packaged food in the house Then, given all the chemicals, I also don’t buy canned foods There are some companies There’s one called Native Forest and one called Eden Foods, which don’t have the BPA lining So there are some products where I might sort of go to get coconut milk by Native Forest, which doesn’t have BPA But it’s always natural foods not in a package RONISH SINHA: And you know, there are a lot of fast foods that you can do quick I’ll give you an example that’s my breakfast So sometimes, I’m in a rush in the morning If I’m not intermittent fasting, I’ve got a microwave egg boiler Literally, while I’m showering, the eggs are done I put them in a container with an avocado, and I’m out the door On my non-egg morning, sometimes, I’m too lazy to even wash berries I’ve got frozen organic berries I have a small container I put full Fat Greek yogurt in there, handful of those frozen berries By the time I get to the office, it’s defrosted I’ve got flax seeds and things in my office I sprinkle it on there I’m done So I think a lot of times, we just get inert But if you get all creative around the principles that we talked about Now, I would say, there’s garbage out there But there’s a lot of good foods that are coming out that are very convenient There’s a lot more options, even in the regular grocery stores because they’re trying to compete with Whole Foods You can find a lot And you can order like through Amazon, or– I’m blanking on the other name– Thrive Market, if you’ve heard of Thrive, they’re a subscription-based service Very high quality foods that will come straight to your doorstep All the criteria will fulfill Prerna’s ideas So there’s more and more options that are out there So I think that’s what we have to start looking at PRERNA UPPAL: You’ve got to really plan ahead I think the key is planning ahead Put aside a couple hours on the weekend as you’re getting started, get the right ingredients at home, and just plan ahead RONISH SINHA: And then come see us if you need help PRERNA UPPAL: Come to the retreat the retreat will have a lot more practical information RONISH SINHA: We’ll have a lot of practical advice Great SPEAKER: All right, thank you, guys Thank you so much Appreciate it [APPLAUSE] [MUSIC PLAYING]