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

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

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, It stands for Environmental
Working 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]

10 thoughts on “Five Steps to improve Heart Health, Avoid Diabetes, and Feel Great

  1. The usual crappy editing where most of the time someone talks about slides which we are not allowed to see. How is it that after a decade Google still fails to get this right – is the editing software required to show the speaker and slides simultaneously somehow blowing the budget?

  2. 49:30 MSG? Really? You mean the stuff that was the subject of a lot of scaremongering in the 80s and has long since been proven harmless in several double-blind placebo trials? Promoting real food is all we need, skip the false claims about the dangerous chemicals.

  3. “Sugar” does not have a GI of 100 – at least not table sugar, which is usually what people mean when they say “sugar”. AFAIK table sugar has 78, while pure glucose has 100.

  4. Probably one of the most important, if not THE most important talk, on this channel of most excellent talks.

  5. 9:21 The buildup of fat inside muscle cells (known as "intramyocellular lipids") is the root cause behind why muscle cells aren't responding to insulin's signal in the first place! A whole-food plant-based diet is scientifically proven to address this root cause (and also to prevent, treat, and even reverse heart disease, hypertension, hyperlipidemia, type 2 diabetes, etc.) as recommended by Kaiser Permanente and Dr. Neal Barnard of the Physicians Committee for Responsible Medicine who presented this fact at TEDx Fremont 2012 and also on PBS nationwide in 2011. Moreover, the root cause is explained and illustrated in detail in "What Causes Insulin Resistance?" by Michael Greger M.D. FACLM in Volume 33 of NutritionFacts at with all peer-reviewed sources cited therein, under the "sources cited" tab.

  6. The person at Google responsible for recording this video needs to be trained on what to focus on, to make this video useful. Keep seeing the doctors face
    When we really would like to see the screen!

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