The Power of Community: Lessons from the BSLM Conference

In this episode of the Microbiomedics podcast, Dr. Sheena Fraser and Dr. Siobhan McCormack share insights from the BSLM conference in Newcastle. They highlight the vibrant discussions on community health initiatives and the role of young advocates, like those from "Bite Back," in combating ultra-processed foods. The doctors emphasize the urgent need to address adolescent mental health and the impact of diet on well-being, advocating for holistic health education in schools. They encourage listeners to advocate for these essential changes in their communities.

This podcast is brought to you in collaboration with the British Society of Lifestyle Medicine.

Disclaimer:
The content in this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast.

Transcript

0:59

Hello and welcome to the Microbiomedics podcast. I'm Dr Sheena Fraser and I'm joined today with Dr Siobhan McCormack finally because we haven't actually done a podcast together for a little while this year and it's really nice to suddenly be able to do this because we're both in Newcastle for the BSLM conference this year. So Siobhan how are you? I am so good it's great to see you and it is great to be in the same place and not be meeting virtually and i guess we're both really buzzed up about this conference so it's the british society of lifestyle medicine conference it happens every year it is the best event on the calendar and this year they've arranged it in the sage in gateshead so this beautiful building right near the millennium bridge and all these beautiful bridges in newcastle i've never been to newcastle before it has been brilliant sunshine every day i I mean, seriously, people are walking around in T-shirts and shorts at September. I'm kind of, you know, I think the people from Newcastle are a bit shocked as well. They said it normally happens, but we're very, very happy. And there's a huge buzz in the air. There's all these brilliant lifestyle medics who are just full of ideas and enthusiasm. It's just all these brilliant talks. And I suppose my only criticism would be there's just too many wonderful people to talk to and too many great talks to go to. Yeah, it's quite overwhelming. I think, you know, it's a three-day conference, which is a lot anyway, but then you've got the fact that there are talks running side by side, and sometimes it's really difficult to know which ones to go to. But it's fantastic. I mean, as you say, really inspirational speakers and such a variety of speakers on so many different topics, all kind of related in some way to lifestyle medicine. And it's just really inspirational. I mean, there are some incredible people out there not just from the UK from all around the world that come to this conference and. They're doing incredible things so so what's been your favorite bit of the conference from yesterday Siobhan? Well it's just I suppose I was going to say on top of that so you've got two big rooms where there's these amazing talk happens but then the magic happens in those outer rooms and haven't really had time so far to explore those where you get these small rooms with people just talking about what they're doing locally and that's where the magic happens so the big rooms is the scientists presenting the research and big important wonderful people but they're talking about you know the bigger issues and at government level but it's the ground root stuff that we all love when you hear about someone setting up something locally for some kids or you know disadvantaged teenagers or people learning difficulties and that is where that is where the magic is. So we're on day two. So let's go back to day one. What did I like? Do you know what? It was so, I loved all the talks, but my head was spinning and my little... Haven yesterday was going to a session by vidya marla birch who is uh who runs breathworks this incredible organization um and she looks at a mindful meditation and that's in chronic pain anxiety but all sorts of other conditions and she's just got this incredible uh community of people and so we went into a room and she just said we could say it and lie and it was just 15 minutes of her voice and a mindfulness experience and just at the end of it I felt really chilled and I thought that was brilliant what about you yeah it sounds like that was needed I in fact I could have done with that today because I have to say it was quite overstimulating by the end of today because there's so many people and as you say it's not just the the main sessions and the main lecture theatres where all the magic is happening actually just networking with everybody And, you know, now that we've been attending BSLM for so many years, we've built this huge network of doctors and nutritionists and yoga teachers and, you know, all these incredible people that come along to this conference that we've befriended over the years, who we network with, who we work with. Who we try and work with. And these are incredible people, and just catching up with them is wonderful. My highlight from yesterday was this incredible bunch of teenagers who are calling themselves Bite Back. And that was an incredible talk. I mean, one, it was amazing because two teenagers, one 15 and one 17, stood up on this enormous stage in this massive lecture theatre and were so confident in front of everybody, which I was in awe of because I struggled with that anxiety on stage myself. But their topic is incredible. So essentially, they are representatives of this group, Bite Back, who are taking on the big processed food companies. And they are essentially saying, we don't want processed food in our lives. And they're trying to tackle it at the level of these big food companies and taking. You know, complaining to them about all the advertising, the fact that they can't go online without being bombarded with processed food adverts. They can't walk down the street without being bombarded with fast food adverts. Everywhere they go in life it's everywhere um and and it's incredibly difficult for them to navigate the the food system when when it's all pointing towards ultra processed food and and they want to maintain their health they don't want to get sick on processed food and i and i just thought this was an incredible um an incredible organization and i'd never heard of them had you no and it's also again and we'll go on to you know what our talk was about this idea of teenage stereotypes that we get oh they like ultra processed food rather than processed food, they like ultra processed food that's what they like, that's what they want. They put up some statistics saying that 80% of adolescents want to eat less of this stuff. They know it's not great, but they struggle. It's addictive. It's hyperpalatable. It's everywhere. And it's what their peers eat. So they'll stand out if they don't eat it. And actually, they don't want to be eating it, but they do, like us, because it's there. You know, it's quite difficult to navigate life without it. But the assumption that we have is, you know, to have this incredible group saying, no, we've got our own voice. Thank you very much. We don't need you to advocate for us. We don't want this stuff in our life. And it's you guys who's put it there. It's very powerful, great imagery, you know, poet, a bit of, you know, lovely slides. And actually, I think everyone learned a lot from how to communicate a message. They were feisty. They were angry. And they were powerful. They were. I mean, they got a standing ovation. Everybody was affected by that talk. Everybody was talking about it afterwards. I mean I think that's exactly what we need with the fast food industry and the processed food industry because at the end of the day it's so much more powerful when it comes from the teenagers because they are the ones that are going to be living their entire lives bombarded with this type of food environment and you know if they don't say it then it's not as effective coming from us because we're always told that they want it and so so this is I think this is exactly what's needed and and i would you know i'm gonna encourage my teenagers to get involved um it's certainly something that i think is is really an amazing organization so so look them up everybody because um yeah they're they're amazing there is one other thing i would say which you've alluded to which is this is an organization that kind of us and adults need to stay away from it's cool it's beautifully designed it's about them for them and it needs to go from adolescent to adolescent if we start kind of getting involved but anyone listening who's got you know adolescents teenagers young people who you know are fed up with you know us adults moaning about ultra-processed food actually this is an organization that I think they will be interested in because it's very it's got that kind of cool rebellious arty feel so yeah look them up fantastic okay all. Right so we just had another day we're on day two um what was your highlight from today Siobhan well today I really struggle today because Sheena and I did a talk today which we'll tell you about later but I was weirdly nervous and that's when you're talking about those teenagers standing up like it was nothing so I couldn't sleep last night and I have to have my sleep um you know it's a big lifestyle thing I actually didn't sleep. You know a wink last night and i sleep nine hours i need nine hours so i was kind of feeling a bit ropey anyway um and but amazingly enough i was awake anyway and that's the thing about this conference 7 a.m i went to a yoga session so there's this brilliant organized organization called the yoga health association alliance the yoga health alliance i mustn't get that wrong um so uh one of the leaders of it paul fox was doing a session today so that's what i love about this conference so I'm going in and then I had to get out of the way of on the way in there was a running group going one way and then there was Daryl Edwards doing his primal I mean what conference do you go to where seven in the morning and you go in as people giving you. Coffee and tea and saying hi it really is the most astonishing experience so I go to this yoga session and there's a few chairs and I think I do quite a bit of yoga and I think yoga and chairs really it was amazing and it was really nice to be led by Paul because he explained that if you put chairs out then there isn't any sense it makes it much more available to everyone because even if people aren't in wheelchairs there's lots of people who've never done yoga they've got back problems and actually they know what to do with a chair so they sit on a chair and they immediately feel grounded and not different from everyone else and there was anyway I was really amazed by the stretches and stuff you can do on a chair yeah and then you were invited to lie down but I thought no I'm staying here this is great so that was really interesting and he was also saying because they're trying to bring it into nhs clinics for health care workers as well that actually what you want to do is break down all the barriers you don't have to be looking in a particular way wearing a particular thing and when people say yoga it's immediately sort of stereotypes a particular class and type of person that you have to be able to stand in your head and do something ridiculous so that was really grounding and nice so we all kind of sat on these chairs and he's just got a lovely voice and a beautiful way about i mean he's been an expert teacher for 30 years so um but the stretches and the stuff that you do on a chair he was pointing out that you could do this, for five minutes between patients and then he showed us what you could do against against a desk and this was not like each thing you do was really really you know stretching and pulling and absolutely brilliant. So that was a real lesson for me because I thought that you sat in a chair if you couldn't do it, inverted commas. Yeah, yeah, yeah, absolutely. And now I'm thinking no, and I'm thinking actually much better to start there. And actually then everyone goes, okay, this is not as intimidating as I thought. What, you just want me to sit on a chair? I can do that. So, yeah, so that was magical. So that was half an hour and then came back and had breakfast with Sheena. I mean, this is lovely having all this time. Staying in the same accommodation. And it's great. So what about you? So that kind of, I really enjoyed that today. What about you? Fantastic. Yeah. So for me, I went to our friend George Ampat's talk. So George, in case nobody knows or has heard of George, is an orthopedic surgeon, although he calls himself an orthopedic physician these days. So George works in Liverpool And he's been a big part of BSLM for many years now. And he's incredibly entertaining. He's a brilliant person to go and listen to because his talks are very inspiring. And he's just got a brilliant way of presenting things so that, you know, you're always entertained and you're kept alert. You know, there's no falling asleep in his talks. But he's always got an incredible message. So last year, his talk was on spines and spinal surgery and how, you know, we're probably doing too much spinal surgery and that we can manage with lifestyle medicine, you know, back problems and back injuries incredibly well. And this year he actually made his talk on knees and knee surgery and and other options with it and his points were quite interesting because first of all he was making the point that when you have osteoarthritis of the knee it's not just affecting the joint it's actually affecting all of the other tissues around the joint including all the musculature and the um the tendons and the ligaments around the joint and you get erosion and damage to all of these things. But this degeneration within the joint is actually something that worsens with inactivity. It worsens with overactivity, but you're talking more extreme overactivity, not your average runner or your average, you know, fitness fanatic, but it's really sort of extreme sports that cause damage to joints. It's when you take too much load through a joint and you can't continually repair that joint that you run into trouble. So it's really only the sort of ultramarathon runners and the. The real athletes that get more erosion to their joints. So that was interesting for me. I knew that the average runner shouldn't get arthritis and that, you know, if you're keeping yourself exercised, it's a really good preventer for arthritis. But I wasn't aware that it was all to do with the amount of load on the joint. So that was interesting. But he was also making the point that on the run-up to surgery, so if you took the average, you know, an average of 100 patients on the run-up to surgery for knee replacement with their osteoarthritis, if they're very inactive, then they're in a pretty poor state by the time they reach their surgery time. And of course, their muscles have degenerated more, their knees have degenerated more. And rehabilitating afterwards is much much harder for them because they then don't have the strong musculature so that makes an awful lot of sense but if you introduce exercise programs for people on waiting lists for osteoarthritis knee replacements you can actually repair a lot of the damage in the knee and what he was finding is that exercise programs on for these patients that are on waiting lists for knee surgery, actually by the time the people got to knee surgery, 40% of them didn't require the surgery anymore. And that's been repeated across several different studies across the world. Which I found really fascinating that you can reverse some of that arthritis to such a degree that you no longer need the surgery or no longer need it for several more years. So he's making the point that, you know, we need to be much more proactive with these individuals awaiting surgery. And that makes an awful lot of sense because, you know, it's bad for them. Not just for their joints, but it's bad for them as a whole to be sedentary. And we know that it's bad for the microbiome to be sedentary so so yeah i thought he made a really good point in his in his um yeah in his talk today and and he's he's a great guy to listen to so george i really enjoyed it thanks for that i mean that's interesting because there were a couple of talks about sort of a lifestyle medicine um you know preparing for operations and recovering from operations because in the nhs you sit in this waiting list and then suddenly the day comes for your operation you have it and then you get sent home but there's so much preparation that you can do with lifestyle medicine that will you know improve your uh you know your anxiety about the procedure will it improve your your health your gut health um your muscular tone and strength and your immune system and make you much fitter for this really traumatic event not only that you'll recover better from the anesthetic um you'll need less painkillers there'll be less inflammation the wound healing is known to be um you know reduced and you're up and about quicker so we're wasting waiting list time when we could be using that to do this kind of you know prehab and and rehab afterwards and that's the sort of thing that the nhs hasn't focused on and there was quite a few talks on that and interestingly another thing that happens in this conference you have the talks you have these rooms you have lots of wonderful people but you just have these. Lovely conversations with people who you might never meet again um and i was talking to someone a plastic surgeon uh about this is what she did she did reconstruction post um breast cancer. Reconstructions and she said she just goes in says my patients aren't eating this food you have to have this you know it's plant-based and not ultra processed food and everyone's going none of the other surgeons want that and she said these are my patients this is my watch they're not eating that on my watch and I love that not on my watch and she said they know what I'm like and they like it because I say I want you to have the best chance of you know and she said I only have a few days with me she said I'm hoping that even for the short time they're in hospital that that messaging will be wow my surgeon thought it was so important that she said no they have this afterwards this is the way they eat this is how I want them to move get them up and I just thought I like that not on my watch so even though she knew that she couldn't be there when they got home she thought no I want they deserve that that was the implication they deserve that their bodies deserve that I know it improves their wound healing so I thought you know you meet these incredible people and then they're gone and then you just think well it's very influential absolutely and that brings us back to the last podcast that we and that I did with the um microbiome scientist that that's studying wound healing and that's exactly you know what she was saying that if you have a good microbiome, a good skin microbiome, and that is largely. Developed by having a good lifestyle and a good diet, then that actually makes a big difference to your wound healing. So your plastic surgeon is spot on. And if we could get more of the consultants out there interested in their patients' gut health and the importance of maintaining that whilst they're in hospital... I think that that messaging could definitely filter down to the hospital caterers and, you know, the people that are responsible for the food system and within the hospital because, you know, it doesn't take much. I read a statistic that it's only within two or three days that the gut microbiome develops quite severe dysbiosis on entry into the hospital. And that's multifactorial, of course. It's not just the food. It's the environment. It's the lack of sleep, it's the antibiotics and the noise, the stress. You know, there's a whole host of reasons why your microbiome is taking a huge hit when you enter into the hospital environment. And of course, the hospital environment is surrounded with quite harmful microorganisms, the ones that can survive the alcohol rubs and, you know, all the hygiene measures that are going on in hospitals. So this is why people are more inclined to catch infections in hospital when they have a prolonged stay. And so again, if you go into hospital and you already made great strides to get your gut into good shape before your operation or before you go into the hospital environment. Then hopefully you won't get such a drop in function of your microbiome whilst you're in and and as you say if we can protect the environment while they're in and really help their gut health as an inpatient I think that would be incredible for for outcomes yeah I mean I want to pick up one point you said about messaging and it being an influencer which we think is something young people do online but actually being the surgeon is incredibly influential if your surgeon says that like you know George Ampert saying I don't want you to have surgery i'm a surgeon but i don't want you to have surgery this lifestyle medicine is what we should do as the foundation and then we'll see where it goes if you get those really influential people in these positions of trust i don't know if they understand that how important that messaging is and then going back to the conference i mean this conference one thing i have to say is the food's great it's nothing fancy we're not fine dining but it's just good plant-based nutritious food not ultra processed and you know you sit around tables and then they've got plenty of breaks plenty of fruit and veg and it's it's that may sound like why am i even talking about this the reason i'm mentioning this is because the nhs when you go to conferences when you go to meetings it's all ultra processed food now this is we now know that this affects multiple aspects of our health and is strongly associated with negative outcomes for, you know, diabetes, cardiovascular disease, cancer. I mean, it's, you know, the evidence is just a massive, you know, ray of evidence. And yet we haven't caught up. It's so strange. And I often think. All of us, you know, we'll have to go to the dentist. When you go to the dentist, you walk into a room, you don't expect to see a vending machine. You don't expect someone to say, here's a lollipop, well done for not getting upset when you saw the dentist. We'd all be outraged. Everyone would think that was ridiculous and a bit of a joke. You know that your dentist has got good dental hygiene and they don't have suites and they advise you about that. And we want that and we accept that. And yet, when we go into hospitals or schools or prisons or, you know, government buildings, there are vending machines and ultra-processed food. It's strange, isn't it? Everywhere. Yeah. Yeah, I don't understand it either. And yes, I agree with you on the meeting front. And it's daft because if you're attending a meeting, a whole day meeting, and you eat ultra-processed food at lunchtime, Well, I don't know what you're like, but I will definitely be falling asleep an hour or so after that because my sugar levels will plummet after an hour or so later from eating ultra-processed foods. So, you know, my concentration is going to be terrible. I'm not going to take in on the talks in the afternoon. Whereas I have to say at this conference, although we're exhausted and slightly overstimulated, we're not exhausted from the food. Yeah. And do you know what? we have in fact i think we should put the agenda at the uh at the end so people can see because you know hopefully people out there will be listening we're thinking wow there's there's doctors who are going to a lifestyle medicine conference you know paying off their own back it's not because we have to do it guys this is because we absolutely love and believe this stuff it's it's incredible the potency of this so we have traveled all from all over the country to meet here because we believe that this is you know the foundations of everyone's health and well-being it's just you know amazing that you know what we're going to be able to do with this um you know all these ideas that people have are just so the outcome measures and things are so um you know really really exciting um but lots of the people who come from we have lots of eminent talkers and professors and and they all say the food is amazing everyone's so nice yeah i love this conference yeah they all say i mean mostly when you go to a diabetes conference or that you You know, you're knackered and you go home. But everyone loves, they fall in love with this conference. And I've noticed that there are several professors who kind of come now every year. You know, there's eminent retired professors who are wonderful speakers. And they kind of fall in love with medicine again. And they want to kind of keep going. And they realize this is where they can put their energy. Yeah. And it's not a small conference. I mean, over a thousand in-person delegates today and many more online that are here watching this. It's incredible. Yeah, absolutely. So what else about today? Oh, well, do you know what? Before we talk about our talk, there was, I want to just take a little moment to talk about Michael Moseley. Yeah. Yeah. It just makes me really sad still. So he was, you guys know that he sadly passed away recently. And it was really nice because he is, you know, absolutely sort of. A pioneer, really. A pioneer of life statement. I mean, you know, like years ago. He always gets to everything about five or ten years before everyone else does. He was incredible. But there was a lovely talk today. He was meant to be presenting at our conference. And we were all incredibly excited about it. And absolutely, you know, devastated for him and family. And, you know, it's just really, really sad. But it was a lovely opportunity for Professor Taylor, who is the professor from Newcastle, who was a very good friend of Michael Molesley's. Professor Taylor did the direct study reversal of diabetes. So they did a lot of talks together. And he was a little bit forlorn on the stage, wasn't he? Because he said they used to do this kind of double act. And he was really loving memories. memories um but it was all about his communication skills and his kind of you know um his his ability and then they showed this lovely bit when he was on loose women i don't know if you guys watch these women but you know if you go in there you're going into the lion's den but he was lovely and charming and taught everyone so much and i thought that was lovely and in fact his book on the gut microbiome uh is so easy to read and that's the one i recommend to people when they say what's an easy read but it's still bang up to date it's so easy to read and yet it's so research-based and it still blows me away how he manages to be so readable and accessible and you know his narrative style is fantastic and that's right sorely missed and there was a few, A few tears shed today. Yeah, it was. It was a really moving piece that they did on Michael. And yes, I think we were all devastated that he couldn't make the conference. And yeah, it was lovely to hear from Sir Roy Taylor and just to hear about what he was like to work with and, you know, to hear that other side of him. Um he was obviously so well respected by his colleagues as well as everybody who watched him and you know managed to if they were fortunate enough to meet him or um you know be a part of his life so yeah no i think standing ovation and it was like there was a lot there was so much love in the room yeah there really because a lot of us started in this area you know with his books and with his and it was this idea that you know rather than waiting for the NHS to catch up I still you know pass people his book on you know diabetes reversal. He's also got a brilliant book on sleep as well because uh yeah I've read that one and it's it's excellent I mean again it's just the way he communicates isn't it he's it's a very easy book to read um because it's full of stories he tells you lots of stories and I love stories that's how I learn best. He does stories about people but he always has his own story you know i'm terrible sleeper i do this or i need and you know he reversed his his pre-diabetes yeah so that was that was excellent yeah so we should talk about our talk yeah um and i really wanted to go into a little bit of detail on what we presented today um and and why we did it really um for the listeners and the people that can't be at the conference so that you can learn a little bit about the teen gut-brain access. So this is what we chose because the theme of the conference this year was start well, live well and age well and really focusing on health through the ages. So we decided to focus on teenagers. Yes we just sort of felt that they were kind of you know often missed and overlooked and seen as quite sort of you know difficult and but it's such an incredible window of opportunity so you can either say oh well wait leave it and but you know we will sort of discuss what's happening in their brains it's just. Incredible hormonal tsunami but that's not all there's just incredible things happening all over the body and it's the most important time to be, not receiving proper nourishment and yet it's the time when you know often they're eating the worst food um but yeah so it was interesting and there's a lot in medical literature at the moment about public participation so this idea which is quite right that the bmj really try and push that when you're doing a talk uh or when you're discussing a group of people you've got to involve them and you've got to say well what do they think and how can we do the talk around that um so we're kind of a bit mindful and I I have to say I didn't do it in a kind of really you know high-end research way but there were just a few teenagers hanging around my brother's house there were five of them and I just kind of got them to have a look at you know chat through and have a look at some of our powerpoints which were quite nerdy I guess and quite um research-based and they were they were funny you know but they were going oh it's like there's too many words there's not enough pictures. And then they were all chatting and then said and and it's really boring and I just thought, yeah I thought okay okay we'll take that uh so anyway that's that's what we said so they said it was really really boring so we kind of jigged it around a bit and then we had this idea that actually instead of talking to adults about teenagers why don't we just say right you guys are all teenagers we're all teenagers here together let's have a look at what's happening with the gut microbiome what's happening with the brain so i guess that's how we started so yeah so i mean yeah absolutely and and we wanted to focus because we'd done a lot of research you and i on the gut brain axis and and i we we we just decided to do um a little gut brain module which we haven't finished by any means but it was really interesting research that we were both doing on this. And so it made sense to focus on the area of mental health in our teenagers. So that's why we decided to go for the gut brain. So, you know, teenage mental health is something that's a little bit close to my heart right now because I have a teenager, I have a 15-year-old, and I hear an awful lot about the problems that our teenagers have. And that's quite hard to hear. It makes me really worried about our teenagers. I'm also a GP, and I see an awful lot of teenagers with mental health problems. And I think since the pandemic, you and I would both agree that we think that's worsened. So we wanted to bring that to light. And that was certainly the case when we found the statistics. It's now one in four 17 to 19-year-olds that actually have mental health disorders. And the peak age that we develop our mental health disorders is actually 14, which is pretty young. So, this is an area that we thought we would look a little bit more into. And we also found that, you know, self-harm is on the rise and that our teenagers are actually super lonely. Yeah, I was really surprised by that. Was that that BBC Radio 4 survey, wasn't it? Yeah, I mean, that's incredible. So according to that survey, 40% of our 16 to 24-year-olds are complaining that they're really lonely. That's in comparison to what I considered was the loneliest subgroup of people, which I thought the old-age pensioners would be the loneliest. But only 27% of old-age pensioners were complaining they were feeling lonely. So it's really sad because you would expect teenagers to be in a family, you know, have people around them. You wouldn't expect them to be on their own. So, you know, why are they so lonely? What is it that's making them lonely? And that's worrying. Isn't that interesting? Because if you think of the number of connections they have through social media, you know, 50, 100, 400, whatever. I don't know how it all works. But, you know, they're so connected in numbers. But this there's a lot in lifestyle medicine about the effects of loneliness on your immune system on your cancer risk on your cardiovascular risk um early morbidity and also death but it's really interesting that it's it has to be real life connection that releases all these positive chemicals and this virtual connection doesn't seem to do it in fact a lot of it makes you feel more lonely because you're you know you connect a bit and then you watch everyone else connecting and everyone else is connecting more bigger better smarter more beautiful it's constant comparison and that that did make me feel i was i was surprised and it made me feel sad and actually. Do you remember that book i was telling you about that i i can't i can't quite finish it because it's too um again i've got sort of you know older than your kids but you know that you're struggling with anxiety and things so the book was um the anxious generation by jonathan hate who's this professor from america who actually has come to the uk and he's done a lot of research about children's play and the fact that they're not playing outside and they're not taking those risks in nature and instead we're trying to protect them we're actually damaging them so his big move at the moment is to ban social um. Sort of smartphones until you're 16 so you can have your flick phone so you can phone and say you're ready to be collected from school but he said it's really really damaging to the mental health um and apparently the uk are really on board so it's going to be interesting some of you listening if you've got kids out there hopefully you'll kind of be hearing this through your schools actually it's not the done thing now to allow your kids to be accessing and hopefully parents out there because i had this pressure that we were the mums of the playground who said oh we don't really want to have phones everyone's going oh yeah but they'll be. Ostracized they'll be teased by their peers and so there was this uncertainty but hopefully some of you listening now will know that you've got the evidence on board and apparently parents are really you know on board as well so hopefully we'll see that over the next year or two that you will have you parents out there will have that support and you won't feel isolated as you try to make your kids do something which other kids aren't doing um but he thinks it's a big of that and that feeling of loneliness i would love personally i would love it if that came in but i have to say the school that my kids go to they insist that your child has a smartphone wow because in the classrooms they're actively using their smartphones with their work and so because it's a state school my children don't go to private school um they there isn't any funding or any money for other devices within the school so for example if they're doing something that involves um any kind of um just using work jotters online or you know just using their google classroom um they have to do it on their smartphone um so that's a major problem and i do know in some private schools they have banned smartphones successfully but they've had the the funding to be able to supply tablets to their children so that they can use their tablets in class. But that keeps them then off social media, which I think is a really, really useful thing. But I would be interested to know how this is going to be funded and how you would get over that issue of children still needing to be able to access Google Classrooms as they're moving through their different subjects. So, yeah, it's an interesting environment. It's an interesting conundrum right now for teachers, for kids, you know, for parents. And, you know, I struggle with it because I don't really want my kids to have smartphones, but without their smartphones, they can't navigate the normal school curriculum. You know, it's as simple as that. Yeah, because I heard him talk, did a program on Radio 4. And actually, I recommend everyone sort of have a look. Jonathan Haidt will put some links in the show notes and listen to him, not to me. But anyway, this is kind of paraphrasing it. But there's a couple of things that really struck me about what he was saying. One was we tend as parents to worry about the extremes, porn, you know, cyberbullying. And he said, look, even if we took those things out and safeguarded kids against that, that's not the solution. Because say, and the example was, say you had a girl who loved horses and she was just looking at horsey stuff all the time. They're friends on horses and her on horses. It was all lovely. He said, you know, that's still hours of her day looking on stuff. Scrolling through stuff, comparing herself to other people. When they should be outside playing they should be talking to each other so that was really interesting because it i always go to oh what are they watching is it going to be really frightening and he's going well that is important but that is there's a bigger thing than that and uh he does a lot of you know trying to introduce the sort of connections and outdoor play and the other thing he was saying was we try and protect our kids from these um you know fearful of people being abducted or our children being you know attacked or is and so you they're in their bedroom and you think they're safe but actually they're entering this place which he said was like a casino in your playground or in your bedroom and you go into casino you don't know where they are and they're in this place where people want to extract money and information from them and you don't know who these people are and you're letting them play there for hours and you know no parent wants that but that really struck me I just felt really kind of you know wow that's really so it's what's happening there but it's also the hours spent in this casino means the hours that we spent maybe as kids because we're getting on a bit now but you know that kind of thing where you stayed outside and rode your bike to your mates and you got that physical activity in there and also you got that thrill you got that you know jumping off that wall diving into that you know which would. Be considered dangerous but it's nature's dangers and exploring uh you know the world and and i guess that's how you're you develop that bit of your brain that that bit that helps you with resilience as you age isn't it because because you have to do things and try things out for you to know whether you can actually um you know tolerate or or cope with it and and it's through all these actions that you you develop confidence and and you build all these different skills and relationships and relationships you know it's that eye contact that raw relationship and you know there's a lot of um learning amongst peers you know and fairness and you know rules that they learn that is nothing to do with us yeah and actually there is that justice system that kind of can work really really well and if we think about it from a microbiome perspective they're outside they're hopefully outside and there's a wee bit of nature there may not be much but you know it's some nature they're also sharing some microbes between each other um instead of being in a in the same room all the time um where they're not really going to be coming into contact with more diverse species and things that might enrich them in some way um so so the more time in nature the better and actually i mean my kids are guilty of this as well they spend far too much time in the in the house and not enough time outside i think um and it is a really hard thing for our teenagers now isn't it when when the the environment is very much geared. Towards spending more time inside on devices and you know what my my son will do these days is is play his computer games with his friends which is all very sociable but they're all in separate houses yeah um which i i don't like you know he argues that they are communicating and it's all good but they're not actually having that face-to-face physical communication that you know there's so much more you gain from that. So it is such a hard, hard environment to navigate right now. It is really difficult. But if we actually, let's use this as an example. So we were arguing in our talk about the importance of the gut microbiome to teen mental health. So, and, you know, when we do any new subject, it is always a bit like a bit weird. You know, how can bugs in your gut affect your teen mental health? And maybe we should just take the example I've just given. So, you know, you've got a teenager in a bedroom scrolling through their stuff and they get some really quite negative feedback about something and you've got to remember at that age what your peers say and shaming is is brutal it's like a physical attack on your body so it's like being attacked by you know a wild animal and the savannah in days gone by so it's it's really stressful and brutal that kid is feeling extremely stressed releasing stress hormones cortisol levels go up um so how how i'm gonna ask you then sheena because okay so we're saying that kid is now really under attack feeling stressed a kid they're scared of a bit of bullying they've got to go to school tomorrow this is something bad's happened what how okay so i get that but how can that social media impact the gut well i suppose if it was just a very short-term insult i mean everybody gets stressed don't they i mean we can't think of stress in its own right as being really dangerous to us because everybody gets stress from time to time. I suppose what I would worry about is not that occasional stress that we might get when we fall out with friends or, you know. Something happens with one of our peer group, but more something that was happening more on a regular basis because it's chronic stress, I think, that is more damaging to our gut. You may get a little insult, which will cause some disruption of your gut microbiome through the high cortisol, the higher levels of inflammation. And that might knock some of the beneficial bacteria down in numbers. And it may increase the more harmful microorganisms a little bit. And that might have an impact on the way the gut works and how much of the very beneficial things like short-chain fatty acids that your gut produces. But I think if that's only a short-term perturbation, you're only going to get a little bit of an insult, then it's going to recover and it's going to rebound and it's going to get back to normal again. But if you have that continual stress, so say somebody was being bullied and it was a more regular bullying that was happening to them, or they were just getting themselves extremely stressed with all the dopamine hits and the social media stress day-to-day. Then that in itself is going to cause more damage long-term because you're not going to get the same rebound. And the function of your gut microbiome is going to be impaired. You're going to have less short-chain fatty acids being produced. And eventually with stress, especially if it becomes more severe and more prolonged, you could risk dysbiosis of the gut, So a really unbalanced gut microbiome. And you could risk even some increased intestinal permeability or some leaky gut, whereby more of these harmful microorganisms that are building up in the gut and their toxins like lipopolysaccharide get into the bloodstream and they can feed back to all the organs in the body. But if they travel up to the brain, then they can feed back to the brain and they can create inflammation within the brain. And that's really one of the hallmarks of medicine. Mental health disorders, behavioral problems, mood problems, you've got some degree of inflammation going on there. And there's multiple reasons why you can get inflammation in the brain. So, you know, a lack of short-chain fatty acids coming from the gut is one reason why you might get more inflammation in the brain because short-chain fatty acids kind of act like a little hose. They hose down all the inflammation in and around the body. And so if we are always dampening the inflammation down with short-chain fatty acids, then you're not going to get that buildup of inflammation and that damage in the brain. Whereas, you know, if you have lots of toxins going into the bloodstream and they can actually create inflammation everywhere they go, that's going to create inflammation in the brain. And so you need that balance to be struck. So not enough short-chain fatty acids, too many of the harmful microorganisms, and suddenly you're in a situation where you've got too much inflammation all the time going on in the brain. Yeah. I suppose traditionally with our NHS teaching and medical school teaching, it's very much sort of silos, isn't it? You go and do neurology and you do the digestive system and then you go off and talk about the heart and you're on the heart ward. And I suppose what people now see is this kind of systems model, but actually it's all one thing. Everything connects, everything chats, everything, you know, there's crosstalk between all these cells, tissues and organs. And this is beautifully exemplified, I suppose, by the gut-brain axis. So the way we have kind of thought of it is you have these motorways, these main highways between the gut and the brain. So you've got your big vagus nerve and then you've got the circulation. So and then so those are your kind of main highways. And then you've got the. What we call kind of chemical languages so you get these little molecules that can travel via the vagus nerve or stimulate the vagus nerve or from circulation so your gut bugs are releasing lots of chemicals that act like little voices little languages so they might stimulate the immune system produce cytokines or they might stimulate your gut cells to produce gut hormones, or they might stimulate your enteric nervous system and that will go on and stimulate to the vagus nerve or as you know you've looked into this a bit more that your gut micros can produce themselves produce neurotransmitters so there's all these you know you know the multilingual i don't think we even know some of the chemicals so they're all chatting to local tissues uh um or you know for tissues further away because they're traveling all around the body uh and acting almost like drug-like molecules they're attaching to receptors all over the body and knocking on the door and saying hi this is happening what do you want to do about it. So uh and the the the transmission between. The vagus nerve the gut and the brain is is really super fast and the circulation is a bit slower but i like that idea that these gut microbes are able to send messages up and then they get messages sent back and sometimes it's just this is happening okay no problem but sometimes it's like this is happening it's an emergency you need to do something about it yeah um so yeah and i suppose yeah the idea of inflammation being central to all these non-communicable chronic diseases whether it's cancer diabetes cardiovascular disease and as you say neuroinflammation everyone seems to be in the lifestyle medicine conference everyone comes back to inflammation inflammation and mitochondrial dysfunction yeah mitochondrial dysfunction metabolic stress metabolic ill health um so absolutely that is key to everything and the metabolism of your gut microbiome is essential so what we mean by that is is how is that community of microbes functioning is that community of microbes working together like a really productive city is it is it managing to take in all the good stuff and then produce and package all these wonderful nutrients hormones vitamins all the best things that our body needs in order to provide really good physiological function all around the body because we can create all of these things in the gut. And then... You know, is it managing to do all of this without allowing certain microorganisms or sectors of the population to take over and become too out of control? And so it's keeping that really tight balance. So you don't have, you've got just enough of the bacteria that are producing the vitamins, and you've got just enough of the bacteria that are producing the hormones, And you've got just enough of the fungi that have their own role to play. And some of the bacteria that are keeping some of the pathogens at bay, you know, they've all got a role. But when one population starts to become too powerful within that community, that's when things start to go haywire. And you'll end up with, you know, one group of bacteria overtaking. And bacteria are interesting that, you know, when they're in small numbers, they tend to be very productive and really beneficial. Like E. coli is a really good example of that. You know, we normally think of E. Coli as a pathogen, something that's harmful to us because it's normally what shows up on a urine sample when somebody's got a urine infection. But in actual fact, E. coli sits very happily in our gut and it probably plays quite a vital role in defense. It probably keeps a lot of the harmful microbes at bay and it's probably quite functional as well in producing some short-chain fatty acids and various things but if that. If that bacteria is allowed to increase in number and it gets to a certain size of population, they start communicating very differently. And that's when they can start to produce toxins. And that's when they start to become a harmful population. And so that's just one example of what can happen in a dysbiotic gut, a gut where you've got an imbalance of microorganisms. So that's where you can end up with this chronic low-grade inflammation through an unbalanced population of microorganisms. And that's not just going to affect the gut, but it's going to impact on the gut wall. And if you manage to penetrate that gut wall through damaging the gut wall by that inflammation, then of course that inflammation can spill through into the circulatory system. And that can then spill through to all of the organs in the body because the circulation can take it there yeah so i mean you've got this this group of we've said teenagers but actually you know we're talking adolescents and all the way up to 30 because your brain continues to develop and i suppose maybe we should we should just say something about that because i i hadn't really appreciated that because when we were at medical schools this idea that you know your brain was kind of fully developed when you know early childhood and that was it and that's certainly true for some parts of your brain so you know your coordination and motor skills and something they do develop and maximize optimize very quickly but they've done these beautiful serial studies mris of people as they age from naught to 30 and they found that actually it didn't stop when you were a young child that it continues to develop and there were certain areas particularly the prefrontal cortex is often pointed out the front bit as a part of the brain at the front that's involved in your tension and impulse control and emotional instability which is still quite. Still developing in in teenage years and it was i've just read quite a few pieces about this because that idea is oh they don't work properly teenagers their brains are poorly developed they're under construction and i really learned doing this talk that actually people are starting to say well what about if evolution isn't wrong what about if actually it's meant to be like that so that these kids are meant to be, uh curious and breaking rules pushing boundaries and exploring the environment otherwise they just sit in the house and wouldn't move and so they're meant to be doing that they're meant to not care what you think they want to be out with their peers their tribe they want to find out what's out there today otherwise they they'd be like with you know phones sort of stuck to walls i mean it all changes in decades they need to know what's what's out there today and i love this idea that um i was watching this lovely piece by this group of teenagers talking about this and they met with a neuroscientist and they did this lovely poem and they said so wait a minute our brains aren't broken they're beautiful and i thought that was great it's actually they're not the problem they're meant to go and explore the environment and then and they're probably meant to take risks yeah because that's probably how as a as a society and as a as a community it's probably how communities. Progressed because perhaps the teenagers were able to experiment more and come up with, you know, more interesting ideas of things to try, things to do. They're more likely to try out things and do things that might seem a little bit crazier to the adults with that safety conscious mind. So it's not a bad thing. I mean, you know, they can discover a lot, can't they, in their teenage years? It did make me feel sad because then you say, well, where's the problem? Well, the problem's the environment they didn't make up social media they didn't make up ultra processed food they didn't make up vapes toxins drugs they didn't go okay let's have those you know they're going out into the environment yeah and we're the adults we're meant to prepare this beautiful environment for these teens and that made me feel really sad and quite responsible yeah um you know and it and we didn't she and i deliberately didn't want to make parents feel bad or you know we actually sort of took it upon ourselves because actually we're sheena and i we're the adults and it's that idea that uh you know planetary health and this decimated planet and um and i thought whoa that's really i felt uh quite heavy um so that was kind of the the gist of it and uh i i kind of i learned a lot from actually doing it and then we sort of talked a bit about some of the lifestyles of lifestyle medicine conferences. So, you know, we picked a couple of lifestyle medicine pillars. Well, that's right, because, well, lifestyle medicine is pertinent for this whole talk, really, because not only is it the pillars of lifestyle medicine, all of those lifestyle medicine pillars are highly important in terms of when they go wrong, that will determine the health of your gut microbiome. So when you're not sleeping, when you're eating the wrong foods, when you're not exercising, when you are under stress, when you don't have good relationships with the people around you. All of this will damage the gut microbiome and it will create that dysbiosis. So our teenagers are at risk because they're at a time in their life where the pillars of lifestyle medicine are haywire and they're more likely to go wrong because of the environment that they're living in. And that's making matters very difficult for them. And that is an issue. And when we consider you and I just choose one of those pillars just to highlight it a little bit more. But, you know, just looking at sleep, for example, the sleep is vitally important for our whole system development. But in terms of the brain, you know, it's vitally important as well. In fact, there isn't a single mental health disorder that doesn't worsen with sleep. And that's because circadian rhythms really are central to the health of all the cells and all the microorganisms. And every cell and microorganism needs a nice regular circadian rhythm. So disruption to that disrupts the health of the microbial species in the gut and it prevents them from being as metabolically functional as they should. And it's going to favor the microorganisms that are more harmful. And the microorganisms that are beneficial to us are the ones that will suffer the greatest from that disruption. So that's a big problem. and Siobhan you were looking at the impact of of the teen diet yeah so I mean because can sound like we'd be a bit naggy isn't it you know the UK adolescents don't have enough fruit and veg but actually when you look at the stats I mean what was it 70% don't have a single piece of fruit and veg day and your fiber you've got to think what's feeding these incredible microbes so they're not getting fruit and veg they're not getting fiber so they've got you know they're taking less than half the recommended daily fiber intake but again that's not a fault thing that's just the way it's kind of the food system looks at the moment but then we were also talking about ultra-processed food and obviously there's that very, um provocative book by chris van tolican ultra processed people um and obviously the bite back. Kids as well i mean you know they're talking about ultra processed food uh it's high fat high sugar it's not going to fiber so you've got any fiber to feed your microbes and it's packed full of sweetness and emulsifiers and it's this kind of you know uh highly manufactured um for profit fake food that's kind of lasts for a year without looking any different and it's kind of you know That's what, I think it's 68% of our UK adolescents are. The diet is made up from this ultra-processed food, which I found was pretty shocking, especially when I heard, I think it's the highest. We can't be higher in America, but I think it's the highest in Europe. Like, whoa, that's high. That's worrying. So, I mean, you know, read Chris Van Tilken's book. It's excellent. and there's lots of stuff recently published about the profound and really strong associations between ultra-processed food and every health outcome you could mention, you know, diabetes, cardiovascular, early death, I've said before. But actually, if we just sort of pull back a bit because we were focusing on the gut microbiome and it's just that heavy gut microbes, they hate this stuff because it's got no nutrients in for them. It's got no plant fiber and it's got, you know, nothing they can work on. So they're starving. But it's not just that. Not only are they starving, they are also then, you know, it's kind of chemical warfare. These sweeteners and emulsifiers cause dysbiosis, you know, wreck the ecosystem, wreck the mucus layer, damage the gut barrier. So you're getting leakage of disease. Bacteria through into the gut where you've got 70% of your immune cells and they're all reacting to these lipopolysaccharides that Sheena mentioned earlier. I'm just going to stop there actually because those lipopolysaccharides is a bit of a long word. So it's LPS. And LPS is a molecule found on the cell wall of gram-negative bacteria. And there's lots of gram-negative bacteria in your gut microbiome. And if they sit outside in the luminal side of your gut and they're not inside your body that's fine it's like a good neighbor thing you don't mind your neighbors being next door but you don't want them all coming into your house and sleeping in your bed and eating all your food so good neighbors they need that kind of that garden fence but when you do get that barrier breakdown and you get these fragments of these bacteria or whole bacteria coming through and they've got this lps on the outside your body's immune system in the gut recognizes that as a serious problem so that lps is a potent activator of the gut associated lymphoid tissues that's all these immune cells in the gut and it's worth mentioning that obviously these poor diets lead to a greater number of these gram negative bacteria in the gut so of course you get much more of the breakdown product much more lps and so there are some bacteria that like this food yeah it's not the beneficial ones that we want in there um and and these ones are harmful to us when they break down. And of course, gut bacteria only lasts about 10 hours. That's its lifespan. So, of course, bacteria are breaking down all the time. And we should be able to get rid of the breakdown products of their cell walls and metabolize them and get rid of them. But this LPS is quite... I think you make a really good point there. OK, so when we're communicating this, there's lots of narratives. We learn in narratives and pictures. And I think we and other people in this area can be criticised, I suppose, for making it too good cop, bad cop, too simplistic. But then, you know, that's education psychology. You've got to hook on to things that you already understand. I mean, I find this very complex. But I think you made a really good point there, this idea of your good bugs and your bad bugs. First of all, the point you made that it's an ecosystem. so the imbalance everyone gets on well but if you get one group that are getting an advantage then there can start to be problems so they're not bad until they sort of explode in numbers and secondly that what we consider bad because we want the survival of us homo sapiens actually for those gram negative bacterias it's survival of the fittest so you know if their ecosystem is is expanding and that's when you get this they're producing these chemicals that are and messaging your brain to increase cravings and you know you're getting this whole it's part of this idea that these ultra processed foods are addictive you're getting all this crosstalk and messaging and triggering of these you know appetite centers in your brain you're getting this almost you know drug-like craving for these foods then arguably that gut microbiome is doing very nicely thank you uh so you know it's interesting isn't it what we consider a successful um you know ecosystem actually for those potentially pathogenic bugs they're like it's going it's all going just fine yeah um but yeah so so that is interesting but uh yeah. So then we we just there was that paper that you sent me um which i was a bit kind of flabbergasted at because we're talking about mental health we're talking about children adolescents and i didn't really when you think about non-communicable non-communicable chronic diseases i always think of older people with heart attacks you don't think oh what's the burden of these on children and adolescents but actually the global burden of disease as 2022 publication and it's sort of saying that children and adolescents are really struggling with these diseases not just the mental health stuff but musculoskeletal diseases and respiratory disease and dermatological diseases you know they are really struggling and then you sent me uh that you know that that picture that the uk children and adolescents out of everyone in europe they've got the the shouldering the the biggest burden of these non-communicable diseases i was i was pretty shocked i mean everyone in europe i know why are we always top of the charts in europe for the worst things the highest ultra processed food i mean that's no that's there's got to be a connection isn't it the highest ultra processed food and and you just. Because we're always looking at america going oh look they've got the highest rates of this they we are like we're pretty close behind we are pretty close because they're over i think their teenagers have over 70 percent of their diet is ultra processed we're we're sitting about 68 percent now yeah i think it's i think it's 68 percent it's unfairly uh divided so i think the average. Recently because i did another meta analysis is the average is about 66 percent in higher socioeconomic groups it's 63 which is still terrible and in the most deprived areas where they've got these food deserts and we are just it's it's so unfair so we're just piling you know one insult after another onto the people who who are the most vulnerable and yeah you know it's again it hits it hits them hardest always absolutely absolutely so so i think that's the important message that whilst we concentrated on the mental health side of things and mental health is certainly related to poor gut health poor gut health of course affects all systems of the body and all communicable diseases start off really with more or are associated with poor gut health so so yes it's not surprising as the biggest consumers of ultra-processed foods and also having pretty unhealthy lifestyles in europe in comparison to a lot of our european neighbours that we're doing so badly on that front, but still pretty chilling and, you know, pretty concerning. That was certainly a wake-up call for me. I did not know that and I didn't quite, yeah, I was pretty... But I mean, the thing is about these conferences, I mean, you could just like pour bad news onto an audience. So, you know, we then have to sort of step back. And this is a bit I love about this conference because the solution is the same, whether you're talking about diabetes, cardiovascular disease, mental health disorders, you know. Yeah, it is, isn't it? It comes back to the lifestyles of the pillars of lifestyle medicine, to healthy eating, to physical activity, to managing your stress, to to avoiding risky substances, to sleeping well and to to relationships. But but that's all very well, Siobhan. It's how we get that message to our teenagers. And I have to say, that's where that bite back really inspired me, because bite back being driven by the teenagers really, I think, is an ideal solution to the ultra processed food issue that we have right now, because if they drive it, then it will happen. If it's been driven by adults, it's much harder. And whilst as lifestyle medics, you know, we're keen to coach our teenagers into having a healthy lifestyle. Obviously, as GPs, we're time constrained in how much time we have for coaching. And, you know, we've got a difficult environment to navigate with them. And we need parental involvement. We need parental help. So what are your tips? How do you manage that? in practice? So I'm going to go further upstream. So as you know, British Society of Lifestyle Medicine, it starts with, kind of you know political systems health inequalities upstream because why are our young people having to even navigate these obstacles i mean why are they having to decide what they should eat and why are they having to step over you know stuff that will cause some disease i mean this shouldn't be there what sort of what's happening in the species. Where we sort of you know our environment is flooded with this so i i suppose you know i know that you feel the saying that it is no one's fault actually it isn't even their responsibility because you know it should be we should be looking after ourselves and having you know beautiful food beautiful environment it's just that we're in such a sort of terrible place at the moment that's why we're having to tell people look while they try and sort it out upstream these are the kind of you know the things that might help you but they shouldn't have to do that you know the food in school should be beautiful should be making their brains you know sing and work well you know their environment should be right that's what they should have and yet we're giving them these all these kind of you know for me i think i'm looking at institutions i think i'm gonna really focus on schools but you know schools hospitals yeah we've got to clean up our own backyard absolutely so hospitals schools prisons i mean we've got to treat you know government institutions where you know all this money is pouring in taxpayers money you know you want to be using that money to you know feed but also nourish the next you know generation of you know workers and you know for economical reasons absolutely and the things that we can do as a community if we want our schools to be better a better environment for our children you know to have. Less impact on their health in a really bad way, then that starts with getting involved with your school council, considering going into the school, meeting with the school, finding out what education they deliver. And, I've been into schools. I've been into my kids' schools. I've given talks on sleep in my kids' school. I've actually been involved in some education there. But maybe I need to do more. Maybe I need to go back there and see if there is anything else educational-wise I can deliver to them. And I know, actually, I was talking to some lovely Scottish lifestyle medics last night when I was out for dinner with them. And actually, that's exactly what they were going to be doing on the back of this conference is going into their local schools and finding out if they needed some education on lifestyle that they can deliver to the teenagers and the the kids in school so that you know they can help to give more resources to these kids and and again you know they were going to deliver the information on bite back and you know there are lots of interesting organizations out there that might be able to help. I mean, the sleep charity has a lot of interesting information on sleep. I don't know whether all parents are aware of the kind of resources they can access with their teenagers. So, you know, there's going to be a whole load of resources out there that schools could potentially get education out to their pupils on. So, yeah, Yeah, I think we could all be more involved in the community and more involved in this type of education. So that's one way we could try and think about moving things in a different direction. Yeah, absolutely. I suppose that the hopeful thing, though, is that, you know, these changes will help. Everyone in every way so it won't just help our teenagers it will help the elderly population it will reduce you know diabetes cardiovascular disease so although it sort of seems quite a complex model that we've got to kind of go upstream look at health inequalities work on these you know lifestyle pillars have more open green spaces in in urban places and get people connecting and talking and reducing you know toxic substances improving people's sort of sleep patterns and it's all doable and it's all you know wonderful doable available stuff we don't it's not complex absolutely it's not easy but it's not it's not complex interventions and they've got side effects they've only got positive effects and there are some incredible examples around the world of of schools that teach their children about food for example i mean look at french schools french schools traditionally have a long break for lunch where they actually educate the children about the lunch the children are often involved in creating the lunch as well and they um that's a big part of their education food is very important to the french and it's the same if you go to um some of the asian countries like um japan where they they educate children really well on food um and and they the children there know that they have to have their vegetables on their plate and their fruits. And they learn how to balance nutrition at a really young age, which I think is incredible. We don't really give our children good education on food. In fact, one of my children, I remember she had a home economics lesson and her home economics lesson was learning how to read a processed pizza label and work out how to cook up an ultra processed pizza. And I thought my god what what are we teaching our children here you know this isn't a life skill that I need my kids to learn I need them to learn how to create that pizza from scratch not you know how to put a um an oven ready pizza into an oven for the right amount of time um so you know can we take that education back a bit can we start you know teaching people how to how to cook the most basic things the the type of cooking that's economical that's that's going to be cheap uh nourishing you know how to make a bone broth and how to create a soup from scratch um or having to or being able to you know make a roast dinner or a you know a stew something that's going to be nourishing and wholesome and you know contain lots of vegetables and teach them how to balance their plate so that they don't have, you know, all carbohydrates on there and, you know. Get them to understand more about different varieties of food so that they're not scared of foods, of different ingredients, so that they can navigate their way around the grocery section in the local supermarket and be able to understand what's in season, what's good and, you know, how to cook those different things you know that that would be my ideal I would love to see that in schools I would love to see that kind of education yeah so anyone out there listening because often when you talk about the gut microbiome people go okay how do we manipulate the gut microbiome and people go on to fecal microbiota transplants or prebiotics or probiotics and which one shall I take we're not saying that those things don't have a place but you know honestly this is like the biggest way on behalf of your gut bugs okay uh this is what they want to hear they want a variety you know diversity of fruit and veg 30 different types of fruit veg nuts is you know a week they want you out in the garden they want you so this is all stuff that you guys listening can do already you know there'll be people who love gardening or who love cooking or who love taking their grandchildren just for walk kick around you know leaves in in autumn in nature that is you know that's what these solutions look like and they need love. Yeah connecting a lecture they do because that. Alters yeah you know i mean lovely data. On what what love and release of oxytocin serotonin all these kind of you know positive chemicals again they hum down and i'm feeling safe yeah that talk today yes you know children dr bird yeah children need to feel safe and if they feel safe in their environment they don't produce all the stress hormones um and they you know they they then don't suffer from as much disease later on in life yeah so it's all these tiny things that you can do so don't go to the drugs cabinet don't go and buy anything expensive just do simple small things in your local community seek out those green spaces um find a friend who's got some potatoes that they're growing in their garden some veg you know veg patches cooking from scratch really simple things with your grandchildren this is where the answers are that does everything yeah absolutely well i don't know about you but lifestyle medicine conference is actually making me feel quite hopeful although our talk i have to say frightened me a little bit in terms of our teenage health i i'm now feeling more confident i'm feeling more hopeful for the future i'm feeling more positive because of the the people that are at this conference that have come from far and wide who are they're all bought into this they all understand it and they're all desperate to make a difference to their community um and i think that's that's the message i would like to give yeah. Absolutely absolutely i think we should just sign off there and we are going to go and get ready because uh it's a nice gala dinner tonight So we're all going to meet with these lovely people. And yeah, so we're going to say goodbye now. Thanks for listening, guys. Bye.