Exploring Fitness and Longevity with Dr Chris Roughley and Dr Mark Gillett

Podcast Transcript

Mr Kash Akhtar:

Welcome to the latest edition of Exploring Health with Cleveland Clinic London. I'm your host Kash Akhtar, Consultant Orthopaedic Knee Surgeon, and today we're diving into a topic that affects us all. How to take control of your health, prevent problems before they arise and get fit in a way that reliably works. If you want to understand how early health screening and structured training can prevent disease, optimise movement and improve long term health and performance? Then this is the episode for you. We're bringing together two experts in this field to bridge the gap between early detection and proactive health management so that you can optimise your long term health.

Mr Kash Akhtar:

Joining me today at Dr Chris Roughley, General Practitioner here at Cleveland Clinic London. Chris is here to discuss the power of screening not just for detecting disease, but for optimising health and longevity. And Dr Mark Gillett, Consultant in Sports and Exercise Medicine and Chief Medical Officer for the Premier League. Mark works with elite athletes and executives to tailor training, recovery and movement strategies for success. So whether you're professional balancing work and health with no time to train, but you know you should be doing something or an athlete fine tuning your recovery or just someone looking to take control of their health and get started, we're going to give you the road map.

Mr Kash Akhtar:

So Chris, let's start with the basics. What is health screening? Why is it important and who should be considering it?

Dr Chris Roughley:

Hi, thank you. So I think fundamentally we should ask the question, what is screening?

Mr Kash Akhter:

Yeah

Dr Chris Roughley:

And that is looking for early signs, early risks early detection of medical problems because the sooner we find things the better the outcomes generally are going to be. So there are a number of ways that we can do this and we are using different modalities that bloods, physical examinations and imaging techniques all combined to look for these early risk factors and enable someone to like you say, take control and improve outcomes. At Cleveland Clinic London we offer a number of different screens. We offer an advanced health screen. This encompasses particularly a heart focused assessment, but is looking at multiple factors of the organs so kidneys, liver, lungs, heart, general physique examination from us. We're looking at nutrition, we're looking at mood. We're looking at your really trying to give a holistic approach to screening. We don't want it to be somewhere where you just pop in for a couple of tests. It is more in depth than that.

Mr Kash Akhtar:

That it's not just MRI, head to toe and off you go.

Dr Chris Roughley:

No, and that's not the way I think screening should be.

Mr Kash Akhtar:

Yeah.

Dr Chris Roughley:

You want to discover a problem, target those risk factors and have someone there to promote and support the change. Just popping in somewhere for a scan, it's not that helpful.

Mr Kash Akhtar:

And invariably they'll pick up something.

Dr Chris Roughley:

A lot of the time,

Mr Kash Akhtar:

Yeah.

Dr Chris Roughley:

And we should probably raise that as a point, there is a lot of talk out there of the negative impact of screening and that it does cause downward stream, additional testing that might not be relevant. However, my experience is quite the opposite, and when you have an expert looking at all those figures and you as a whole, we know what to do and what not to do, and I've only seen really successes in identifying serious problems early on and then supporting that person through to make better, better choices.

Mr Kash Akhtar:

So you mentioned this screening programmes at Cleveland you’ve mentioned the advanced health.

Dr Chris Roughley:

So that's their first phase, beyond that, we have the Executive Health Screen and a Women's Health Screen.

Mr Kash Akhtar:

OK,

Dr Chris Roughley:

The Women's Health screen is a relatively new package that we’ve offered primarily targeting women over the age of 45 with mammogram and hormone testing, as that's a real hot topic at the time.

Mr Kash Akhtar:

That’s also going to be our next podcast actually.

Dr Chris Rougley:

Yeah, yeah. I can believe it. So that's an Advanced Health package with those additional factors. And then we have the Executive Health Screen and that is a much larger programme of investigations. That is a real head to toe review of somebody, really really trying to target as much as we can to get those individuals in absolute pristine condition. They're often very high functioning individuals with very demanding jobs and little time, so we need to be in there, very clear on what we're doing and targeting as much as we can to get them absolutely firing on all cylinders.

Mr Kash Akhtar:

Right, because we because we know that the early detection of heart disease and cancers and various things can improve outcomes.

Dr Chris Roughley:

Phenomenally so, just this week I've had someone that I, fingers crossed, have absolutely stopped him having a heart attack. He had a very, very vulnerable blockage in his heart that he was unaware of, had no symptoms of, but was a ticking time bomb. And through our executive health screen we were able to very quickly identify that and within two weeks, he's clear.

Mr Kash Akhtar:

Which is a great example, the next question I had which is what do you what do you say when someone says I feel fine? I'm not worried about anything. Why should I get screened?

Dr Chris Roughley:

So some individuals head towards screening services because they just would like to get to know their body and get a baseline for where they're at. You don't have to have a problem to come for screening. There's many different reasons why people come but, you know, I'd put it out there, you know? Would you like to know what's going in your body? Do you want to know what's happening to your heart? I think if you asked everyone on the street. People would love screening, they'd love to understand themselves better, and we're here to just support that.

Mr Kash Akhtar:

And I guess some of the challenges of screening on a national level are predominantly health economic arguments, but I guess we're quite privileged where we are that actually that's not so much a challenge and you can actually get the test and do the things that you want to do.

Dr Chris Roughley:

I think we are still thoughtful and mindful of what we are investigating. We don't check for everything we should do it in a considered approach, but yes, we have the most amazing facilities and resources and the teams. One of Cleveland's I think unique selling points is the fact that we are a team of teams and I find it a real privilege working where I am able to just cross a corridor and speak to an orthopaedic surgeon, to cross the other corridor and have a chat with the cardiologist, and we discuss our patients and we share feedback in real time. That makes screening amazing for me because I pick something small up, I'm not quite sure what's going on, I'll find out in 15 minutes.

Mr Kash Akhtar:

Yeah,

Dr Chris Roughley:

Because those resources are there. It's not somewhere you just rock up, have a few tests and go home, and you might get a paper report that that's not.

Mr Kash Akhtar:

Yeah.

Dr Chris Roughley:

That’s not really the Cleveland Clinic way.

Mr Kash Akhtar:

I'm going to have to clip this bit where you said it's a real privilege to talk to an orthopaedic surgeon.

Dr Mark Gillett:

I’ll have to disagree with you there Chris.

Mr Kash Akhtar:

And that, and it's interesting because now we're, medicine historically has been reactive. And now we're moving towards this almost proactive approach. I was talking to mark the other day, I was reading Peter Attia’s new book, outlive. He talks about medicine 3.0. Medicine 2.0 was kind of you've got an infection? Here's an antibiotic. you've got an issue with your knee? Here's a knee replacement. But now we're moving very much towards preventative medicine and so we are, things are really beginning to change. So Mark, Chris has talked about identifying risks early, but once we have that information, what do they actually, what should they do with it?

Dr Mark Gillett:

I mean, I think there’s two broad categories that you need to consider. One is identifying your risk factors for chronic disease, it's clearly a priority and you know we’ve spoken about screening so for a man that might be prostate, for a lady, it might be breast. You know, all those typical things that we look for. And then I think my job and the way we're moving on, we get to take it to another dimension is how do we get to perform better? So my job as a Sports and Exercise Medicine Specialist, I think you know we should replace the exercise bit with performance because you know there's a lot of things in terms of the way people function. Both you know, physically, psychologically, nutritionally, that we can optimise and make people feel better.

Mr Kash Akhtar:

Now if we look at how to kind of take the bridge from screening towards you know your action. Say you've got a 40 year old executive who's found to be hypertensive. How? What's your approach for that?

Dr Mark Gillett:

Well, I mean, I think medically, what's the immediate risk of the hypertension? So you know, is it immediate risk of a complication of hypertension, in which case you probably needs to see somebody who deals with that as part of their core medicine. And my job is then you know, so what, what's your lifestyle like? What do you want to do? Where do you want to go? So once the medication's been brought under control I’ll add thing in terms of your lifestyle, I’ll add things in terms of your exercise habits, I’ll add things in terms of nutrition, I’ll add things in terms of your stress, all that we can factor into, you know, really developing and performance solution for you.

Mr Kash Akhtar:

One of the challenges now we see so much conflicting fitness advice,

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

Particularly on social media,

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

You go on Instagram it it's mad.

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

What are the biggest mistakes people make when they're trying to get fit?

Dr Mark Gillett:

I've had this conversation a few times today, so you know I've been a Doctor for a while now. You know, you and I both know how long that's been and I’m probably not going to broadcast that on the podcast. But you know, when I started in Sports Medicine I had people who were sedentary coming to say, I want to run a marathon and now they come in and say I want to do an Ironman. Sort of, well, well, well, why? Why? Why do you need to do that? So you know, why don't you give yourself some staged targets which you can maintain and you can progress over a period of time so people give themselves a schedule which they can't possibly maintain. You know, a lifestyle they can't possibly sustain, and they end up falling off a very steep cliff and going back to where they were.

Mr Kash Akhtar:

And that's without overuse injuries, tendinopathies,

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

Stress fractures, you know, the rest, muscle issues the rest of it.

Dr Mark Gillett:

Yeah, I think possibly to a degree but I mean, I think the major problem is you're, you know, you're writing a cheque which you can't continue to cash. So if you're going to the gym two hours a day, five days a week, you know you're not going to sustain that.

Mr Kash Akhtar:

Hmm, you can’t no. Do you have any examples of common fitness myths that actually cause harm?

Dr Mark Gillett:

Yes. I think so poor advice is very easy to find. I think the problem with medicine is up until now, the advice people get about exercise has been binary. So, if you got a bad knee, don't run. You know, if you got a bad back, don't squat. Well, actually run in a way that doesn't upset your knees and squat in a way in which your back and tolerates. So, you know I think there's always a way, you know, I always like to think about rather than most patients I see have been told what I can't do, my job is to tell them what they can do and then build from there

Dr Chris Roughley:

I say it almost to every patient I have, it’s this word sustainable? It has to be a sustainable change so that someone will engage with it forevermore.

Mr Kash Akhtar:

Yeah,

Dr Chris Roughley:

That they will see continued improvement and gain from. If you do a fad, any fad, whether it's backed by science or not, if it's a trend thing, it's not going to last. I don't think it's got to convert to that sustainability.

Mr Kash Akhtar:

And we see it every January 1st, don't we? The people that are hitting the gym with the new fitness regime that doesn't last beyond a couple of weeks. And it’s interesting we talk about, you know, as a knee surgeon, the thing I hear other knee surgeons say is don't run it's bad for your knees. And yet there's so much value physically, physiologically, mentally, from running and I always say to people, if you want to run, run but let's find a way that you can do it and it's about appropriate load management, isn't it? I say, your load normal load management is here, you've got a cartilage issue, you've lost some meniscus. Your load is now down here.

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

So what's that envelope of function? Well, maybe you can run 5K once or twice a week, but again, beyond that is a bit too much. You get pain and swelling, your body tells you it's too much, just dial it down. Work with that envelope and with your strength advice, the conditioning that can go up a little bit.

Dr Mark Gillett:

Yeah, I think you know, so it's got to be some level of compromise and acceptance from those patients, a common sort of question I have or common discussion I have with runners is don't run long and slow. So it's really easy if you're a runner, just get into a lazy training programme where you come home from work, what do you do? You know, run for 30 minutes and the problem with that is that if you've got a lower limb injury, the slower you run, the longer your foot is in contact with the ground, the greater the contact force is, the greater the load on your body, the greater the toll, the greater the recovery time, all those things. So if you want to run initially run fast and run short and run those intervals and then build from there.

Mr Kash Akhtar:

Hmm.

Dr Mark Gillett:

So and that's difficult for a runner, so, suddenly a marathon runner you know is used to a high volume programme that's ,you know, that's compromise and that's how you you sort of build a training programme that really works for them.

Dr Chris Roughley:

And I think one thing that I have noticed in kind of our collaborative working is that Mark is great at all sports, you are an all sports guy and you are able to really ascertain that individuals needs and have the most amazing connections of supporting that person and finding the right trainers etcetera that really match them. And I can really see that and then the benefit my side of a happy GP patient.

Mr Kash Akhtar:

And as you say Mark, it goes so much beyond that doesn’t it. For runners, you want to make sure they've got appropriate footwear, that they are... the biggest failure I see, or the biggest challenges for runners, is they don't do any strength and condition, they just run and then they'll end up with gluteal weakness, resulting in ITB syndrome or something like that.

Dr Mark Gillett:

Yeah. So two major problems generally with endurance athletes, one is you're right, conditioning work is the first to go. Secondly, they have what we call a poorly periodised programme, it's not enough variety and there's not enough recovery time, so they tend to do same thing time after time and that's what leads to injury. So things like a heart rate monitor really, really, useful. So you're working in a different training zones, you're stimulating the different parts of your cardio vascular system and you're really developing your fitness and I think it's very easy, just… a training programme by definition must be progressive so it's very easy to do same thing and all that will do is you won't get any fitter and you'll end up getting injured.

Mr Kash Akhtar:

So if we talk about how to go from screening results to an effective training programme, what should they prioritise?

Dr Mark Gillett:

So I think the biggest change in Sports Medicine, Exercise Medicine and in my time of being involved in it, has been the understanding now that maintaining muscle mass as you get older is really vital to aging well,

Mr Kash Akhtar:

And the key to living longer.

Dr Mark Gillett:

Yeah, absolutely and we all want to do that. So making sure that you have a strength stimulus in whatever you do, it's really, really important.

Mr Kash Akhtar:

OK and you mentioned periodisation. Can you explain that for me? Because I don't quite understand it.

Dr Mark Gillett:

Right, so periodisation means, so different zones of training, so there's obviously the lower zone, zone one and two work, where you know your heart isn't working particularly hard and then three and four which is, you know, you're sort of general zone where people are trying a little bit harder and that's you know probably what people would do when they come for a comfortable jog. And then you go above that to zones five and six which are at threshold and VO2 Max which are at the higher end of your physiology and really you’ve got to stimulate all parts of that spectrum to fitter.

Mr Kash Akhtar:

And I guess there comes a point in where form is key as well for a lot of things, right movement,

Dr Mark Gillett:

Technique.

Mr Kash Akhtar:

Yeah technique.

Dr Mark Gillett:

So we know that, you know, so the low compromise but is, low compromise discussion is a really useful one and a really, sometimes quite difficult to get across the patients. So if you're a bad mover, you're mechanically inefficient and it's going to take a lot less load to get you injured. So part of the buy in in a rehab programme is to make you more mechanically efficient so you can absorb more load, you can train more and get fitter. So that's the investment you're asking patients for.

Mr Kash Akhtar:

Right and say you've got someone who's now starting out the, I think the reflex a lot of people is to just get a pair of trainers and start running or join a gym and just go for it. So how would you advise someone to start training from scratch?

Dr Mark Gillett:

Well, there's nothing wrong with that. So I think you don't want to, you don't want to be a killjoy and damping everybody's enthusiasm, so, you know, find something you love, find something that you enjoy. And so, I always say to people, particularly when they're full of vigour and you know, they really want to make the change. Imagine the busiest week in your life. Imagine your busiest week at work, your busiest week at home. Some bottom line you can't drop below. So what's your bottom line for your either your rehab for strength stimulus or for your fitness to get fitter? And probably it's about 15 minutes three times a week. About that type of time period. So if you can do that, you can start with that, you can get fitter and you can get healthier.

Mr Kash Akhtar:

I think if you start from scratch, there's huge value in working with a strength and conditioning, coach or personal trainer to guide you to show the correct exercises, perhaps to create a programme for you.

Dr Mark Gillett:

Yeah, yeah. I use a strength coach once a week on a Friday and it's great. I don't have to think. He tells me what to do, you know, it's a very efficient way of using an hour. It's relatively expensive. But you know, it's a very, very good tool if you, that's something that your mean can stretch to.

Mr Kash Akhtar:

Yeah. And I would say there's lots more online apps and programmes now that seem well structured. It is interesting because having accountability, is huge, isn't it? For when it comes to sustainability? So having a training partner, I started working with an online strength and conditioning coach a few months ago and honestly he intimidates me slightly, so it's kept me accountable and it's meant that I kept doing it because I know someone's going to be asking me and checking on me. It's only been a few months, but you know you don't get a body like this overnight. So there's huge value in that.

Dr Chris Roughley:

Yeah but I actually think even taking a step before then, that actually on the Exec Health screening programme that we offer, we're doing that. We're your initial performance coach and I am holding patients accountable and I am saying to them, you know, you've invested well in this screen. I am here for you. This can be an amazing partnership and I will help you get from A to B but I need you to be committed and you know, if you're interested, I will give you my time and I will find the best people for you, etcetera, we’ll work out where to start and I'm seeing the whole breadth of absolute peak fitness people already that really need athletic Olympic guidance and I'm seeing people that are ready to start couch to 5K. Yeah. And it is, you're trying to find the right fit for them, the right step for them, the sustainable step for them but we'll start that partnership here.

Mr Kash Akhtar:

Yeah an get the ball rolling. Can I ask about, for both of you, diet and nutrition? Because that's a thing that it's not really taught in medical school and yet it's vital, isn't it? You can't out train a bad diet. So do you have any rules, any pointers, any kind of go to’s for when it comes to diet and nutrition?

Dr Mark Gillett:

So this is probably controversial, but one thing I find frustrating is the adage that people stick to meals. So I think if, so, I always explain to patients, I always say to them look, learn to eat when you're hungry, not when society tells you should, and I think if you can, you can learn that and there are ways of learning it, and there are ways of introducing it. Intermittent fasting is a great one. You know you can really inform people about how that really works, but I think you know there's a lot, again, there's a lot of bad advice out there. You’ve got to have breakfast? Well, why? You know, it's much more helpful if you don't eat for 8 hours a day and you know that insulin sensitivity and all that type of thing that we look at. There's a lot of ways where you can really, you know, develop that sort of intuition.

Mr Kash Akhtar:

I think the thing that's really come to the fore. I've been doing it for the last kind of 8-9 months.

Dr Mark Gillett:

Oh I hadn’t noticed.

Mr Kash Akhtar:

Yeah, I don't like to talk about it, but it's been and I perhaps I've gone a bit further, but the challenge, I think the thing that's interesting is that rather than eating because it's, as you say, because it's lunchtime. And this is something that you don't, you’re not particularly hungry or eating just because you think you should. If you're not hungry, you're not or you're, you know, and with our work schedules, there isn't time to perhaps have something healthy and rather than just eat a sandwich and a pack of crisps and a coke can and a Mars bar, it's almost better just to keep going, have a black coffee. And I’m not saying that works for everyone, this is not medical advice for everyone, but I'm saying for certain people and certain lifestyles and certain mindsets, I think it really works.

Dr Chris Roughley:

Yeah, I think that's what's good in getting to know a patient. Number one is what's their schedule, what will fit in with their scope. What can you adjust in an agreement together? The exec health programme comes with a 30 minute nutritional appointment, so you're going to get dietician support from us anyway from the doctor as well, but there's additional support there available automatically, which is great. I work quite closely with them and because it's such a massive area and there's so much chat and you know I can't help but scroll on Instagram sometimes and I'm, it is, what do you trust? I intermittent fast as well, a little bit, I can't help it at weekends, I’ve got to break it sometimes, but I do think that's helpful. Little bits that I like about nutrition is one, what you're breaking your fast with? I think it's makes such a difference if you start healthy, if you get the right ingredients there, that definitely for me means that I make better selections throughout my day. I'm far less likely to snack on bad things if I've started right and.

Mr Kash Akhtar:

And if you've planned meals, I guess in advance as well.

Dr Chris Roughley:

Yeah and there's a lot to be said for prepping to try and fit in those healthy bits in the day and I do argue that healthy foods don't take ages to make. That bowl of yoghurt and seeds and fruit take me 90 seconds to make in the morning. You know, it's not hard, I think, to start right and even that's step that can be step one with a patient. Just that one.

Mr Kash Akhtar:

Making decisions in advance rather than on the hoof means that you can really be well prepared.

Dr Chris Roughley:

But even if you start right when you're then on a hoof  later on, yeah, you're more likely to make the right choice then as well. So you've actually then won twice in your day and you can feel good about that. And the other thing that I like is when you go to eat, is that going to, one really make you happy? Are you going to feel guilty after it? You're going to feel bad for having it. Will that really help you? And if you can take that 10 seconds to think about it, you'll probably make smarter choices and it's those little steps that get you into thinking in a healthier way.

Mr Kash Akhtar:

And it could be that if you're talking in a fasting, but you don't have to get breakfast, it might be that you have breakfast and lunch and you skip dinner. There's different ways to make it work

Dr Mark Gillett:

Whatever works for you.

Mr Kash Akhtar:

So we talked, you know, about weight management. I think one of the challenges of managing weight, it's a problem worldwide community wide and so we touched on intermittent fasting other things that have been quite prominent have been things like the five-two diet. Do you ever discuss that with patients? Is that thing that comes up with you?

Dr Chris Roughley:

I don't. I think that one kind of died down a little bit in terms of trends. I think it's more intermittent fasting, that's popular. I think the thing is to get the patient on board with their weight. What would they like to do, first of all? Because they might be happy with their weight. But I think when we've done all the screening and you can put together the body composition testing.

Mr Kash Akhtar:

Yeah. Tell me about the body commission testing. Sorry to interrupt there.

Dr Chris Roughley:

So we have a machine it’s called seca. Very simple thing. You stand on it, you put your hands on the side of a rail and it gives you a load of data. We're looking at BMI, fat mass percentage, skeletal muscle mass, amongst many other factors. Visceral adipose tissue. It gives you something called a true score at the end, which can be a helpful marker. A true score is looking at same age, sex and height of an individual and a hundred is kind of your go to average figure that you want to reach to be healthy. So you've got a marker there of. Am I under average? Am I above average? And you know, if people come back for regular screens, that's quite a nice marker for them to see where they’re improving. I'm really interested in the fat mass percentage and the skeletal muscle mass, and really the skeletal muscle mass probably because like Mark has said. And you have said. Muscle strength. Longevity. It's there. If you've got good thighs. You're living well. Yeah, it's thigh muscle mass is.

Mr Kash Akhtar:

Yeah, is thigh muscle mass the?

Dr Chris Roughley:

Yeah there's good data for it yes. So I find that really interesting and I think when the patient can sit down and go OK, like I know I've been overweight for a little while, but now you've just presented to me that I'm 48% fat.

Mr Kash Akhtar:

Yeah,

Dr Chris Roughley:

It's quite powerful I think part of it is knowing what normal range is, so for some females over 30% of fat mass is normal and that's OK and you know, they might be panicking that they're really overweight. I'm like, no, no, you you're actually healthy but your skeletal muscle mass could do some work. So yeah, it I find the seca body composition a really helpful tool in screening

Mr Kash Akhtar:

I wanna have a go at that. Sounds really quite interesting. And you've got experience with these new GLP1 agonists, the Ozempic’s picks, the Wegovi, the Mounjaro. What's your, tell me about those?

Dr Chris Roughley:

So these are medications that are making you feel fuller so that you are less likely to eat, so it's helping you essentially with a degree of portion control. Now I think they have a place. I'm not issuing a lot of it. I'm really trying to get people to have a real good grasp of their diet, of their exercise and work on some good plans to make positive body changes

Mr Kash Akhtar:

Sustainable ones.

Dr Chris Roughley:

And what we see, the data is out there at the moment that when you are on things like Ozempic, when you stop that weights going back on unless you've really made those sustainable life choices and you're less likely to engage with those life choices. If you've seen me and got a script rather than worked with me in partnership so I'm looking for the partnerships.

Mr Kash Akhtar:

So you see it so differently cause a lot of people think that these new drugs are going to be revolutionary and will, you know, beat the obesity crisis.

Dr Chris Roughley:

Like I say, they have a role. I think they will be really important for some demographics of people and what we don't know fully is long term use. Is it OK to use them for a decade? Is it safe just for two years? That's the kind of stuff that we're not there yet, but it's become very popular very fast. So we need to be mindful. I'm not saying that we should not be using these at all, we just need to be mindful and it's about getting the right expert to help you.

Mr Kash Akhtar:

With that, yeah.

Dr Mark Gillett:

I think you know, so I see certain patients whereby, back pain is a great example, whereby you'll put them in an MRI scanner, no sciatica, so then we know that injections don't work so well and they're you know 140 kilos. That's always difficult because there's no medical intervention really that will affect their further outcomes more than weight loss. So I think, you know, there is, it's very definitely a time and a place where a patients body mass is almost at such an overwhelming risk factor that the Mounjaro, Wegovi all those drugs you know, and that's where I see their real value.

Dr Chris Roughley:

And they can really start someone off on a great path. I just think they need that additional support alongside to sustain the change.

Mr Kash Akhtar:

Yeah, no, we recorded the podcast in here on exactly that and as you say, you need that wrap around care as well because you need the psychological, the dietician support some physical support, you know, for exercise. And if it's just have these injections and then wean off once you get to goal, that's never going to last.

Dr Chris Roughley:

No absolutely.

Mr Kash Akhtar:

Mark mentioned strength training is a key pillar of health. Do you see that reflected in screening outcomes?

Dr Chris Roughley:

Yes, it's probably the simple answer, definitely the people on the body compositions that are hitting the good goals in skeletal muscle mass, that's achieved through weight lifting I think and some really good exercise. And you are seeing those people have strong true scores. I think that's a bigger positive indicator for it in being a strong level And you can see it where someone is weak, you are more vulnerable to not getting over illnesses as quickly to being more likely to fall and cause a bigger injury. You see it as people get older, they get increasingly less active and it's a bad, vicious cycle. There should be some programme out there just making everyone do squats really.

Dr Mark Gillett:

I'm slightly obsessed with squats, which we'll come on to in a minute.

Mr Kash Akhtar:

I don't think, he can't reach you under the table to kick you. And Chris, not everyone may be familiar with the term metabolic health and yet that is a thing, you would think that people who are fitter, stronger, more active, would as a result have better dietary choices, better health and better metabolic health? What is metabolic health?

Dr Chris Roughley:

It's a kind of all-encompassing term for cardiovascular and hormonal kind of health. So we frequently see, this, what we call a metabolic syndrome and it's a person with high fats in their blood, extra fat around their tummy, high blood pressure. It all starts kind of again a bit of a vicious cycle of multiple comorbidities, multiple illnesses that will steadily cause harm to the body, and if you can really tackle that weight. Ideally you start to see all those things improve and with tackling weight you improving diet, exercise all those things that will help it improve.

Mr Kash Akhtar:

Because people you hear people about the inflammatory syndrome and people being in it, it being metabolic syndrome being inflammatory and so is it fair to assume that the people have that more risk of getting heart disease, diabetes, cancers?

Dr Chris Roughley:

That will all interlink or sure, we know that if you've got extra fat around your tummy, it's increasing your diabetes risk. It's increasing your cancer risk, it's going to increase your musculoskeletal problems. There's more strain on your heart. It does all interlink and I think it's more than inflammatory. There's so many asks effects to it, you know, even touching in with hormones being affected. This is where the screening I think is so good because it doesn't just focus on one little bit. It's got all of it. And I think there's even more that we can do even. I'm starting to really think about testosterone in men because that feeds into that metabolic syndrome to a degree. There's lots of interlinking cogs into what's happening as we age and I think if we don't take stock, take a baseline, make a plan. Holistically moving forward, you're going to end up with some health problems.

Mr Kash Akhtar:

I mean, there's so many factors at play that go far beyond just, you know, you've got diabetes. Here, have some metformin. You know, as you say, there's and now diabetes, certain type diabetes can be treated reversed with weight, weight management, can't they? It's where a lot of the GLP 1 agonists came in the first place.

Dr Chris Roughley:

There's some very interesting, very simple programmes out there that people can follow. I can recommend books and things.

Mr Kash Akhtar:

Tell us.

Dr Chris Roughley:

So there’s a book called Post Diabetes and the gentleman that wrote that Eric Edmeades I might of pronounced that incorrectly. He's got a very clear programme to get you into normal blood sugars. It has just not been endorsed by the right people.

Dr Mark Gillett:

It just amazes me that it hasn't come into common place sale yet I do find that frustrating in that you know, so when you and I are out sometimes you’ll come across a patient who will be on fifteen medications. You know you go and see somebody and every problem led to another prescription. Now with diabetes, if you've got type two diabetes and you're obese, or you got a high BMI and you reduce that BMI, surely you've got to re-evaluate the medications you're on. I mean, that's common sense. I just don't think that we're progressive enough in the way that we do that.

Mr Kash Akhtar:

Mark, I want to talk about how to create long term sustainable change. I think most people know what they should do but struggle to follow through. So what's the key to making lasting changes?

Dr Mark Gillett:

We've touched on it already, so small impactful changes and building from there. So you know start small, start with something that's achievable. Don't set yourself up to fail, set yourself up to succeed so you know. So if you're somebody who's entirely sedentary and you want to think about, you know, how you begin to exercise, just 15 minutes couple of times a week just walking, getting into that habit, making sure that you do it every day regardless, or you know every time you're scheduled to do it. Rather than finding something else to do and starting that meaningful habit change, I think that's really, really important. You’re almost making a contract with yourself whereby you agree to do that and you build from there. You know, I had a quite a almost, so, you know intuitively, a football doctor, a Sports and Exercise Medicine doctor, you know, somebody who wants to lose weight sometimes intuitively they think you know you're the last person I want to speak to. But actually, if you want to make that commitment and you want to change, I'm exactly the type of doctor you want to speak to because you know I think we're very respectful of people who make that commitment to themselves and we've got expertise to really support them into doing it. I had one who came to see me about back pain and it's all, you know, I do appreciate the honesty and the candour a patient you know has to admit to you when they say look you know I know I'm overweight and that's a really big admission for a patient.

Mr Kash Akhtar:

It's a difficult conversation.

Dr Mark Gillett:

Yeah it is, you know again, just you know, supporting them. You know, this guy was a chef, you know lost a lot of, gained a lot of weight, had an injury and we were just able to give it some simple stepwise progressions where we can and be healthy and happy. And I think that's really important.

Dr Chris Roughley:

Yeah, I think from liaising with the dieticians, I really like their small step of saying every time you go to the supermarket, buy one thing you didn't have last week, just pick one different veg, one different fruit and that will just automatically make your gut happier. You know, give that give that variety coming in and I'm like that's such a simple thing to do. I think even in my own life, I've tried to do that simple small step. I now add seeds, you know to something? It’s a small step

Mr Kash Akhtar:

Chia seeds

Dr Chris Roughley:

But psychologically, I'm feeling happier with myself because I've made a step and I'm feeling better for it. I think I'm doing something with my health. I'm now more likely to make the next step, and I think that you just need someone alongside you to support that.

Mr Kash Akhtar:

Yeah, so small changes that are realistic. I've just bought a treadmill.

Dr Mark Gillett:

Yeah, sounds like a pretty big change.

Mr Kash Akhtar:

I’ve never run

Dr Mark Gillett:

Oh right

Dr Chris Roughley:

So you’re the bad patient

Mr Kash Akhtar:

Yeah. So my goal, yeah, so my goal, I shouldn't aim to run 5 marathons in five continents this year?

Dr  Mark Gillett:

I’d rather you didn’t no

Mr Kash Akhtar:

I’d fall apart

Dr Chris Roughley:

But if you do go and see Mark,

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

Yeah.

Dr Mark Gillett:

He’ll be needing to see himself didn't see himself.

Mr Kash Akhtar:

And I think one of the challenges is that many issues. So we talked about screening, but a lot of issues aren't visible on scans.

Dr Mark Gillett:

No, you’ll know this in that people put a lot of emphasis on scans. So, if you have a normal scan and you've got pain, doesn't mean you don't have pain it just means it's not for a structural reason you can’t see on the scam. So you've got to explain that to the patient and you've got to have a strategy whereby that, scan positive scan negative and you can solve either way, but they’re not the be all and end all of those things and I think good doctors know that and we have good doctors in Cleveland. So, I think you know there are very, very few cases where scans are treated rather patients.

Mr Kash Akhtar:

And I must say I've had a couple of consultations today like that. One of them is a colleague of ours where there’s pain and the scans are essentially normal or under remarkable, the challenge is that the quality of the scans is so high and the radiologists are so good that we pick up things and our job is to go well that don't worry about it, that is in the different place. You don't have, you're not symptomatic of a meniscus, you got a meniscus tear, but you're not here because of your meniscus tear, don't worry about it. And I think that that that's a skill and a challenge to try and do that and at least once or twice, every clinic I will say whatever pain you've had, you've caused no lasting damage on your MRI. There's no lasting damage in your knee. Your knee is not fragile, your knee is robust, your knee is strong, but we need to put in things into place to help manage your symptoms so you don't get this discomfort, this pain that a certain amount of time of your run. And that's where then I need help from people like you, from physiotherapy, from other people who are better placed than they do than me.

Dr Mark Gillett:

So I think the best example of that is probably a labral tear of the hip now in some people, so you know, the labral is a part of it which gives it more structural integrity.

Mr Kash Akhtar:

Almost like a, the meniscus of the of hip

Dr Mark Gillett:

Yeah, exactly that so I use that analogy all the time. Now a labral tear, it can be an observation and it usually is. So, it's a mechanical observation that you've got this on your scan and that probably explains why your hip’s a little stiff. Sometimes it’ll give me a diagnosis now probably in my practise 90 to 95% of the time it's observation, 10% of the time it's a diagnosis. So you know you've got to inform… I'm one of those people you probably remember years ago where doctors would judge on how few MRI scans you did. Now I don't subscribe. I think the MRI provides you with useful information mostly, but you've got to be able to describe it accurately and you've got to be able to explain its place and its relevance to the patient so that they, you know, they’re left in no doubt, you know what that means.

Mr Kash Akhtar:

Yes because virtually every MRI scan on anyone who does sport shows a bit of…

Dr Mark Gillett:

Of course

Mr Kash Akhtar:

Shows a bit of inflammation deep to the IT band, a bit of lipedema with an office fat pad and it's very much, you know, interpreting it as you say.

Dr Mark Gillett:

Well, so the best example, I’ve probably told you this before if you do a football medical on a Premier League player, you know if you've got a normal lateral ligament of your ankle and sometimes you used to wonder what you've been doing in your football career because I think I've only seen that once out of, you know, a hundred times.

Mr Kash Akhtar:

Yeah, Chris, you know, when you give patients some health advice, what do you think separates those who go on and benefit from it and succeed and those who don't?

Dr Chris Roughley:

I think where they're at mentally, are they in a place for change? And I think part of my role is working that out and not always forcing them into that, you know preparing them, but facilitating them to be in a place where they're willing to make a change. I think there will be people that come and see us that just want the scans, because those people exist in the world but I think when you have an experience at Cleveland Clinic, it's a good one and you see the benefit and then you can show how bringing on another expert, you know, or making a change will positively impact you. I think part of the skill is getting on the right level of that patient and every patient is different, but that that's kind of a GP's skill it's you know we see so many different varieties of people with so many different problems getting on their level and making them see, helping them see the best way forward. That's what I'm here for.

Mr Kash Akhtar:

Great, Mark, there's now wealth of data information available. Can we just talk about trackers? Because you see people with Garmins, with Whoops, I see people with continuous blood glucose monitoring who are not diabetic? Talk, tell me about these

Dr Mark Gillett:

So we've been talking about that all day today. So look, I mean I think the way that I look at it now is, that bearing in mind, so you know I was privileged enough to work full time in premier league football for a decade so pretty much every metric going is monitored.

Mr Kash Akhtar:

In those bra tops.

Dr Mark Gillett:

Yes yes, in those in those GPS tops, other ways and trackers, whatever. So it's every bit of data that you can imagine, and now we're all coming into an age where we're talking about data burden. So you know the sheer volume of data you're giving these young people is overloading them and you know every week is another metric. Now if you wind that forward to the type of patients that we, you know, we enjoy seeing at Cleveland it's not dissimilar in that you've got to pick the metrics which are relevant to them, agree you know, how you want to manage to them, how you want to improve them and not overload them. And the example I always use is, so I like to get on a bik and the number of times you meet people for their, for your sort of coffee before a ride. How are you this morning? I'm not too good, I'm not good at all, Why is that? Well, I've just looked at my Whoop and my Whoop has said I've slept really badly and I felt right when I got up but I've looked at the Whoop and it says that, you know, my REM sleep is down and now I’ve started feeling really really tired. So I do think again, you know that it's, you know, really choosing what's important to you and not overloading yourself with data and using data to inform your life rather than leader.

Mr Kash Akhtar:

So it's funny, I've got a tan line here where I used to have a Whoop

Dr Mark Gillett:

I’m not surprised

Mr Kash Akhtar:

And I've just returned it

Dr Mark Gillett:

Have you?

Mr Kash Akhtar:

And it's slightly controversial because it is kind of the thing to have and yet, you know, I've got four degrees, I'm not stupid, but I couldn't read it. I struggled to interpret the data and there's a wealth of data and you know, some of it is so fine that it's really hard to understand even as a doctor and then, and as you say, it tells me I slept badly. I know I slept badly

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

So that data is, I think there's value in it for some people, but I think it's really quite overwhelming. Are there any trackers that you recommend? I mean, are you against them?

Dr Mark Gillett:

No, not at all, I'd say so data quality is really important. So, one thing I think is really important, so a resting heart rate is really, really important. Now personally, I think it's very difficult to get an accurate resting heart rate from a watch. You get a much better quality from a chest strap, and I think that's one thing I would say because knowing what your resting heart rate is, is really, really important. So it's important for two major reasons. One is going back to those training zones so you'll probably calculate your training zones from your resting heart rate and your heart rate maximum, so knowing both of those accurately is important. Secondly, again, going back to all those years where I was looking after, you know, athletes, there's no doubt that the most sensitive way of detecting whether somebody either an athlete or anybody is feeling over fatigued or not recovering or moving towards an infective illness is when you have an increase in resting heart rate. So even two or three beats per minute can be really significant, and so managing and measuring that really accurately I think is really key.

Mr Kash Akhtar:

And it's interesting, a cardiologist once told me that across multiple species, the one, a major predictor of how long you live is your resting heart rate not just in humans.

Dr Chris Roughley:

I think my view on data and trackers and things is you should be thinking about what you'd like to know, and then pick your item after that. You shouldn't just be picking a tracker and then your left confused about what you've got. I think it's, it should be the other way round a little bit

Mr Kash Akhtar:

So tell me about, you'll have experience with continuous glucose monitors, the Zoes and things like that you must see patients who have them.

Dr Chris Roughley:

Yes, but not that many and you only use the monitoring for a little while I think if you do so I have definitely had patients that have done the programme. I think it is interesting.

Dr Mark Gillett:

Yeah

Dr Chris Roughlet:

They are trying to get some data so I think we should wait and listen and learn. I don't know that we all need to be jumping in there at all, you know, we know that if we're going to eat some food, your sugar's going to go up and then it's going to go down. I think you can listen to your body and know that bread makes you feel sleepy. Do you need a glucose monitor to tell you that? There might be some nuances to your learning and things but you might be able to do that from a food diary and just how you feel. And I think it's like you were saying about the tracker in your sleep, listen to your body, you know, and be guided by that. There's a lot to be said for the body's not stupid. A lot of the time.

Dr Mark Gillett:

I'm not saying that trackers, all data is, you know, I definitely do support. Just be choosy about what you want the tracker to measure.

Mr Kash Akhtar:

Yeah, I think the challenge is that we are, there's so many options now that there is a there's an avalanche of data and there are so many trackers, there’s so many different types out there now that I think a lot of people can easily lose sight of it. And in this day and age, I think we're looking more and more for quantification, for things that certainly my mind.

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

Mark, let's talk about sports medicine. In sports medicine, recovery is huge.

Dr Mark Gillett:

Yeah

Mr Kash Akhtar:

But in general health, people don’t, we don't really, it's often ignored. Tell me, let's talk about that.

Dr Mark Gillett:

That's probably so, the two biggest reasons why I see athletes with injuries, so we're talking about, so we're talking about people who come to see me because they've got an exercise induced injury. Generally poor periodisation, which we touched on or inadequate recovery and again basic principles are getting fitter, stimulate body, you have a super compensation, a super response, and then you've got to allow your body to recover so that you can go again. Now if you keep training at the peak of that curve, then you're going to introduce yourself so our recovery, active recovery is really, really important. So I battle with players for for many, many years, so it can be easy to recover if you're lying flat on your back and you've got a masseur and your lying on a beach. You know, what's that but actually the value is, the value of recovery is very simple so nutrition, sleep, hydration and flexibility and doing something active the following day, so active recovery, which means that you're taking responsibility of your recovery is absolutely key.

Mr Kash Akhtar:

And you know, whenever you see players on TV and things now, you see them a lot in cold plunges.

Dr Mark Gillett:

Yeah, yeah.

Mr Kash Akhtar:

Do you have any what? What are your thoughts on coal plunges? It's not thing, I hate the cold so? .

Dr Mark Gillett:

There's definitely, there's definitely advantages to them. So cold water immersion, if you look at that, the evidence base is probably not as, is not a nice level, but there's no doubt there is some evidence and evidence in athletic individuals that cold water immersion can improve your recovery.

Mr Kash Akhtar:

Because often you see in social media so many people as part of their morning routine, they're doing like a 2-3 minute cold plunge.

Dr Mark Gillett:

Yeah, yeah.

Mr Kash Akhtar:

In an ice bath.

Dr Chris Roughley:

I think there’s, again I'm not sure on the amazing scientific level of the evidence, but evidence of definite mental health benefits for cold plunging. I think my understanding was there's less for the musculoskeletal recovery aspect of it and that actually almost warms.

Dr Mark Gillett:

Yeah, yeah.

Dr Chris Roughley:

Potentially better.

Mr Kash Akhtar:

Yeah, and Peter Attia was talking about how, you know, he's kind of one of the world experts you know on health and wellness, was talking about how there's really strong evidence now for saunas. It's not a thing I do, but I think I should start. But there's real strong evidence that that is very well linked to wellness.

Dr Chris Roughley:

Yeah. Reduced dementia risk, things like that. Yeah, I think it's three times a week or 15 minutes.

Dr Mark Gillett:

Yeah.

Dr Chris Roughley:

I think it's the programme,

Dr Mark Gillett:

Did you do that?

Dr Chris Roughley:

I don't have my own sauna, I'm debating it, but if I go to the gym and it's got a sauna I'm, I will be in now.

Mr Kash Akhtar:

You’re in there?

Dr Chris Roughley:

I will be in there but I like the warmth.

Mr Kash Akhtar:

Me too

Dr Chris Roughley:

But I will cold plunge too.

Mr Kash Akhtar:

1. Yeah no I stay clear of that, I come from tropical climate.

Dr Chris Rouhgley:

I think the bit that I like about it and that I take from it is about mental clarity and coping with a stressful situation. So I know when I do it I visualise, so I'm practising my visualisation kind of mindfulness and then when you are in a stressful position, elsewhere at work, etcetera, you should find it easier to be in control and manage that situation, and I do think that has a little element to it.

Dr Mark Gillett:

It I might, I might that so when I'm in cold water immersion I'm normally swearing. Which would inform the way I respond at work.

Mr Kash Akhtar:

Yeah.

Mr Mark Gillett:

So maybe I need to change that.

Mr Kash Akhtar:

Yeah, let's, let's, let's switch that up.

Dr Chris Roughley:

Yeah, I think, I think it's trying to find the right place. I think I was lucky enough that I did some dedicated call plunging in Thailand and I can take myself back to that image of being pretty much in the jungle. And it just it, it's a happy place.

Mr Kash Akhtar:

Yeah, Zen.

Dr Chris Roughley:

Whereas I think if you're maybe in a football changing room, it might not be the most calming environment.

Mr Kash Akhtar:

Let's talk about supplements.

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

Well, what's the role of supplements? Any supplements that you I think absolute necessary, some that you think are not?

Dr Chris Roughley:

I was helping men's health do an article the other day on supplements.

Mr Kash Akhtar:

As part of your cover shoot.

Dr Chris Roughley:

I was trying to get on the front. Again heavily with the dietician support from Cleveland Cleveland London and I was amazed I even got to mention because my general view is stay away from supplements. I think if you are having a healthy balanced diet you're pretty much covered. I'm a bit more open to vitamin D because of this country.

Mr Kash Akhtar:

Yeah, I was going to say.

Dr Chris Roughley:

and the lack of sunlight that we get. Yeah, and people being indoors, et cetera.

Mr Kash Akhtar:

And I'm seeing even now more in Caucasian patients.

Dr Chris Roughley:

Yeah, yeah, yeah. I think we are getting better at sunscreen and staying out of the sun and the people are definitely trying to look after their skin, wrinkle less from sun exposure so you are seeing a little bit more of vitamin D drops. We're testing it more though I think as well so we are probably picking it up more and we're definitely open to that. Other than that, I would probably generally advise patients steer clear. However, there are definitely times and places. You know, if you have an absorption issue, a gut problem, that you might be a high performing athlete, that it is a nuanced business and you will have a highly trained nutritional support guiding you. But I don't think we all need 10 supplements in our cupboards that we're picking out now and then.

Dr Mark Gillett:

So I’d say C, D, zinc and creatine would be the fours things that I'd probably use regularly. An this time of year, I have got to have my vitamin C with some zinc in, you know I think that can be really helpful with your immunity. Generally, we like to keep people, athletes, athletic people vitamin D closer to a hundred and it's pretty difficult to do that in the British winter. So, most people can benefit from high quality vitamin D supplement and then, if you're an exercising athlete, creatine can be can be quite helpful.

Mr Kash Akhtar:

Creatine is interesting. I've started taking it a few months ago at 5000 milligrams a day.

Dr Mark Gillett:

Have you put on weight?

Mr Kash Akhtar:

I haven't actually, no. Yeah, but interestingly it's supposed to be good for training for muscle, for muscle building, for explosivity.

Dr Mark Gillett:

Absolutely.

Mr Kash Akhtar:

Is that, that’s the value for it right?

Dr Mark Gillett:

Well, I mean it has its used in endurance sports as well, but most people know it as improving your anaerobic burst. But yeah, it's certainly a reliable supplement that can, you know if it's part of a balanced training programme, it can have additive value.

Mr Kash Akhtar:

And there's, I've been looking into it and there's quite strong evidence that it's, that there's very little downside to taking it.

Dr Mark Gillett:

Yeah, it's been around a long time now, and I think people you know, I'm certainly pretty happy its safe.

Mr Kash Akhtar:

Yeah, great. What about glucosamine chondroitin? Because that's another one that comes up in knee circles.

Dr Mark Gillett:

I always say to people, look, I don't think that will do you any harm. It's unlikely to, you know, make you any better.

Mr Kash Akhtar:

Testosterone?

Dr Mark Gillett:

Interesting.

Mr Kash Akhtar:

Yeah.

Dr Mark Gillett:

You know, I think in the right people in the with the right measurement, there is no doubt that testosterone can have a role. It's just I think it needs to be bespoke and accurate rather than generic. I think if you're giving testosterone generically, you know, there's going to be people who experience health side effects because of that, so we have got to be careful.

Mr Kash Akhtar:

So I get that if someone who has a deficiency has a low, low score below the normal range, it makes sense to top them up. Are there ever, is there a role to give it when someone's in the normal range?

Dr Mark Gillett:

Well, if their SHBG is high. So they're, sorry that’s their SHGB ratio, their free testosterone is lowered maybe, although I'm told that there's very little evidence for that. I think it's very new and also, you know, it's quite difficult to find that sort of information and clinical support on that at a really high level.

Dr Chris Roughley:

I agree.

Dr Mark Gillett:

And I think that could definitely improve over the next five years.

Dr Chris Roughley:

I think it's a real hot topic now for sure, I feel like it's been neglected.

Dr Mark Gillett:

Yeah.

Dr Chris Roughley:

And I think we should be, I'm definitely screening testosterone way more than I have ever done before and I, yeah, I kind of don't understand why we haven't been

Dr Mark Gillett:

I agree.

Dr Chris Roughley:

I think even if you were down at that borderline range, why aren't we trying to optimise that? We're trying to do it with so many other different things.

Dr Mark Gillett:

Well, I think you're right, because I think because we don't do that well enough opens the door to people who do it badly. You see what I mean? So if the ethical and the well trained doctors aren't really, you know, committing to do this well and you know, that could be a problem.

Dr Chris Roughley:

Yeah

Dr Kash Akhtar:

And I realised I got very excited to talk about supplements, because it’s a thing that interests me but, and both of you said a healthy balanced diet.

Dr Chris Roughley:

Yeah.

Mr Kash Akhtar:

But we haven't really quantified what a healthy balanced diet is. Are we talking about and you know, and the all the rage right now is about protein, protein requirements, macronutrients. So, could you just explain what you consider that to be?

Dr Chris Roughley:

I think one thing is about protein, people struggle to get the recommended protein amounts into their diet with traditional eating habits. And so I think coming to us and getting some guidance on what your requirement is, your levels for your weight etcetera, are your training etcetera. I think that is really important. I think I really like the 30 plants a week. I don't think Tim Spector's at all bad with that view of just trying variety and in trying to keep a rainbow coloured plate in front of you, that makes sense to me. It's getting the right nutrients, a range of nutrients into your body. If you've got a healthy gut microbe.

Mr Kash Akhtar:

Microbiome

Dr Chris Roughley:

Then, there's so many things going on, I think that we don't understand yet fully that food gut access, body access is really an interesting area. I find it interesting that still the dietitians are very much still held on the Mediterranean diet and so I think they're still using that as a basis, but they are really trying to encourage those whole grains, proteins, range of colour.

Mr Kash Akhtar:

Yeah. No we did a, I did a podcast elsewhere in on microbiome, but I draw the line at sauerkraut and kimchi, I can't do it. Can't do it.

Dr Mark Gillett:

I’m not surprised.

Mr Kash Akhtar:

Mark what's your take on protein intake?

Dr Mark Gillett:

I think one thing to recognise is it's expensive, you know, so it's the most expensive part of your meal so you have to be respectful about that with patients. But generally I think it's important. So somewhere in the region of a gramme per kilogramme per day is about the right range, probably varying a little bit depending on how much or how little exercise  you're doing or how old you are. But definitely I think I'd agree with Chris people struggle to get enough protein a daily basis and enough high quality protein and that's really important.

Mr Kash Akhtar:

So protein supplements, protein shakes, protein bars do they have a role?

Dr Mark Gillett:

Yeah, I think you know, so with things like whey protein, which you can get relatively cost effectively and are relatively digestible if you can take that immediately after you’ve exercised, it protects your lean body mass, your protein turnover and it can be very effective.

Mr Kash Akhtar:

And are you telling people to take pre workout?

Dr Mark Gillett:

I mean, I'm a real caffeine enthusiast, in all its different forms, in a drink, in a supplement, in performance enhancing supplements, but again, you've got to get the dose right. So somewhere depending on what your tolerance is, somewhere between a hundred and two hundred milligrams probably an hour before or half an hour before you exercise.

Mr Kash Akhtar:

1. And yeah, and time it such that it doesn't then interfere with your recovery and your sleep?

Dr Mark Gillett:

Yeah. Yeah, yeah, yeah.

Mr Kash Akhtar:

1. So we've covered screening training habits, if we wrap up now with some quick actionable takeaways. Is there one change you wish more people would make for their health?

Dr Chris Roughley:

That’s really hard to surmise in one point and I also think it depends on the individual because we see so many different people that have probably got one comment for different people.

Mr Kash Akhtar:

I'm going to come to you in a second, have a think Mark.

Dr Chris Roughley:

Yeah, I have been thinking about this all day really and what I could do. I think people should move more and eat a greater variety. That's probably the simple things.

Mr Kash Akhtar:

OK, that's two things but I let it slide

Dr Chris Roughley:

Yeah, I think I would encourage probably for people to move.

Mr Kash Akhtar:

I think that's thing that's missing in the society at the moment is movement. Yeah. Mark, what’s one wish you wish, one thing?

Dr Mark Gillett:

Well, you've already touched on it. So, I think everybody should learn how to squat properly. You know, I think that is a great skill that underpins pretty much all of human movement. And if you can do that well, it's building plots and do anything else.

Mr Kash Akhtar:

A body weight squat.

Dr Mark Gillett:

Yeah.

Mr Kash Akhtar:

Great. Chris, where can people go to learn more about health screenings?

Dr Chris Roughley:

So you can have a look at the website so clevelandcliniclondon.uk and have a look at the GP Institute

Mr Kash Akhtar:

I did. That's the URL, is it? I didn’t know what the URL was.

Dr Chris Roughley:

I come prepared. You can feel free to e-mail us. So, we've got healthassessments@ccf.org, F for freddy.org. Or if you're interested in the exec, exechealth.london@ccf.org.

Mr Kash Akhtar:

Thank you.

Dr Chris Roughley:

I mean, I would also add to that feel free to just come and have a conversation with one of the GP which is.

Mr Kash Akhtar:

Yeah, we can and have a chat, we'll.

Dr Chris Roughley:

We'll because we have things different things on offer, we can bespoke it, tailor it, etcetera. Sometimes it's good just to have that initial consultation just to find the right fit.

Mr Kash Akhtar:

And where do you direct people who want to learn more about training effectively smart training?

Dr Mark Gillett:

That's a good question. I mean, I think probably them away from Instagram is what I’d saying so, it's about moving them towards something more constructive. You know, one thing I'd say is that probably to get stronger, you've got to work with something more than body weight so I would think about, you know how that might work for you. Now it’s much easier if you go to a gym and you've got a range of weights, if you can't do that there other ways of doing it. But you've got to move with good technique and you've got to load up to get the gains you need.

Mr Kash Akhtar:

Perfect. So basically, the takeaways are screening is isn't just for the sick, it's, you know, to help optimise health at every stage and if you train, do it smart, build strength, resistance training is where we are going. Recover well as we're going recover, have an appropriate diet and focus on small, purposeful habit changes.

Dr Mark Gillett:

Brilliant

Mr Kash Akhtar:

So, you've been listening to Exploring Health with Cleveland Clinic London. I'm Kash Akhtar and it's been a pleasure to have Chris and Mark on today’s episode. Thank you for sharing your insights. If you've been listening or watching and you want to take charge of your health, please check out the links in the show notes. Book a screening at Cleveland Clinic London if you're interested, or go to the website if you want to learn more about optimising your health. If you found this conversation valuable, please don't forget to subscribe, leave a review or share it with someone who you think may benefit from this. Thank you until next time.