What Is Health, Really?

Health isn’t a one-size-fits-all concept. It’s as diverse and dynamic as the people who experience it. In this episode, I challenge the narrow, static definitions of health and asks whether health is a basic human right or a privilege. A binary concept or a specturm. A journey or a destination.

If you want to explore health in more detail, don’t miss my FREE workshop, Redefining Health, available to download anytime.

Feeling exhausted by the endless "New Year, New You" hype and its narrow definition of health? Join my FREE 7-day email challenge - the perfect antidote to diet culture January.

This week's Everything You’ve Been Told About Weight Loss Is a Lie features  the article "Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies" (Mazidi, 2019)

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Transcript

0:07

Hi everybody and welcome to episode two, season five of the Fat Doctor podcast. I had to think about that already, it's only been the second episode, that's worrying, that does not bode well for the future. Um, today I am going to be getting back to basics. Um, yeah, I have realised the more and more I get into the specifics, the more I long to get back to the basics at the same time. And I have to limit, I have to limit the amount of time I spend digging and digging and digging and digging and further digging into the kind of like, what I can only describe as the foundational principles for me when it comes to weight inclusive care. And weight inclusive medical care is not something that you can like, You know, go and learn. You can't study it at a university. You can't be like, I'm going to do a master's in weight inclusive medical care. I mean, it's not something that exists yet. But I truly believe that during my lifetime, I am going to see a real shift in the way that we practice medicine and that that will include weight inclusive medical care. I know it's optimistic, But, I believe it's possible. And, um, if we're going to do that, if we're going to usher in an era of weight inclusive medical care, then there needs to be some basic foundational principles, right? Like, these are the very foundations of the care that we're offering up. And I think that it's important to devote some time to them. And to really, to really be curious. Practise some curiosity. Pick apart the most simplest of things. And the most simplest of definitions, the term, and in this case, the term health. Um, you know, when I say health, I want you to be healthy, health, you deserve health, you deserve health care. Health is like one of those words that has so many different connotations. And actually, if you go back to season two of my podcast, you will find 14 episodes, I believe, in which I asked lots of different people about health and everyone had a very different, um, opinion and something very different to think, something very different to say. And so I am going to be exploring a little bit further, sharing my own thoughts. Uh, season two was a couple of years ago now, at least. So, I've come on a fair bit since then. I'm going to be talking about health because, and this is like the first principle. I'm going to read it out because I've already done. This is the first principle as far as I'm concerned. Health is not a one size fits all concept. It defies simple definitions. Ask a dozen people and you'll get a dozen different answers. At its core, health is more than just a set of metabolic markers. or the absence of disease. True health must account for the realities of aging, disability, environmental factors, and trauma. It's dynamic, not static. A journey, not a destination. Health isn't inclusive, health isn't exclusive, um, to those who fit a narrow ideal. It belongs to everyone. To truly embrace health, we must look at the whole picture, making space for the diverse ways it shows up in our lives. It's nice isn't it, I had to read it out because there's no way I'm repeating that from memory. So what is health? What is health? Um, there are some very traditional kind of biomedical definitions that I think the vast majority of us when we think about health this is how we see it. Right? So there's the WHO definition which I think a lot of us will have heard of by now. It was created in 1948. Quite old now. Um, health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. Now folks, I think we can all agree that complete is very binary and, and as, as, as lacks the nuance, most of us don't have complete physical, mental and social well being. Let's be honest, the person who does is me. very privileged. Um, but at least they've gone so far as to say it's not the absence of disease or infirmity, because I actually think, even though it was written in 1948, still the vast majority of us believe that health is the absence of disease or infirmity, right? Um, so even though this definition, which is very widely known and also very widely criticized for being too idealistic and too static and too exclusive, or, you know, I would still argue that the majority of us are more conservative in our opinion of what health is. The biomedical model is basically the absence of disease, illness or injury, which is, I think, the model that we focus on, right? It focuses on measurable physical and biological factors. Blood pressure, cholesterol, HbA1c, leptin, CRP, BMI, all abbreviations, of course, because we love to abbreviate, it makes us sound more professional. But the medical system that I work in very much favours the biomedical model, and actually, it's getting worse and worse and worse, not better, as far as I'm concerned. Um, and yeah, I don't, I don't really like that definition because I think it's very, very limited and it excludes the vast majority of people and it causes a lot of problems, but that is our reality. So when I talk about health, I guess I think of what health is. And in reality, what health is portrayed as, and I think health is, is, is portrayed as the biomedical model. I think it is, and I think that's the way that social media and mainstream media and politicians and healthcare professionals and public health professionals and everyone, that's what they fixate and focus on. The real kind of measurable physical and biological factors. Because then we can measure them and audit them and white supremacy the shit out of them. Um, yeah, come on now. Like, most of us, when we think about it, we, we would agree that there's a little bit more to it than that, right? It's not just blood pressure. So, um, There was, um, a group of people, um, Huber et al, uh, who first described in a 2011 article in the British Medical Journal, I'll have you know, uh, that the article is entitled, How Should We Define Health? Go read it if you want to. It's passing as far as I'm concerned, but anyway, it's, it's the dynamic concept of health, right? And in this paper, you know, how should we define health, kind of proposed a shift in the way that health is understood. Moving away from the very static World Health Organization definition as complete well being, because like, who's complete in any way? Towards a more kind of, you know, like, Nuanced, complex, dynamic, and functional perspective. And here's where it goes wrong for me, but allow me to, uh, allow me to quote. So health is the ability to adapt and self manage in the face of social, physical, and emotional challenges. You know, it just, it feels very much like we're still focusing on the individual and just adapt, be resilient. Manage yourself, uh, version of health, but at least, at least it's, at least it's a bit flexible, that's a bit adaptive, that's a bit dynamic, which is better than this whole, like, you're either in complete physical, mental, and social, uh, well being, uh, or you're not, you're either healthy or you're sick. At least this is like, well, no, it's more about, like, adaptability. So, that's some progress. kind of. Um, Huber et al, Huber and her colleagues, very much, uh, I think she's, I'm pretty sure it's she, I think I'm using correct pronouns here, um, focused on the idea of, focused on the key, like, buzzwords, resilience. You know, you hear resilience a lot? Yeah, that's probably coming from Huber. Uh, not only Huber, but definitely one of them. Um, so it's about, like, my ability to maintain balance. When I'm met with challenges, you know, I'm resilient and so what that does is it suddenly allows people with chronic illnesses or disability to be included in the definition or the concept of health, which up until this point in time with the WHO definition, no, because if you didn't have complete physical well being because you were born with a congenital defect or you developed a disability or, you know, you developed a chronic illness, you And or disability. That was it. You're out, no longer healthy, sick, gone, out you go, no health for you. I mean, that just didn't feel right. So now at least you could be disabled. You can be chronically ill and because you're resilient, because you can manage in the face of these challenges, you're still healthy, but you still have to manage, mind you. Alright, if you're not managing, you're out. Um, some people will argue that this definition shifts from perfection to practicality. I would argue that it shifts from perfection to individualism. That's what I would argue. It's all about like, well you just pull your socks up and be healthy for goodness sake. Um, so like, And also, again, why are these three dimensions? Why physical, mental, and social? Why are the only three dimensions in life, these three? There's more to health, surely. So like, physical health is the body's ability to cope with physiological demands and challenges. Physical health. So like, if you need to be able to walk down the street, And you're disabled, but you are able, like, maybe you can't walk without a crutch, uh, or a stick, or, or, or, maybe you need a wheelchair, but you are able to get down the street, then physically you're healthy, according to this definition. Sure. What about the people who can't manage to walk down that? I take it they're not healthy. Right now, I'm like, serious, I'm serious, having serious problems with my shoulder. It's very difficult for me to get dressed in the morning, so I'm guessing I'm not healthy at the moment, because, you know. My shoulder hurts. Uh, mental health. Ooh, I love this one. This one is the brain's capacity to manage thoughts, emotions, and behaviors. effectively, definitely not mentally healthy, I can tell you that for free, because I can't always manage my thoughts and emotions, folks. Um, and then there's the social health component, which is the bit that pisses me off the most, which is the ability to fulfill social roles. Fulfill social roles and maintain meaningful relationships, and this is where I think it goes awry. It's already gone awry, but for me, our ability to fulfill social roles, and by that I think a lot of the time people will interpret that as, you know, function in society, provide some kind of substance, be worthy, you know, be productive. Ideally work, 95 or 8 till 8, and make money for the man, like that, if you gotta do that. What, you're unhoused. Can't even keep a roof over your head. What, you're, I'm sorry, you, you can't work. You, well, you're not healthy. Socially, you're not healthy. That's, that's the end of that. Again, very exclusive, these definitions of health. Um, But, because it's radically different to the WHO, a lot of times you'll hear like Hubert, Hubert, I assume it's pronounced that way, um, being quoted like, yes, you know, the dynamic, uh, what's it called? It's called the dynamic, the dynamic concept. like it's brilliant. I'm not sure. Um, I think health is more than that. I think it goes beyond the surface. Um, I obviously goes beyond metabolic markers, right? Like we can all agree, agree on this. It's obviously not in yes or no, in or out. I think we can agree on this as well. Um, it's not numbers on a chart. It's not test results. It's not kind of like tick boxes. It's that's not health. It goes beyond that. Um, and of course these metrics. massively exclude people as I've already said. We know it's not dyna it's dynamic, that it's not static, that it changes over the time. We have to make room in our definition for aging, and for personal circumstances to change, and for unexpected events like injuries. You know, um, just developing an illness, which happens over time, folks. Like for the majority of us, we develop an illness over time. So it's not fair to say that only young people can be healthy. So we have to understand that it's dynamic. Um, and there's, you know, this perhaps health is a journey, not a destination idea. Yeah, I like that. I like that. And actually, that's probably the underlying concept behind Salutogenesis. Uh, Salutogenesis. Google it. S A L U T O G E N E S I S. Um, it was introduced in the, I think, late 70s, early 80s, uh, by a chap called Antonovsky. It's Antonovsky. Antonovsky. Aaron Antonofsky. Uh, there was a book called Health, Stress and Coping. I haven't read it, can't on the table. But like, Antonofsky is, is, you know, the founding father of the concept of Seleucid Genesis. And, um, there is like, for that, there's like a, it's almost like a, uh, a continuing and continuum between health and ease and disease. So health and disease, ease and disease. And so it's like a Sort of like a continuum. So there's like two ends of the spectrum and everything in between. And, um, so it's not a binary state of being, it's not healthy or sick. It's, you know, that's great. Cause we don't like binary in, in our neck of the woods, do we? No, we're not into binary. No one, I'm just speaking to a resident non binary person. So no binary definitions for us. Um, and so. I guess the idea of solution genesis is rather than focusing on who's healthy and who's sick, we can, we can study what keeps people on the ease side of the continuum, you know, on this as opposed to on the disease side. I like that. I really do. I think that's good. There are some other bits that I'm not so sure about. Um, if you're, if you know what solution genesis is, or you Google it, you might read about the sense of coherence. Um, and I sort of like Antonovsky was a sociologist, right? So already he's cool. Not a doctor. Oh, I mean, not a medical doctor and so saw health and ease and disease through the lens of kind of this idea of coherence and I've written some notes here. The sense of coherence is, um, reflects a person's ability to see the world as comprehensible, manageable and meaningful. You're getting quite the education today. You're welcome. Um, so when I say complements, when he says complements, comprehensible, he means that like life events are structured, like that we understand them, we understand what's going on around us, they're predictable. So I guess, Like a genocide is not comprehensible, it's incomprehensible, right? That makes sense. Um, so like we, there's, we have certain expectations of how life is going to go. And we need, we need to be, to be manageable. So, um, in order for things to be manageable, we need resources. And I think a lot of us talk about health now in terms of being resourced. Are you resourced? How can you be healthy if you lack the resources? So, I mean already, Seleucia Genesis is really Ticking some boxes. Um, and also the whole concept of life having meaning. Okay, like what is the per point? What is the purpose? That's really important too. So I kind of like this. I like that this is how we are looking at health. Um, so Antonovsky argued that like if you have a strong sense of coherence, right? So life is comprehensible, you understand what's happening, it's manageable. You have the resources, it's meaningful. There is meaning and purpose to your life. Then you are more likely to have health or ease as opposed to disease. Oh, nice. Cool. Um, there's, there's, um, generalized resistance resources as well, and these are like both the internal resources and the external resources that we need to navigate stress, to navigate, like, the challenges that we face in life, um, so that could be, like, You know, your family, it could be your community, your social support, it could be your education, it could be your financial stability, um, it could be all to do with your self esteem, it could be to do with your culture and your kind of like, you know, where you grew up, your sense of traditions. Now, all of these things are generally excluded from other health models, right? Because health models are like mental, so physical, mental, and social. Well, what about cultural? What about, like, you know, what about What about environmental? What about financial health? As far as I'm concerned, these are very important parts of health. I, I would argue that you can't really be healthy if you're living in the midst of a genocide, for example. Or if you don't have enough money to support yourself. Um, uh, if you are, haven't had the care and the love and the compassion of parents or family that have kind of like, you know, been there to support you, to resource you throughout your life. Like, it's very difficult to be healthy without those things. So I, I would argue that health is much more than, uh, than just mental, physical, and social. And I'm glad that other people agree with me. Sociologists, they're the best. Um, and of course, Like, this model makes room for the fact that it's not a static state, right? It's not one or the other. As life changes, so does our perspective on health, and I like that. Um, there's a real focus on how we, how, how do we as healthcare professionals, or as public health professionals, put systems in place in order to ensure people can Stay on the health or ease side of the spectrum as opposed to the disease side of the spectrum. So all in all, gets a thumbs up, still think it's missing some key or doesn't, or perhaps the way we interpret it, uh, is sort of, again, often we, we kind of go, oh, yeah, that's really important for like, you know, mental health, you know, but nobody ever goes, yeah, financial and environmental well being is really important for cardiovascular health. Like, that's the problem. salutogenesis kind of put in the corner with the kind of like sociologists and the psychologists and like, I don't, I don't know if I've ever told you this, but when I was studying medicine, uh, I got, I learned, I had two years of non clinical work. So two years of just studying and going to lectures from nine in the morning until five in the evening. Um, they don't do it like that anymore, but in the olden days when I was at medical school, you had all these lectures and, you know, you like had to learn pathology and microbiology and cellular biology. Virology and then you had to learn about the cardiovascular system and the respiratory system and the gastrointestinal system and I could keep going and going and going, but you know where I'm coming from. And then he did one semester where they took psychology and sociology and they put them together in one module. Um, and it was called psych soc, because of course we can't say psych, psychological, social, and that was it. That we learned all of psychology and social sciences in one semester and it wasn't like even like the whole semester was dedicated, it was part of the semester. I think we had two lectures a week or something like that. It was ridiculous. We had to do a project, but it was just ridiculous. When you think of that, kind of like when you think in terms of that, that my medical education, I think that really highlights how little importance there is placed on solution genesis and that kind of. model of health, even though this existed well before I went to medical school, right? Like decades before. There wasn't really, you know, it was still very biomedical and this was kind of shoved in a corner for like a semester in my second year of university. That was it. So, um, I think the problem with this, uh, this kind of definition of health or this, or this way of understanding health is that we just don't use it enough. We don't, we don't, we don't use it when it comes to, um, to. physiology or pathology. And I think that's really problematic. I think as a result, um, we, um, cause a lot of harm to the aging population, to disabled population, um, and to the marginalized and oppressed, intentionally marginalized and oppressed population, because we refuse to consider the external factors that influence the health. Remember when I was talking about salutogenesis and we were talking about resources, it was internal and external. And external resources. Well, what about if you don't have the external resources? And what about if you, the fact that you lack those external resources are actually intentional. Like the government is intentionally denying you access to those resources as a means of oppressing and suppressing you. What about that? How does that factor into health? And I think, you know, we don't, these are, all of these factors are massively overlooked when we have these, you know, in the mainstream, when we're having these conversations about health. We don't talk about trauma. Only, if I bring up trauma, you know, I remember, For a long time, I used to say, health is a privilege, um, not an achievement. And, you know, it's funny because I agree and disagree with that statement because I don't think health should be a privilege. I think health should be something that everybody has access to. But in reality, it's not. In reality, in the world we live in today, health is a privilege. Not everyone has access to it. And that is primarily because of the external influences on our health that nobody likes to talk about. So trauma, childhood trauma, trauma in adulthood. Um, so people who are practicing healthcare without a trauma informed lens, like I don't even think they should have the right to, but I didn't learn about the impact of trauma. Like when I was studying psychology and sociology, believe me, it was more about how to stop smoking than it was about the impact of trauma and ACEs on a person's, you know, health, um, and wellbeing. And it excludes, as I said, marginalization. I love looking at other, like, non traditional definitions of health, right? Because there's the biomedical model, there's the WHO definition, and all the other definitions, and then there's salutogenesis, and then there's, there's like, when you look at other, like, for example, like, if you listen to Indigenous perspectives, um, I love listening to Indigenous people talking about health. Definitions of health that were passed down through generations, any kind of cultural perspective. What does health actually look like? And oftentimes, especially in indigenous cultures, there's this idea of harmony or balance. If you really, I mean, I'm a big fan of things like, you know, chakras, for example. Just take chakras, this idea of balance, this idea that everything has to be in balance. And that's. Health, right? I love that. Um, health often is about connection. It's about your ancestors. It's about your community. It's about the environment that you live in. It's about spirituality. And you know what's really fascinating? Fascinating? Is science is starting to catch up. We are actually starting to see like medical, like, journal articles that support the very things that indigenous communities have been talking about for literal millennia. Um, yeah, balance, spirituality, harmony, connection, all of these things are a massive kind of part of health and well being. Yeah, if I'm going to pick any definition, that's the one I would pick personal, personally. Um, also I think that, and I think we've talked about this before in, I've certainly talked about this and I, um, I have a, even a free course available to those of you who want to have a go. I'll link it to the show notes when I talk about like how I, um, Like how I view health and how I, like the, the, what's the word, framework, that's the word, the framework I use to examine a person's health and well being. Um, and I talk about it in terms of relationships. Um, but I also talk about the fact that it's very personal, right? Your definition of health is going to be personal. And. Um, a lot of times when I ask people what, you know, what's health mean to you, they'll say it's about like feeling well in myself and being able to live a fulfilling life and like, you know, being able to achieve certain goals. And so there's like a, you know, for me being healthy is, and for some people it's run a marathon and for other people it's like being able to get out of bed in the morning and everything in between. I. I like that. I still think that oftentimes, because of the ways that we're raised, because of the society we live in, oftentimes our personal definitions of health, rather than focusing on community, rather than focusing on connection, rather than focusing on balance, is often goal oriented. Because, you know, white supremacy, colonialism, capitalism, misogyny, all of that bullshit. So people will all sort of be like, for me being, you know, being healthy is, you know. Being able to do X, Y, and Z. Excuse me, I need to take a drink of water. It's a doing, rather than a being. Um, but actually, do you know what? I believe in autonomy. So if that's your definition of health, that's your definition of health. And others it's more relational, right? Like I said, it's about community. It's about being able to be part of society. Again, oftentimes that's doing rather than being. So rather than just being in a community, it's what can I do for this community? But there is that sense of belonging, that sense of connection, um, as well as contribution. So There are lots of different definitions of health, not just the ones that are recorded in medical journals or books or referred to when we're like, ah yes, salutogenesis, yes, because we're all very clever and we've gone to university and studied things. Like, there are just personal definitions of health which are just as valid and just as important. And, not but, let's say and. I want to get back to the external factors. I want to determinants of health. as they are, you know, often described as, the environmental factors. I want to talk about, um, how, um, how health isn't just about individual well being, but it's actually about collective well being. That's pretty radical, isn't it? Let me say that again. Health is not about, just about. Health is not just about individual well being, it's about collective well being. Because. In order to be healthy, we need resources. We've already covered that. We need opportunities. We need to be in an environment that allows us to thrive. Allows us to be on the ease side of the spectrum. Allows us to, um, be, you know, socially, like, able to cope with whatever challenges we face socially, mentally, physically. In order to do that, we need resources, and these resources are external, and they are limited. All resources are limited. There are enough to go around. There's enough food in this world for everybody to eat. There is enough money in this world for everyone to be, to be well. To have what they need. The problem is that these resources are gorged upon by the minority. And so the, so the majority, the global majority, are left lacking and in need and without enough. And if you don't have enough resources, if you don't have enough opportunities, if you don't live in an environment that allows you to thrive, then how can you be healthy? And so rather than it being an individual thing, it's, it's a communal thing. So. I really quite like the health equity lens, the critical, um, the social justice definition of health, if you will. I like this idea that we look at health from a, from the perspective of like, is everyone, does everyone have equal access to the same resources? And the answer is no. There's no equity, there's no justice in health. So when I say health is a privilege and not an achievement, what I'm saying is right now, health is not fair. It's not fair. It's like, you know, the dice are loaded. The deck is stacked against us. I don't know, there's lots of metaphors out there, none of which are coming to my mind right now. But, um, It's not fair. And if you are marginalised, and when I say marginalised, I mean intentionally marginalised, if you belong to a group that society has deemed inferior, if you are black, or brown, or indigenous, if you're disabled, if you're neurodivergent, if you're trans, queer, or there's more, I'm sure, if you are, if society's taken one look at you and gone, mm mm, mm mm. Oh God, I'm fat, obviously. Sorry. The obvious one, fat. I mean, I am the fat doctor, it goes without saying, but yes. If you're fat, society takes one look at you and says, No, you are inferior, you are beneath, you are not good enough, you do not meet the standard. And therefore we are going to intentionally Marginalize and oppress you and that systemic oppression and it's throughout all of our lives, right? it's it's it's not just in terms of medical care, but also in terms of the justice system and education and employment and And housing and everything like, you know travel clothing, you name it. There's oppression everywhere we go And as a result of that it's not possible to be healthy And then, people have the audacity to say, this group of people right here, they're not healthy. No shit they're not healthy! Of course they're not healthy! By definition, they can't be healthy, because they lack the resources. And as we have established, even, like, you know, forget your stupid narrow minded, very narrow focused biomedical definition of health. When we actually look at health as a whole, and we actually listen to clever people talking about health, whichever way you slice it, how can fat people be healthy? When the definition of health excludes fat people, and black people, and trans people, and, you know, obviously, disabled people. It's not fair, and it's not because of the individual. Let's stop blaming individuals for a moment, shall we? It is not possible to be healthy because of the society that we live in. And so, I'm going to give you a really radical definition of health. Alright? Brace yourself. Health is the freedom from societal pressures that dictate how one's body should look, feel or function. Health is freedom from societal pressures that dictate how one's body should look, feel or function. Maybe rather than trying to find a definition of health that includes everyone, instead we could say, actually, health is is freedom from the definition of health. Liberation. That I don't care whether my body looks a certain way, feels a certain way, functions in a certain way. I don't care whether I meet your very narrow or very, very wide, very expansive definition of health. I am no longer going to let you define me by my health. I mean, it's pretty meta, what I've just said, right? It's a little bit, out there. But I think it's, it's also very radical, you know? Yeah. Actually, I hate the, the current definition of health, whatever definition it is. I hate, I hate it because it's exclusive, because it often focuses on what we can and cannot do. It's always about doing, instead of it just being, you know, something that we, that we're allowed to be. It's about what we can do. There's this very narrow idealized version of health. Go and ask any child, right, any child, what does healthy look like? Ask them to draw it, ask them to describe it. In fact, don't even ask a child, ask anyone, but especially a child. They will tell you that healthy looks like Thor, or healthy looks like you know, a marathon runner. Healthy looks a certain way. Healthy has a body, a certain body type. And, and healthy is probably white, if we're honest, and is cisgender and is heterosexual, because that's the image that we are teaching everybody, especially children, about what healthy looks like. It's such a narrow, idealized version. And this is perpetuated By all areas of society, including and especially the medical profession. What about the fat, black person in a wheelchair, doing wonderful things, but more importantly, not even doing wonderful things, just being a wonderful person? Are they not? The idealized version. Why can't they be the image that we have when we close our eyes and think of health? Health should belong to everyone, right? I think health, as I said, I say it's a privilege because in reality it is. But it shouldn't be a privilege. Health should be just a basic right. It shouldn't be a privilege that is reserved for certain people who meet certain criteria, who fit a certain box, who, who, who, you know, who, who look a certain way. It should be for everyone, but the reality is that it isn't. And so when we talk about weight inclusive medicine, it's, you know, people are like, wow, there's all this information out there, actually, there's all this data, there's all this evidence. Why don't doctors just stop talking about weight? Because we're challenging. The very definition of health here, folks, and that's not something that people can easily get their heads around. It goes against everything we've ever been taught, ever in our entire lives. So it's a really big, it's a really big shift in mindset. We need a holistic approach to health that values internal and external resources. That goes beyond just mental, physical, and social. We need to start making space for the diverse ways that health manifests. And we need to, I think, you know, change starts at home. Is that, is that right? We need to start by asking ourselves, or what does health mean to me as an individual? And if you find yourself going, health means I can do this and I can do that, you need to ask yourself, Oh, hmm, do, hmm, interesting. Why is that the first thing that came up? Be curious about it. No judgment. Just be curious about it. Um, Gosh, I'm just, my brain just stopped. It just stopped. I should be better prepared. It just stopped. Um, I like to do a little everything you've been told about, uh, weight loss is a lie, uh, bit. And I'm so not prepared. Oh, deary, deary me. I'm so not prepared, but don't worry. Everything we've been told about weight loss is a lie, as I'm sure you are well aware and Last week I was, um, I was doing, uh, module three of No Weight. For those who don't know, No Weight is the book that I'm writing. It's basically a book about why doctors need to practice weight inclusive healthcare and never, ever, ever prescribe weight loss to their patients ever again for the rest of their entire lives. Um, I'm writing this book and as I write this book, I am also, uh, as I'm sorry, as I'm writing this book, I'm also kind of doing a course that people can join in. And, uh, I, I was talking this. week about the difference between a lifestyle and a diet. So everything that you've been taught about, um, weight is a lie. Today we are going to be, uh, looking at, um, Mazidi et al. Mazidi? The problem is, like, I don't know how to pronounce people's names and I make a fool of myself. It was published in 2019. The title is Lower Carbohydrate Diets and All Cause and Cause Specific Mortality. A Population Based Cohort Study and Pooling of Prospective Studies. Did you get that? This is all about low carb it's January, we're all talking about diets at the moment, and everyone's, like, doing, and it's, well, it's not a diet, sorry, sorry. diets, so 2010s. Um, this is 2020s, mid 2020s now folks. No, we don't do diets. We do lifestyle changes and one of our lifestyle changes, I'm just going to cut, cut down on carbs. So I had so many carbs and so many carbs carbs anymore. I'm cutting down on carbs, carbs, cutting down on carbs, cut down on carbs. It's so much better for you, isn't it? That's what we've been told. Cutting down on carbohydrates is better for you. So this was a, uh, meta analysis. And, uh, population based cohort studies and pooling of perspective studies. Um, uh, it basically took a lot of information. I think they, I can't remember how many people they had. Let's have a look. I've got my notes. Data from 24, 825 participants in, from the, um, the famous NANES, or NANES, NANES study. N H A N E S. It's a famous nurse's study that's, um, We often use, um, because they have lots of information that we've been studying for decades and there's also, um, nine cohort studies, 462, 934 participants. We're looking at over 500, 000 participants, folks. No, not quite 500, 000, half a mil, so I mean that's a pretty big database, right? And all they were looking at was, um, um, mortality. Mortality, um, we know what mortality means, right? Death. That's what they were looking at. Death. So, you've been told that going on a low carb diet is going to improve your health, right? It's a lifestyle change! It's not a diet, it's a lifestyle change! It's January! Cut down on the carbs! No carbs! Because that's what you've been told. But as I said, everything we've been told about weight is a lie. And so, here are the results. You ready? Participants with the lowest carbohydrate intake out of half a million people. Participants with the lowest carbohydrate intake. Overall mortality, 32 percent increase. Cardiovascular disease mortality, 50 percent increase. Cerebrovascular mortality, that's stroke for those who don't know, 51 percent increase. Cancer mortality, 36 percent increase. I'm just going to sit here very smug for a moment. Now I want you to know, That this does not mean that people on a low carb diet are going to die. Okay, it's a population based study. All I can say is out of the 500, 000 people or so that they studied, those on the lowest carbohydrate diets were more likely to die. I don't want to infer anything from that data. I don't want to then say, therefore, if you eat a low carb diet, that means you're gonna die, because you can't make those inferences from that kind of data, because we don't know why people are on a low carb diet, and we don't know if those people on a low carb diet also had other things going on that could, could have contributed to their health, right, and to their mortality. So we cannot make any assumptions. However, I think it's safe to say that if in a half a million people on a low carb diet, you're more like, more likely to die at that time. I think it's safe to say that low carb diets don't improve your health. How's that? Now there could be caveats, There are children with epilepsy that have to go on low carb diets to manage their epilepsy, and if they don't, they could have a seizure in the night and they could die. Now, I would argue that a low carb diet is definitely in their best interest. A lot of people are going to say, but what about diabetics? And I'm a diabetic, and I've heard all of the arguments for like, why low carb diets are good for you, and I don't agree with any of them, but I'm not going to get into the specifics because this evidence, this particular study I'm looking at, does not cover that. But it's safe to say that this healthy low carb trend that everyone's going on Has not been shown to improve your health, if anything. Studies have shown that people who are on a low, low carb diet are actually at an increased risk of health conditions. Make of that what you will. And if you're watching on YouTube, yes, you can see my smug look. And no, I'm not apologizing. Um, I don't have a question, which is a real shame because I wanted to be able to answer people's questions, but I didn't get a question, so we're gonna have to leave that for now, but I'm gonna be a bit more organized than he says. Absolutely certain I'm gonna be more organized. I'm trying to organize a guest for the end of the month as well, like I'm really trying, folks. Whether or not that actually happens is yet to be seen, but at least I'm trying. The effort is there. But I hope you enjoyed this episode. I'm gonna be signing off next week. I'm going to introduce you to a new character. It's like, um, you know, creating a book or something, um, of characters. I'm going to introduce you to, um, someone else's story. I'm going to be telling you someone else's story. I don't know who they are yet because of my name. I should really have given them a name already. Should we give them a name now, live and in person? Where's my list of names that I saw? Just let it come to me. Let it come to me. Let it come to me. Let it come to me. Let it come to me. Do you know what? I think it's going to be really basic. It's going to be Jo's story. Jo. Jo. Or J. J or Jo. J. J's story. I might just make it J the like, um, you know, not even J A Y. I might do J. I might do Jo. I don't know. It's one of them. One of them. That's a good one. Okay. Thanks for listening. See you next week.