Indian vegetarian if you look at the diet it is a mountain of rice or three roties one Dal one little suby the hero of the meal is always grein it should be the other way around I born in a South Indian family I was a vegetarian for the first 30 years my mom raised me giving me one cup of sambar rice every day thinking I'm getting protein but right up there there is this misconception that Dal is protein ch is protein Chana is protein or rajma is protein the right definition of these Foods is complex carbohydrates with protein what are the practical problems that you are facing in your practice while you are trying to implement this the first thing that I will hear is there is something going on I'm not hungry I'm worried that I'm not getting enough food misconception actually it's a good thing second very practical challenge that happens is carbohydrate delivers every other food into our mouth if I want to eat a vegetable in the Indian Spectrum wherever you come from I don't know how to eat that vegetable on my own unless there is a Roy with it I don't know how to eat Dal on its own unless there is rice I call it that we have simple carbohydrates which act as a wow that's that's absolutely true so India has a product called soy chop which a lot of vegetarians eat thinking it is the tanduri chicken equivalent but it is a lot of vegetable oil mixed with MAA so it is junk and a lot of vegetarians eat that thinking they're getting some high protein option like a tanduri chicken outside on paper a lot of things sound great talk yes rajma rice yes Chana and whatever but that a lot of noise goes on social media that I'm here to convert people no no no not at all for 35% of my clientele are not even egg eating vegetarians you you may or may not believe what I'm going to say I'll tell you where your oil intake is going completely wrong see younger people okay your app deliveries one meal a day is outside that is a lot in your uh dietary plan nuts and seeds play a role 100% fist full of nuts in a day give you your decent amount of healthy fat that is needed uh only thing people I tell people is don't go crazy over this nut and Jager ldo that is where now you are changing the profile of that if you don't have protein driven calories in the earlier part of the day this is proven your propensity to junk on junk calories in the later half of the day is very high because hunger catches up having food you have cramps you go to the bathroom very common that is what IBS is hi Sita thank you for coming Dr pal pressure to be here so happy to have you here so happy to have you here and and you are done doing a wonderful job in your uh social media and um this discussion is to make sure that you know we can give our audience in terms of different aspects of the same nutrition uh and then see what can be implemented uh to come to a common line of discussion to see hey you know this is working on both aspects from a clinical aspect and also from a nutrition aspect absolutely so right off the bat I wanted to come into a discussion in terms of I'll give you a patient case scenario that I saw in California and then if this was a patient to you what will you do that's the situation usually happens sure interesting so um so uh this patient is a diabetic gastroparesis patient MH so as you know gastro means stomach parisis means paralysis so when there is diabetes there is increase sugar in the blood the sugar attacks the nerve Supply not only the the not only in one part of the body multi system so that's why we call when the nerves are uh affected of when the foot nerves are affected we call peripheral neuropathy right and then when the kidneys are affected we call nephropathy correct nephropathy when the eye nerves are affected it's called diabetic retinopathy retinopathy correct and uh when the same thing is affecting the stomach we call this gastroparesis paralysis of the stomach so how we know is that patient has been having diabetes for a while and A1C is higher let's say 8 8.5 something like that and then as with many patients they are not compant with the diet and blood sugar is not controlled so they come to me with epigastric pain nausea and vomiting we do an endoscopy what we see is retain food in the stomach what I mean by that is for Endoscopy we make them nothing by mouth for 8 hours technically speaking any of peristalsis should move the stomach contents uh within the 8 hours so if you don't need anything after dinner in the morning at 8:00 a.m. and we do a scope inside the stomach the stomach should be empty I put the scope inside the stomach the morning Dosa that he ate was still there H okay and there was a reason for the pain so I said you know you have gastroparesis usually what I do is I don't give any medications right away I say that the underlying problem is a sugar okay so you need to decrease it I want A1c to come to 5.7 and he said how you do it I said um you need a good nutritionist okay I don't think you'll be able to do this by yourself and I gave him a little bit of uh uh advice suggestions okay this is what you should do and everything so let's say that if that nutrition is you and he comes to you where will you start okay very interesting so I think uh there are two aspects that first a patient needs counseling on that one they already know that they have diabetes depending upon how long the history of diabetes is second is given the eting patterns now the diabetes is progressing into other chronic conditions and the commonality between um the the lack of gastric emptying pardon the technical words I don't know no you're absolutely right right the the the delayed gastric correct which then causes probably a lot of gas flatulence pain Etc at one end and at the other end the the the acuteness of the hba1c the cause is the same that the body is now unable to metabolize sugar effectively right um or the way I I I'd like to term it is now the person has reached a level of carbohydrate intolerance so that is the first uh reality that needs to be told to the patient or the client right now we know uh uh the other commonality is When anybody irrespective of the diabetic nature of this gastric issue people who are not even who don't even have diabetes or have elevated hba1c their Ultra processed food consumption and sugar consumption already causes gas issues and there is gastric trouble we know that and it's been there is enough research Etc around that okay so I have uh a simple uh three4 Point uh uh program okay that helps in nutrition counseling so I would start with saying I don't even start saying lower carbohydrate don't people don't like to listen to that okay we are that attached to carbohydrates but I say let us first identify what's missing in your diet and in most cases it is healthy protein and fat first uh most diets uh forget globally we'll talk in an Indian context only living all over the diaspora our diets have progressed for various reasons and we can discuss that in detail whether it was the Raj whether it was tropical country therefore for accessibility to more agriculture whether cultural uh aspects of it has progressed somehow to include carbohydrates in disproportionate amounts okay now the chicken and egg question is is it more carbohydrate or is is it less Protein that's an interesting question to ask in most cases it is more carbohydrate at one end and less protein causing a double vamy which makes you increase your consumption of carbohydrate more and more because you don't have the satiety factor in your meal which protein and healthy fat bring so Point number one prioritize protein along with healthy fat how much RDA we know8 G per kg of body weight but in my practice I tend to take it a little higher 1 to 1.2 so that the hunger is solved for which is again a very common problem with diabetic patients we know that they are constantly hungry partially medication partially glucose metabolism going wrong partially insulin being always elevated so there is a hormonal play there so first that number two prioritize uh complex carbohydrates or carbohydrates that are predominantly fiber so fruits which are above the root so non-starchy fruits and low sorry uh non-starchy vegetables and fruits that are low fructose or low glycemic index so berries guava citrus fruit kiwi apple pear in moderation but try and stay away from the very very high fructose fruits exactly jack fruit um pomegranate things like that right or chiku third uh that I then come to is lower your grain consumption or your entire grain consumption or depends now there are some people who are happy to completely give up grain but can be very difficult but I will say lower your grain consumption to form a very small part of let's say you're doing three meals in a day bring it to one meal okay and use other complex carbohydrates for example like pulses legume Dal Etc to kind of replace your uh simple carbohydrates that's number three number four we would love for everybody to go and strength train because uh I don't know if the audience knows having a healthy skeletal muscle uh helps you metabolize glucose better because muscle is the largest disposible site for glucose okay uh muscle is hungry for glucose hungry for glucose and it is greedy it will not let it go so the more muscle you have and therefore the more you strength Trin you will be able to kind of handle that glucose better and your diabetes levels and hba1c levels come down now that's a far-fetched dream the way the way things are currently to be very honest but I at least tell them walk 45 minutes a day walking is a very underrated exercise and uh we have studies that have shown that 15minute walk or even a stroll uh after every meal and if you can't even do it after every meal after two meals or if you can do a long walk that helps in bringing your glucose levels down okay so that is um the next something that you'll start with that is something I start with because people get very overwhelmed when you too many changes it can you will not start anywhere at the same time the lowest hanging fruit is something that you do three times a day every day versus 40 minutes in a day three times a week which is exercise so you're eating three times a day with a snack in between and doing that every day so if we attack nutrition first chances are that you know they will have easy or or early outcomes which then they uh can can can kind of move the needle by saying okay now I'm walking now maybe can I go to the gym once a week things like that beautiful beautiful so I absolutely love the approaches so this is what I do in my practice as well right um so you know we have a GI dietitians and then we both work as a team so I say that you know this is what the protocol that we have and the diti will go deep in terms of what your diet chart and everything and then uh we always start with the diet and as you know 80% is we always believe 80% diet absolutely 20% physical activity and if you do everything together it's good but if you can't do anything at least start with the diet exactly so we'll go one by one the first thing that you said was the protein protein so in this patient uh I will give you another patient as well okay so we can so that the audience can understand where is a clinical context of this so this is a patient the first patient is a uncontrolled diabetes where he has a diabetes he was on Metformin and uh he was just taking met but not making any lifestyle changes so the A1C slowly crept up and only when the A1C is more than 6.4 uh then the nerve Supply damage will starting to appear slowly so this guy was 8.5 and that level so the nerve Supply started uh getting damaged there is an other common scenario is new onset diabetes in new practice you see it all the time pre-diabetes pre-diabetes between 5.7 to 6.4 6.4 yeah they will not have nerve damage at that time but the point is if they don't do all these four that you're talking about you will get there unfortunately it has to it will it will I've seen it it that is how pathophysiology works I'll take one minute to explain the pathophysiology where we talk about insulin resistance um just uh refreshing about our discussion as well where there's a lot of insulin but it's not working so you need to give rest to the insulin so so that's why I promote time restricted feeding where overnight you don't eat anything so your insulin sleeps so your quality is better that's number one number two is and you go down on the carbohydrate intake again the work on the insulin is lower yes so whatever the insulin is left it is trying to come back and attach to you so that it don't divorce you yeah okay so these are all the two major points yeah these two points has to be remembered in either of these two patient scenarios yeah in for that to happen all the four thing that you said should happen so number one protein okay let's start with protein so I have done some small research within my clinical scenario I get a lot of Indian patients in California because of my uh social media reach and I have had a small Excel sheet in terms of okay what is their protein intake my dietitian and me will work together we have done a small study on that the average protein intake in in a vegetarian patient I the sample size is around 1,000 okay in, average protein intake is only 40 G per day you have topped my sample size of almost uh 600 vegetarians I had once done a free calling my S my sample size showed 30 G so yours is slightly better 30 G yeah it's abysmal but you you are there you're probably right 30 40 yeah you're right but all of these people the body mass index the measurement body weight is around 70 correct so BMI is okay you're say BM is normal that's the thing that's a trick with IND exactly BMI is normal again as you know BMI is also tricky with Indian Community usually should be lower BMI of 23 the lower end of the spectrum Indians should be should be uh and the 24.9 is for the Western people and not for us yes so if you look at the research paper BM is 23 around that for Indian Community so these people are around 23.5 and they don't look obese they look a normal um so protein is 7 uh 70 gram is needed but they only reach 40 okay the first problem that I am facing is the weekly followup that they come to see me I say what is happen to your protein in they said I don't know what is protein which amount is there how do you start with them how do you teach them so do uh my consultation calls last anywhere from 30 minutes if it's a slightly evolved patient to almost an hour if it's vegetarian uh not a patient I should say cons clients uh so the first education exercise that I do after basically a kyc on the client knowing their history family history health condition evaluating their blood markers I'm I am equipped to read some basic blood markers and then when I take a diet recall what's your average day of eating so the first thing that I do I don't even like I said for me carbohydrate reduction comes later because that's an easy thing to do the the biggest education exercise that happens on every consultation call is to explain to vegetarians what a class one protein is and what a class two protein is so what are your primary protein um uh sources and what are your secondary protein sources and there is a lot of mythbusting there okay now I am born in a South Indian family I was a vegetarian for the first 30 years my mom raised me giving me one cup of sambar rice every day thinking I'm getting protein no fault of hers but you as for Tamarind race as well yeah but right up there there is this misconception that uh that Dal is protein don't get me wrong or similarly Cho is protein Chana is protein or rajma is protein the right definition of these Foods is complex carbohydrates with protein okay and there is a primary difference uh between class one protein which tend to be animal based protein which are meat uh all red meat poultry eggs and chicken uh seafood fish prawns Etc Dairy Dair okay so these are your CL anything that comes out of an animal is actually what we call class one protein there are two reasons for it the amino acid profile is complete without getting very technical they are not only complete but they are there in the right balance that is needed for the human body which people miss out in plant protein one the amino acid profile is incomplete and second yes on paper you can uh you can combine Dal rice you can combine rajar rice and complete the amino acid profile so if one amino acid is Miss in rajma for example that amino acid is present in rice yes your nine is complete but you do not get it in the right amount that is needed per meal for your body to absorb that's number one and carbs to protein ratio in plant protein is 3 is to1 uh or 4 is to1 okay so I'll explain the cars ratio a little bit sure so uh just you know it but I'm just for the audience sure is carbs to protein ratio is for example 1 G of protein you don't want too many cups yes so for one gram of protein let's say you have only like two or three gram of Cups it's good yeah no actually you were actually explaining one is to three so for one usually if you want a protein Source you don't want carbs in it you ideally want fat in it because that is how protein and fat are designed in nature and egg has no carbs chicken has no carbs fish has no carbs paneer has no carbs okay the only exception being curd and milk they have certain carbs in it because milk is for children so you have all three micronutrients so ideally you want a protein where if the protein is one you want the carb to be at least 0.5 or equal at worst case scenario okay so let's say 100 G of uh let's say cooked Mo Dal or we can take raw people go and search raw if you have 100 G of raw Mo on an average 22 to 24 gam of protein depending upon the moong that same 100 G will have about 70 plus gram of carbs and then when you add rice to complete the protein 100 gr of rice will give you probably 2 three gram of protein but you are taking 35 gram of carbs so basically for a very small amount of protein you've taken excessive amount of carbs which calorically is not value for money for you because to just complete that protein requirement you taking too many calories and if you don't use those scarp calories you're going to store it so coming back okay that that is a I completely agree with you this is my thought process as well yes but there was a guest that we discussed the same topic we discussed the point of angle was complex carbs because it has a fiber um the carbs count is not the same so technically speaking even if it is let's say she also agreed that you know the carbs protein ratio is very high so 20 g of protein even if you have like 150 gam of carbs those carbs are complex carbs with fiber which will not affect the insulin levels that much my I'll tell you my thought process partially true H that's what I'm saying it's I think it depends upon the overall clinical profile of the patient one and if you're going to have only plants only plants okay Whole Food plant based W uh uh wfpb exactly Whole Food plant-based and you're what vegans do even Dair is not there remove Dairy because Dairy is an animal protein Indian vegetarians have a strange confusion with that but we'll leave that apart if you're going to a whole food plant-based and let's say you want to hit a protein Target of 70 G to hit that protein Target you and let's say your standard calorie intake per day for you to lose lose some weight or whatever it is maintenance is 1,800 calories you will have to one you a you will automatically go to up to 2, 2,500 calories number one one your caloric intake will go high two you have to probably count for more plant protein because it is less bioavailable there are two challenges which is why so which is why if you look at people who are vegetarian and let me take some common examples we know vegan body Builders vegan athletes vegetarian bodybuilders vegetarian gym trainers they are not uh they're not going a whole hog on rajma and Dal they supplement with a whe protein because that little bit of way protein or processed plant protein even whether it is pea protein or soy protein in smaller number of calories gives you the Complete Nutrition more protein more protein and more bioavailable because it is an isolate form okay so on paper a lot of things sound great talk yes rajar rice yes Chana and whatever but and if we if we add another layer as to how sedentary we are while the while the while the carb component of the complex carb will not Spike insulin as much as probably rice or wheat or bread but the total caloric intake has gone high and unless you count for activity level to that extent you're going to store energy and gain weight correct I think that was the discussion that we had that if let's say the patient is physically active lots of muscle mass the metabolic rate is very high high so in that particular profile maybe the complex cars doesn't matter a lot but that is not the patient that we usually see in my clinical practice or in your practice and neither is a lay man that Physically Active even like to be very honest I consider myself Physically Active I probably go to the gym three to four times a week 45 minute to 1 hour session I try and do 8,000 steps a day even this kind of activity which you know from your practice is not H not common even for you it's very difficult yeah even for me it is very difficult to that's exactly what I was trying to say if I don't control for the quantity of my calories by focusing on uh quality of calories that is where so coming back to uh I think your point is very true that that's not the common patient you see that's not the common client that I see so coming back to what I do in the practice so therefore if it's a if it's a meat eater or a non-vegetarian very easy for me okay relatively because they don't I eggs chicken and the more uh Variety in their nutrition the far easier it becomes but if you're a vegetarian the major counseling goes to say that you have to figure out within this is not about converting anybody not about for in choices I have to figure a way to work with the the the person depending upon their way of eating cultural practices beliefs all of that a lot of noise goes on social media that I'm here to convert people no no no not at all for 35% of my clientele are not even egg eating vegetarians I speak to a lot of so so vegans egg egg no no they don't eat egg they're Indian vegetarian basically non-egg eating vegetarians what we call lacto vegetarian lacto vegetarian yeah some are over lacto vegetarians they drink milk yeah Dairy is there so there I have to explain that listen um paneer uh a little bit of milk if you're able to tolerate it that's again very different lot of South Indians after the age of 30 35 don't tolerate milk but if they can yes so pan just a point on that is uh we'll come back to the proc I just wanted to add this point that um this lactase deficiency uh we are seeing a lot yeah uh in my practice because they come with bloating I'll tell you my close friend he had bloating okay and he called me he's a cardiologist he said dude I have bloating what do I do I said first stop the filter coffee in the morning right he could not stop the filter coffee he could stop the filter cof but he went on low F map diet which is a diet for bloating okay irritable bubble syndrome in that low for map will include Dairy except for dairy he include everything else but the bloating was still there then I said at least now we remove the bloating so as soon as he stopped uh he got better yeah so then we both started doing some research on his cardiology practice and also is my practice as well and then for for some reason I don't know immigrant population in United States he is in Minnesota I'm in California lactose intolerance is almost rampant it's almost I would say like one and two or even even more than that have lactose intolerance in South Asian Community South Indian Community yes it is I also think that um it's because the indog gantic plane descendants and the dean descendants have been raised on very different topography ancestry uh which is why I feel that I have never seen South Indian even in my own family uh people being able to pound lassi and paneer and and whatever we do better with fermented da so C and buttermilk and all of that so coming back so so you talked about about uh we talk about lacto vegetarian huh lacto vegetarian for the audience it's basically vegetarians who consume Dairy okay so first option is I have to bring paneer and somehow paneer is a form of cheese which even South Indians can handle they do they may not handle tons of milk but they can handle paneer so paneer uh CD okay if you can hang the CD like basically drain the curd of the watery part it becomes a little more protein efficient okay can you explain a little bit more how do you do do it exactly it's actually very simple make CD at home okay you get muslin cloth okay a muslin cloth is everybody knows what a muslin cloth is it's a it's a white color drain it has small holes in it so you put your entire curd in it and you drain it okay and you leave it for an hour or two so the drip drip drip drip the buttermilk in it or the thing in it will drain then you will get a really thick Cur now that has a little better protein quality okay now if you don't want to do all of that I understand we're all time sensitive now India and abroad you have Greek yogurt I'm India we have now two three brands um so Greek yogurt is a great option uh I think uh in the US chabani is a great favorite if you are uh in UK the diaspora there's I think this the spelling is f a g e f or F that's that's a brand in India there are a couple of brands that are there two three two brands we have which are doing good work so Greek yogurt is a very good option for you also Greek yogurt tends to have two strains of bacteria that's better for your gut health one point for Greek yogurt is Greek yogurt give you 10 gram of protein 10 to 12 gram of protein EAS depending upon the brand chani I use chabani all the time uh please don't use flavored Greek yogurt let me just come to that abouted to say that no I'm not yeah yeah this this is not sponsored by chani no no neither is it sponsored by so there's a point affiliations at all there's a point in the probiotics where exact point that you mentioned when you add flavors to it you have invariably added sugar it yes so then the probiotic effect is Blended that's what I'm saying you you've damaged it by adding uh uh if you have a mango Greek yogurt or a vanilla or a blueberry Greek yogurt it's better to put real blueberries on your Greek yogurt that's my favorite snack or real strawberries on your Greek yogurt than to have a flavor and sugar in it so yeah slightly more nuanced option practical option is that when I was in the journey I I knew that additional sugar is going to blend the fermented effect of yogurt but at the same time I couldn't eat the plain yogurt by myself so I added blueberri strawberry similar to what you said it is still better than plain yogurt but not as good as the flavored yogurt right compromise so what I did was I started with the flavor at least I'll get the protein right then I got used to The Taste and the reason is I wanted to introduce my gut bacteria to this new thing and usually in my practice I will say 6 weeks yeah uh anything new the new lining will usually 3 months but at least 6 weeks there'll be some change then you'll be able to handle the taste better yeah that's what happened with me then I then I went to plain yogurt with strawberries which was much better yeah yeah yeah no fair point the everybody has a way to transition like ultimately you know I know we say food is for fuel and food is energy but it has to go bya the mouth if it doesn't solve for Taste there is nothing we can do of course of course exactly so coming back so there Greek yogurt Greek yogurt uh now I would urge people not to fear supplement with some way protein uh yes I'm sure you've been aware this this protein powder and process protein powder has been lot in news for um adulteration and um wrong claims and things like that these things will continue to happen that doesn't mean that that product itself is bad please be a Discerning customer talk to some experts your doctor certified nutritionist they will point you towards right sources so do supplement and not nothing happens with that way protein or even if you're taking if your preference is not way some people are better suited to plant protein isolat PE protein soy protein if it suits you please take that now if you're very worried like you said we need our gut to get used to it don't have a whole scope start with half a scope every other day slowly introduce a new thing and you will get it and finally there are two more sources but India doesn't like them a lot tofu and Tempe very popular outside India a lot of my Indian clients in Germany um Europe London us they all like tofu and Tempe uh it's plant protein soy based protein fermented soy I'm not a big fan of the soya chunk doctor I will tell you is that I'll come to that H so uh so these are your two options the reason is this um that form of soy is highly processed one two that particular form of soy because of the lack of fermentation which protects Nat Tempe uh tofu because of the ferment the anti-nutrients which we know soy is a one of the top eight allergens in the in the world right if you have eight allergens in the world there are top eight soy is one of the top eight that people are allergic to what makes soy easy to uh digest without a lot of side effects of bloating is the fermentation process that Southeast Asian South Far East and all of them do this soy protein lacks that and I have seen that after a couple of uh weeks of consumption there is invariably some gastric issue bloating of gas coming up and things like that now that's one second that's the one form of soy is highly processed uh further processed in the name of soy chop so India has a product called soy chop which a lot of uh vegetarian eat thinking it is the uh tanduri chicken uh equivalent but it is a lot of vegetable oil mixed with MAA so it is junk and then more oil brushed on it in a completely alter process and a lot of vegetarians eat that thinking they're getting some high protein option like a tanduri chicken outside so that form of soy uh is avoidable as much as possible so coming back if vegetarians are able to get all this in their diet let me just add a point on soy soy is one of the complete protein yeah plant-based PL based complete protein yes um and you you just talking about the soy chunks I'm saying only that which India largely consumes it's not found uh not soy milk soy milk for the entire um uh in terms of 100 ml you won't get a lot yeah 78 G yeah 78 G so you're better of eating Tempe which is 19 G and we have to why tofu tofu is very tasty I'll tell you what happens with tofu with so every time I go to uh uh Indian vegetarians right and they get when I when they get they get fed up with paneer obviously because I say that these are standard these have to be there every time see tofu doesn't have soy itself doesn't have a indigenous dish in India if you see your if you spoke to your mom or your grandmom I don't think they've ever made soy nobody's Grandmom has made soy the problem with tofu which I get is they don't it has a slippery yes uh slimy kind of a uh uh taste and texture which 90% of my Indian vegetarian clients don't eat but the Savior has been Tempe and there are one or two brands that have launched Tempe in India which are more crunchy and they have come with some Shawan this that little bit of flavor uh which is great but for me I I've tried both you've tried both but I absolutely love tofo Tempe taste is not that good for me huh very individual individual very individual tofu I've have seen many people yes uh younger people like it who are exposed to so a lot of vegetarians if you've traveled to Southeast Asia you know it can be a challenge to uh everything is meat bed so younger people who've traveled who've experimented um oh some people I recommend to do a paneer tofu mix which then the T each taste balances each other and what happens is you cut down the fat content of the paner if you're watching your calories that carefully you'll cut down the fat content of paner you'll raise the the the protein content by adding tofu and the texture gets better wonderful so I do a combined one of the recipes that I give is a sofu tofu this combined then you're able to have it like a Bui or whatever right so so this is what I tell most vegetarians and then I tell them what are your support protein now comes your support protein all forms of moong uh soy bean the whole bean um you have edame then you have your Cho Chana rajma all of that I said use them as support protein now after that please focus on fiber vegetables and fruits then the grain so when I structure and explain in a counseling chart and then I do when I when I prepare my nutrition this way and I tell them you cannot negotiate on the primary protein one or two forms of that has to come has to come either you do paneer and whe protein in in two different meals or you do Greek yogurt and V protein or you do paneer and V protein I need the quality protein to come in one more thing I want to tell you doctor this is may not be in in studies and research uh people don't digest this legume variety that well okay this pulses and legumes right every day if you tell them to have Cho and Chana and rajma and um all of these things no matter how much it is soaked and boiled intrinsically I think because of the nature of that uh food you know they do complain about digestion issues that is where I again say mix and match so this is how I educate vegetarians egg eating vegetarians again to the top yeah so overl to vegetarians I say okay to the top layer of dairy add the eggs okay then you use your support protein right and then it becomes relatively easier you must have seen this you say Okay increase your protein content vegetarian they increase the legume CH Dal lentil and right away the next day you say I feel bloated I have pain uh I can't do this the reason is that they most of them most of them have poor small intestinal motility probably and the reason is that overall you know lack of sleep stress physical activity everything overall eating pattern and lifestyle lifestyle yeah have slowed down the morality of the G tract so and then small intestine is supposed to contract and only then your food digestive food goes into the large intestine and then large intestin absorbs the water stool is formed and comes the an when the motility is low what happens is the food doesn't get past very easily so it's like a stagnant pipe with secretions are getting stagnant so what happens is you our bacteria love stagnant okay so similar to like how in a mosquitoes or in a stagnant water in a stagnant secreation in small intestine bacteria comes and acts how do we know is when we do the endoscopy we take something thing called small bubble aspirate when we look into the microscope we count the number of bacteria right and usually in as you know there are 100 trillion bacteria in the colon yes there will be only 1 million bacteria in the small intin 1 million 100 trillion so the diversity significantly different because large intestine is the main right small intestine supposed should not have bacteria not more than than 1 million very minimal because it's very active all the bacteria pushed into the colon correct so what is happening now because of slow intestinal motility when you look at this ball B aspirate you are seeing like billions of as billions of bacteria in small intestine because all these large interestin bacteria are slowly coming back into this it's getting backed up yeah because their food is right there because it is stagnant so when it is there they absolutely loves cops doesn't matter whether it is healthy cop unhealthy cop doesn't matter so complex cups are healthy and you ask the patient to take they take and they are not eating it the bacteria eats it and the byproduct of CO2 is the abdominal bloating correct correct this is what we call it a CBO SI stands for small intestine Bo stands for over yeah so the point that you saying when we are hiding legumes and lentils maybe not the inherent nature of the food maybe a little bit partly contributing but other part to this is the inherency that is being associated even without any GI symptoms yeah yeah no all yeah and on top of that sometimes you cannot blame I do understand that legumes are there is this narrative right that legumes have a lot of anti-nutrients plants have a lot of antinutrients legumes have Fates and this and that but sometimes I feel that a single food cannot be vilified so much unless you take a look at the context of the entire individual and what they are consuming what is leading to that it can't be that one food alone because I work with a lot of people on a spectrum of IBD and IBS and I'm sure we'll come to that it is the overall uh abuse of the system largely the gut which then the gut starts rejecting almost everything and that is where elimination diets start to come into right right so yeah I get your point I I'll tell you a beautiful example Sangita um this is mind-blowing the treatment of irritable bubble syndrome is what is low for map diet that is a treatment yeah people who want to see check low for map diet we'll check out put that in the description what does low for map diet contain lentils legumes dolls all good foods it's Andy it's not like something very bad oh avoid chips it's low foram diet is not chips low forb diet is your regular food and I am a gastroenterologist I'm telling you don't eat it yes very difficult I was about to say that I thought you'll uh uh you stop the podcast because that's the first thing I do don't eat that first no no the reason is these patients will not be able to handle itle it yes because they don't have the gut back to to handle it yes if you Circle back it's absolutely mindblowing that if you would have taken all this F map diet high F map diet to start with you will not be in the situation at all true huh because you didn't take that you are you are developing IBS now the good food that you are supposed to take you're not able to take for a short period of time yeah yeah yeah I think that's that's what that's what I said that in the in the growing up years or when you post puberty if you don't develop your gut microbiome and get bacteria and at that time your tping Cokes and pizzas and you have changed your gut bacteria and then one then outside food and if there is alcohol and smoking if there is sleep deprivation all of this is fairly common doctor or you're going every day out every third day having Biryani and Coke ordering in ordering on all the apps you know so this is where then the gut comes to a problem it starts with a mild I've seen it in my practice starts with a mild acid reflux mild heartburn then food backing up then palpitation then d diarrhea uh 7 to eight times then eating food and then within half an hour having crabs cramps and wanting to go to the L right so when they come to this stage then there is a very narrow scope to work with then every elimination and slow introduction begins that's what I do the one that you mentioned having food you have cramps you go to the bathroom you feel better very common very characteristic of IBS yes that is what IBS is is yes and when we say irritable bubble syndrome basically it is high time that you repopulate your gut bacteria by changing your lifestyle so that is what you were discussing that legumes will have some difficulty initially similar to the way protein that you said yes uh initially you need to figure out whether do way protein concentrate isolate what it happens even with something as wholesome as eggs doctor see yeah yeah when I when somebody is cons consuming one egg a day I cannot take them to six eggs a day immediately they're not going to be able to handle that food because they don't have the requisite ability to handle that food it is the same thing with fiber if you if you're with if you're like 3 gr and 5 gram of fiber in a day if I take you to 30 G which is what we you will have a lot of gut distress so say even protein when when when bodybuilders Etc or not bodybuilders there people who are into aesthetic Fitness they come to me and they say I'm not a I'm I'm able to do only like say 70 gam I want to go to 1.6 G can we start tomorrow I said you cannot start like that you if you're at 1 1.2 you go to 1.3 few weeks 1.4 you know so I think everything is like that but uh but sure there are some people who cannot tolerate certain kinds of food then okay you can keep that away of course of course in my practice um okay so I say this to patients two things will happen one the other the patient will come back next you know six weeks for followup sometimes they will come back because either the problem got Sol or they went to a different doctor great yeah that former yeah but the person who's coming back in six weeks invariably they say that my symptoms are 50% better better invariably invariably and it all takes time it does it all takes time because all the damage didn't happen overnight happen overnight exactly I always say this that you know people yeah people want to do one month trials with me I'm like this is not a car you can test drive for 2 kilomet today and then say I'll buy this car I know we've had analogies of the human body with the car but you've taken 5 years 8 years one month of trial even the gut doesn't change right like you you're saying minimum six weeks week minim so patience is definitely needed relearning eating behaviors need to be uh evaluated your understanding of what real food is has to be changed so yes those things are are important and right so coming back to the protein thing that you said so pretty much we analyzed everything in the first point the protein thing right what are the practical problems that you are facing in your practice while you are trying to implement this so invariably after 8 to 10 days of following a adequate I'm not even talking high protein okay I'm saying adequate protein anywhere between 1 to 1.1 gam the first thing that I will hear is uh there is something going on I'm not hungry I'm worried that I'm I'm I'm not getting enough food misconception actually it's a good thing because you're not eating that much yeah you're not eating that much and there is a concept called um protein leverage okay and it was uh by two scientists Robin Heimer and Simpson founded in the in the late 80s that human beings have a a unique appetite to search for protein in their nutrition and they will eat until they complete that requirement therefore when you eat low protein diets your energy consumption bya other macronutrients go by and possibly this is one of the reasons that is driving obesity in an environment where protein is expensive and everything around you is either carbs refined carbs fat and salt which is basically Ultra processed food okay or refined carbs right so I go back to them and tell them this is actually a good sign okay you're instead of you um you uh using willp Power white knuckling motivation to kind of reduce your uh hunger it is happening automatically because you're taking protein now this take a lot of explaining because people are coming from from the habit of three big meals two snacks in between Sometimes Late Night snacking you know how we eat so one challenge is this which they then get an understand second very practical challenge that happens is very unique Indian challenge carbohydrate delivers every other food into our mouth let every other hood has cars no no no I don't mean that if I want to eat let's take an example of uh vegetable if I want to eat a vegetable in the Indian Spectrum wherever you come from I don't know how to eat that vegetable on my own unless there is a Roy with it I don't know how to eat Dal on its own unless there is rice CH needs a Puri CH needs a so I call it that we have simple carbohydrates which act as a delivery vehicle of other nutrients into our mouth wow that's that's absolutely true so that's absolutely true uh so so there's no concept of just eating Chen alone why can't you eat a lentil salad lentil salad sorry or just a lentil soup or a lentil soup I mean just a sambar alone sambar alone exactly why can't your moong Dal which is what you go out is called a lentil soup with the less Masala or why do you have to eat Nan and butter chicken why can't it be chicken grilled or butter chicken alone okay so I have found out in mind of course this Insight that we need to relearn our way of eating and then we are told CH is the combination yes okay aamal is the combination Malabar par and beef is the combination SAR idly sambar is s idly sambar do Chutney so the first thing I have to teach them is you don't need the carbohydrate to do the delivery okay and because of that the carbohydrate because the maximum portion of your meal how many times have you noticed that if a suby or a vegetable is there in the plate the person will ask one more Roti or some more rice to finish that vegetable or if the sambar is remaining or vorn something is remaining or you yeah yeah of course you add more idly you add more idly or yeah or Chutney is remaining one more ID eat the Chutney on its own no problem so we have developed and it's a tough one to break this is my by far my toughest one say reimagine your again in The Breakfast even if you're eating an egg where is my toast okay so when I'm trying especially with diabetic patients see if I'm if it's somebody with obesity I can still introduce I will say instead of four idlies eat two idlies add one boiled egg or add 100 gram of paneer add a salad they're like breakfast salad breakfast you want me to eat a suby no so that concept is gone so I that this reintroduction that if you're doing a Dosa eat an egg Dosa like how the Sri Lankan eat that what is it Hoppers Hoppers I love that concept or make a moong DOA and put egg over it the profile of the food has changed completely or if you're a vegetarian have 100 gr of tofu or paneer on the side with salt and pepper and eat uh one idly or two idlies and do have a salad doesn't have to be complicated it can be a Raa okay this is one so realigning that you don't need carbohydrate to do the delivery of everything learn to enjoy food on its own I did a video in S I went there and I said hey look at this not a paid promotion s doesn't needo exactly from anybody it's in Canada yeah um maybe that one will need because tast was so I went there and then uh the concept was okay so I'm going to get protein 25 gam on this mean so I always say um it's a vegetarian place place hard vegetarian so my advice to my followers is 20 gam of protein per meal so that you try to achieve that somehow yes it's a good starting point good starting point somehow 20 GRS of protein and I always say um I'm sorry I'll take the back so 20 g of protein and 10 G of fiber in every meal in every yes you big on plant points fiber points plant points so let's say you have three hopefully you'll get 30 gr of fiber and 60 gram of protein I'm happy I'm happy your G will be happy that's what my at least you can try starting there okay 20 10 is so the purpose of the video was I'm going to go there and then I'm going to show I'm going to get 20 and 10 I go there and then I order uh idly okay and then I they came in idly and sambar correct that's the combination that's a combination so idly has what 2 three g of protein very minimal two idlies only 4 gram of protein Max Max okay not more than that yeah then I said okay there's nothing else over here and I ask them to see can you give me eggs or anything like that it's surround yeah yeah don't even [Laughter] mention okay then I said okay milk you have milk they had milk H uh they brought milk chocolate milk with sugar it's already chocolate milk and they're giving sugar as then I said did you succeed then I said only pure milk pure milk who gets pure milk with Filter coffee uh filter coffee it's already sugar added yeah I said okay that's okay at least it's okay okay then I drank the milk and the filter coffee daba was so small okay so it's not even 8 oz I have to get tum the Tumblr South Indian Tumbl only I said okay give me one more Tumblr so I got like 8 n gam of protein in that little thing okay so total is 12 and then only idly sambar is another thing and already I'm full yeah I was about to ask what happened to the tummy how did you eat after this after this and also my I'm not hungry anyways in the morning that much uh because of the fasting I'm not hungry anyways yeah so I I said okay so what do I do I as them to bring CH okay I them bring CH you know what they did they brought CH but there was Puri right next to it I'm see this inside that I'm telling you exactly the delivery mechanism of everything else on our plate is via a carb it's like forget the spoon we use Puri Roti rice as the spoon and the folk that is how we deliver it and we don't know it's we don't know how to eat without that I'll give you another example doctor I mandate that there needs to be 300 G of vegetables in your meal 100 100 100 within a week I will get frantic messages can't eat so much vegetables and this is from vegetarian you're a vegetarian if you can't eat vegetables what are you eating why can't they eat vegetable because it's bloating no oh they don't Indian veget Ian if you look at the diet it is a mountain of rice or three roties one Dal one little suby the hero of the meal is always grain it's they're always grain maxing unfortunately it should be the other way around if you actually want to eat properly you have to not have more than 80 g of cooked rice or one Roti in your plate two subies at least I mean how does where is the nutrition coming from like you said that you did the case study right with your GI diation 30 g of protein I also did one more thing I said in a person who calls themselves strict vegetarian what is the one is 30 to 40 gr of protein 70 G of carbohydrate for what for the total caloric composition in a day if they're eating 30 to 40 30 g of protein in my calculation it is 60 to 70 G of carbohydrate so you're you're maxing so much and out of that carbohydrate the largest portion is refined carbohydrate which is grain now we are assuming they're all eating clean now let us add the kak the biscuit the sweet the theia the the all of that when they come that carbohydrate consumption in a day goes to almost on an average 300 G obviously you will fall ill because that is energy toxicity in your body so this is the problem the next challenge is how do I teach people and that is where the entire counseling happens and every time I will get when do we go to normal way of eating I say what you are doing is abnormal way of eating this is normal way of eating okay so that might be the patient when I ask how are you in the hospital he says if I was better I will not be here every time I get this when do I go to normal I said your normaly has brought you to me there is something abnormal about it and of course uh one more thing happens doctor because people don't come to me only for it's I don't just run a weight loss I'm sure you know even in your practice in your clinic along with and in Indians even without a lot of obesity there are issues of fatty liver there is uh High insulin High fasting insulin first thing I see is a is a dyslipidemia basically the the the uh the liver the the lipid profile is not optimized high triglycerides uh people think they're eating a people think here that you know they're worried about saturated fat the LDL is not high because of the saturated fat coming from one or two spoons of ghee it is coming from all the fried nonsense that you eat in the name of food absolutely wonderful one or two spoons of ghee people are making saturated fat into this coconut oil TKA that you put in uh or the coconut chutney that you eat or even the the the coconut milk fish curry that you're making at home or you're cooking your one egg or two eggs and butter that is not the saturated fat problem um so uh very important point to discuss where the same previous discussion that we had we talked about ghee yes and the discussion was oh ghee is okay no no she said ghee is not okay ghee is completely not okay uh because it is uh saturated fat uh saturated fat and rich in calories yeah but I said all oil is rich in calories all oil is n so I said her you know I think one to two tablespoons of ghee per day is completely okay uh as long as you don't overdo it but the point she was mentioning was people always overdo it they he was saying they're putting the ghee on the Roy uh and then when they do TKA they do ghee over there as well and then they use ghee for or cooking uh or the sambar or not my experience at all I see in fact there is so much fear of saturated fat in the last 30 40 Years everybody I know has moved to peanut oil mustard oil sesame oil and worst case all the Safa sunflower oil whatever that's a completely different podcast we can do there is a lot of awareness about ghee okay when we think of oils first and foremost we should think of how we are consuming it the first way there is excess oil in your diet is when you take Ultra processed food there is palm oil there is z oil there is that oil also ghee is really expensive nobody is put using it that much really and there is so much fear of ghee and cholesterol ghee is expensive a good decent brand is, rupees I'm not even getting into that Bona method and all which is now it's almost priced as gold 1,000 rupees for an Indian household for a liter of ghee that's member of it's as a four member family is very expensive the problem is not the ghee it is the overall consumption of uh in what all ways fat is coming into your diet just like in what all ways scabs are coming into your diet when you eat the T the M when you're eating you people don't even think about the oil that they eating in a Biscuit in a day with two cups of tea four biscuits in a week it is probably three packets that is where your oil is creating a problem for you or when you sit and eat banana chips or it's very healthy made in coconut oil but to what quantity and every day so my thing is if you're you're right if you're overall mindful about the quantity of oil another big um um what do you say culprit outside food ordering they are designed to to put more oil make it tasty make it tasty correct you make grilled chicken at home I make it in 6 to 10 gam of butter you oil grilled order grilled chicken from outside or tanduri chicken if they are even if they're writing the they'll tell you it has 28 G fat that is their job so it you don't have to fear yes do not have these highly refined hydrogenated oils our traditional oils including ghee are fine the overall see what your overall diet is comprising of that one ghee that you put in sambar or even that your mom will put that Cham much in the in the the CI and put a little bit on that is not the one that is it is the ice cream it is all of that that you do on a daily basis is a problematic so fat B rotate your fat don't worry about saturated you have different kinds of fat and Indian cultural wisdom doctor if we are from the south so we used Nalan sesame oil for certain things we used peanut oil for certain things if you from Kerala you didn't use peanut oil you used coconut oil for certain things ghee was for certain things we always rotated our oil so depending upon which part of the country you are rotate your oil so that your Omega 369 isn't the problem today is the ratio between Omega 3 and 6 has become 1 is to 22 which is highly inflammatory and that is coming because of again and again we can say this your bat food your junk food consumption your fried food eating all these other things so that that is where it is there is no need to fear ghee and butter when you're talking about fried foods is like samosas yeahii look at what gets served in a regular corporate office between four and six vapo Samosa bread pakoda kachori uh ma all the baji if you go down south bond baji buia is buia is that um is that thingy that sa but that's de FR as well huh of course huh yes now they have baked version of it it's just that they're adding everything but instead of deep frying the oil is pre- added they're only baking it is that right yeah yeah yeah we have baked version of the save now but it's just that in the dough itself the oil is added so they don't have to fry it they bake it so so that is the oil part of it so educate us about this omega3 Omega 6 ratio and everything okay so the in human beings the ideal Omega um Omega 3 to Omega 6 ratio should be 1 is to two so one part omega3 two parts is acceptable uh of Omega 6 if you push it a little modernization 1 is to 4 can also be okay but you'll be shocked to know that this Omega 3 to Omega 6 right now is 1 is to 22 in some populations even 1 is to 30 so uh this Omega 6 if it crosses the omega3 I'm sure you're aware it's good it's very good brain health omega-3 HDL uh yes HDL lowers your triglycerides plays a very important role brain development children okay um aging omega-3 has a lot of roles to play and you get it bya Seafood largely fish right uh Omega 6 is where it is highly inflammatory and the the research is current ly pointing out to what we call vegetable oils or seed oil usage is become uh way more way more than uh very pervasive so commercial oils educate the audience about seed oil what is seed oil okay it is marketed as vegetable oils but they don't really come from a vegetable uh they are also so you have plant fat and you have animal fat Okay so let's start there animal fat is uh your ghee your butter even white McAn the the white butter that North Indians use lard pork lard you have goat Tallow you have beef Tallow you have all of that so uh that is animal fat which is considered a very natural source because it a is attached to the protein okay and yes it is high in saturated fat but we can discuss that's a completely different discussion as to how much of it is good so these are good for us okay now there is plant fat and even in plant fat there are certain plant oils that are good olive oil is very good coconut oil high and saturated fat but very good avocado oil very good now in the recent 60 years we have seen oils made out of things that are not necessarily source of oil so if you look at rice bran oil the name itself tells you that you are crushing brand to an extent and processing it to an extent to derive oil out of it soy bean oil that's the second one rape seed oil canola oil safflower oil sunflow oil so these are basically coming out of seeds or outer structures of a plant that are not supposed to be Al it's very simple you uh you crush an olive you can feel the Olive in your uh hand hand yeah you may not be able to do that with a peanut but you lightly blend peanut you're getting peanut butter out of it there are these these kind of U plants that we are or seeds that we have to use thousands and million tons of them and they have to go through a highly industrialized process of bleaching Etc which is now being used and marketed worldwide which is one of the theories is that they are high uh not it's not a theory yes they are high in Omega 6 and one of the the the reasons of uh co-actor of insulin resistance High inflammatory markers um uh raising risks of obesity is the usage of seed oils now India is a bit of an exception we've used two two three other kinds of oils in our mix peanut oil um sesame oil depending upon where you come from we've also used mustard oil mustard oil I'm sure you aware it's banned in the US yes and in the eurin okay so there is there are there are certain regulations outside the country because of a certain kind of an acid I won't get technical but that it's banned for that because it's supposed to be not good for humans but in India these uh these two oils sesame oil and mustard oil mustard oil is common North India yes even Bengal Bal fish certain fish then SAR kasag that's made again it comes to how we were using it sesame oil Nal that we call in Tamil generally very common but both these are not uh used to high smoke points and they are not regular features in our diet traditionally they are flavoring agents they are used in certain seasons for certain Cuisine so they were not main stay of Indian traditional cooking even the sesame oil in the South it was used for either idly pdy or a certain kind of a sambar that was made uh it was not was not the universal oil it was not the you were not cooking day in day out in it neither were you cooking day in day out in in must must oil so I get a lot of question on what about sesame oil and mustard oil it's been used use it the way it is meant to be used as a TKA as a flavoring agent in a certain recipe in a certain season you're all right your main stay will always be the other combination now because of the in now obviously there's been large scale production of seed oil so soy bean is and canola every commercial kitchen you can be sure it is that every not even peanut oil it's not even peanut oil okay so commercial kitchen you're talking about Resturant hotels restaurants uh when you do because the cheapest cheaper shelf life shelf life is longer much longer you can buy uh soy bean oil and it'll stay for 5 years so it's been bleached and so these are the oils obviously they're cheaper like we just discussed the cost of ghee let's talk the cost of olive oil in India first and foremost you won't get olive oil that's not not blended with something it's not suited for Indian cooking any minimum is 800 rupees avocado oil forget it avocado only we can't afford in India avocado oil is expensive very expensive uh now cold pressed oil expensive so these are the oils that are available depending upon which sale and which big basket whatever you going into at from 80 Rupees to 150 versus if you look at Cold plus all the other oil they start a good uh whole press coconut oil is probably 300 to 500 rupes minimum ghee is 1 K like I said 1,000 rupees right so so clearly five to 10 times more at bare minimum three times even in low in in tier one tier two because of this and of course all of this commercial usage are these ratios have tilted and Omega 6 is one of the very clear reasons for having an inflammatory effect C CRP or S CRP level cyto kind storms all ultimately come and fall into the gut right uh so yeah one one additional point I was to say was I was under the impression that you know if you look at any influencer any Instagram thing they'll say oh this ships packet has seed oil oh I can't believe that they're having this um and this is going to if you eat this you're going to get cancer and all those things right I was under the impression that U see you know you cannot say that don't have chips uh it is just about the amount so I was always focused on the amount of the oil uh you know you just be mindful of how this is included if that includes within your calorie limits and if seed oils are coming in you should be reasonably okay if you can completely avoid it yes that's the best thing to do not practical what I told you so for example see 8020 rules follows everywhere doctor right now uh in your home even if you're going to have a mix of peanut oil ghee olive oil whatever you can afford you use a mix like I said rotate your oils someday you'll go out and eat okay someday one from outside some mku packet will come not necessarily it is made in ghee okay so if it is far and few okay it is okay any even like I can't if I go to a I'm traveling I'm going to a daa he's probably using some oil so the thing is there I'll avoid for example fried food be be intelligent because I don't know first and foremost what oil he's using and then generally fried food how many times that oil is being reused and reheated that is where it gets even worse for us so if you remember there was this uh Outlet called hot chips everywhere yes yes yes in the South everywhere it was very popular because still there I don't I didn't see it in Hyderabad so I I hope people have understood that it's not healthy at one point that guy because he would start in the afternoon and the batch would end people thought it was fresh because he was frying but the same oil the same oil the same oil so if we have let's talk about hierarchy because we have to give practical solutions for people okay so if you want to look at the hierarchy regular usage stick to the fats that cooking fat and oil that we always grown up with I've mentioned what all depending upon which part of the country you come once in a while if you go to a restaurant there is no point in fighting with that guy why he's using soyab bean oil okay let's he's going you come and run the restaurant yeah or worst he might do something else to your food which you don't want the waiter to do correct right so yes gut bacteria yeah problematic right so if you're a family that eats out every Saturday every Sunday cut that eating out to probably first only one meal in a week how do you minimize all of this okay so cut that when you go to a restaurant don't very clearly don't order deep fried dishes because you know that's a commercial fryer he's not changing that batch of oil with every french fry or every Puri or every kachori goby 65 yeah goby 6 he's not changing it okay so avoid uh the The Ordering of fried foods okay if you ever want to eat fried food eat it once a month in your own home you know what your oil you're using and then like my mother please don't reuse that oil for one month my mom used to do that for things she didn't know it's out of ignorance so no I I was in Madura recently my mom was using the oil and then uh I said what are you doing uh and this is for you she's reating the oil for the Pam that she's doing for you and she's having separate fresh of oil another another dish another vessel on the second Stu what is that that is for my grandkids that's fresh oil she G you reused oil we have to further the for the grandkids fresh oil yeah so we parents have their own logic so I'm saying so reduce the I'll tell you where your oil intake is going completely wrong see younger people okay your app deliveries every the amount people order is not funny so reduce those orders okay so when you do all of this in in your practice how often like a young software professional in Hyderabad or in every single day doctor they order every single day sometimes even two meals two meals they're ordering in every single day um software Prof professionals working um uh you know uh night shift us timelines uh a lot of high pressure job where they don't wake up before 11: but they working till 4: maybe one meal when the mother is around she will give something or if they have a wife or whatever and if both husband or wife are working all one meal a day is outside that is a lot and I so I specialize in the uh the there are 100 million no no there are 100 ion clubs and 100 million films and 100 CR I specialize in the 100 plus kg category I hate to say it it's very sad a lot of lot of my clients are 100 plus kgs age group being 25 to 45 45 so it is everywhere younger older older people have different issues but younger audience is indiscipline of I'm I'm very concerned about the 25y old me too me too 45 at least the damage still is going to take longer this 25 year old I'm very concern very so the it's this this high pressure job of of you know being there wanting some you know the taste is also great convenience of ordering uh let's say some project delivery needs to happen at 1: in the night after eating at 9:00 ordering again something at 11:30 that's a that's a big one big one so if you stop doing all of this now that exactly by mistake one seed oil meal is not going to hurt you or if you go to somebody's house and by mistake they're using SAA whatever is not going to hurt you don't don't major in the micro right yeah I think that is the problem I think that is where the context is being missed yes yes yes see my my son when there are tournaments he's an aspiring cricketer like we discussed yes when there are tournaments and he plays matches for 15 and 15 days together or one week together there are multiple matches he's in a restaurant in some he's in a he's in a hotel like a three star uh if there is enough sponsors it is a better Hotel otherwise it can be some Dom okay where one daa will be there in some outskirt you where is he going to get uh clean food but the only thing we and I can't tell him don't go play that match he will disown me he will say you your nutrition fundas you keep to yourself I have to play the match that is more important so the rest of the time when he's there we try and clean up obviously his diet keep it all very nice and whatever that compensation is not happening yes that's what the problem is yes and you have to be practical also and give practical Solutions that's the thing so with seed oils minimize the instances don't have to get all crazy about it so um so that's why I tell my patients is that doesn't matter what where the oil is coming from but the amount is important so 2 L for a family of four per month so 500 ml per person so how it translates doctor is 1.5 tblspoon of fat per person per meal if you are looking if you are watching your weight trying to be healthy I'm not I'm not saying you have to fear everything you can go one or day a little more or back but largely that is the quantity of fat we can healthily use in our diets I'm so glad I know a lot about nutrition more than any of my gastrological very very very happy to know that no obviously this they don't teach this all this in the curriculum so you unless we learn by ourselves um so once you do that the amount is limited so then your your ratios become better and then once you start recognizing what are Omega-3 Foods now difficult if you're a vegetarian to get it or if you somebody who's not um um who doesn't like seafood and fish supplement a little bit uh you there are some plant sources but they don't convert very well like flax seeds right so we don't convert the Ala very well so again uh you know we have to look at some amount of supplementation and you're taken care of the the problem is minimize that that ratio which is causing the inflammation by all of these methods methods in your uh dietary plan whatever you say nuts and seeds play a role 100% so there are there are two ways to look at it I give it almost like plant points or Fiber points and healthy fat points okay so nuts depending upon the objective okay if sometimes people have the nuts are not very satiating you can eat 200 250 grams in a go ah that that is a nature of without knowing knowing so if somebody's objective is weight loss somebody's objective then I tell them watch the quantity very carefully because nuts can be overeaten uh otherwise I like to do combinations like I will say take your seed mix toast it and sprinkle it like a thing on your vegetable you'll get pumpkin pumpkin watermelon all the good seed mix where you get all your micronutrients okay now if you want to eat almond Walnut yes eat it uh you can also like saute it and coarsely grind it and put it on top of your Greek yogurt it has a nice nutty flavor so I do these things for healthy snacking option between 4 and 6 instead of going and reaching out to some biscuit or some save or something like that so one to two tablespoons of a seed mix and probably a fistful anybody's fist fist full of nuts in a day give you your decent amount of healthy fat that is needed uh only thing PE I tell people is don't go crazy over this nut and Jager ldo that is where now you are changing the profile of that what does this nut and Jag do so they do a lot of these they they'll crush a lot of seeds and nuts add Jagger to it and make it into a healthier ladu ah like as if it is healthier than a Mur ladu or a basin ladu so don't do things like that once in a while maybe okay than eating a jelabi so then that is a marketing problem yeah it's a marketing problem or it is a what you see on Instagram right this is a healthier L because it doesn't it doesn't it doesn't have sugar and it has whatever caloric value of that is high and you don't need to eat it in that form so it is part nuts and seeds are always part of a plant but I I make like I said combinations or if you are somebody drink whe protein and follow it by a handful of nuts and one fruit it's a great meal on its own it has healthy cup you've got your protein you've got your your fiber and fruit in it so I have this is the third challenge people need healthier snacking option yes I will always say don't snack but I think if you're coming from a practice of fasting it takes a very long time to get to that period like I don't snack at all just a additional point on this is that I am big on sarian Rhythm time restricted feeding correct and uh I'm not saying fasting is the Holy Grail I am saying that fasting is one of the sustainable option for a busy professional that's how I usually put it for my patients and if you want to maximize the fasting you start with 12 hours of fasting and then you maximize to 16 based on whatever you are and Studies have shown that the less disturbance that you're giving to the insulin the more rest that you give to insulin correct it is better correct so I do I eat snacks but I eat in that window that's what along with lunch yeah I eat uh say whatever B whatever I I I don't avoid I don't avoid any food at all but I take in very limited portions but I add it to the dinner so my insulin stimulation in that one meal and then you're done with it instead of stimulating the insulin every two hours by going on I call it grazing gra intermittent eating yeah intermittent eating correct so initial problem when I did this was I was extremely hungry I thought initially at 4:00 p.m. M but it was not hunger was thirst thirst yes yes so I drank water okay it just extended on black coffee extended around uh then he drinking black coffee at 4:00 5 p.m. Disturbed my sleep so then I just water I cut back then I realized one of the most important hack that absolutely helped me was having that water bottle right next to me yeah it's a wonderful thing I know it's a very simple thing but what has happened is I know at 400 p.m. I'm hungry we miss the signals also there are confusing signals confusing signals so let's say the water Bo is right next to me I keep sipping I don't feel hungry at all but let's say that there's no water Bo right next to me I busy at some work then my hung I miss the window yeah then I'm not going to drink water to extend my f I'm going to eat something so a point to that is yes two meals as much as possible avoiding snacks is the ideal thing to do yeah but difficult I'll tell you why because if you look at how Indian people work Urban places right 7:00 they're still at work the dinner if they do at 9: I'm happy let's say you've done your lunch between 1 and 2 let's say you're in Bombay or Bangalore by the time you've clocked out I'm very optimistically you're clocking out of work at 6:30 you 1 hour commute you come home by the time you've sat to the table 8 look at the Gap that four to I call it The Witches Hour 4 to six that is when everything goes for a toss most of these people also when they don't bring adequate protein in the first two meals which we discussed as a problem if you don't have protein driven calories in the earlier part of the day this is proven your propensity to junk on junk calories in the later half of the day is very high because hunger catches up so it's very logical so when you uh when I say let's say 30 30 30 30 grams of protein in the first two meals and that snack I give them one of these options then they're able to go home large protein Centric dinner no carbs they fine now few of them obviously trans fasting is something that I do in my practice big I'm a intermittent faster myself 7 years now 2 and a half meals is what I have in the same window um but when people come into fasting I do the same thing like push like 9 to 10 10 10 to 11: where in the morning in the morning they are not willing to cut down the night time I'll tell you why Indian work system again that is the only family meal if you have kids in the morning you're taking them to this one somebody's grabbing a breakfast somebody's eating breakfast in the car in the train wherever you are so family is not there afternoon you're doing office lunch night is the that dinner is a reward one all socializing going to somebody's house whatever is evening all going out is evening so I know every research points out that end it at 7 right and if you have to skip skip night maximum people have a very strange thing if I don't eat in the night I can't sleep it is very common they'll say Okay Sangita I know I I'll I'll but I I say 8:30 and then at least give me a two 2hour break how often 8 8:30 is CCT iCal you think I say 8:30 they'll go to 9:30 9:0 9:30 yeah but 9 9 people who come on my program if they are very serious and then they do whatever they will ensure that they do if they know it's going to be a late night then they will make some arrangement at work or something like that and work usually gets over by 6:30 huh what work in general it is supposed to I mean I've I've I've worked a corporate career myself very diff there is no timings no if you work in software if you work you know software uh if you work in the media industry if you're an editor if you work in entertainment industry uh if you are uh if even banking which is supposed to close on time if you are going by month end schedules and quarter ending schedules plus commute is very difficult that is where the life goes one one hour is very very conservative so very difficult for people to uh and uh 7:00 so you extend the breakfast so I extend the breakfast and to take people through a breakfast I do many tricks black coffee is one some people like black coffee some people don't I say okay not technically a fast try with buttermilk like watery buttermilk do 200 300 ml if it can help you push fresh lime soda with salt especially when you're getting into a fast one of the first things people will complain I'm feeling lightheaded I'm feeling dizzy I feel like a headache is coming it's basically electrolyte withdrawal if you do a little bit of fresh lime soda with salt works so of time only concern of the buttermilk is you know we did a research about what is stimulating this insulin right I mean basically insulin is like rajata if it works it's good insulin is so powerful extremely powerful so it is even secreted when you tasting while you are preparing for the seic phase of insulin r seic face is even when you watch it looking like an or or smelling your gastric acid secretion insulin doesn't come that much in calic insulin is only when you put anything in so when you tasting something the all it needs is five micro calories of carbs in the blood okay how are you tasting it needs to go to the blood okay so insulin is stimulator so many people ask me okay so can I taste I said when you're starting it is totally okay don't this is what I do so I will tell them don't do a ly do the the South Indian very watery more very watery with salt in it okay the other option that I do is you will better off doing ghee coffee ah butter in yeah because fat doesn't uh yes yes absolutely that doesn't stimulate insulin that much I do that as well yes that's the other idea like if you like coconut oil depending on what your taste is G coffee butter coffee it gives you that energy so uh I'm going to tell you a trick in terms of what I do I have realized that to extend the fasting in the morning so we have we have finally come to an agreement that okay it is not that easy to decrease from 9:00 p.m. to 7:00 p.m. yes very difficult doctor practical modern world issues okay so in that case I think that 12h hour window should be at 9:00 a.m. uh 9:00 p.m. so let's say you waking up in the morning and you were craving for that filter coffee in the morning what I did to get that craving out was I had a black coffee initially uh I said for this I will just drink the fter coffee I absolutely hated it so then I you had it with milk filter coffee with milk H and no sugar or you had it sugar no no no no sugar but doesn't matter I broke my fast yeah you said okay no the minimum I can do is 6:30 to 9:00 p.m. I was like I can't do this black coffee thing yeah it's not happening it's not happening so then I realized that okay see insulin is sensitive only to cups large lar large not that much to fat and you have fat insulin is also secretor but not to a level as a c yeah so then almost insignificant almost insant so that's why I said you know the drip coffee there is this PO that you put it on kod and then the curing maker makes a black coffee um then I add creamer to it creamer is your uh butter version of the yes I got it it comes in those little PS and there are hardly 5 G of creamer in it yes it is high fat high fat only fat it is fat yeah there's no yeah so you add that and I realized that I was able to sustain that 3 hours or 4 hours so then I started noticing changes in The Taste to a point that I'm able to do black coffee now so the point I'm trying to say is that you need to figure out the way what works for you what works for you somebody said bullet coffee is good it doesn't mean it's good for you correct also there's a lot of chatter doctor like on the internet saying that oh like for example you had filter coffee with milk initially at least you just only had filter coffee you didn't eat a meal you were trying to push it right so allow yourself smaller things that you can do to be a work in progress than to be a non-starter ah very important when you're having any new practice if I if I cannot go six 16 hours is the Bible of a fast no for you if you're somebody who's achiev 12 and you're going to 13 that is progress okay if you've managed to take out sugar and just have 50 mL of milk and and coffee that is an achievement eventually you'll take out that milk add butter so every day you're and that is where even in my practice slow steps and don't let people tell you this is a right way of fasting this is a technically am I in a fast not enough a fast no you're progressing so that's very important of course of course Very and that is how you also I've always believed that when a person has come to a point and they come to you to change their health whether as a doctor as a nutritionist as a wellness coach you have to give them small wins otherwise they are not coming back they they'll change the doctor they'll change the nutritionist worse still they'll go back to doubly doing what they doing which is even worse I'm happy even if they change but people they just said they give up they saying this is too hard so I think yeah there are trick like this that you can do to take it forward my buttermilk trick is diluted buttermilk I know you're technically not doing a fast but at least you you've dropped your calories to an extent where you're getting used to hunger a little bit and you're moving the needle a little bit just a point on that getting used to the hunger experiencing that discomfort yeah is a good thing correct not I'm not talking even in a fasting world I'm just talking in a philosophical world where where we are so comfortable at multiple levels where whenever there's a stressful factor that is coming in either it is fasting or a pressure at work or a mental health issue where there is a stressful factor that is coming I am seeing my patients are not able to handle at all completely and that is very visible why I'm talking about mental health a lot this one and two patients walking into my gastroenterology service have mental health problems but there is the gutb brain AIS which is very proven very proven so in my practice I say fasting and everything right the I know they're not going to do it but at least they will try because I said I told them to do so when they are doing that discomfort they are creating that neuronal plasticity a new neuron that is being developing handling that discomfort so I think there's one thing that everybody should say okay it is okay to have the disc okay to feel hunger uh it is not the end of the world and everybody knows that we are not going to die because of the hunger of that one or two hours yeah doctor I've often compared fasting to medit meditation always I said meditation is not the uh loss of thought you will never be able to meditate if you want to it is not not having thoughts it is when you're starting the practice even for that 10 minutes it is being comfortable with all the thoughts that are coming and going knowing that over a period of time all these thoughts will pass hunger fasting is the same it is not it is not starvation it is just knowing that this gin which is going to the hormone which is coming up and down or which is affecting me wanting me to be hungry I'm just watching that come and go for a period of time till I get used to it yes you will not succeed the first day it takes time but like you said that good stress or that good discomfort is helpful also because it's happened with me I don't know if you if it's happened with you you start to recognize what real hunger is versus what snacking out of boredom is what versus what is eating out of stresses or coping mechanisms it resets your relationship with hunger uh you will no more be hangry like next half an hour is my meal time if I don't get that meal and let's you have to wait another half hour and a half it's not like my my moods are going all over the place so it while people uh I get a little um on the back foot when people say it's just a way to restrict calories sure it is but it is much more than that mentally resilience yeah resilience mental resilience is one of the main thing um I you you may or may not believe what I'm going to say uh in all my J patients working into my office I don't prescribe any medications at all I prescribe only one or two or three things one is I do fasting which is overnight because I strongly believe that when they have rest overnight hormones itself will take care of the problems and as you know it's neuro hormonal thing most of the times the second thing what I say is you need to experience a discomfort somehow you have to there is no other option you're anyways experiencing it and it's the worst kind of thing you know where you're unable to lie you have to lie in this position you're burping you are having flat there is a discomfort either way choose the better one choose the better one okay they say no doctor choose your hard everything is hard so my prescription is firstest 8at by 700 p.m. and when I say 700 p.m. they'll at least eat by 9:00 p.m. or whatever it is I always go hard so that at least if I get 50% of it I'm okay so it be 7:00 p.m. and then 7 hours of sleep so I say okay okay you should not go to bed 3 hours after you your last intake inake intake that's very key difference because let's say you start your dinner at 7:00 you're not going to finish by dinner at 700 you're going to finish your dinner only at 7:20 yes I always ask my patient to uh start the timer clock end of the after washing the hands correct after washing the hands I know it's only 15 20 minutes but it makes a huge difference in fact I think doctor sorry to it was Sachin panda on the huberman episode who said it is not until almost 2 to 2 and a half hours after your last intake that the actual fasting begins if correct me if I'm wrong because you're still digesting 3 hours yeah 90 minutes yeah 3 hours so your actual if you have to count fasting no that's why it's called Deep fasted State huh deep fast where you start your sleep in a deep fasted State yeah so you sleep better ah and you get the benefits as benefit out of it so let me let me tell you two examples 900 p.m. you're eating 10 p.m. you are sleeping 9:00 p.m. you start eating 9:20 you are finishing 40 minutes corre let's say 2 hours okay the thing is 90 minutes to 3 hours so let's say an average 2 hours 9:20 2 hours 11:20 your digestive hormones are done but you are sleeping at 10 1 hour and 40 minutes your body is confused yes yes whether you you want me to shut down and make digesting and that is that work needs to be done so it will it will compromise on probably your Sleep Quality while doing that sleep initiation is a huge problem maintenance is maybe okay correct correct initiation is a huge problem so if we do this clients who tell me I have counted thousand sheep looking at the ceiling if you you remember we have that technique look up and count the Sheep 300 sheep and you I have thousand sheep I'm not falling asleep so so these are three things I usually say eat by seven sleep for S hours and then 3 hours definitely should not eat should not go to bed after your last meal yeah uh I said should not sleep right my patient send me a picture you know you can communicate through inbox messages send me a picture doctor as you said I am not sleeping but he's lying down on the [Laughter] bed you we have you have to be specific doctor it's your your fault then then I change my wordings I said okay 3 hours before you go to bed I'm not making it a true story I can imagine I can sure imagine how all these things come up but I I was curious about something you said you said you don't prescribe medication but there are certain urgencies right like when you have to do n and ppis temporary handling of of symptoms yeah yeah I'm talking about GI symptoms in young patients with bloating and abdominal pain if there are no red flags I know what's the problem right uh the brain good tax is not working they must be changing the doctor because you're not giving medication no my my Approach is longer yeah and they don't like it right so they want some so let's say I give an antispasmodic it's very easy for me to give an Antipas and they get used to it ah uh then they will not change they will not do yeah I said you know you do this you come back after two weeks and then see let's see how it goes I don't know whether it goes or not the patient goes because we have this um there is unfortunately so we have a very pill popping let us fix this issue in the temporary fre Quick Fix with everything and with this also you know there is an effort you have to eat at a certain time and do at a certain time no just give me something that I will sort it you know that sustaining the pain yeah that will apply to physical activity as well initially it's going to be painful and I went to a gym the all the guys I got so scared you know what they did they lift the weights and then they said no pain no gain no pain no gain they said I'm not coming to the gym I the game you don't have to do that really I don't I don't want I was just be coming to check how much was the price but um anyways wonderful discussion thank you same your I've had a great time and hope it's been um of been takeways I'm sure you know there are we talked about a lot uh I'm sure if I was listening to this podcast I will at least write down the points yeah physically so that it gets registered in the mind right so that at least 25 to 50% you try to implement in some yeah I'd like to offer another solution if there is something that you haven't understood uh let audiences post it in your comment section yes of course and you I am happy to clarify or if if it's related to your expertise obviously clinical experience you can clarify happy to do that because it's been there's been a lot of back and forth in this conversation there's something that you haven't understood and how to go about it right happy to do that of course that's so nice of you that's so nice of you thank you so much for being here thank you Dr pal you're a riot as usual I'm so glad that we could do this thank you thank you thank you that was a wonderful episode I learned a lot I'm sure you learned a lot as well I really want you to make sure that the discussion that we had if at all there are some points that you have noted I really want you to take some time understand what those points are see whether that is applicable to your life and and if it is please write down in the comment section in terms of what you learned as usual so that that gets registers in the mind the more you put writing and uh writing in words that thought process gets registered a lot more and there are multiple resarch to prove that as well so I'm hoping that the techniques that we discussed will be implemented in your daily lifestyle as well thank you so much for all your support the whole goal is to make this podcast a real Health podcast with credible information coming out so that you can pick and choose your lifestyle based on the recommendation that is discussed we have two new YouTube channels G feeling with Dr pal shorts and gut feeling with Dr pal Clips these are all shorter versions of the hourong podcast episodes to highlight the salian Futures these are all 8 to 10 minute long or sometimes 1 minute long for the real please consider subscribing and extend your support we will make we'll make sure that we'll provide the high quality content to you by giving you a wide variety of input from multiple medical experts in case if you want to to listen this in audio format while you're commuting or while you're driving please check us out in Spotify with the name gut feeling with Dr pal and please consider extending your support by subscribing to that channel as well as usual it is one belly at a time it is absolutely important I'll see you in the next video