Dr Ally Jaffee on Nutrition and Lifestyle Medicine
About
In this episode, Dr Elisabetta Burchi speaks with UK Doctor, Ally Jaffee, who is an expert in Nutrition and lifestyle medicine. Dr Jaffee founded Nutritank in 2017 and has been pursuing a mission to educate on food, nutrition and lifestyle medicine so that it can be applied to benefit communities, patients and the wider society.
Guest
Dr Ally Jaffee
Medical Doctor, NHS
Co-founder, Nutritank
Female Entrepreneur, Change-Maker
Mental Health Speaker | Psychiatry
Host
Dr Elisabetta Burchi, M.D., MBAClinical Psychiatrist
Parasym/Nurosym
Interview
Dr Elisabetta Burchi 0:05
Hello everybody. Today, we have the pleasure to have Dr. Ally Jaffee.
Dr Ally Jaffee 0:15
Hello. Nice to meet you.
So lovely to meet you too. Yeah. Thanks so much for having me.
Dr Elisabetta Burchi 0:23
Of course. So despite your young age, you have already had a huge impact on our society because Ally launched in 2017, Nutritank, an innovation, let's say information hub about nutrition and lifestyle medicine with the goal to promote...To promote what? Ally, tell us.
Dr Ally Jaffee 0:51
So, we set out to promote great nutrition and lifestyle education within medical training, so that frontline doctors are equipped and confident to have conversations with their patients around diet and lifestyle interventions that they can make in their everyday life to not only prevent chronic disease but also manage the symptoms of chronic disease.
Dr Elisabetta Burchi 1:12
That's amazing, Ally. So to say a few words more about Nutritank and I have some notes here.
In the last year, from the launching Nutritank has achieved the growing momentum across the UK, from setting up over 50 Nutritank society, branches, different medical schools, right.
To social media engagement and the creation of key projects on a local and national scale. So, and I agree with you, food, the lifestyle medicine should become part of the core curriculum of all health professionals, clearly for the benefit of all the patients and the broader community.
Tell us what started the Nutritank?
And, how did you shape it and execute your, ideas? Because, this can be very inspirational for all our young colleagues.
How can we, often we have nice ideas, but it's difficult to implement them. How did you do that?
Dr Ally Jaffee 2:19
Absolutely, So my co-founder and I were all about action over talking.
So we met in our second year at medical school. My co-founders called Dr. Ian Broadly, and we saw a massive gap in our training when it came to diet and lifestyle being mentioned in any of the treatment pathways for any condition we were taught about.
And we felt there was this huge disconnect there because we were already interested in the areas that we knew about the rich research basis that was to show the benefits of diet and lifestyle interventions, but we weren't actually being taught then.
So we went away to research the problem, and we found that the nice guidelines, which stand for national Institute of care and excellence, which are the guidelines in the UK, that healthcare professionals, abide by for treatment or conditions.
And we saw that the first line management of every chronic condition was to offer patients, diet and lifestyle. And then the next level of that escalation was pharmaceutical interventions.
And then, surgical interventions, when necessary.
So we thought to ourselves, it's being given lip service. It's written about in the guidelines, but no one knows how to actually implement it because then I've been taught it.
So we then decided we wanted to get a real landscape and big picture. I'm kind of shocked of what's going on in the country.
So, we surveyed medical students and junior doctors around the country and found that when we asked them about their opinion about nutrition education, they said that the main barrier towards them not having the education was due to the lack of confidence rather than lack of time, which really showed us on a really grand scale that how do we get confidence?
We get confidence through education and through training. So if we can change this, we can create a confident workforce. That's really able to help manage and reverse chronic disease in our Western society.
And so, that's when we thought, okay, we've got to do something about this because, you know, the skeptical senior members of faculty who said it was due to a curriculum crowding and a lack of time, and that's why it's never been done.
That's the barrier. It was actually not the truth. The truth was, it was just pure confidence. That was a pure lack of competence, which was the barrier.
Dr Elisabetta Burchi 4:44
That's very interesting. So everything started from a question now, like, okay, we have this sensation that lifestyle, medicine is not truly part of the training and the knowledge of the health professionals, but let's, make sure that this, this thought is true.
And so you made this survey and then once your right path is what's confirmed that, then what did you do?
How did you actually started Nutritank?
Dr Ally Jaffee 5:19
Yeah. So once we confirmed our hypothesis and we knew that we had enough evidence gathered to show that the problem was in fact, a problem we then solve to think about what's the solution, because we know that when we talk to senior members of faculty or any kind of senior members of an organization, you don't want to give more problems to add to that list.
You want to give them a problem and a solution, and actually say to them, listen, if you give us the opportunity, we can help fix the situation.
So we essentially came up with a solution whereby we'd create a hub, and this hub would be a place to bring together like-minded individuals from all over the country.
And that we'd take a bottom-up and top-down approach to improve the situation. And that's how Nutritank was evolved.
So, Nutritank has now evolved into this innovative hub, food, nutrition, and lifestyle medicine. And with our bottom-up approach, we wanted to create a network whereby we could have all different medical schools across the country, within their own medical school lobbying for local change, because curricula in the UK is all autonomous to the medical schools.
So you learn different things in different news. It's structured in different ways, based on the critical expertise of the faculty, etc, but you all obviously set similarly exams at the end and become qualified doctors.
So in order to make change, it actually, isn't a standardized thing. You have to do it quite locally. So we took this bottom up grassroots approach, which is a key value of ours and all about youth empowerment and having a voice, even when you're not far along on your job.
So, we created these branches largely due to social media and getting the word out. And then from a top down point of view, we started to talk a lot in the media about the problem and about ourselves and how few hours medical students get of nutrition education in a five to six year degree, which is anything from two to 15 hours or so, which is really quite outrageous.
And so from the top down approach, we started talking to the media and having policy conversations and also producing key research as part of our think tank function of Nutritank.
And so with that key research, we produced the paper that was in the BMJ, and it's called time for nutrition education, or it shows you what their opinions are of the workforce for this type of education.
And, we also, published two other papers, looking at what the landscape looks like, and that is really how Nutritank evolved.
And it kind of had a snowball effect. We started speaking to more and more media and more and more, stakeholders who were able to help us, really, get the message out.
And then we started collaborating with like-minded nutritional education organizations, and then really excitingly in October 2021.
So just a few months ago, we actually had the first nutrition, education curricular for undergraduate medical students launched, which essentially holds the potential for all medical students in the UK to be trained in nutrition education, which is really remarkable.
And I should say it wasn't actually the first-ever attempt, but it was the most kind of successful attempt.
Dr Elisabetta Burchi 9:00
It was also because you have probably also shaped the old curriculum.
Dr Ally Jaffee 9:09
Right. So, that was just a really, really incredible milestone. And it's now down to our, we have two-thirds of UK medical schools with Nutritank branch, then essentially it's now down to them to work with that faculty to ensure that this curriculum is now implemented because now we've got the right gold standard guideline.
You have to really work on the implementation, which is arguably probably more challenging.
Dr Elisabetta Burchi 9:41
That's amazing. That's amazing. So, I was going to ask you, I mean, since, we all know, and we have always known, at least in the last decades that, nutrition is a part of medicine clearly, What do you think, beyond what you've ever done in the UK, our curricular lag behind in incorporating such novel, knowledge. Why so?
Dr Ally Jaffee 10:17
So obviously this is just my opinion, so just to practice it, but obviously, I feel like through the work we've been, you know, running each type for five years now, I think we've got a pretty good understanding of why there's been such a delay in this kind of education.
And I guess the first part is a lot of inertia. So a lot of just not knowing what you don't know.
So I think that's been a huge factor, not actually knowing what was out there in terms of the rich, research basis in nutritional sciences and knowing kind of what trials have been done to show its impact on preventing, managing, reversing chronic disease.
So this, you know, kind of, feeling of inertia. And then when we started working with faculty, there was a lot of generational skepticism.
What, whereby they said things like, well, we're successful clinicians and we didn't learn it. Why do you need to learn it?
You know, why do you need to have a whole new, kind of tool when we've been fine all this time?
Which really is quite short-sighted because arguably generations above me have practiced medicine in a time where the problems were far more acute and far less chronic.
And I'd say that now with western society and an aging population we are in a situation where there is a lot more chronic disease.
So people need to be able to feel empowered and have all different sets of tools to help manage their symptoms.
So that was a huge factor as well. And then there was a lot of, how do I say this politely?
I'd say there was a lot of, medical arrogance, I'd say towards the fact that they, a lot of conditions believe that the field of nutrition was actually more of a pseudo-science and nothing robust like biomedical science and biochemistry, physiology, anatomy, pharmacology.
So they often found that it was just quite wishy-washy, airy-fairy, and didn't really give it the gravity that it deserves, because I'm sure they, weren't also aware of, you know, the trials that have been done, etc.
And then there was, you know, also a kind of political situation between the professions with registered nutritionists, dieticians, arguing about, who does war and dieticians and medics arguing saying, stay in your lane.
So there were all kinds of different situations that I ensure really slowed down any process of it being able to be part of mainstream clinical care.
and what's more is, it's just change. And people don't like change, you know?
So, kind of that seems daunting and they just want to kind of brush it under the carpet. Where really what we were suggesting wasn't a whole new stand-alone module, which the curriculum doesn't have space for.
In fact, we were suggesting an integration of nutrition, interventions, and advice to mirror the nice guidelines and going in that level of escalation for every chronic condition that we're taught as students.
So if you're sat in your own college, a lecture or a cardiology lecture, the slides could literally mirror what the guidelines are. Taking you through the physiology pathophysiology of the condition, whatever, and then just move on to, okay, this is diet and lifestyle advice you can give to your patient based on these studies.
Let's go away and have a consultation skills practice and rehearse how you'd actually in the application, have those conversations practically.
And then, so second-line medication, third line surgery where appropriate. So that's really what we were suggesting.
Dr Elisabetta Burchi 14:19
To restructure basically this all body of knowledge following the structure that is already incorporated into medicine with the guidelines for the various diseases. I really would like to highlight a couple of things you said, let's say that tradition.
I use this word that the resistance that every field, every in each field that has, towards the new knowledge, towards incorporating new knowledge into a body, which is quite consistent on the body of knowledge in medicine.
So in this regards nutrition again, there are fields that are quite affectionate tools such as neuroscience, for instance, and we will discuss about nutrition and mental health in a couple of minutes.
So this is a big topic, I think, how do we, facilitate, the evolution of, in this specific case of Medicine, what we teach in universities, so that, what medical doctors know is up to date with the research now, the gap researching and, in clinical practice.
And another thing, you mentioned, it's about, a factor, in a certain way, is that the source of this, difficulty in having nutrition inside the curricula, maybe it's also all this misinformation, which is around the nutritional, right?
They feel the nutrition, we can say is characterized by a proliferation of, multiple and discarding information.
So, probably with this crowded, with people without a medical background. And I think that they leverage the fact that nutrition is related to wellness and, physical appearance, which is something that in a certain way buy us.
Dr Ally Jaffee 16:43
Absolutely. Yeah. And, so just to add that, I wanted to mention actually another barrier, which I should have mentioned before is when we went to speak to the faculty, these, you know, really senior, very intelligent intellectual, huge kind of researchers, turned around to us and said, well, it's really hard to implement nutrition into the curriculum.
When I was about to name the tabloids when certain tabloids in the UK have different nutrition nor claim every week about the same product or same ingredients.
So one week we'll say tomatoes will help prevent prostate cancer. Another week, tomatoes will kill you or something very dramatic along those lines.
So they said, we just don't aware, you know, whichever way the wind blows with nutrition. We just don't know. We don't know what we don't know.
And then what we do know we're confused about. So how do we go about having level balance, nutritional research and, application within a medical curriculum that needs to be robust and evidence-based.
You just need to know the right places to look really, but obviously, we're up against a huge amount of misinformation that is very unique to the specialty of nutrition compared to any other specialty, because you've got it intersecting with so many different fields, food production, through manufacturing and agriculture, and just hospitality, everything.
Dr Elisabetta Burchi 18:16
That complex intersects with.
Dr Ally Jaffee 18:20
And there are also different camps, different tribes with different opinions about things. So if it's tricky.
Dr Elisabetta Burchi 18:26
Absolutely. But since we have talked a little bit about this, the bulk of misinformation, what would you like to tell our broader audience, about that intense diet regimens or supplements? What's your opinion about that?
Dr Ally Jaffee 18:47
Yeah, so it's a big question, but I guess just starting off with the basics, we advocate for whole food for Nutritank, and to try and get every nutrient through your diet.
And we're also diet diagnostic, which essentially means we don't sway towards any type of diet or any type of cultural influence on the diet because we want to be one of our big foundational values.
Each time is inclusivity. So if you are just going to talk about the plant-based diet, you're going to completely alienate so many people who have cultural diets, where meat is, you know, parts of it, and they can't see themselves ever restricting or giving up.
And I think that is so important to take into account. And likewise with the Mediterranean diet, yes, it's got the largest evidence basis for all the interventions that have been done in trial to the Mediterranean diet, whether it's depression and the smiles trial, or cardiology in the Mediterranean diet, whatever it is.
But you have to also think that that is biased. That is your centric. What about, people from ethnic minorities who have, equally kind of well-balanced diets?
So you have to really think about it as a big picture. So, and each time we say whole food fast, and we say, go by principles rather than nutrients per se.
And, you know, it's all about small changes and additions and swaps rather than restriction because the last thing we want to promote is any sort of disordered eating.
We only want people to make changes for improvement to that health and wellbeing, and to actually enjoy that food rather than feel like it's very prescriptive.
And, we don't want to medicalize it too much because food is, you're Italian. You know, food is enjoyable.
There's much social and cultural benefits of food and meal times as well. So in terms of supplements, the only supplement we really talk about is Vitamin D, because we live in the UK and we don't have sunlight that's permeable to make goods natural within DNR skin from the months of November to March.
So that's what we talk about. Other than that, we really advocate for whole foods first.
Dr Elisabetta Burchi 21:19
I do agree with your approach.
And I will add to Vitamin D, omega-3, which is the only supplement together with vitamin D, for whom there is evidence.
Dr Ally Jaffee 21:30
Yeah, like they say, if you're plant based, or week, go for it, if that's where your heart is and you, you know, your mindset, but do it wisely, do it with the right supplements that you need to replace or know how to make a complete protein and things like that.
And how to get omega 3 and a B12 from non-animal products. So just be aware,
Dr Elisabetta Burchi 21:56
Sure, and these are consistent with your approach of first diagnosis.
And then, and we try to treat if there are currencies, clearly, otherwise, you, you will prefer to get, the nutrients from the food then instead of supplements, it's really truly clear, what's your suggested.
And, I found the interesting how you like the fact that we are a little bit biased in our research because we don't know the, what minorities do, what they eat and prescribing a diet has different facets.
So eating is more than a prescription. So we must also if you think about it holistically, eating involves also other aspects of society agriculture, and it's, it's complex, it's complex. So I agree with you, we need to take into account various aspects.
But we were talking about mental health.
So, we know about microbioma. We know about the connections, we hear all the time about connections between the brain and the gut.
What would you like to share with us about this whole new, field?
Dr Ally Jaffee 23:24
Yeah, it's my absolute favorite field. I couldn't be more passionate about nutritional psychiatry and I'm just so grateful it exists and that there are so many amazing experts, all over that are now pioneering this work.
And I just think it's so important because I'm someone who has suffered from poor mental health and you can feel really helpless and feel really empowered and unmotivated.
I just think preventatively, it's such an amazing thing to know that you have the tool of diet and nutrition to be able to keep you well.
And there's so much amazing evidence to really show that. So, you know, we've got the smiles trial, which was led by Felice Jacka, and it was all about, it was a randomized controlled trial, which is really uncommon when it comes to nutrition and mental health.
So a very revolutionary trial and it looked at two, whereby, the one arm was a group of patients that she chose a population of patients in Australia with major depressive disorder.
And so the one arm using psychotherapy and the other arm were saying so psychotherapy, pharmacotherapy and then nutrition with a dietitian input. And the arm with nutrition and a dietician input had the strongest results for putting a 40% or something.
I can't remember the exact percentage of the patients into remission of that depression, which was such a powerful statistics.
And it showed that it actually cause a lot of the time healthy eating gets the kind of reputation of, I would say expensive, you know, only the rich only the privileged can be health.
And, and what was brilliant about this trial is that they actually put an economic analysis as well. So the meals were all really affordable and ended up being cheaper than fast food that you can get in Australia and really fascinating.
Dr Elisabetta Burchi 25:30
Do you know about the kind of regiment, the kind of food?
Dr Ally Jaffee 25:37
Yeah, so they used, they used something called the Modi med, which was, a modified, Mediterranean diet based on the kind of cultural needs of Australian.
So they didn't have as much kind of boiling fish for instance, as the Mediterranean kind of diet prescribed. So I think they replaced it with Lean meat.
And there were a few other modifications that I can't remember to make it more relatable to the population that they were dealing with.
Exactly. So quite bespoke and tailored to what they were used to. Cause I think that's really important. It goes back to what we were just discussing with the year centric nature of the Mediterranean diet and it's that if you're sat across someone who is from an African country or a south Asian country, and you're talking to them about the Mediterranean diet and they're from generations and generations of whatever their native country is, it's just completely unrelatable.
So you really have to work with them on what that cultural diet is, and then apply principles of sources of those nutrients you want them to have in your diet and that diet, but from foods and ingredients that they know and have that they know because otherwise how's anyone going to be compliant with a whole new way of life.
Dr Elisabetta Burchi 26:57
Absolutely, absolutely flexibility. I think it's, decores of everything also in medicine, you know, especially, the compliant with the regid, the schedules and regimens is tough and we do not promote compliance.
So, absolutely, And, do you know anything about neuromodulation, how can neuromodulation affect nutrition, but also appetite, there are a lot of studies about the vagal nerve stimulation and, as you know, the vagal nerve is involved, both in the brain side, the end in the gut side.
And so it can be something that are many, many articles in many researches that, if I highlighted these roles in the modulation of appetite and the absorption also of nutrients and also for direct effect on the vagal nerve but also through action on the microbiome.
And so this can be truly something to go deeper into. And I, I don't know if, you are developing this kind of reserves about neuromodulation, which is kind of cutting edge.
Dr Ally Jaffee 28:43
Yeah, the, I mean to me it's an area that I'm personally very fascinated by because I'd say psychiatry and neuroscience is kind of the lens I hope to look through nutrition, little term.
And we had a talk and one of our symposiums delivered by a gastroenterologist who was also a trained breathwork specialist.
And so she's actually doing a Ph.D. looking at the function of breathwork and, Vagus nerve, parasympathetic overdrive versus sympathetic overdrive in benefiting our digestive system and causing far less chronic stress and inflammation and more beneficial populations of microbes within the gut microbiome, which I found very fascinating because it's kind of come down to like ancient and cultural practices around mindful eating and finish, you know, when you're full, you stop and you're not eating mindlessly in front of the television, it's with social interaction and with family.
And so I find that really interesting how you can stimulate the vagus nerve and cause the parasympathetic nervous system to dominate over the sympathetic, which is obviously far more beneficial to the digestive process because we know that you get a lot of indigestion and irritation when we're eating when we're stressed when we're sat at the desk. We're not giving ourselves time to digest things like that.
We also know that it can have an impact on our blood glucose levels over time.
So, I find it a very interesting area, but I can't say I know much more than what I've spoken about.
I often find it very interesting, the potential of nutrition changes for neuro-plasticity within the brain. And there's a lot of research coming out at the moment.
We recently had a talk by a brilliant, nutritional physiatrist in New York. Dr T. Rams, spoke to our network on Thursday evening.
He spoke about brain growth, commencing, nutrients, which he's been looking at, which is really interested.
Dr Elisabetta Burchi 31:07
Let's just think about serotonin. The core molecule of antidepressants accessorize and is the main neurotransmitter present in the gap.
So the connection is clear. By the way, just to reconnect to neuro-plasticity once we thought in the past, that so-called antidepressants work, just because of, increasing the level of serotonin actually did the common denominator of all antidepressants beyond the death class is the action on a brad manera 25, through neuro-plasticity.
So probably neuro-plasticity nutrients now, if we make this leap and there is probably a relationship that still needs to be totally understood.
So, we were looking forward to additional research and, we are really excited about what you're doing and maybe in one year, you will enlarge Nutritank branch beyond maybe the UK.
Dr Ally Jaffee 32:36
Yeah, absolutely extensions, definitely on the cards. We just need funding in order to do so, but no, we definitely want to help, you know, countries beyond the UK, because we think it's such an important change.
Dr Elisabetta Burchi 32:51
Absolutely, Ally. Thank you so much for being with us.
Dr Ally Jaffee 32:55
Absolute pleasure. Thank you so much for having me.
You can follow us on our socials. On Instagram, we are nutritank_official, on Twitter nutritank_info. We're also on LinkedIn and our website is nutritank.com.
Dr Elisabetta Burchi 33:13
Absolutely Thank you again.
Dr Ally Jaffee 33:17
My pleasure.