Small Changes, Big Impact: The Power of Lifestyle Medicine

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Intro and Outro: Hello and welcome to Sound Living, a podcast by the British Society of Lifestyle Medicine. (00:05):
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Intro and Outro: Join me, your host, Dr Mike Banner, as I chat to experts on various topics related (00:10):
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Intro and Outro: to health and well-being to figure out evidence-based approaches to help people (00:15):
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Intro and Outro: get the most out of lifestyle change. (00:19):
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Intro and Outro: Today I'm joined by my good friends Dr John Sykes and Dr Punam Krishan to (00:22):
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Intro and Outro: set the tone for this podcast. (00:26):
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Intro and Outro: We delve into the topic of lifestyle medicine itself, as the three of us got (00:28):
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Intro and Outro: into the journey around the same time. (00:32):
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Intro and Outro: We talk about the challenges faced by lifestyle medicine and also the general direction of travel. (00:34):
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Intro and Outro: I hope you enjoy listening to this episode as much as we enjoyed recording it. (00:40):
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Mike: Hello and welcome to the first episode of a new series of the British Society (00:46):
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Mike: of Lifestyle Medicine podcast, Sound Living. (00:51):
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Mike: My name is Mike Banner, I am a GP and I am joined by two of my very good friends (00:54):
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Mike: and lifestyle medicine colleagues. (01:00):
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Mike: Dr. John Sykes and Dr. Poonam Krishan. How are you guys? (01:02):
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Punam: Hello. (01:07):
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John: Hi. Yeah, good. (01:08):
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Mike: Welcome to Sound Living. (01:09):
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John: Thanks for having us. (01:10):
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Mike: This is very, very exciting. Oh, I'm excited. I don't know if everyone else is, but... (01:11):
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Mike: So... (01:18):
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Mike: Over the years, the three of us have talked a lot about lifestyle medicine, (01:19):
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Mike: and that was probably the main reason that I thought it would be really interesting (01:23):
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Mike: to have the two of you on this podcast, because I think we've probably been (01:26):
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Mike: through our lifestyle medicine journeys together. (01:31):
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Mike: We all met up a few years back when the BSLM was really kind of in its infancy, (01:34):
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Mike: and everything has changed since then. (01:40):
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Mike: And people's approach to lifestyle medicine has changed, the (01:43):
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Mike: way that people interpret lifestyle medicine has changed the bslm has (01:46):
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Mike: changed and I think it's been (01:49):
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Mike: a really interesting story and I think that the future is bright and (01:51):
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Mike: I thought it would be a really good opportunity for us to kind of sit back reflect (01:54):
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Mike: on the journey of lifestyle medicine and also how we see it progressing and (01:58):
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Mike: also just discuss kind of the pitfalls and and and what it means to us so I (02:03):
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Mike: guess that's my opening question really is what does lifestyle medicine mean to us john. (02:08):
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John: It's a good question I think I think it can mean (02:14):
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John: a lot of different things to different people and I think (02:17):
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John: the concern I suppose I always have is that (02:19):
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John: it's seen as what we see in social media which (02:22):
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John: can be the you know the perfect run on the beach it (02:25):
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John: could be the perfect holiday away or spending 10 (02:28):
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John: minutes a day meditating when for me I think lifestyle medicine is a little (02:32):
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John: bit more gritty um I think if you broke it down it would probably be kind of (02:36):
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John: evidence-based looking at behavior change in a kind of person-centered way and (02:40):
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John: trying to like look at those six pillars of lifestyle medicine, (02:46):
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John: which I'm sure we'll come on to in a little bit and those things being the priority really. (02:51):
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John: I often talk about the story that I think you mentioned Mike last time we chatted (02:56):
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John: about things where it just kind of puts through the story of it being a bit (03:01):
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John: more gritty than I think maybe people interpret. (03:07):
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John: So it was a lady who was a chronic smoker who came to her GP who had another (03:09):
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John: her chest infection and was struggling once again with trying to clear her chest (03:14):
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John: she started off initially saying you know I'm not going to make any changes (03:18):
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John: doc I'm not going to stop smoking I smoked all my life. (03:21):
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John: I'm not going to change now but the doctor tried a slightly different approach (03:24):
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John: and he tried to look at it from a different way of looking at behavior and challenged (03:28):
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John: her on how much the actual smoking habit cost her a year and they actually analyzed (03:33):
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John: that together worked to how much money it was, (03:37):
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John: and she reflected on that but at the end of the consult she kind of shrugged (03:40):
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John: her shoulders and said well that money's all good and all and I'd love to go (03:43):
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John: on that holiday to marbella or wherever it might be but ultimately I'm not going (03:47):
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John: to make those changes so that was where the conversation ended but 18 months (03:51):
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John: later the gp got a postcard in his inbox having not seen this patient for, (03:55):
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John: 18 months pretty much from our (03:59):
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John: bear saying that she was there and saying that she was so (04:02):
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John: glad that she's changed her life because of the conversation that (04:05):
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John: she'd had and that was a very short brief intervention around lifestyle which (04:08):
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John: genuinely changed that woman's life um so lifestyle medicine is all those things (04:12):
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John: but for me I think it's it's gritty you know it's the hard stuff to change and (04:16):
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John: to challenge but it's also a life changer it has so much potential to change (04:21):
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John: the way we look at healthcare yeah. (04:25):
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Mike: I completely agree and I think what I often find quite frustrating about. (04:27):
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Mike: And we'll come on to more of kind of the criticisms of lifestyle medicine. (04:32):
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Mike: But I think that a lot of people in healthcare look at lifestyle medicine as (04:36):
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Mike: kind of obvious things that people are supposed to be doing. (04:42):
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Mike: And I suppose for many, many years, we've had this idea in healthcare that, (04:45):
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Mike: yes, we tell people to make changes. (04:50):
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Mike: We might tell people to do more exercise or tell people to stop smoking, (04:51):
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Mike: or we might tell people to lose weight, or we might have done in the past. (04:56):
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Mike: Um but there's been very little (04:59):
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Mike: focus until more recently on actually how (05:02):
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Mike: we help people implement those changes and how (05:05):
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Mike: that gets facilitated from a professional basis and (05:08):
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Mike: I think that that's come with a greater understanding of (05:11):
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Mike: the fact that these changes are complex it's not you know (05:14):
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Mike: we used to put so much emphasis on personal responsibility (05:17):
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Mike: and I guess some health practitioners still do um (05:21):
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Mike: but it's the understanding that it's how (05:24):
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Mike: it's how that is implemented and how it's facilitated that can (05:27):
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Mike: really make the difference between it being successful and (05:30):
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Mike: it just being a tick box for things like coif where you know (05:33):
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Mike: yeah we told them to stop smoking so our work here is (05:36):
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Mike: done um and that's always you know been a (05:38):
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Mike: bit of a frustrating thing because it's it is it's a (05:41):
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Mike: huge part of medicine but it's just a part of medicine that because it's been (05:44):
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Mike: thought to have been the easy bit which in reality of course isn't it's largely (05:48):
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Mike: been ignored by a lot of people and I think that's what what can be quite frustrating (05:53):
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Mike: about it punam tell us what your thoughts are on what last time I said it all (05:56):
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Mike: I knew I knew he'd take all the good stuff. (06:02):
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Punam: Um I mean what is it what does it mean for me uh I think really the crux of (06:05):
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Punam: it is helping people to find a way to live their lifestyle in as healthy a way (06:11):
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Punam: as possible as life happens to them, (06:17):
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Punam: and I think this is something that wasn't taught to us when we were studying (06:20):
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Punam: medicine medical school very much, you know, we had very kind of rigid, (06:23):
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Punam: guideline-based, evidence-based, absolutely for all the right reasons, (06:28):
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Punam: way of managing and approaching conditions and diseases. (06:31):
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Punam: But actually, when you start migrating through your years as a doctor and you (06:35):
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Punam: start seeing people and all the complexities that they bring and they come with (06:40):
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Punam: stories, they come with life that is happening in their own individual circumstances, (06:43):
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Punam: you've got to meet them where they're at. (06:47):
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Punam: And a lot of the time, whilst, yes, absolutely, the tests and the investigations (06:49):
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Punam: and the treatments and the pills will be required to help, (06:54):
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Punam: but you have to meet them and understand exactly what has been their story thus (06:57):
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Punam: far that has informed the point that they're at. (07:02):
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Punam: And how can you help them in as compassionate and as non-judgmental a way as (07:05):
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Punam: possible to help them bring about realistic changes within themselves? (07:09):
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Punam: And I think that for me, it was very much a personal journey that brought me (07:13):
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Punam: into appreciating this, which was finding myself as a patient who up until that (07:19):
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Punam: point would have been like, well, I'm healthy. You know, I live a very healthy lifestyle. (07:24):
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Punam: I've nothing ever as bad happened to me. But then suddenly I find myself quite vulnerable. (07:28):
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Punam: My story was that I'd had quite a traumatic birth experience (07:32):
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Punam: that then led me to having quite a lot of health complications so (07:36):
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Punam: it was then trying to retrace and think of okay well you know (07:41):
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Punam: how am I going to build myself up again and I didn't need (07:43):
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Punam: people telling me at that point it's a pill (07:46):
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Punam: that's going to do this to you or the guidance says this I needed (07:49):
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Punam: people to meet me where I was at and take me from (07:52):
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Punam: a point of there to look at what were the small changes (07:55):
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Punam: that I could make that would help improve my sort (07:58):
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Punam: of overall lifestyle thus for my health and (08:01):
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Punam: my mental well-being um to to (08:04):
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Punam: gradually work myself up to you know just health again um so yeah I think it's (08:07):
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Punam: helping helping people compassionately to find a way to live their lifestyles (08:13):
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Punam: um and uh yeah like I think that that's what it means to me does that kind of (08:18):
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Punam: answer your question 100. (08:24):
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Mike: Percent And I think it speaks to something that I think is a really important (08:25):
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Mike: component of lifestyle medicine and one of its greatest strengths, (08:30):
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Mike: but also one of its greatest drawbacks in some ways. (08:34):
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Mike: And I'll kind of explain why I think that. and that's (08:37):
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Mike: that I think that the majority of people that are interested in lifestyle medicine and (08:40):
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Mike: that are interested in kind of forwarding the (08:43):
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Mike: narrative of lifestyle medicine are people who have had personal experiences (08:46):
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Mike: of lifestyle being beneficial to them or at least personal experiences of poor (08:49):
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Mike: health that might have been impacted positively by lifestyle changes right so (08:55):
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Mike: I think that that can be frustrating for for a number of reasons and part of that is that I think. (08:58):
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Mike: That we've got a lot of people who love lifestyle (09:06):
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Mike: meds and love lifestyle change because they have (09:09):
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Mike: always been into having (09:12):
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Mike: an active healthy lifestyle and so (09:17):
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Mike: sometimes they cannot necessarily get their heads around what the barriers are (09:20):
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Mike: to other people not having an active healthy lifestyle but I also think that (09:24):
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Mike: if you've not necessarily faced poor health yourself it's really easy to have (09:28):
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Mike: this real privileged view of what being healthy means. (09:34):
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Mike: And also this idea, this kind of, I guess. (09:39):
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Mike: Somewhat moralistic view that the reason that you are healthy is because you've (09:43):
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Mike: made good decisions with your life and you've been determined and ambitious (09:50):
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Mike: and you know that you've got a good work ethic and all of those sorts of things. (09:54):
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Mike: When in reality, we anyone who has suffered with (09:59):
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Mike: poor health knows that sometimes that just comes around (10:02):
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Mike: and hits you despite whatever you may be doing to (10:04):
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Mike: try and avoid it um and I think that (10:08):
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Mike: it's it's kind of comforting to people because it makes life (10:11):
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Mike: feel controllable in some ways it's it's a real comfort to (10:14):
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Mike: think oh I'm making all these great decisions I'm eating healthily I'm doing (10:17):
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Mike: lots of physical activity therefore I will always be okay and then (10:20):
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Mike: in reality we know that yes that while that increases our chances (10:23):
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Mike: of always being okay it doesn't mean that you know (10:26):
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Mike: that that we're completely safe as it were and that sounds like a really um (10:29):
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Mike: you know morbid way of looking at things but I think it's also reality but it (10:34):
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Mike: can also create this real divide between the quote unquote healthy and unhealthy (10:39):
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Mike: people and this idea that it's people's fault if they're not well well. (10:43):
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Punam: Absolutely and I think that's something that's really important is that it's (10:47):
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Punam: not often a choice for a lot of people um especially (10:49):
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Punam: you know I work in practices like I've always worked in (10:53):
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Punam: a quite a poor demographic where children are born into poverty (10:56):
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Punam: or you know that it's not been their (10:59):
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Punam: choice and therefore when they find themselves at a (11:02):
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Punam: point where perhaps something has happened and they they need help they they (11:05):
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Punam: really need that compassion they need that um the person that's kind of managing (11:10):
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Punam: them to to say look that this wasn't this wasn't the making of view this isn't (11:15):
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Punam: your fault and I think that this is a important thing when it comes to lifestyle (11:19):
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Punam: medicine is that it's not a blame culture, (11:22):
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Punam: but it very much depends on the demographic that you're speaking to but I think (11:25):
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Punam: as practitioners and clinicians we need to appreciate that. (11:29):
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Punam: It's it's very complicated the concept of lifestyle medicine it's not just you (11:34):
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Punam: know of course we talk about the six pillars but sometimes I'll never forget (11:39):
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Punam: you know when I first um got into you know learning more about lifestyle medicine (11:42):
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Punam: and I was speaking to my patients you know the type 2 diabetics or those struggling with weight management. (11:47):
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Punam: And one of my patients just went well I don't actually know (11:52):
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Punam: so there was me spouting off like you need to be eating this and you (11:55):
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Punam: need to be doing this and it was such a real (11:57):
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Punam: um moment for me as a doctor where they (12:01):
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Punam: just turned around and said but I actually don't know how to (12:04):
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Punam: shop for that stuff like I don't know what you're talking about (12:07):
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Punam: and I was like (12:10):
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Punam: pardon so like here was me 10 steps ahead but (12:13):
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Punam: actually I needed to go right back to basics (12:16):
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Punam: with them and understand so I was like well why don't we go to the (12:19):
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Punam: supermarket together because I I just want to understand (12:22):
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Punam: where you're at and that's where one of the things (12:25):
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Punam: that um I know that you've seen before is I used to (12:28):
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Punam: do little walks with my patients and it became thanks to (12:31):
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Punam: that one person that you know showed me (12:33):
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Punam: how they shopped and then I showed them how I shop but when you (12:36):
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Punam: walk into the supermarket and actually appreciate it from somebody who perhaps (12:39):
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Punam: is living on benefits or has got no money or when they walk in that they have (12:42):
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Punam: been cultured and programmed from a very young age to walk in and see that there (12:46):
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Punam: is a multi-bag of crisps that's on for sale and that might be cheaper than say (12:49):
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Punam: if they went further in to buy you know some veg for themselves and how would they go ahead and. (12:53):
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Punam: Cook that you know you have to really go back and (12:58):
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Punam: that in itself was a massive shift for me as (13:01):
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Punam: a doctor to think ah right well it (13:04):
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Punam: really needs to be individualized and tailored to the person you're speaking (13:07):
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Punam: to and actually just a small change of showing them how to to shop in the in (13:10):
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Punam: the center go to the veggie aisles to teach them about salt content on packets (13:14):
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Punam: of meat something as simple as that went on to to make big shifts for these (13:17):
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Punam: people um and I think that that's where when we talk about you know privilege (13:22):
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Punam: but also appreciating it's not always a choice. (13:26):
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John: 100% totally agree and just (13:30):
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John: to jump in there like I think again this is why the (13:33):
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John: picture of lifestyle medicine I described at the start really worries me (13:36):
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John: because I think it shows it to be this someone who's (13:39):
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John: hanging 30 minutes of exercise every day they're eating perfectly they're (13:42):
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John: meditating that you know they're in the zen mode all (13:45):
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John: the time whereas life isn't like that (13:48):
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John: ever for anyone really if we're being honest and I (13:51):
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John: think one of the things that I really like about the kind of core principles (13:54):
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John: of the British Society of Lifestyle Medicine is they really look at the kind (13:57):
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John: of awareness around the fact that socioeconomic background (14:00):
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John: plays such a big part in someone's health (14:04):
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John: and I think that's all about kind of appreciating (14:06):
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John: where someone's at and really having this person-centered approach (14:10):
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John: I think you really touched on that really well there putting them in your own story and (14:13):
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John: also in the story with your patients because ultimately (14:16):
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John: I'll never forget being asked to give my (14:19):
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John: opinion on certain things that have been said with public health or (14:22):
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John: whatever and they're saying oh you know they're giving this opinion and it seems. (14:25):
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John: Quite generalized and I'm like well it may be generalized and (14:28):
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John: that may not be a good message for um you (14:31):
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John: know maybe someone who's very healthy already or in a certain situation (14:35):
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John: where they know all that stuff but actually that message (14:38):
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John: for the general population could mean that their (14:40):
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John: health is that little bit better and I (14:43):
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John: think that's something that sometimes we don't appreciate enough (14:46):
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John: that these small changes so you know (14:50):
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John: I'm always talking about being active and I sometimes feel (14:53):
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John: with my kind of social media stuff that people are saying oh john (14:56):
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John: thinks we need to be running every day and go to the gym every day I don't (14:59):
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John: at all I really enjoy it and I put it out there just because (15:02):
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John: I like doing that stuff but actually we know that (15:05):
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John: 25 of the uk population are inactive which (15:08):
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John: means they do less than 30 minutes of activity a week so (15:11):
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John: you know that's a standpoint where (15:15):
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John: we're at that's the position we're in and that's (15:17):
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John: where we need to meet people at that level and actually (15:20):
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John: not judge them not make them feel bad (15:24):
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John: not to make them feel guilty but understand the barriers that (15:27):
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John: they've got in place to stop them and because there'll be (15:30):
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John: good reasons a lot of the time where they can't do that activity get help (15:33):
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John: break down those barriers help use behavioral change techniques to (15:36):
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John: enable that patient to make those differences and make (15:39):
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John: those changes to allow them to even do you know (15:42):
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John: that half an hour which means they're no longer inactive and (15:45):
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John: that would be enough to make a huge difference to their health and this (15:49):
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John: is what I suppose when I said gritty at the start of the podcast I mean. (15:52):
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John: It's not about achieving this optimal health for people it's it's about making (15:55):
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John: people that little bit healthier with simple changes and what's a simple change. (16:00):
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John: For one person will be you know something that someone can do very easily for (16:04):
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John: someone else but it's all about individualized care for those things that we (16:08):
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John: know will make a difference absolutely. (16:12):
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Mike: I always use it as an example of this kind of, you know... (16:14):
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Mike: Cumulative change my from (16:19):
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Mike: from my own personal perspective I used to be you know (16:22):
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Mike: I grew up completely inactive with absolutely no interest in food (16:25):
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Mike: and nutrition other than just eating as much as I wanted and (16:29):
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Mike: as much as I could get my hands on basically like I've always really (16:32):
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Mike: enjoyed food and never enjoyed exercise um and you know I feel that my health (16:35):
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Mike: was starting to suffer as a result and I made some massive changes with my lifestyle (16:40):
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Mike: but one of the examples that I'd give of that is that I remember joining a gym (16:45):
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Mike: where they did exercise classes at 6 30 a.m. (16:50):
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Mike: And I had never in my life this was now by the time I actually joined this gym (16:55):
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Mike: to put into context I'd actually lost a significant amount of weight I'd been (16:59):
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Mike: going to a gym regularly for I think. (17:03):
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Mike: Almost four years by this point but I had never exercised before work I'd never (17:07):
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Mike: been to the gym before work. (17:13):
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Mike: And the idea was inconceivable to me. I thought there is no way I would get (17:14):
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Mike: up early enough to go to the gym or exercise before work, not just because I (17:19):
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Mike: valued my sleep and didn't want to wake up early, (17:23):
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Mike: but because I didn't think I would be capable of mentally functioning throughout (17:26):
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Mike: the day if I tired myself out through exercise. (17:29):
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Mike: And I was worried about the impact that it would have on my practice and all (17:32):
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Mike: of that sort of stuff as well. (17:35):
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Mike: But I joined this gym and the only times that they (17:36):
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Mike: had for their exercise classes were (17:39):
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Mike: 5 30 a.m and 6 30 a.m so I (17:43):
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Mike: reluctantly signed up to this 6 30 a.m class thinking I was like you know I'll (17:46):
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Mike: just give it a go this one time and I couldn't believe that I went to work and (17:50):
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Mike: I actually was you know smilier and happier and like you know less moody than (17:54):
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Mike: I might have been normally and I thought god this you know this might be a bit (17:59):
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Mike: of a game changer perhaps I could sustain this and I started doing it more and more regularly. (18:02):
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Mike: And as time went on, I found myself thinking, oh, do you know what? (18:05):
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Mike: When I do the 6.30 class, like by the time I've had a shower and then made myself (18:09):
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Mike: a coffee and done all this kind of stuff, it's really tight getting to work. (18:13):
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Mike: I'd like to be a bit more chilled out about it. Maybe I'll just, (18:16):
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Mike: you know, give this 5.30 a.m. (18:19):
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Mike: Class a go. And I started going to the 5.30 a.m. gym class three times a week. (18:21):
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Mike: And I loved it and I did it without fail. But (18:26):
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Mike: if you had told me that the way to get fit (18:29):
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Mike: was to go to a 5 30 a.m gym class you (18:32):
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Mike: know a few years previously I would have laughed you out of the room and and (18:36):
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Mike: that's the thing is that when you present people these huge changes that are (18:40):
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Mike: so far away from where they are at the moment it is impossible for them to fathom (18:43):
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Mike: it and sometimes those changes are just too much too soon too fast and it can (18:48):
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Mike: ruin everything when when you try and behave like that, (18:52):
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Mike: And that's why, you know, the one change campaign. (18:55):
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Mike: So anyone who's listening, who isn't aware of this, like the BSLM main kind (18:59):
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Mike: of hashtag is one change. (19:03):
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Mike: And that's what lifestyle medicine means to me is that the idea of just doing (19:04):
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Mike: things a little bit better than you did maybe yesterday or last week or last month. (19:09):
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Mike: You know trying to make tiny tiny changes (19:14):
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Mike: along the path of least resistance to make (19:18):
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Mike: your life as easy as possible but to make you (19:21):
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Mike: feel better to make you healthier to make (19:24):
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Mike: you you know to make you feel you know that they're meant (19:26):
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Mike: to these things are meant to make you feel good and I think that's the thing (19:29):
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Mike: that is often massively lost in translation is that you're not meant to be miserable (19:33):
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Mike: from exercise you're not meant to be sad you're not meant to be starving and (19:37):
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Mike: hungry you're meant to be nourished and fulfilled and this is supposed to be (19:41):
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Mike: enjoyable rather than annoying. (19:46):
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Punam: Yeah I completely agree with (19:48):
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Punam: that and I also think though that I wonder if you (19:51):
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Punam: two you you will have noticed it as well is that there (19:54):
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Punam: comes a sweet spot in a consultation which is (19:56):
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Punam: where you know I wish as gps we had way more time with our (20:00):
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Punam: patients but you could meet the same person you (20:02):
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Punam: know repeatedly but there will be a sweet spot where suddenly you notice that (20:06):
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Punam: there's a tonal change because the person that you're speaking to has to also (20:11):
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Punam: be at a point where they're willing to listen or willing to connect and willing (20:15):
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Punam: for the change to happen and I think that that's where skill comes in and this (20:19):
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Punam: is where life's a medicine it's an art, (20:24):
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Punam: not just to be able to kind of practice and deliver it but to be able to convince (20:26):
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Punam: someone to just to give it that little go of making a tweak and that's where (20:30):
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Punam: all your history taking comes in of like are they actually ready are you know (20:35):
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Punam: there's no point speaking to someone like john you said the person is who's (20:38):
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Punam: you know smoking like there would have been a point where, (20:41):
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Punam: you know something's clicked that they're fed up that they are fed up they don't (20:45):
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Punam: want it anymore they might have said that they're not listening but you've just (20:49):
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Punam: done enough to spark some inspiration motivate them without because I think (20:52):
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Punam: it is a fine balance like you know I'm I'm a busy mom and Until I had kids, (20:57):
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Punam: I was somebody who would, I'd be that person, that really annoying person who (21:02):
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Punam: would rise with the sun and I would do the journals and, you know, (21:06):
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Punam: that was such a beautiful sort of moment and phase of life. I... (21:09):
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Punam: Tired as brutes every single day I'm (21:16):
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Punam: just like absolutely exhausted and I live (21:20):
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Punam: on coffee and there's just so many things that have just happened over (21:23):
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Punam: the last couple of years of having sort of a young baby during what (21:26):
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Punam: has been a stressful time and there's been moments where (21:29):
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Punam: I have looked at other people's instagrams that's very you know positive but (21:32):
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Punam: also quite a toxic place at times where I've kind of felt really bad about myself (21:36):
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Punam: and I've gone I should be doing all those weights and I should be doing that (21:41):
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Punam: because you know when when knowledge sometimes you know can it can be great (21:44):
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Punam: knowledge it can be great but it can also let you down sometimes and, (21:48):
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Punam: I've had moments where I've gone god why am I not doing that I'm I'm (21:52):
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Punam: a failure because I can't get up and do x y or z but then (21:55):
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Punam: I've got to appreciate that I've got to just look at my own (21:58):
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Punam: situation I can perfectly still practice and (22:01):
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Punam: get some fitness and with kids I can get them along (22:04):
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Punam: with me you know mindfulness no longer is the meditation at (22:07):
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Punam: 5am because I'm dying of tiredness but there's (22:10):
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Punam: nothing stopping me from doing a little bit in the evening before they go to (22:13):
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Punam: bed where we can do it as a family together you know it's finding out and evolving (22:16):
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Punam: as life happens to you of what can you do what's the changes you can bring about (22:20):
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Punam: that work for you that still allow you to know that you're doing your best and (22:24):
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Punam: that that is enough and being kind to yourself about it you know and I think (22:28):
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Punam: our patients can often see that when we present it to them as that too. (22:31):
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John: I'd also like to go back to part of your story, Mike, because I think you represent (22:36):
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John: the idea of this cumulative change really well in that, as an example, (22:41):
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John: diet, very controversial, very divisive. (22:46):
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John: Someone could say to you in your journey early doors, (22:49):
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John: tell you all the changes that they think that you should make which at (22:54):
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John: that time would probably have been quite overwhelming but I know you (22:57):
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John: were someone who did kind of use certain processed foods (23:00):
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John: for example and that was something that in your journey was (23:03):
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John: actually a healthier option than what you were (23:06):
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John: to have otherwise so as an example we've talked (23:09):
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John: about this before and we you know microwave meals and things and actually (23:11):
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John: at the time that replaced something which would actually be (23:15):
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John: not as good as the microwave meal so (23:17):
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John: you know I would hate to think that anyone that would (23:21):
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John: see me as a lifestyle medic and be oh you know (23:24):
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John: dr mike you shouldn't even be having that microwave meal it's about compromise (23:27):
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John: it's about again meeting that person where they're at and seeing what changes (23:30):
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John: they can make put them being a busy mum being stressed and that and and me saying (23:34):
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John: to you you need to get up five minutes earlier and meditate is the most unhelpful (23:39):
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John: thing I could probably say so I think exactly I was thinking I'm standing. (23:42):
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Mike: Back because I'm worried. (23:49):
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John: I think appreciating the person again (23:50):
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John: is absolutely key and the (23:53):
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John: idea that lifestyle medics which I've seen labeled on twitter is (23:56):
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John: oh it's just doctors saying to move more and (24:00):
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John: eat less and all this there's so much more (24:03):
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John: to it I think the other side of it (24:05):
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John: that I'd like to talk about would be the aspect of I (24:08):
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John: totally agree with you put them I think sometimes when someone's in a position where they (24:11):
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John: then they're not going to change I think it's we shouldn't be um (24:14):
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John: using certain interventions in that situation so (24:17):
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John: long drawn out conversations getting them involved in maybe coming back for (24:20):
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John: follow-up sometimes that's difficult but there's great evidence to show that (24:24):
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John: brief interventions work kind of what that guy did with the the smoky um just (24:27):
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John: a little bit of little bit for them to maybe tug on doesn't waste too much time (24:32):
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John: can be 10 15 seconds a little bit to tug on. (24:36):
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John: If they don't tug, that's fine. You just have to leave them to it. (24:39):
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John: And then there are other more kind of detailed interventions. (24:42):
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John: So, you know, group consultations, health coaches, social prescribing, (24:44):
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John: you know, we've got cognitive behavioral type stuff, positive psychology stuff, (24:48):
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John: motivational interviewing. (24:52):
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John: This is all stuff that we are integrating into lifestyle medicine. (24:53):
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John: And it's something that we can do in the NHS and actually help patients with. (24:57):
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John: And I think sometimes I, again, I really fear that lifestyle medicine (25:03):
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John: gets seen as this just a private business for one-on-one coaching (25:06):
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John: where you get an hour with someone to optimize every aspect (25:09):
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John: of their meditation and kale salad (25:12):
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John: like that's not what lifestyle medicine is it's so much (25:16):
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John: more than that and yeah I just hope that message does get through and again (25:19):
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John: that's why I'm delighted to be doing this podcast and really why I think the (25:25):
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John: the message that british society is putting out there of lifestyle medicine (25:28):
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John: to you know really support that is is is essential and it's I hope that message is being heard. (25:31):
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Mike: Yeah and I think like just as you can live (25:37):
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Mike: a good life without kale when we're trying (25:40):
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Mike: to encourage like can you yeah you can I'm (25:43):
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Mike: pretty sure of it I definitely that's what that's the (25:46):
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Mike: one thing I want to prove with this podcast okay I have to (25:49):
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Mike: get some nutritionists on I'm right (25:51):
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Mike: there with you like in the same way (25:54):
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Mike: that we're saying that that we want to encourage patients and (25:57):
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Mike: clients to um you know to make little (26:00):
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Mike: changes and to introduce little bits of these things into their (26:03):
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Mike: lives that we you know that there's always something that we could be doing (26:05):
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Mike: a little bit different that might have a positive impact on us the same (26:08):
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Mike: with practitioners you don't have to have a huge interest (26:11):
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Mike: in lifestyle medicine to just introduce a few little bits into (26:14):
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Mike: your practice like you said it can either be it could be 10 seconds at the end (26:17):
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Mike: of a consultation or if you're super interested in it you can be spearheading (26:20):
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Mike: group consultations in your practice there's there's a huge spectrum of what (26:24):
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Mike: it involves to be to mean you know to be getting involved in lifestyle medicine (26:27):
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Mike: as such um but I think it's really important to bring into the conversation what, (26:31):
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Mike: what lifestyle medicine isn't and actually you very recently did um a very good (26:38):
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Mike: post on this john and I think that the other I hate keeping talking about the (26:42):
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Mike: downsides of it but I think one of the biggest downsides of lifestyle medicine (26:46):
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Mike: is the general misunderstanding. (26:49):
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Mike: Both among you know among patients and and among practitioners and like I say (26:52):
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Mike: like I I class myself you know my former self obviously I'm still the same person (26:57):
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Mike: but I often look at content on social media and in the press and stuff about (27:02):
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Mike: how all of these things are presented. (27:09):
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Mike: And I imagine myself from several years ago, seeing this stuff and rolling my (27:11):
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Mike: eyes and going, oh, really? (27:17):
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Mike: And the one thing that we forget is that for all of the people that struggle (27:19):
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Mike: with socioeconomic factors and other barriers towards them seeking. (27:24):
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Mike: Like health-seeking behaviours, there are also this huge (27:29):
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Mike: cohort of extremely privileged people like my former (27:32):
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Mike: self who are simply not interested in engaging (27:35):
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Mike: in lifestyle change because it sounds boring as hell (27:38):
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Mike: and so that's why it's so important for me to (27:41):
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Mike: try and give this representation that actually you don't (27:44):
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Mike: have to be bored you don't have to be sad you don't have to be miserable you can (27:48):
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Mike: enjoy it and I think that sometimes this is (27:50):
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Mike: this is hampered by this kind of like perfect instagram (27:54):
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Mike: lifestyle that punham was talking about that just makes (27:57):
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Mike: people feel bad about themselves and I think that you know (28:00):
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Mike: there are a lot of um a lot of barriers (28:04):
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Mike: to lifestyle medicine being accepted one of (28:07):
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Mike: those is that kind of you know that that that (28:10):
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Mike: sort of the wishy-washy approach to it where there's not much said at (28:13):
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Mike: all other than just you know just do it um the (28:16):
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Mike: other is this kind of potential for I guess aiming too high in terms of what (28:19):
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Mike: we're expecting people to do and what we're suggesting is you know you know (28:25):
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Mike: these unnecessary health interventions like you know detoxes and juices and um you know. (28:29):
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Mike: Kale basically like you know I I know that I (28:37):
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Mike: know that kale has some benefits I'm not going to (28:40):
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Mike: take them away but it's disgusting it (28:43):
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Mike: doesn't taste nice and so if you're somebody who (28:47):
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Mike: is like that and I I don't mean that in any way to (28:50):
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Mike: offend anybody who loves kale I totally respect like people's (28:53):
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Mike: personal tastes when it comes to food but if you (28:56):
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Mike: are somebody who is very accustomed to an (28:59):
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Mike: extremely flavorful diet of perhaps (29:02):
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Mike: processed foods and things like that and you try kale in (29:05):
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Mike: all likelihood it's not going to massively appeal to you so I just I don't know (29:08):
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Mike: why we end up going down these rabbit holes of trying to convince people to (29:14):
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Mike: do things that yeah would have some benefits but would have the the types of (29:18):
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Mike: downsides to them that might put people off why do you think that is. (29:23):
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Punam: So I'm kind of going to go back to the kind of cohorts that I work in, (29:28):
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Punam: the demographics that I serve, where, you know, people, it's generally quite (29:33):
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Punam: poor backgrounds, not very much in terms of education. (29:38):
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Punam: And absolutely, if I was to turn around to start saying to my patients. (29:43):
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Punam: Right, OK, the way that you're going to reverse this is I need you to live off (29:47):
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Punam: quinoa and kale for the, you know, and make sure that you're having overnight oats. (29:50):
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Punam: And you know like it's an instant turn off (29:55):
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Punam: for them they're not going to engage in that a lot of (29:57):
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Punam: this stuff whether we like to believe it or not you know they are expensive (30:00):
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Punam: so you've got to kind of start with baby (30:03):
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Punam: steps and look at what is their current diet (30:06):
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Punam: and lifestyle like and what is a very realistic (30:09):
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Punam: change for those people but it comes back down (30:12):
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Punam: to it's not just it is well you (30:15):
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Punam: know it is it's about finances it's about (30:18):
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Punam: socioeconomic background it's about culture you know I'm indian (30:21):
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Punam: so like I've grown up on a very rich indian diet that's (30:24):
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Punam: been kind of indowestern you know my parents came here and and (30:28):
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Punam: I we grew up in a corner shop where you know I was (30:31):
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Punam: eating a lot of sugary things and lots of (30:34):
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Punam: crisps and biscuits and my family really embraced that this was (30:37):
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Punam: a western diet it was a cut you know um so (30:40):
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Punam: I grew up on quite a lot of like good indian stuff but also (30:43):
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Punam: quite a lot of like rubbish fried stuff um and (30:46):
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Punam: therefore you know I look back and I think that some of the changes that (30:49):
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Punam: I've made over my diet over the years I've had to find ways (30:52):
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Punam: which still incorporates the richness and some (30:55):
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Punam: of the bits of of my diet but I'm not (30:58):
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Punam: somebody I'm with you like I'm not a big kale eater I I really struggle unless (31:01):
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Punam: it's like doused and a whole load of other stuff which then you read and it's (31:05):
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Punam: like oh well don't put the sauces in because you know the sauces aren't very (31:09):
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Punam: good for you and you're like oh bloody hell I might just live on a great diet. (31:11):
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Punam: For the rest of my life it's about it's about finding where you're at but I (31:14):
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Punam: think getting that message across to people... (31:18):
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Punam: Of of things like you know making it a bit (31:21):
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Punam: more colorful adding in you know you don't need to be vegan you (31:24):
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Punam: know this is the other thing isn't it because I think a lot of social media tends (31:27):
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Punam: to be like if you're into lifestyle medicine you must be vegan you must (31:30):
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Punam: be completely vegetarian don't eat this and immediately (31:33):
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Punam: what you start doing is you start alienating large cohorts (31:37):
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Punam: of people you start turning them away they start thinking you're (31:40):
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Punam: part of a cult and that's not that is absolutely not (31:43):
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Punam: what the job of us as as healthcare professionals and those practicing lifestyle (31:46):
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Punam: medicine should be it's about giving them the evidence of that it would be better (31:50):
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Punam: for you to eat as much of this as you could and incorporate more of this if (31:54):
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Punam: you can but absolutely we're not telling you to completely go one way or another (31:57):
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Punam: because then it starts sounding like a religion which is not what we are. (32:01):
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John: Totally and I think we also get hung up on the kind of, (32:05):
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John: small kind of things which you know exactly like (32:10):
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John: that you know the diet side of things I think certain aspects (32:13):
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John: we really cling on to and people see that and they (32:16):
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John: think that's the thing that defines lifestyle medicine which (32:19):
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John: is not that at all and I think you know (32:22):
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John: the reason why I'm suppose so passionate about lifestyle medicine is (32:25):
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John: because I know if someone comes into me and they've got high blood pressure (32:28):
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John: I could give them a tablet if their blood pressure (32:31):
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John: is a certain level I know that tablet probably won't be enough they'll (32:34):
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John: probably have to go on a second tablet in fact if it's high enough they may (32:37):
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John: even need three I also know that my three medications (32:39):
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John: aren't actually going to reverse that hypertension they're just (32:42):
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John: going to put it on hold um there was a brilliant analogy I (32:46):
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John: heard recently um it's from a learning module it's actually (32:49):
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John: coming it's good good little um thing to. (32:51):
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John: Tip in here with yeah a little plug uh learning (32:54):
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John: academy coming from the bslm there's there's really good resources (32:58):
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John: coming um which I'm very excited about anyway there (33:01):
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John: was one that talked about this analogy so it (33:04):
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John: talked about the tap analogy so the tap is on and (33:07):
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John: there's water everywhere um you think gosh what (33:10):
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John: am I going to do well I'll go get some tissue paper mop up the (33:13):
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John: water that's fine but there's still water everywhere you know (33:16):
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John: you're not solving the issue right I'll (33:18):
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John: go get the mop I'll get the mopping you know we're mopping up and still water (33:21):
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John: everywhere you're going to get the bath towels and you slam them down it's (33:24):
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John: still soaking just water everywhere bath towels (33:27):
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John: are soaked through now because you're not (33:30):
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John: addressing the cause now the key thing to say (33:33):
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John: here is obviously the cause is not as simple as turning (33:36):
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John: off a tap you know issues around lifestyle are (33:38):
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John: not as simple as that and we definitely appreciate that but (33:41):
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John: the joy and benefit you get from changing that tap doesn't just kind of make (33:45):
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John: things a little bit better doesn't just mop up the water a little bit it has (33:52):
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John: the potential to genuinely change the whole situation and can even reverse disease so I think that. (33:56):
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John: The reason people see it as a cult, the reason maybe people see it as this thing (34:04):
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John: which is a bit unrealistic is because of those factors. (34:08):
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John: But I really wish that people would grasp the fact that the reason we're so (34:11):
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John: passionate about it is because it genuinely has such huge power to change people's (34:14):
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John: health, change people's life, reverse disease and just generally make them a (34:19):
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John: lot happier and healthier. (34:24):
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Punam: Do you know, I'm going to add in there just because recently I was having this (34:25):
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Punam: conversation with my eight year old and I reflected back to when I was a child (34:27):
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Punam: and what we were taught about when we were younger was about investment in terms (34:31):
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Punam: of like finances and your career and success. (34:35):
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Punam: You know, that's the kind of investment things that we were taught about. (34:39):
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Punam: We were never really taught to think of your health and your life as being your biggest investment. (34:42):
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Punam: And I think that where we are as a culture right now is everything is so now it's got to be instant. (34:48):
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Punam: It's got to be about the present and therefore (34:53):
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Punam: you're never thinking about where are you in five (34:57):
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Punam: years time you're thinking where's my career in five years time but are (35:00):
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Punam: you thinking what's my health look like in five years what does my health look (35:03):
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Punam: like when I'm 80 nobody thinks that far and actually when we're talking to people (35:06):
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Punam: about these lifestyle changes it's about trying to get them to connect with (35:10):
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Punam: their future self and their future self of being one which is so heavily invested (35:14):
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Punam: in that it looks prosperous, (35:19):
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Punam: that it looks healthy, that it looks fit, that it doesn't look like it's unwell. (35:21):
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Punam: So we're not then having to retrace back to 20, 30 years of going, (35:24):
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Punam: right, how can we reverse all that change? (35:30):
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Punam: And I think that that's the difficulty that we have nowadays. (35:32):
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Punam: And I was talking to my little boy and, you know, he's kind of, (35:35):
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Punam: luckily, the generation of kids growing up just now, they are being taught about (35:38):
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Punam: health and well-being and it's so beautiful to see. (35:42):
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Punam: But, you know, he gets it. He's like, you know, I start my (35:44):
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Punam: day with Weetabix mummy because it's so good for me and I like to have a (35:47):
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Punam: banana for my snack and I'm like you sure you don't want crisps I I (35:50):
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Punam: used to eat drumstick lollipops for my but it's just that they're getting it (35:55):
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Punam: they're getting of what the the benefits of these very essential tools and lifestyle (36:02):
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Punam: changes are at a very young stage but the people that we are looking after at the moment. (36:08):
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Punam: They don't get that. And I think until people start grasping in this idea of (36:14):
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Punam: I'm doing it, this is like essentially investment into X, Y and Z in the future. (36:18):
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Punam: You know, we're not going to win. And that's where lifestyle medicine really comes in. (36:25):
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John: Totally. And I think you've actually highlighted there another reason why some (36:29):
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John: people get put off by the lifestyle medicine message is that we are all about the now. (36:32):
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John: It's 12 week transformation. (36:36):
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John: It's detox yourself in 10 days. Like it's now, now, now. (36:38):
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John: You know, people who I think I've had my biggest successes with (36:43):
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John: from a lifestyle point of view we're talking (36:46):
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John: 12 months um you know long long (36:49):
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John: term changes not drastic cuts in (36:52):
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John: calories not massive suddenly becoming marathon runners we're talking about (36:55):
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John: someone changing their step count a little bit altering the way they do life (37:00):
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John: a little bit trying to cut back in certain areas and it's not a 12 week fix (37:05):
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John: It's not a two-month fix. (37:11):
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John: It's genuinely long-term fix. (37:13):
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Punam: Sustainable, yeah. (37:16):
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John: And in a way, that should seem attractive because those things are actually easier to do. (37:17):
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John: It's a lot easier to increase your step count by 2,000 steps a day for a year (37:22):
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John: than to do it by 20,000 steps a day for two months and then be back in where you were before. (37:28):
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John: So in a way, it's not the way people are thinking now. (37:34):
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John: It's not the mindset people have. they're all about quick change and they're (37:38):
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John: all about the gratification now but if we can again just switch that switch (37:41):
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John: to to think differently about that change then actually it can be really empowering yeah. (37:47):
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Mike: Yeah 100 and I think that. (37:52):
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Mike: It's it's difficult because people are (37:55):
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Mike: both worried that they're going to fail so they (37:58):
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Mike: want to shovel their changes in really quickly because they don't know (38:01):
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Mike: how long they're going to last doing it they want (38:03):
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Mike: the the results immediately because that's just what we're trained to do (38:06):
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Mike: but the reason that people do keep failing is because they (38:09):
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Mike: keep you know they become accustomed to failure so they're expecting (38:12):
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Mike: it not to last very long that's why they only want to give themselves six weeks (38:15):
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Mike: or eight weeks because they don't think they'll be able to carry it on longer (38:19):
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Mike: than that but I just want to go back to your tap analogy for (38:21):
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Mike: a second as well because I think this is another big misunderstanding (38:24):
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Mike: about lifestyle medicine is that it doesn't involve (38:28):
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Mike: using drugs and I think that a really important thing (38:31):
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Mike: to remember is that even if you turn off the tap you've still (38:34):
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Mike: got to clear up all the water that has been (38:37):
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Mike: leaked already um and (38:40):
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Mike: turning off the tap doesn't do that alone and actually often (38:43):
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Mike: we need a lot more than just just lifestyle changes as (38:46):
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Mike: well and I think that it's it frustrates me that that (38:49):
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Mike: sort of people think that if you're into lifestyle medicine that (38:52):
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Mike: you will somehow be anti-medication or (38:54):
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Mike: anti other sorts of forms of interventions like surgery (38:58):
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Mike: and stuff like that as well which you know as we know (39:01):
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Mike: isn't the case at all we just we want to incorporate it into you know normal (39:04):
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Mike: normal medicine it's not alternative medicine it's just a facet of medical care (39:11):
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Mike: and of of good medical care and good medical practice in my humble opinion absolutely. (39:17):
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Punam: And I think that that's where the confusion lies is that something (39:22):
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Punam: that is evidence-based scientific you know it's (39:25):
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Punam: backed up um it often because (39:28):
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Punam: of the way it's portrayed on social media by some people it gets confused um (39:31):
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Punam: because alternative practitioners sometimes use it as a term and therefore when (39:37):
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Punam: there's crossovers between other types of alternative medicine people then start (39:42):
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Punam: saying well like some medicine just sounds like woo woo when actually, (39:47):
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Punam: it is completely not it makes not even (39:51):
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Punam: if you didn't have like the evidence to back it all up it just makes logical (39:54):
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Punam: sense it's the way that you live your life that will ultimately affect your (39:57):
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Punam: body like you know how you run your car is going (40:00):
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Punam: to determine how long your car runs for and whether it (40:04):
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Punam: is is going to take you many many years or if you're going to run it into the (40:07):
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Punam: ground if you're not doing regular motifs if you're not fueling it up it's not (40:10):
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Punam: going to work so if you are doing the same with your body which is the vehicle (40:13):
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Punam: that we have then it's going to take place But I think that the confusion comes (40:17):
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Punam: when you've got the alternative world, (40:21):
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Punam: you know, and I'm not going to shun anyone or anything, but I think that there (40:25):
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Punam: are alternative practitioners who, because of the way that their information (40:28):
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Punam: is delivered, it can often taint the message that we are giving out the lifestyle medicine. (40:34):
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Punam: And I think that there's potential for harm there. (40:39):
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Mike: Yeah I think that that's another important thing to (40:43):
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Mike: sort of touch on is that you know like there's a (40:46):
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Mike: place in the world for everything except things that can (40:48):
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Mike: cause harm and actually people's opinions and people's beliefs (40:51):
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Mike: are one thing and that's really important to respect that and cultures are really (40:54):
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Mike: important and what people believe is really important but also science is really (40:57):
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Mike: important and evidence is really important and protecting people from harm is (41:02):
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Mike: really important as well and sometimes it can be quite difficult to balance (41:06):
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Mike: those things together in a safe way, (41:09):
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Mike: without potentially saying actually what's happening over there isn't the right (41:12):
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Mike: way to approach something or there might be some evidence that that can cause harm. (41:17):
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Mike: And I think that, you, (41:22):
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Mike: we can do that we think, well, you know, there might be no evidence for that, (41:26):
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Mike: but what's the harm in it? (41:29):
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Mike: The harm can sometimes be that it's done at the expense of other things that (41:31):
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Mike: do have evidence behind them. (41:34):
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Mike: And that's when it becomes difficult and tricky. And that's why we've got to (41:37):
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Mike: approach everything very carefully from that perspective, I think. (41:39):
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John: Definitely. (41:43):
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Punam: Couldn't agree more. (41:44):
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Mike: Right. I think that we have probably been rambling on for quite a while now, (41:44):
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Mike: but what I would probably like to round off with is we've made a couple of allusions (41:48):
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Mike: to the pillars of lifestyle medicine so I'm just going to ask you guys to take (41:55):
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Mike: us through what those six pillars are um just for anyone who's listening who (41:59):
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Mike: might be new to this way of thinking. (42:03):
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John: Do you want to take it away put it no john you you (42:06):
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John: go for it I think you will articulate it in a (42:09):
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John: more concise way than I will so yeah (42:13):
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John: it's the six pillars so we've got (42:16):
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John: mental well-being so obviously looking at mental health side of things um we've (42:19):
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John: got healthy relationships physical activity healthy eating sleep and um kind (42:25):
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John: of substance misuse and those are kind of the six main things um and I suppose (42:31):
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John: again going back to what we've been talking about throughout the whole podcast it's not about, (42:35):
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John: nailing every single one of those it's about making a (42:40):
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John: change to one of those things at the place where (42:43):
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John: you're at at that time in order to kind of (42:46):
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John: get a bit healthier and then hopefully feel (42:49):
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John: better as a result of that one change and then go (42:52):
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John: on to another one um I think mike's story is a really good example of that and (42:55):
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John: I think ultimately that's when I've seen again in my patients the the ones who've (42:58):
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John: made the the biggest successes is the ones who've just taken one step at a time (43:04):
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John: and managed to incorporate an individual change into one of those areas, (43:07):
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John: which is quite a realistic one and I think the other thing that you kind of touched on mike is um. (43:13):
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John: Not having guidance with this so people do this quickly because they're (43:20):
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John: like I don't want to fail so I'll do it really really quickly but I (43:22):
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John: think that's where using regular follow-up whether (43:25):
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John: we're in general practice whether it be with a nurse with a gp with (43:28):
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John: a healthcare assistant if we're not thinking if we're thinking outside (43:31):
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John: the medical model if we're talking about follow-up with a personal trainer (43:34):
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John: or nutritionist or another healthcare professional involved (43:37):
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John: in behavior change that follow-up can be (43:41):
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John: a real key we know that adherence to diets (43:44):
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John: adherence to exercise programs is often very dependent on (43:47):
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John: follow-up and I think even just that small step (43:50):
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John: of encouraging follow-up can make (43:53):
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John: a big difference to enhancing a behavior and I (43:56):
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John: think that's sometimes where we miss a trick when we're trying to help patients (44:00):
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John: with behavior change um I often if (44:03):
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John: I've seen someone who who I you know we've suggested a lifestyle (44:06):
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John: change I will try and either book them in or really (44:09):
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John: encourage them to try and come back and see me even in a (44:12):
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John: month's time because I think if that's possible you (44:15):
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John: know it's things are crazy busy at the moment but (44:17):
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John: if that is possible then that I think something can (44:20):
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John: make a big big difference to the situation and hopefully steer us away from (44:23):
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John: that need for you know instant success instant changes instant lifestyle revolution (44:28):
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John: because it's unrealistic and actually we know long term that probably isn't (44:34):
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John: going to be that healthy anyway and. (44:39):
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Punam: I think it's also agree with all of that is reminding (44:40):
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Punam: ourselves as practitioners as well as with our (44:44):
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Punam: patients when we're treating them is to remind ourselves (44:46):
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Punam: that we are all a work in progress and as (44:50):
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Punam: you say being able to pick up and you can pick up things (44:53):
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Punam: sometimes you can slip up and I think just being compassionate (44:56):
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Punam: along the way is really important and I think that's (45:00):
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Punam: something that we don't do a lot of in lifestyle medicine we focus a (45:03):
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Punam: lot about nutrition and sleep but you (45:06):
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Punam: know the mental health aspect is so important (45:09):
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Punam: because it's where everything starts when you (45:12):
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Punam: are in the right mental space when you're really (45:15):
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Punam: prioritizing and working on that as being number one priority (45:18):
undefined

Punam: for health then everything stems from that (45:21):
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Punam: so you know being able to touch in with your patients and (45:24):
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Punam: and everyone around you and just making sure that you are okay is is a huge (45:27):
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Punam: step in the right direction to then being able to to as you said tug at any (45:32):
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Punam: other potential areas and knowing that you're not alone I think the comparison (45:36):
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Punam: culture is real I get sucked into it a lot and I have to really take a step (45:40):
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Punam: back myself sometimes and go do you know what Purnim where are you at, (45:44):
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Punam: What are you going to do for yourself? And it's okay. (45:48):
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Punam: Like, you know, it's thinking about myself in 10, 20, 30, 40 years and seeing (45:51):
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Punam: health as that, the playing the long game. (45:56):
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Punam: And therefore, when you see it as that, you know, what happens in the next six (45:58):
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Punam: weeks, it's a start. And then you just go from there. (46:01):
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Mike: 100%. (46:06):
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John: And again, that comes back to the person-centered approach, isn't it? (46:07):
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John: So if I'm looking at your situation, (46:09):
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John: Poonam, and I'm trying to coach you through that situation, I'd have (46:11):
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John: in my head punham probably is you know (46:14):
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John: in that social media culture where there is comparison all the time whereas (46:17):
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John: maybe if I'm speaking to you know my other (46:20):
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John: patient who doesn't really go on social media at all that isn't something which (46:24):
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John: is bothering him so again it's that person-centered approach and appreciating (46:27):
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John: where that person's at and appreciating the right things which are going to (46:30):
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John: motivate them to help them with that change um and I think yeah it's so individual (46:34):
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John: I think that's a real nuance point which sometimes doesn't really get considered. (46:40):
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Punam: Yeah do you know it's something interesting just you shared a reel (46:43):
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Punam: this morning john and I loved what you did because often (46:46):
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Punam: again on social media like I'll see things and I do a lot of eye rolling (46:50):
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Punam: lab like oh yeah right okay you know but you did (46:53):
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Punam: a reel where you were just highlighting about different types of physical activity (46:55):
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Punam: and as you're like doing your training and then you've (46:59):
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Punam: got your football and I was like oh here we go and then you did (47:02):
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Punam: just a normal one where you were like oh just go for a walk and I was like (47:05):
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Punam: love it yes because you know what (47:07):
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Punam: that was meeting me where I'm at you know because I (47:10):
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Punam: can't at the moment for lots of different reasons I can't get out to (47:13):
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Punam: things at the gym or whatever but you spoke to every person in (47:16):
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Punam: that reel and I think that that's extremely important when (47:19):
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Punam: we're approaching lifestyle medicine from even when (47:22):
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Punam: we're sharing education or information that we (47:25):
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Punam: are inclusive of other people never with the intention to (47:29):
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Punam: make anyone feel bad even if you're a (47:32):
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Punam: super fit that's brilliant you know bring people along on on (47:34):
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Punam: the journey with you but just be mindful not (47:37):
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Punam: everyone watching the content is going to be in that space and they'll be watching (47:40):
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Punam: it from maybe a rough night or a hard day at work or having some issues in their (47:44):
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Punam: life might not be in a position you know and I think that it was really effective (47:49):
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Punam: so uh yeah go you I loved it that's very kind very kind but. (47:52):
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John: I think again that that's a really key thing isn't it I think you can easily see (47:58):
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John: someone's social media and think they've got all their (48:01):
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John: health answers in the world um you know (48:04):
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John: it's really rarely ever the (48:06):
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John: case um and I think that comparison um idea which which happens all the time (48:09):
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John: you know comparison is the thief of joy I think it is and I think actually sometimes (48:15):
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John: we really need to be very very careful about about doing that um but I think (48:19):
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John: that's that's that's the perfect example isn't it really do. (48:23):
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Mike: You know one of the one of the things that always strikes me about um about (48:26):
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Mike: exercise is again this portrayal of this image like you you, (48:31):
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Mike: you often just see people exercising loads on Instagram and they're super fit (48:35):
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Mike: and they're really happy and they're exercising. (48:38):
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Mike: And for me, there's always been this massive mismatch because like when I'm (48:41):
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Mike: doing any exercise, I'm complaining between 80 and 100% of the time while I'm (48:45):
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Mike: doing it, whether it's, whether even like on a park run, (48:51):
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Mike: like even, you know, I'm the one that kind of rolls my eyes. (48:54):
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Mike: You know, when people clap for you at the end of your lap of park run, (48:57):
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Mike: I'm sort of rolling my eyes. (49:00):
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Mike: I hate this so much. And I never understand. (49:01):
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Punam: I do it for the clap. (49:05):
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Mike: Yeah, I never, it always almost frustrates me that nobody seems to like to kind (49:06):
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Mike: of hate exercise as much as me. (49:11):
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Mike: But then I do group training with other people and I'm like, (49:13):
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Mike: they're all whinging as much as I am. And why does no one ever do this? (49:15):
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Mike: So I started recently trying to be more, you know, like trying to make sure (49:20):
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Mike: that I was including all of this kind of, you know, in my Instagram stories, (49:23):
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Mike: I'll always include the rows that I have with my trainer about, (49:26):
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Mike: you know, the exercises that we're going to do and stuff like that, (49:29):
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Mike: rather than just posting like perfect, (49:32):
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Mike: you know, look, these these are my perfect squats or bench presses (49:34):
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Mike: that I did today and instead I'll be whinging about (49:37):
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Mike: having to do them and it's really funny to me because (49:40):
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Mike: everybody sort of you know even even my coach comments on (49:42):
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Mike: it saying he gets all these messages from people saying I (49:45):
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Mike: can't believe how you managed to to put up with with mike (49:49):
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Mike: and and and is is whinging like how do you manage (49:52):
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Mike: it and he's like but what clients are other (49:54):
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Mike: personal trainers like this is what people do this is this is (49:57):
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Mike: what everyone's like and I think we've almost you know (50:00):
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Mike: by wanting to appear perfect and by wanting to appear like everything is great (50:04):
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Mike: we're making it look to people who don't think everything is great like there's (50:08):
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Mike: something wrong with them and there isn't it's just a normal part of life no (50:13):
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Mike: one you know is always happy about exercising I think john you are a bit sometimes (50:16):
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Mike: though aren't you you quite like, (50:21):
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Mike: You quite like to feel the burn, don't you? (50:23):
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John: I like exercise, but I think one thing that I wish people would see is that (50:26):
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John: I'm rubbish at sleeping. (50:30):
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John: I'm very bad at getting to sleep on time, and I get up very early, (50:33):
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John: so I am bad about getting my eight hours. (50:37):
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John: I've got friends who come up to me and go, oh, you're so healthy, John. (50:41):
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John: Well, actually, I'm really bad at getting good sleep in, and we know how important (50:44):
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John: that is. so I really wish sometimes that image wasn't portrayed and I suppose (50:48):
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John: maybe that's an insight to me that I need to post me enjoying exercise less. (50:53):
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Mike: No no not at all I think it's also not at this is (50:57):
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Mike: my point is that for you for you it's like I'm saying there (51:00):
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Mike: are some there are people that genuinely enjoy it and we (51:03):
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Mike: don't want to ignore those people either like this is the point of inclusivity is (51:06):
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Mike: that we have to understand that everybody approaches these things in a (51:09):
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Mike: different way and some people will genuinely love exercise yeah yeah some (51:12):
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Mike: people will love not drinking alcohol and some people (51:15):
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Mike: will find it really difficult not to drink alcohol it's just (51:17):
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Mike: and this is the point of person-centered care and understanding (51:20):
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Mike: that everyone deserves to be represented and (51:24):
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Mike: everybody has something to do something (51:27):
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Mike: to improve upon and something that they find really easy and (51:30):
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Mike: the point is finding those easy things and doing (51:33):
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Mike: those easy things so for example if I'm trying to work on (51:36):
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Mike: my energy balance I'm not that fussed about drinking alcohol (51:38):
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Mike: but I am massively fussed about eating cake so it's (51:42):
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Mike: important to me to balance those things together and actually I'll find it (51:45):
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Mike: easier to maybe not drink for a couple of weeks than I would be (51:48):
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Mike: to not eat cake for a couple of weeks but somebody else (51:50):
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Mike: might be the opposite so I shouldn't be telling them to just oh just don't drink (51:53):
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Mike: alcohol for a couple of weeks and then you know you'll make some changes because (51:57):
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Mike: actually that might be a really important part of their social life it might (52:00):
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Mike: be a really important part of of what they do for other reasons as well so I (52:03):
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Mike: think that's just the point that I'm making is definitely not that we you know. (52:07):
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Mike: Is in some ways that I want people to be transparent but they (52:11):
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Mike: shouldn't feel guilty for then enjoying the stuff (52:15):
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Mike: on the other side of things as well they shouldn't feel guilty for finding it (52:17):
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Mike: easy either because actually that's amazing and it's and it is inspiring like (52:20):
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Mike: it's inspiring to me to see other people enjoy exercise I just want to know (52:25):
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Mike: that I'm not completely abnormal for not always enjoying it that's all I'm kind (52:29):
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Mike: of the point I'm making with that. (52:34):
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Punam: But I think that this this goes right back to the very beginning (52:35):
undefined

Punam: of where we were talking about what lifestyle medicine means and it is (52:38):
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Punam: it's about finding a way of lifestyle that works (52:41):
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Punam: for you as your life happens to you and we're (52:44):
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Punam: all so individual and I love the fact you (52:47):
undefined

Punam: know that we're able to share the realities because we're humans like (52:50):
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Punam: it's it would be really bizarre if we liked (52:53):
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Punam: doing all the things that textbooks tell us to like like it's (52:56):
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Punam: just just I mean there's very few people that you will meet (52:59):
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Punam: and we have the privilege in that as gps we (53:03):
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Punam: really get to see people and their lives behind (53:05):
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Punam: closed doors you know so you see the front of everyone (53:08):
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Punam: looking all pristine all happy or whatever in (53:11):
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Punam: the waiting room then you get into there and you know that even the person that (53:14):
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Punam: might be telling you that they are or might be (53:17):
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Punam: um showcasing the most perfect looking life (53:20):
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Punam: outside but inside actually there will be issues (53:23):
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Punam: happening to them too and I think that we we (53:26):
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Punam: all the more open we are about the (53:31):
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Punam: things that we're very good at but also the things that maybe we struggle (53:34):
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Punam: with I think the more um the more (53:37):
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Punam: kind of human everything becomes and I think that (53:41):
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Punam: you sharing your whinges Mike I'll live for your whinges because (53:44):
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Punam: I'm sitting in bed at that time having had about three hours sleep going yeah (53:47):
undefined

Punam: that's exactly why I'm not going to the gym right now and whereas you know like (53:50):
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Punam: john absolutely when I see you kind of doing exercising and things like that (53:58):
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Punam: and it is really inspirational but equally you telling. (54:01):
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Punam: The fact that you struggle with sleep you know there's there's bits (54:04):
undefined

Punam: that we're all working on for me mental health is absolute priority (54:07):
undefined

Punam: people always kind of send me messages going god you're so amazing like as in (54:10):
undefined

Punam: like you just look like you've got it all under control you're juggling things (54:13):
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Punam: so well and I'm like you are seeing such a tiny part you know it is stressful (54:16):
undefined

Punam: and how do I manage that stress and for me the goal in my life is to kind of (54:21):
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Punam: bring calm and collectiveness. (54:25):
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Punam: Find those little pockets of peace throughout the day because if (54:28):
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Punam: I am mentally well then everything around me and my family and (54:31):
undefined

Punam: work and everything will continue okay and I appreciate that (54:34):
undefined

Punam: for the time being you know I tried to drop cake many times this (54:37):
undefined

Punam: january it just didn't happen and I (54:40):
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Punam: was like okay I'm okay with that as long as mentally I that's my (54:43):
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Punam: goal right now is just to kind of keep things going for me mentally get (54:46):
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Punam: some sleep in and whatever else that (54:50):
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Punam: I can achieve is a bonus but just that that's just it's because life is happening (54:53):
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Punam: um and if we three came on right now and we're just basically said that oh yeah (54:57):
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Punam: we're happy like vegans we live in kale all day we're excited you know what (55:03):
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Punam: I wouldn't want to listen to this podcast so you know we're keeping it real yeah. (55:06):
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John: I do think our kale sponsorship's gone down the. (55:10):
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Punam: Toilet we. (55:13):
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Mike: Should have thought that through more. (55:15):
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Punam: Seriously but. (55:16):
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Mike: Remember about 15 minutes ago when. (55:17):
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Punam: I said we. (55:19):
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Mike: Were wrapping up the podcast I we've definitely got sidetracked (55:19):
undefined

Mike: from that so I'm I think that that's a that's a good (55:22):
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Mike: and important part of the discussion so thank you guys I guess all that's (55:25):
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Mike: left really is for me to say a big big thank you to the two of you for joining (55:28):
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Mike: me to kick off this very exciting podcast before we go um where can people find (55:33):
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Mike: you and find more about you if they want to talk to you or just uh read about you or whatever, (55:39):
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Mike: I love the politeness here. You should just clamour over one another. (55:47):
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Punam: Probably the best place to find me is on Instagram or Twitter. (55:54):
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Punam: And I'm at Dr. Poonam Krishan. (55:57):
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John: And yeah, same with me. So Instagram at Health and Fitness Doctor. (56:00):
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John: And on Twitter, which I'm not on very often, I'm at Dr. John Sykes. (56:04):
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Mike: Excellent. Thank you so much for being here. I'm just going to bring us back (56:09):
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Mike: to the mission statement of this podcast, because I'm excited that we're going (56:13):
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Mike: to have some really exciting episodes with some great people and to get into (56:16):
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Mike: some interesting topics. (56:20):
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Mike: So to bring us back to what we are going to be doing, we are going to be looking to provide balanced, (56:22):
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Mike: nuanced and impartial conversations about lifestyle and behavior change in order (56:26):
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Mike: to help health professionals develop an evidence-based, person-centered and (56:31):
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Mike: compassionate approach to facilitating change. (56:35):
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Mike: It's difficult to say that all in one breath, isn't it? And it took me ages, (56:38):
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Mike: it took me ages to write that because I was like what do I want this to be and (56:42):
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Mike: now I can't even remember I have to read it out off a page um but that's what (56:45):
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Mike: we will be doing in this podcast I really hope everyone has enjoyed listening (56:49):
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Mike: to this and if you have please don't forget to, (56:52):
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Mike: subscribe or no yeah like it I do you like (56:56):
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Mike: podcasts whatever rate it give it five stars (56:59):
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Mike: if you like it if you don't like it just don't say anything that's it's it's (57:02):
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Mike: fine it's fine just not to say um but if you do like it tell us tell your friends (57:07):
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Mike: and uh keep in touch thanks for listening thanks. (57:13):
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Intro and Outro: For listening to this episode of sound living and we'll see you next time don't (57:21):
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Intro and Outro: forget to subscribe to the podcast and if you enjoyed this episode leave us (57:25):
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Intro and Outro: a review and make sure you share it to social media. (57:29):
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