Fasting & Dietary Strategies For Health With Dr Matthew Philips

Lisa: Well, hey team, and welcome in this week to Pushing the Limits. Absolutely fantastic to have you with me again today. I've dug up another absolutely amazing person for you to listen to. I have Dr Matt Phillips to guest. He is the metabolic neurologist — that's a bit of a new tune for most people. You might know what neurologists are, and he is a clinical and research neurologist at Waikato Hospital in Hamilton, New Zealand, and he explores everything with the metabolic side of neurodegenerative diseases, cancers and so on.

Lisa: He's currently doing a clinical trial that combines intensive fasting with the ketogenic diet alongside standard treatments for patients with glioblastoma, and he's also conducted research for people with Parkinson's disease using this fasting and ketogenic approach. So we dive deep into the weeds, really looking at mitochondria. You may have heard again and again on this podcast me talking about mitochondria being at the base of so many of the lifestyle diseases that we have, and that metabolic dysregulation and the metabolic disorders that come from our current lifestyle — the way we live, the food that's available, the processed food, the carbohydrate excess that we're eating — and how it contributes to many, many of these disease processes. I certainly believe that, and so does Dr Matt Phillips.

Lisa: So we're discussing today the implications for things like Parkinson's, multiple sclerosis, dementia, Alzheimer's, also for cancer of course. And when we talk about all these differing diseases, you may wonder, how can that be relevant to all of these things? But at the basis, it's all about mitochondrial health, and that's what we do a deep dive into today.

Lisa: So I do hope you enjoy this episode with Dr Matt Phillips. He's really a very critical thinker, someone who has spent, I think, in excess of 15 years studying his profession and then developing and working in the clinic as well as doing research, which is a bit of a heavy load to take. He's also someone who walks the talk. He uses himself as an n of one. He's done extensive fasts himself, he understands the implications of it, how it's affected him and his performance and how he feels, and the benefits of metabolic flexibility and all of that sort of stuff.

Lisa: So we get into a bit of a deep dive today into the metabolic approach, not only to cancer — you may have heard me talk about the metabolic approach to cancer — but also the metabolic approach for all these other neurodegenerative diseases and other lifestyle diseases, and how you might optimise your life through fasting and the keto diet, and what that actually entails and what's actually involved.

Lisa: So I hope you enjoy this show. Before we head over to the interview, please give us a like, a review, a rating, depending if you're on the podcast or on our YouTube channel. It really helps us get the word out there. Share this with your family and friends, and do check out the stuff that we do. lisatamati.com is the main hub for all of my programmes, for coaching, corporate wellness programmes, speaking, health consulting, as well as my anti-aging and longevity supplement range, my books — four books over there on lisatamati.com — so make sure you check that all out.

Lisa: And if you want to support the show, you can support us by going to patreon.lisatamati.com, and for the price of a cup of coffee a month you can support the show and keep this free to air and get some great benefits on the side. Or you can go to Buy Me a Coffee forward slash LisaT, I think it is. I will get the right link and put it in the show — oh no, it's just opened up that page — so you can buy me a coffee if that's within your means to do so. I really appreciate your help, as always. And if you have any questions or you want to reach out to me or my team, please email support@lisatamati.com. Now, over to the show with Dr Matt Phillips, the metabolic neurologist.

Lisa: Well, hey everyone, and welcome back to Pushing the Limits. Today I have the honour of having Dr Matt Phillips with me. Welcome to the show, it's fabulous to have you. Matthew, can you just give us a little bit of a background before we dive in? You're a metabolic neurologist — what the hell is that?

Dr Matthew Phillips: Yeah, thanks Lisa. It's good to be here. It's a term I coined, so I thought, I want to specialise in metabolic therapies or metabolic strategies, call them what you will, and no such specialty really exists in neurology. So I decided I was going to have to start it. So I just started calling myself a metabolic neurologist a few years ago and got the website up that a patient started for me, and that's it. It's something I sort of coined.

Lisa: Yeah, and it's so appropriate for the discussion that we're going to have today, because it's all going to be about metabolic approaches to everything from Parkinson's to cancer to neurodegeneration — who knows where this will go.

Dr Matthew Phillips: Sounds good.

Lisa: But you've got a very interesting background as well. So you're a medical doctor, you did your medical studies in Australia, I believe, but you come from Canada. Can you just give us a little bit of a brief on how you got here?

Dr Matthew Phillips: Of course, yeah. I grew up in Canada, British Columbia, in the north near the Alaskan border, a small town called Terrace. And I did two degrees at Queen's University in eastern Canada. The first was a bachelor degree in biology, evolutionary biology — nothing to do with people at all, it was animals, plants, fungi, bacteria, but all the good stuff. And then I did a two-year master's degree over there which was in fish physiology, so I learned some biochemistry, chemistry and some physiology during that. And my supervisor was an excellent guy named Dr Bruce Tufts, and he really showed me how to apply the scientific method properly when you want to answer a question, and I think he influenced me a lot later on.

Dr Matthew Phillips: Anyways, at age 24 I finished all that, and then a couple of years there where I did a bit of travelling, did a couple of other things, got my pilot's licence, worked in a telecommunications company named Nortel for about a year with my friends and whatever. Moved to Australia age 26 to start medical school in Adelaide at Flinders University. Why? I think I was mainly just bored, and I wanted to see the world. Did the four-year degree there in Adelaide and then jumped right into training. Did the first few years of general physician training in Adelaide, and then my neurology training, I did the bulk of that in Melbourne at the Royal Melbourne Hospital. And then at the age of 38 I had finished my neurology training, I was a neurologist.

Dr Matthew Phillips: So I decided — I've told this story a few times — that I wanted to specialise in a therapy, but I didn't know how to do it, because it was really not possible the way our system is designed and the way people think, as I'm sure we'll get to. And I decided to sort of travel the world and do a bit of volunteer work and work in a couple of other places for about a three-year period before moving to New Zealand. And then in New Zealand I was inspired and energised and ready to apply metabolic therapies in clinical trials to people with these difficult disorders, and it's been about seven years now that I've been doing that, just over seven years, and here we are.

Lisa: Overachiever, by the way. Incredible back story. And you've really focused — I've listened to a few of your podcasts and lectures and things that you've done, and you talked about being frustrated a little bit as a neurologist, dealing with the symptoms and the medications, not getting to the actual root cause. And so you sort of spent some time trying to work out, how do I approach this very complex disease from a different perspective, or these diseases, and came up with the metabolic side of the equation, which I'm very interested in because I've done a lot of work in the whole metabolic approach to cancer side of the story, and I know the power of changing your metabolic health and the importance of mitochondria.

Lisa: I think at the base of all of these lifestyle diseases is mitochondrial dysfunction to some degree or another, and this is the unifying factor in all of these diseases. When you're talking about different diseases like Alzheimer's and Parkinson's and multiple sclerosis and cancer, what do they all have in common? Dysfunction at the mitochondrial level. Would that be fair to say, in your opinion?

Dr Matthew Phillips: Very fair to say, Lisa, yeah. I think in medicine, I look at disorders now as icebergs. In medicine we tend to look at the top of the iceberg, this part you can see. So you take a disorder such as Parkinson's or Alzheimer's and you get the memory problems in Alzheimer's, you get the movement problems in Parkinson's and so on. So we try to treat those with drugs, and as long as the drugs mitigate or improve those, we feel like we've done a good job. However, we haven't really treated the whole 90% of the iceberg that you can't see. And the deeper you go, I think that is where you get into the more metabolic sort of side of things, and at the bottom of those icebergs — I'm agreeing with you on most of these disorders now — is mitochondrial dysfunction.

Dr Matthew Phillips: Why can't we see this? I mean, a lot of doctors know that mitochondria are dysfunctional in a lot of these disorders — not all of them, many don't, but a fair number do. I think we don't appreciate mitochondria enough. We still have this antiquated view that they are mainly just a powerhouse of the cell. However, if you look at what mitochondria do, they actually coordinate all kinds of things. They actually coordinate the cells. In my perspective, I see them as sort of the fundamental unit of life rather than the cell.

Dr Matthew Phillips: They undergo biosynthesis, they make things, molecules. They are responsible for producing steroid hormones. They strongly influence neurotransmitters, which is how cells, neurons in particular, communicate with each other. They determine when the cell lives or dies, so they're in control of programmed cell death. They actually coordinate the expression of the genes — that's epigenetic expression — so they determine which genes are turned on and off. They do all these things, and yet we still have this really old view that they are powerhouses and that's all they do. Yes, they make almost all the energy, crucial, however they do a lot of other crucial things. And I think as we learn more about mitochondria in the upcoming years, we're going to start appreciating that mitochondrial dysfunction is at the core of virtually all our lifestyle disorders, and that is the bulk of what is killing us today.

Lisa: Yeah. And these mitochondria, these are ancient bacteria that back in the primordial soup, so to speak, became symbiotic with us and we have our relationship. They're not even human DNA, they have their own DNA, don't they, as opposed to ours?

Dr Matthew Phillips: Exactly, yeah. Life has been around on this planet for maybe four billion years, and the going theory is that around two billion years ago, give or take, there was this endosymbiosis thing where these two ancient lineages — one was sort of archaea, and the other, there was this sort of prototypical bacteria. And the archaea was more similar to the cells we're made of nowadays, and it engulfed the bacteria, and the bacteria became mitochondria, and the bigger cell, the archaea, became sort of the host for this thing.

Dr Matthew Phillips: And together they formed this eukaryotic cell, which is the kind of cell that we're all made of now, multicellular complex life forms. The idea is that the archaea engulfed the bacteria-like cell. However, I see it as the bacteria-like cell took over the function of the archaeal cell. And if you look at that, then you say, okay, cells are not in charge of the mitochondria, mitochondria are in charge of the cells, to put it in a very simplistic way.

Lisa: Yeah.

Dr Matthew Phillips: And it's that shift in perspective that's crucial. Without the shift, you can't actually really understand all the nuances of the metabolic machinery and what these disorders might be at their core and what might be a better way to treat them.

Lisa: Yeah, and this opens the door — in the cancer world, the somatic mutation theory has been the dominant theory since, well, what, the 50s or something? If we go right back, actually — if we go back to Otto Warburg back in the 1920s, 30s, who won the Nobel Prize, we were on the right track, the Warburg effect. And that side of the theory of cancer, it lost its way when we discovered DNA and what it does and the genetic side of things. And for the last 50, 60 years, however long it is now, we've been spending billions of dollars and huge amounts of clinical research into the genetic mutations that are involved with cancer, as opposed to looking at: is it the mitochondria that have gone awry first, that the dysfunction in the mitochondria are causing the genetic mutations? And of course, Professor Seyfried's work and others who have done these — how do you explain that? The experimental nuclear transfer, yeah. Explain that a little bit, because I always get it around backwards when I'm trying to explain it.

Dr Matthew Phillips: Yeah, these are experiments that have been done by several groups around the world. They're called cybrid experiments, where you take a nucleus from a normal cell and you put it into a cancer cell that's had its nucleus removed, and vice versa. You take the nucleus of a cancer cell and put it into a normal cell that's had its nucleus removed. And what you find when you do these hybrid experiments — so you transfer nucleus or cytoplasm between normal or cancer cells to create these things called cybrids, which are like hybrid cells — what you find is that it's the cytoplasm, and therefore presumably the mitochondria, that determine whether the cell stays normal or becomes cancerous, almost all the time, rather than the nucleus. Which implies strongly that the cause of cancer is somehow tied to the cytoplasm and ergo the mitochondria.

Lisa: Yeah, exactly. And this is a massive philosophical shift, because the target is: you've got this genetic mutation, therefore we're going to go after this. And when you actually look, the genetic mutations are there, but they have come as a follow-on. They're further down the chain. And when you look at a tumour, they can have different mutations on different parts of the tumour, and then metastasis, actually.

Dr Matthew Phillips: Yeah, exactly.

Lisa: So it's like a whack-a-mole type of approach. You're trying to fix these mutations rather than going a little bit further upstream and going, hey, if we used fasting and the keto diet, for example, are we going to create some change in the mitochondria and the energy production and then influence that from a different perspective? Can you give us that shift in mentality, the great leap that this is for the oncology world? This is a major paradigm shift, and that's why we're having such a hard time shifting the ship, really.

Dr Matthew Phillips: Yeah, so we'll talk about cancer a bit, I guess. The somatic mutation theory states that the nucleus gets these genetic mutations, damage, for various reasons over many years, and then these mutations — some of them control the growth of the cell — and then the cell loses its ability to control its growth and becomes a cancer cell, it just keeps dividing. And the alternative theory is that the problem is not the genetic mutations per se, it's mitochondrial damage, dysfunction. If they're in charge of coordinating cell growth, which I think they are, then damage to them over many years from various different sources eventually means they can't control the cell anymore, and then mutations are acquired mostly at random, because the cell needs really good, optimised energy in order to keep repairing mutations. Mutations occur all the time, the cell just — they get repaired. So you get these random mutations, and maybe somehow the cancer state arises from that.

Dr Matthew Phillips: Now, some of the mutations I don't think are random. And the reason for that is interesting, and we can speculate. I think what happens is, again going back to that evolution, the first two billion years of life, cells were the archaea anyway, they didn't have their little mitochondria inside them. They were dividing and growing in these primitive oceans constantly, almost kind of like cancer cells do today. And I see that with cancer, you get such mitochondrial damage that eventually the mitochondria can't control the cell anymore, and the genetic programmes for that ancient archaea state are still there, they're just written over. I think this is called the atavistic hypothesis of cancer. And so if the mitochondria are damaged, then you get these ancient programmes reactivating, these old genes reactivating, that can actually create the cancer state too.

Lisa: Wow.

Dr Matthew Phillips: And so some of those are not random. A lot of those, they are sort of there and they get activated because the mitochondria are so damaged they can no longer coordinate the cell properly. So I think that's a possibility here. So it's partly random mutations and maybe partly not. But anyway, the idea is that if you want to stop all this from happening, you don't try to fix the mutations, because they are, as you say, a downstream effect of this whole process. Well, they are, whether they're random or not, they're a downstream effect. If you can improve the mitochondrial function and heal them up, restore their function, then you might be able to just stop this whole process in its tracks.

Dr Matthew Phillips: Now, some cells would be so far gone, their mitochondria so damaged, they're highly malignant, you have to take them out, destroy them. And this is why — I have a huge respect for Thomas Seyfried and a lot of these other guys, absolutely — however, I'm not necessarily against the standard treatments, because they are good at killing highly malignant cells. The problem with those standard treatments is they hurt a lot of other things, and the metabolic therapies can come in there and help restore mitochondrial function in normal cells, maybe cancer cells that aren't too far gone. They can protect normal cells from the standard treatments, the chemo, radiation. And of course they make life difficult for cancer cells because, as you said, they rely on the Warburg effect, they rely on glucose fermentation, so a lot of their energy comes from glucose, and the fasting and ketogenic diet therapies of course knock down the glucose levels.

Dr Matthew Phillips: So yeah, I think there's such a huge theory underpinning all of this. Evolutionary, it's mechanistic, but the real key to it all is sort of looking at the theory of cancer, the somatic mutation theory of cancer, and going, does that make a lot of sense compared to this other competing theory, this upstart theory, this mitochondrial metabolic theory? And if you look at it objectively — I mean, remember, I was schooled for years in somatic mutation, and I was not against it when I finished my neurology training — but if I look at it objectively now, and that's difficult because of the work I've been doing, I think the mitochondrial metabolic one makes a heck of a lot more sense. So anyway, I'm trying to design studies and doing this current glioblastoma trial now based on the lines of that second theory, to see if we can help these people live better and live longer.

Lisa: Yeah. And glioblastoma is one of the worst things you could possibly ever get a diagnosis of, an absolutely disastrous, horrible thing. I heard you say in one of your lectures, "I look at results, clinical results, then I look at the facts, then I look at the expert advice or the expert opinion." And I thought, yeah, damn, that's me, you know, what's actually working with the people.

Lisa: And one thing that really resonated with me with your story too is that you're an n of one. You've gone out, you've experienced the things that you're asking people to do on your own body, and you've nuanced this and finessed this and experienced what it's like to do the fasting — because we're going to get into fasting and the ketogenic diet in a minute, because that's where we're going with how we fix these mitochondria — to see what it actually does on your body and to feel the effects. And I think that's a real hallmark of someone who's actually really standing behind what they're looking at and actually really doing it.

Lisa: And it's not easy to fast. I mean, I'm struggling with it, to do longer fasts. I find it very, very difficult, more psychologically difficult than physically difficult. And I work with a lot of cancer clients and help coordinate and get them under the right people and do that sort of work. And it's the behavioural change that is the tough thing when you start talking fasting and ketogenic diets. It's for a starter a massive education piece that you're required to do when you're working with someone. You're just trying to change maybe 50, 60 years of programming that you should get up every morning and have your Weet-Bix and your bowl of cereal and your milk and coffee with two sugars on it, and that breakfast is the most important part of the day, and all of that programming that we get brainwashed with every day, the adverts on the television and all of that sort of jazz, and then shifting that.

Lisa: And people think that that's a healthy diet. You ask someone, do you eat healthy? And they go, yeah, I eat healthy, you know, I have my Weet-Bix and I have my — I'm not picking on Weet-Bix, by the way, I'm just saying — this is just general, all of those sort of carb-based, high-carb processed foods, grains and things like that. It's a big paradigm shift in getting people to educate them, and this is why I do these podcasts, because these interviews are coming from the experts explaining it a hell of a lot better than I can to my clients, right? So I can get them to go and listen to this and then we'll talk. Because it is a big shift in paradigm thinking, for a start. It's massive.

Lisa: And I'm constantly shocked, working with people who are diabetic, got cancer, and other ailments maybe, and nobody has explained to them what happens with high blood sugar. Nobody's explained insulin resistance or diabetes, or what actually goes on in the cell, not even to the basic degree, and they don't understand any of these concepts. And to me that is criminal. Why are we not taking the time to explain to people? And I know a lot of doctors and things are just rushed off their feet, overwhelmed, overworked, and they don't have the time. And this is where

Lisa: I think health coaches have a place in the world. But to not tell someone because they're not going to do it anyway is not really good. That's up to the person to decide, and you need to give them the science behind why I'm asking you to do this. That's an education piece, and that takes time. Why do you think there's something...

Dr Matthew Phillips: Well, it comes down to that. I don't know if you've read *The Obesity Code* by Jason Fung, but he basically says, why are there overweight doctors? Either they don't know how to not be overweight, or they don't care. That was an interesting comment when I read it many years ago. I think most doctors don't know. I think most doctors are very caring — doctors are extremely caring. It's just that they don't know the bottom of the iceberg, these deeper things that allow you to really maybe achieve health, rather than trying to make people better on a superficial level.

Dr Matthew Phillips: And in medicine we are extremely busy, we're rushed off our feet, as you say. And there are other things, life gets in the way, there are other things to do, and the system is very busy now — it's even worse since COVID. But if you understood them fully, the metabolic therapies, fasting, keto diets, then I believe you would do it yourself. There's no reason not to. And I know that's a strong statement, and I'm not saying people that are in the keto sphere or the metabolic sphere that don't do them are hypocrites or anything. However, if you really believed it, that it was helpful, you'd do it, at least try it and give it an honest effort.

Dr Matthew Phillips: I think that's been very powerful in getting my patients to do these things, because I've been doing it. I've been straight-up keto fasting for over seven years now. I do one meal a day, pretty religiously, one meal a day now. I used to sneak in a two-meal day, but that's very rare now. And I still do a multi-day fast every couple of months. Feel great. It's the kind of thing where you just get better and better and feel better. The first couple of years of the fasts, yes, they're harder — it's the whole hormesis thing. But as you do it, it gets easier.

Dr Matthew Phillips: In terms of getting people to do it, explaining things mechanistically, as you said, that's very important. However, it's crucial not to just explain the how, but the why you'd want to do this. Why would you want to eat once a day and fast? When you start understanding that physiological ketosis is actually our normal evolutionary state, that this is the state that people around the world, regardless of culture, race, whatever, were in most of the time for two to three million years of our evolution, and that what we do now is the aberration — it's not normal. If you can help someone see that, flip that, that actually what everyone else is doing is not normal and this is just returning to something that's more normal, when cancer was very rare in our hunter-gatherer societies, extremely rare, and you're just resurrecting an ancient state that we can all do that maybe is really a lot healthier — if you can get that light bulb moment, then the person's internal enthusiasm takes hold.

Dr Matthew Phillips: And people are awesome. Almost every patient wants to get better that I've met. Yes, there are some that don't want to get better, which you come across, people like that, for various reasons. But most people want to get better, they just don't know how. It's not that they don't care, they don't know how. And if you can be that guide and help them to discover that inner spark, that inner enthusiasm which you were born with and you've never lost, you've never let anyone stamp it out — but a lot of people get that sort of stamped out, and they listen to the experts. Some experts are great, some are not. And then over time you start doing what everyone else is telling you to do. It's really about trying to help people question everything and think, what is healthy, what is not healthy? You've got this tumour, so clearly something maybe isn't right. Can we correct this? I think we can. Maybe this is the way.

Lisa: Yeah, we need more of that in medicine, and it's about doctors not being gods. I really think we're still struggling with that concept, that we're guides.

Dr Matthew Phillips: I'm not here to tell anyone what to do at all. I'm here to offer options and say, this is one option, this is one option, this is one option. And then if I say a long fast is an option and a patient goes, "That's crazy," then I am able to say, well, I might be doing one right now, I'm on day four of a fast or whatever, so it's not that crazy.

Lisa: Yeah, I mean, this is irrational. We have this fear because we're trained and we're also conditioned, and part of our evolutionary past is to seek out food, right? Because we didn't have enough, it wasn't on every street corner, and we would go for the high calorie. That's why we like sweets, that's why we like high-calorie foods. And of course the big food marketing industry has utilised it. They're making profits — that's their job, is to make profits — but you have to understand that it's made to get you addicted. It's made to tap into those pathways that are going to drive you to eat not one chip but the whole packet of chips once you start. They have very carefully studied how to do this, and your evolutionary self is sort of driven to do that. So you have to really dial that back.

Lisa: I think stepping people into that lifestyle change — and I'd love to get your take on things like exogenous ketones and MCT oils and ketones and things like that, which I use to help people migrate out of that glucose-dependent state into a more flexible state, to make it an easier transition on occasion, depending on the person obviously — but to help them get into that so they don't have the mass of cravings, because nobody's got the willpower to withstand some of these evolutionary forces that are within us. Once you get started on something, I mean, sugar is as addictive as they say cocaine is. So just trying to transition them out of that state first, and then slowly work into the fasting and stuff.

Lisa: And then you've got the psychological. I'll be honest, this is an area that I've struggled with. As a teenager I had anorexia, bulimia and things like that when I was young, and so I'm very cautious with myself as to how I approach things, because I do everything to the extreme, in the sport, in my life. So I'm a little bit more careful on how I approach things. So I think there's also a conversation to be had: there are certain people that shouldn't be fasting — pregnant mothers, for example, maybe not — or the elderly population needs to probably have a protein-sparing sort of option built into that. So there's more nuance again to this conversation as to how we approach things so that we don't tip people into anorexia, for example. What's your take on that sort of a thing?

Dr Matthew Phillips: Okay, that's a lot there. With reference to the exogenous ketones and everything, I'm up for whatever works. I'm not biased against any treatments — whatever works and gets you that result, because as you say, results over expert opinion. It's results that matter. That being said, I'm very pro-evolutionary. I'm basically essentially trying to aim for physiological ketosis as an ancient evolutionary metabolic state that we're supposed to be in most of the time, where we perform better, that heals our mitochondria, and that's the goal with these disorders.

Dr Matthew Phillips: Now, ketones are just a small part of that. When you're healing up the mitochondria — all those functions I mentioned earlier about controlling the genes and controlling your steroid hormones and controlling the sulphates and all these things — you're aiming for all that stuff. So you do keto diets and fasting protocols to heal your mitochondria and optimise your health, because health is optimised mitochondrial function, from my perspective. So ketones are a small part of that. If you're dumping in exogenous ketones, to my mind that will have some benefits on your mitochondria, but not the big capital-B benefits that we're really looking for. So using it as a bridge to get into a more natural physiological state of physiological ketosis, no problem, do it.

Dr Matthew Phillips: I don't use them at all in my patients, for those reasons, but also money matters for some people. One of the things I really love about the fasting and keto diet protocols, if you combine them and do them correctly, is it actually ends up being cost effective for people. And fasting definitely — there's no socioeconomic barrier to fasting, which is great. A lot of these drugs, we could talk about cancer, I have to admit a lot of those drugs are extremely pricey, and a lot of people just cannot afford that. So I like that. But I guess that would be my main answer to that question of yours: that I'm trying to resurrect this natural state, physiological ketosis, that is aimed at helping the mitochondria, which I believe are the problem when it comes to cancer and the neurodegenerative disorders like Alzheimer's and Parkinson's, and I think multiple sclerosis, heart disease and all the lifestyle disorders.

Lisa: Yeah. And I think with ketones as well, you get some clients that have got complicated histories and they're on drugs that can prohibit them getting into a ketotic state naturally, and that can also be a little bit problematic. How do you deal with those sorts of situations when you've got someone on, say, steroids because they've got GBM or something like that, and they can't?

Dr Matthew Phillips: Yeah, I mean, we're getting into that right now. We're doing this glioblastoma trial now. We've got a bunch of people now doing a very intensive fasting and keto diet protocol. Basically it's the most intensive that I know of in any advanced cancer ever, in a large group of people, more than an n of one. The first patient in the trial is out to almost two years, and we have a pilot patient that's almost up to three years.

Lisa: Wow.

Dr Matthew Phillips: So steroids — prednisone is the hardest thing for me to marry with the metabolic programme. The protocol is timed with the chemo and radiation, no problem. As I said, I favour those because they are good at what they do, and I'm all about the middle road, Lisa. So I'm not just mainstream, I'm certainly not just alternative, but I think trying to marry them in a logical, rational sense is where we're going to have success.

Dr Matthew Phillips: That's a pretty lonely road, I've got to say, but that's what we're trying to do. Now, when it comes to the steroids, they use a steroid called dexamethasone in glioblastoma. The steroid is used when people get weak or get seizures because of swelling around the tumour, and the swelling can happen because the tumour is growing, but it can also happen when the tumour is dying — it's inflamed and it's getting killed. So it's always hard to say when someone gets worse in terms of weakness or a speech problem or a seizure, is that a good thing or a bad thing in the long term?

Dr Matthew Phillips: The standard approach is to give the dexamethasone because it gets rid of the swelling, and no matter what the cause of the swelling, the person will get better within a few days. So dexamethasone is great short term because it gives you that function back for a while. The problem is, in the long term, as you know, it jacks up your blood glucose levels, knocks down your blood ketone levels, and if the metabolic theory of cancer is correct, which I believe it is, then you're possibly getting a short-term gain but long term feeding the tumour more and helping it more down the road. That's my concern.

Dr Matthew Phillips: If you're just looking at the top of the iceberg and you're just looking at things — I don't want to say superficially, but I will, I just said it — then using more steroid than you need is okay. If I'm a doctor, an oncologist, and I don't know the metabolic theory, or I don't think it's right, then there's no barrier to using high doses of steroids. You can use them, because sugar doesn't matter anyway to the tumour. But from a metabolic perspective, you want to use just as much steroid as you need and no more, to get that person better, and then get them off the steroid as soon as you can, as soon as the fluid, the oedema, is gone.

Dr Matthew Phillips: So this is the one that I have the hardest time with, because I can't get too involved in the standard of care ethic. It's just not the right thing to do. I'm supposed to be doing the metabolic side of things, the oncologists are doing the standard of care. My oncologist colleagues are awesome in allowing me to do this trial. But it is difficult, because I can sort of nudge them and say, is it possible to get the steroid dose down? And a couple of times I might have taken it a little too far, because I feel quite strongly about it. And not all oncologists are as interested in the metabolic trial as others, so it's difficult. There's a lot of politics in it. But that would be the hardest thing I'm finding in terms of trying to marry the standard medications with the metabolic therapy.

Dr Matthew Phillips: Other than that, no issues with any other meds, actually. It's awesome, to be honest. We're able to usually reduce the seizure medications, because fasting and keto diets are really great against seizures. I don't worry about most of the other medications. They might influence the metabolic therapy a little bit, but I'm all about the big picture.

Lisa: This is a fantastic conversation, and kudos to you for getting these studies up. Because when I go to the oncologist with Mum, they're telling her to eat a pudding on the way out the door. Like, "Oh, Isobel, you've lost a couple of kilos, we better get you some pudding on the way home, please." And Mum just looks at me and goes, yeah. That's another thing — the pathological weight loss versus healthy weight loss.

Lisa: On that point, how do you deal with it when you've got a really lean, fragile person doing a fasting protocol? How do you manage that side of things? Because you are going to lose weight on this diet, for starters, and it's healthy weight loss as opposed to the pathological type, but it's still weight loss from somebody who's small and losing weight.

Dr Matthew Phillips: Okay, so not one patient in this trial has yet been unable to do their five-day fast, and each patient undergoes an average of eight to fourteen five-day fasts. So it's a lot. Some of those patients are thin, they're not all overweight. The average patient in the trial is high overweight, almost obese, but some are not. What you find is, when they do the fast, first of all they can't get as high ketone levels in general, being thinner — that makes sense, there's less access to body fat and so on. But you find they also lose less weight, especially once a person is fat adapted, keto adapted, like several months into the programme. The weight loss, even for a five-day fast, is very small.

Dr Matthew Phillips: I've got a couple of older women whose BMI is around 20, 21, 22, so low normal, but normal. They lose about a kilogram on a five-day fast, which to me — I still kind of can't believe that they only lose that much, but they only lose that much. They're so fat adapted, I guess, and they're already small people, but they don't lose that much. Whereas someone who's overweight, especially if it's their first couple of fasts, they'll lose five, six kilograms on a single fast.

Dr Matthew Phillips: So it's really about a metabolic reset, where I like to think — I hope I'm not deluding myself — that we're resetting the health of these people, and that includes a normal body mass index and, exactly as you say, the eradication of the insulin resistance, and nice physiological levels of ketosis, around one, two, three, nothing crazy. But for the keto diet fast it will go higher, and so on. A reset means you get to normal, you don't go underweight and into scary levels of low weight. And that's what we're finding, despite this really intensive protocol. So I think the oncologists at my hospital have now been reassured enough that this is what's happening, and it is intentional weight loss, as you say.

Lisa: Not unintentional. Unintentional is bad, that usually means you've got cancer cachexia and the body is inflamed and the cancer is really getting a little out of control. And that's not what we're seeing.

Lisa: That's the thing, people think weight loss with cancer is the cancer getting bigger. This is healthy weight loss. The cachexia is the bad weight loss, and the more the cancer grows, the more doors it opens up on its cell to intake all the glucose, and it's going to suck you dry. It's going to take all your energy and then it will grow, and then you will lose weight, and then it is bad weight loss. Getting that concept through to oncologists and to doctors, that this is good versus bad, pathological or not.

Dr Matthew Phillips: Well, it's the perceptual mind shift again. If you're not trying to lose weight, weight loss is bad. If you're trying to maintain weight, weight loss is bad. But if you suddenly embrace the opposite perspective and go, intentional weight loss is good, and you go for that and that's the goal, now it's good, right? So it depends — I always come back to the perception of what is good, what is bad, what is disease, what is health. And if we want to correct things and really take this whole field forward, I believe it's about helping people alter perceptions, one at a time, and making sure we don't force it onto people, because my perceptions might be screwed up, right? I might be looking at this talk ten years from now going, oh my gosh, I can't believe I said all that stuff.

Dr Matthew Phillips: But it's really about examining your own perceptions, your own biases, and then helping — if you really think, and it's nice to have some evidence, if you really think that this can help someone, you go for it, you work together, you don't push it on people ever, you act as a guide, and then see if amazing things can happen. That's the way to do it, I think. I see no other way. You can't push it on people, otherwise you're just enslaving them to your mindset. But you can't just have a great idea that you think might work and say nothing, because then you're being neutral. And we all know, the best thing is a great decision, the second best thing is a bad decision, the worst thing is no decision.

Lisa: No decision. If we look at germ theory — we've gone after the lifestyle diseases, the Alzheimer's, cancer, cardiovascular disease, diabetes, all of those things with that germ theory mindset, that we're going after a target. Alzheimer's, we're going after the amyloid plaques, we're going to rip them out. I had Dr Dale Bredesen on a couple of weeks ago, who's a wonderful guy, and he's like, just coming in with a drug that you've spent billions on in clinical research to get rid of the amyloid plaques is very simplistic. It's a response of the body, and it can actually cause more harm being ripped out, and causing bleeding and all sorts of things, he said. He likens it to 36 holes in a roof that we're trying to plug, and we need to be looking at fixing all of the holes in the roof, not just going after the simplistic view: we've developed a drug to fix Alzheimer's, we've developed a drug to kill cancer, just kill. The one pill will fix the world approach.

Lisa: In my very biased, very limited experience, that is not the way. A programme approach is the way that I've had success — plugging that hole, and that hole, and that hole, and then, where's the next thing that I can improve? And constantly having a mindset of there's more out there, there's more out there, there's more out there that I have to learn. So just being an insatiable sponge for information, and then processing it, and then starting to connect the dots, and then hopefully putting together a good plan to move forward. And you make mistakes. Definitely when I look back at some of the things that I've done with Mum over the last eight years, I'm like, oh my God, what was I thinking?

Dr Matthew Phillips: That's where you learn the most, unfortunately.

Lisa: Yeah, it's a hard way to learn some of those lessons, especially for the patient. But she's still alive to tell the tale, and has had miraculous recoveries again and again and again. I mean, stroke, aneurysm, a dozen concussions, and brain cancer — I see it as a lymphoma. That's a pretty hard thing in your 70s and 80s, by the way, not in your 30s and 40s. Talk about up against it. And how long we'll succeed, I don't know, but I just go with, well, we're aiming for 120, and I'm an ultramarathon runner, right? I'm going to take on a big goal and go hard and go for the big one.

Lisa: And we may fail along the way, and we're all going to die at some point. But I think that approach of hope, vision — and this is the whole spiritual side of things that I think is also very important, or the mental side, the holding of a vision, the belief that you can get better — all of those are part of the way I approach things when I'm working with someone. If I can hold a vision for them of them seeing themselves well, and then get them to maybe do that too, because they've been beaten down, they've had 100 people tell them there's not a good outcome here, or there's nothing that can be done. I've had a debate with the head of the Medical Council. He said, "Aren't you giving false hope?" And I said, "No, actually, you're taking all hope." It's a philosophical difference in the way we think. To me, life is very precious and we fight. Like, I fight every day, I'll fight for life, because you want to give it every shot. You want to know that you've left nothing on the table that could have been done. That's my very extreme mindset approach, I suppose, and that's not the approach for everybody, certainly. But that's the way I approach it with my mum, who's under my care — holding that vision for her. "You're going to get well, Mum. You are going to drive the car again. You are going to get your life back." And she's aiming every day at that goal, because when you've got somewhere to aim for, you're more likely to get there. I think that's a big part of this protocol, whatever you want to call it, this programme of getting well. It's a piece of that puzzle.

Dr Matthew Phillips: Yeah, yep. It's very hard to balance. I mean, you clearly have gone through a lot yourself as well with helping her, and are still going through it. It's really hard to balance that no hope versus false hope, because obviously A and B are both bad options. I mean, you have to limit the thinking to A and B, and as soon as we dichotomise things and get into us versus them, that's where destructive things occur, I've found. I'll be the first to admit, my first year of starting this a few years ago in the hospital, I was all full of fire and vinegar at that point, and I would get into arguments with heads of endocrinology and oncologists and so on, and it was not constructive, it was not going to go anywhere.

Dr Matthew Phillips: So there are other options. It's not false hope or no hope, it's hope with a plan, and recognising — as long as the person, the patient, recognises — that success is not guaranteed, that they are a pioneer, that they are trying something that doesn't have the evidence behind it. If it did, the standard of care would incorporate it. And that's another problem, by the way: we still lack really good evidence in these therapies in cancer, and that's why I'm really focusing on trying to do good clinical trials. We need the evidence before we can actually convince my excellent colleagues, most of them.

Dr Matthew Phillips: So it's about having hope and a plan, recognising that the hope is absolutely crucial, as you say, that vision of hope, but a good workable plan that makes sense on a mechanistic and evolutionary level, and just taking it forward and focusing on process over outcome. Yes, we all want the great outcome, but it's the process, the day-by-day doing this every day, whatever it is — that's what wins the game, as you would know in your training, I'm sure. If you focus on where you're going to be a year from now, you'll just lose focus. Maybe it's just the next step that's the most important step.

Lisa: Yeah, not the thousandth step, or the one millionth step, or the one you did 10 steps ago. It's the next one.

Dr Matthew Phillips: So psychology is everything, and if you can help people understand that, if they accept that, then it's all good. The oncologist or a standard doctor might say... well, anyone who says that you're giving false hope, I would say is a rare person in that sense. If they see the patient has accepted it on that level, and that you're not trying to give them false hope — like saying, "Oh, try this," when there's no evidence for it, and you don't really know anyone that's done it, or you read about it somewhere on the internet, because there's a lot of false information on the internet — then that's when they get worried. But if you can say, "Look, there's some evidence here, there's some mechanistic theoretical basis, the person understands there's no guarantees. I'm going to help them, they're going to help themselves, let's go for it. Can you support us?" — almost pretty much everyone does. And that avoids the whole us versus them, the A or B. Let's go for option C, and both work together.

Lisa: That's the best, wouldn't it be? There's a lot of psychology, and I've got to say, it requires a lot of self-work as well. There's a lot of maturity. I'm still working on that piece.

Dr Matthew Phillips: Well, it's difficult. Sometimes things really throw you off centre, but yeah.

Lisa: I mean, emotional control, being the master of your emotions, is really, really crucial at times.

Dr Matthew Phillips: Yeah, absolutely.

Lisa: If we step back a little bit into Alzheimer's, Parkinson's, multiple sclerosis, neurodegeneration, dementias, cancer — the unifying thing is that whole mitochondrial aspect. And looking at how do we make the chances less that people can develop these things, how do we stop it once it's started? And when you say ketogenic diet, some people think that's butter, bacon and pounding the... there are variations in the keto diet. What's your take on the variations, the vegan versus the carnivore? Sorry, big question.

Dr Matthew Phillips: No, no, it's fine. So first of all, the term "ketogenic diet" or "keto" is not liked by a number of people in the metabolic community. I wouldn't say that — it's been misused, so you can go to the supermarket and find keto desserty things that say keto on them, and they're missing the whole point. So those people prefer to call them ketogenic metabolic therapies. Fair enough.

Dr Matthew Phillips: My interest in a ketogenic diet is that it's actually the state I'm interested in. I want to resurrect that ancestral ketogenic state of physiological ketosis where the mitochondria are optimised and healthy. So it's a state, and the diet is a way to get there. Fasting is the best way to get there. Now, the diet in terms of the actual food one eats can be carnivore, it can be vegetarian, it can be omnivore, it can be any cuisine you want. I've got patients on multiple cuisines, and as long as they get into ketosis and they're not eating processed stuff — trans fats, for example, that should not be part of a good keto diet. The closer the diet is to our pre-agrarian, non-agricultural state, probably the better. So Dr Zsófia Clemens would arguably have the claim to the best keto diet in that sense, because she's hardcore pre-agrarian with her paleolithic ketogenic diet.

Dr Matthew Phillips: So that's the idea, and I think if you just remember that the keto diet is aiming to achieve a state that restores your mitochondrial function — if you can really understand that at a deep level, you can carry that forward and avoid all the various parking spaces and detours that might trap you. That's why weight loss is a side effect. It's a nice one for most people, but it's just a side effect. It indicates that you're getting metabolic health, and that's really about it. Yeah, you look nicer, but it's a side effect, and there are a lot of other great side effects, but the aim is to get your mitochondria going. That's the way I see it.

Lisa: So let's go and talk a little bit about mitochondria themselves, and the structure of mitochondria, what mitochondria do. I've heard you talk about — and this was sort of a new thing to me — the fission and fusion of mitochondria, and the mitochondrial biogenesis and the mitophagy. I know we're getting into some big words here, so hang on, us people. But can you explain what happens when I fast, what happens when I'm not eating and my body goes, "Oh, there's no glucose here, there's no carbs coming in"?

Dr Matthew Phillips: Okay, so it's an evolving area, remember. But I'm going to start a story from when I was a graduate student, when I was doing that physiology degree at the age of 23 at Queen's University in Canada. I remember we had a mitochondria expert in the biology department — I won't say his name, he's an awesome guy. He showed me something under the microscope and said, "I don't know what these parasites are in these cells, they're moving around." And then a couple of days later he showed me again, "I don't know what those are." And a couple of days later he came around to my lab and said they were mitochondria. This was a mitochondria expert.

Lisa: What?

Dr Matthew Phillips: Okay, now if he doesn't know what they look like in the flesh, then how can you expect anyone else to? So mitochondria are incredible, and we don't know — forgive my language — we don't know squat about them. There is so much we need to learn.

Dr Matthew Phillips: So there are these tiny organelles, which means they're a little body inside the cell, and there are generally hundreds of them, or maybe thousands, in most cells. There are very rare cells that don't have mitochondria later in life, such as red blood cells, but almost all of them have lots of these things. Mitochondria are typically thought of as bean-shaped; however, they can change their shapes. They can become more circular, long and skinny. And yes, all these hundreds of mitochondria, as this mitochondria expert learned — and I'm sure he knows a lot more now — they don't stay in one place. Sometimes they do, but often they're moving around.

Lisa: Right, okay.

Dr Matthew Phillips: So if you have a neuron — some neurons are up to a metre long, these are big cells.

Lisa: Wow, yeah.

Dr Matthew Phillips: So the mitochondria are going up and down, moving around. Sometimes they've got to get smaller to fit into the little nooks and crannies, sometimes they've got to get bigger when they want to do things. So they constantly fuse — undergo fusion, which is mitochondria coming together — or fission, which is mitochondria splitting into smaller ones. Mitochondria do this all the time. They're dynamic, they're moving around, they're like a life force. Now, they don't just sit in the cells. We've now found out in recent years that they actually can move between cells. They can actually move from one cell to the other.

Dr Matthew Phillips: And none of this stuff is what I learned about mitochondria. I didn't know this in the 1990s at Queen's University in all my biology courses. They are not static, as you see in a picture. They are mobile. They are not confined to the cell necessarily. And they are not just there to make energy. In my opinion, my perspective is that I think they are running the show. So we talk about the gut microbiota, for example, fantastic thing — there are lots of bacteria and

Dr Matthew Phillips: — viruses in our gut and so on. But even as impressive as that is — they say there's five to ten times as many of them as there are cells in our body — even that is utterly overshadowed by our mitochondria. There's even a great paper that came out by a Canadian researcher, Picard, I think it was, this year — it might have been last year — called "Mitochondrial Signal Transduction and Cell Metabolism". Awesome paper. And he sees the mitochondria as a collective processing unit that communicates with itself and communicates with the cells, and even allows inter-organ communication throughout the body. So it's like its own processing unit that does all these things that we mentioned.

Lisa: Wow.

Dr Matthew Phillips: There's just so much we need to learn about them, and we keep focusing — because of our perspective, our chosen perspective, is to focus on cells. Let's learn about neurons. I learned a ton about neurons and muscle cells and cardiac cells and kidney cells and stuff in med school. I learned just a little about mitochondria. It was, "Oh yeah, this little bit does that little bit," and that's it. We did learn biochemistry, like the Krebs cycle and the electron transport chain and all that stuff, which occurs in the mitochondria, but it was kind of disconnected from the idea that these mitochondria are actually moving around and coordinating the cell and doing all these things.

Dr Matthew Phillips: So I think we're just learning a lot more about mitochondria as we learn about the lifestyle disorders, because the mitochondria are the main problem, I think. I do not know — I think. But as we learn more about them and start to have more success against these disorders with good clinical trials, I think we will learn more and more and more in the decades to come.

Lisa: Wow, my mind's blown. I didn't realise they could even go intercellular and hop into another cell. So it's like they've got their own little brain. They seem to have their own consciousness and talk to each other and do things and tell them collectively.

Dr Matthew Phillips: Yeah, yeah. I see them as — I'm just coming up with this now — if you looked at Earth from a satellite or whatever and you looked at a city, and you looked at all these houses and buildings and people running around inside them and sometimes going between them, you might think that Earth was a collective of buildings. But really, we know that the fundamental unit of whatever makes the city anyways is not in its buildings, it's in the people that make the buildings and maintain them. And I think it just depends on your chosen perspective, and we've, for various historical reasons, chosen to view cells as the fundamental unit of life, when it's probably not the case.

Lisa: Wow. Yeah. And one of my great teachers, Dr Elizabeth Yurth, who I absolutely love, she's a top cellular health expert, and she's always talking about mitochondria, that they're the basis of pretty much every — not every, but pretty much every disease.

Dr Matthew Phillips: Yeah, not always, not always, but I know what you mean.

Lisa: Yeah, it's at the basis. And this is where it's so powerful, because then you don't necessarily need to be a specialist in Parkinson's disease to have an effect by trying something safe-ish, like fasting or a keto diet, and have an impact. You're not asking someone to take a really dangerous drug, you're asking them to eat less, less often, and the right things, and to try that. And this is an intervention that could have a massive impact on the course of their disease process, or stop it and reverse it.

Lisa: I've seen in the work that I've been doing quite a number of people who have been diabetic for 10, 15 years or something, not diabetic when we get them. And it's not rocket science, it's just understanding what's going on, then starting to change their lifestyle and starting to eat correctly, and hello, they're not dependent on their insulin anymore. And they understand that that's the gateway to all of those other things.

Lisa: I had Dr Ross Pelton on — he's the natural pharmacist, that's his website, and he's written 13 books I think, his latest being on rapamycin, which was very interesting. But he talks about — oh, I've completely lost my train of thought. Rocket science. Yeah — mTOR and AMPK. He said this is the most fundamental, if we can get people to grasp what mTOR and AMPK are, and how to manipulate mTOR and AMPK. And this is the nuance the science has to work out: what combination do we go? The hardcore always-fasting route — and then the calorie restriction society and the way they approach things, they end up looking like a wizened prune, but you'll live for a long time. Where is that nuance in that conversation, and how do you turn on the mTOR, which is all the growth stuff, and then turn on the AMPK, the recycling?

Dr Matthew Phillips: Well, I guess it's about balance, isn't it? So you want a proper balance of mTOR and AMPK. For people that don't know, mTOR is mammalian target of rapamycin. These are both master regulators of metabolism, mTOR and AMPK. So they sort of do opposite things: mTOR kind of builds things up, AMPK sort of breaks things down, to put it very, very basically. So mTOR is essentially anabolic, building the organism up; AMPK is catabolic, breaking it down.

Dr Matthew Phillips: And organisms such as human adults that aren't supposed to grow or shrink, not greatly, have to have a balance of building up and breaking down, not just in space but in time. So parts of the body might be building up or breaking down, and then at certain times you might want to build up and break down. And to me, it's all about the balance. And if you understand the balance, then you can understand mTOR and AMPK — because they are, again, mechanisms, they're the how. Understanding things at the why level always gets you there further.

Dr Matthew Phillips: So, why is the balance so important? Because unless you're pregnant, a woman with a baby, or you're a kid and you're supposed to grow, or something like that — those are not most people — then you don't want to be mainly anabolic. If you're overweight, as in a lot of fat mass, not muscle mass but fat mass, or even some people with too much muscle mass perhaps, then you want to be mainly catabolic until you get reset. So what the balance is that you're trying to achieve might be different depending on your starting point. But eventually you want to get a balance of anabolism and catabolism. And so sometimes it might be good to grow, sometimes it's good to eat; sometimes it might be better to get smaller, sometimes it's good to fast. And that to me is the balance that you're trying to achieve.

Dr Matthew Phillips: But the balance isn't just about being grey. The balance, as you said, is about trying the extremes. You're oscillating between anabolism and catabolism. How do you learn about something the best? Not by taking the middle road. I ride a motorcycle, that's all I ride. Riding down the middle of the road — I'll do it sometimes, but it's the least safe part of the road. You want to oscillate between two extremes to figure out, to achieve that balance. It's the sum of anabolism and catabolism. Does that make sense?

Lisa: Yeah.

Dr Matthew Phillips: I think a lot of people, when they think balance, they think, "Oh, grey, boring, maybe calorie restricting and just having boring food." But no, it's about — in the example of diet, and we can apply this to anything in life — feast and fast. When you fast, do it properly. When you eat, eat like a lion.

Lisa: I love it. Yeah, it is about what you're trying to achieve at that time. And when you have a disease process on you, you want to be perhaps catabolic, because we want to get rid of some stuff.

Dr Matthew Phillips: Yes. So if you have a disorder — I like to call them disorders, because that goes back to that germ versus terrain theory thing — cancer, you can look at it simplistically as excess anabolism. It's an out-of-control anabolic disorder. So we're trying to apply catabolic-based therapies to try and achieve some kind of balance. There's more to it than that, but you can use that argument in any disorder, I think, to an extent. So obesity — I don't see that as a disorder, I see that as a response, but it's indicative of excess anabolism, and you want to try and get catabolic-based therapies in order to correct that imbalance.

Lisa: Yeah, absolutely. It's brilliant, and it's going in between these things. So at some times, when I'm trying to build muscle, I'm maybe eating a bit more protein, doing a bit more of things for a certain period of time. Other times, when I'm trying to get over a virus or something, then maybe I'm doing more of a clean-out phase, being more in AMPK, and maybe even taking some supplements — or at least that's what I do — to help clear out that process.

Lisa: But one thing I heard you talk about too was anti-fragile. You mentioned a book — I've forgotten the title completely and who wrote it, but it was something about being anti-fragile. And I thought, yeah, that's it, we want to make people anti-fragile. Can you explain a little bit what that was about?

Dr Matthew Phillips: Sure, sure. You'd love my friend Deborah Murtagh, because she loves that concept too — she's a nutritionist. So the book was called Antifragile and it was by a guy named Taleb, T-A-L-E-B. I can never remember his first name, but I think it's Nicholas — I might be wrong there. But anyways, I believe he's originally from Lebanon, but the story goes that he was trying to find out what the opposite of fragile was, and everyone he asked would give him an answer like, "Well, the opposite of fragile is robust, or solid, or resilient." But he said, "No, that's not the opposite, that's the grade, that's the neutral." So you look at a rock: it's stable, robust, it's not fragile, but it's not anti-fragile.

Dr Matthew Phillips: So he said a fragile thing is something that sort of gets broken under pressure; an anti-fragile thing is something that doesn't stay the same under pressure, it gets stronger. And then he looked at — I think he looked at cultures, it's been many years since I read the book — but he couldn't find a word for this in any culture, so he decided to make the word anti-fragile, and he carried on the rest of the book talking about this concept.

Dr Matthew Phillips: And if you look at it, many aspects of life are anti-fragile. You need a stress before things get stronger. And one example would be like some kinds of cones in some forests need a forest fire in order to germinate. They can't do it without that catastrophic event that kills everything else. So that's the concept of anti-fragile.

Dr Matthew Phillips: And I think that's so crucial, again, on a psychological level. You look at a devastating thing in life, whatever it is, there's always going to be black and there's always going to be white. You can choose which one is bad and which is good — again, it depends on where you come from. But I would say there's always some good and there's always some bad. There's always a silver lining, there's always a dark cloud, even in the greatest event or the worst event. And it's taking the one you want, which for most people is going to be the silver lining, the good part.

Dr Matthew Phillips: And working on that and saying, "Okay, this terrible event happened, but here's the advantage of it, and I'm going to use this and make the whole situation, maybe even myself, better in the long run." That's being anti-fragile. Being fragile would be, "For me, this terrible event happened, I'm going to focus on all the bad things, there's nothing I can do, I'm a victim." This is just the mentality, and then you can't see the good thing, and then of course what you predict will become the truth and things make it worse for you overall.

Dr Matthew Phillips: So I think there's a lot of power and perception in how you see an event. And I'm not just saying this not coming from bad events myself — there are a number of them — but you must do that. And as you do that and make it routine, as you know, discipline wins over motivation. Day by day doing something consistently, then you will change yourself, and suddenly these events will stop happening because you have improved and you are getting the events you desire more. I really believe that this is powerful stuff. And yeah, you can take it to an extreme and lose yourself, but if you do it properly with temperance and constantly re-examine yourself, it can be a very good thing.

Lisa: Yeah, and I mean, that's the way I've approached some of the horrific things that have happened in my life — what can I learn from it? Of course you're down from the start, it's normal, it's human to cry and be flat on the floor trying to work out what the hell just happened to us. But that's why I wrote this book, because it's like, well, in this story I could be angry at the world because this happened to my poor dear mother, or I can go, "Here's what we learned, guys, here's what we found." So writing the book was an exercise in anti-fragility.

Dr Matthew Phillips: And you've made a positive out of that. You've made a positive event occur out of this terrible one.

Lisa: Yep, and I try to do that with everything that I've experienced that's horrible. And it's not easy in the immediate aftermath necessarily, but when you gain a little bit of perspective and time, sometimes you can turn it into something good. And that's at the end of the day what you have to have, that approach.

Lisa: I mean, looking at what the world's just been through in the last three years with the big C — if you like, the other big C, not the cancer — we have to turn some of the mental health issues that have come out of what we've all experienced and turn it into something positive. I don't want to get into the politics of it too much, but let's say, okay, this has happened, there's been some pretty horrific things that have happened through it. What can we learn moving forward? What can we take from this learning journey and how can we empower us moving forward?

Lisa: There's things to examine, I think, with the way we responded and all of that sort of jazz. And what I would have liked to have seen more in the conversations in the scientific community, especially in the medical community, would have been: how do we make the people more strong? What can we do — not just the one drug or the one vaccine or the one thing approach again — but what is it that would make these people stronger? Are there supplements that we can take? Are there things that we can optimise? Sleep, can we lower stress, can we do exercise, can we do these things so that you're more anti-fragile?

Dr Matthew Phillips: Yeah. So the elephant in the room with the whole COVID experience is, why are we so susceptible to a virus? This happens in history periodically in the setting of war, famine, that kind of thing. But it's the opposite now. Now it's happening in the setting of poor health on the anabolic side. We're not excessively catabolic, we're excessively anabolic. We're too fat, we have too much insulin resistance, type 2 diabetes is out of control, high blood pressure is out of control, the metabolic syndrome's out of control. And now we're unhealthy in the opposite way, and now we are susceptible to a virus. You look at the people who are most susceptible, they are people with poor metabolic health.

Lisa: A hundred percent.

Dr Matthew Phillips: But you're looking at things from a terrain theory perspective, whereas most people will be looking at it from a germ theory: there's a virus, we have to kill it, so we need a vaccine, we need whatever, we need something that targets it or limits it, eliminates it, so we don't get it. But the terrain theory, a health-oriented perspective, would be: let's get it. If we're healthy, it's not going to be a big deal.

Dr Matthew Phillips: I can tell you right now, I guess I don't mind saying it, I didn't want to get the vaccine at my hospital. I was one of the very last, if not the last, senior medical doctors to get it. But there was pressure, and it was either that or I was going to lose my job. It wasn't so much the loss of the job, it was that I wouldn't be able to continue my trials. My glioblastoma trial was too important — I think it's too important for humanity potentially.

Lisa: Absolutely.

Dr Matthew Phillips: So I got the vaccine, fine, did that. But in all the last three years, all my colleagues have been sick, some of them, many of them, multiple times. I have not been ill from anything. I haven't had one sick day since I've been at Waikato. And it's not always a good thing, because when you're on call and you're sick you have to do it anyway.

Lisa: Yeah, yeah.

Dr Matthew Phillips: But maybe I got lucky, you could say, but I'm around lots of people with COVID all the time, or I was — not so much of it now. And I was doing a lot of fasting, keto diets, I try to get good sleep, I do my high-intensity exercise protocol, blah blah blah, try to stay healthy, think I am healthier — and I don't know, I didn't get ill. So that to me is a much better way to approach it than to just vaccinate everyone.

Dr Matthew Phillips: And I don't like the philosophical idea of humanity being so weak that we just have to rely on vaccinations created by big pharmaceutical companies where, let's face it, their bottom line is to make a profit. I'm not a conspiracy theorist, and I'm not necessarily an anti-vaxxer either, but I just think that we didn't, as you say, we didn't examine the equation properly. We castigated anyone who had a different perspective. And it's really important as a scientist to question everything, be open to all perspectives and give them all their time and place in the discussion. I really think that things were tilted a certain direction with that whole scenario.

Lisa: Yeah.

Dr Matthew Phillips: So I hope we do learn from it. I think a lot of people have learned from it and are learning from it, so I think you're right, we are. I do think that we have a long way to go, though.

Lisa: Yes, I do too. I didn't get vaccinated. I'm in the position of being self-employed, and so I couldn't work — a lot of my work I couldn't do, and my family members lost jobs and things like that. But apart from what I see was wrong with that — you don't force people against their will — it is just this very singular approach again, there's one. And when you have people that are in a fear state, they will take anything, they will take any answer that you give them because they want the answer.

Lisa: I see people coming to me with, "Give me the one thing that's going to fix what I've got." And when you say, "Well, actually, hang on, it's going to be a programme of things and maybe we'll get better" — it's just a more difficult concept and a difficult sell. People want the silver bullet for everything. That's the way we're programmed, just to want the simple.

Dr Matthew Phillips: Focusing on outcome over process. You've got to focus on process over outcome, and you hope to get that outcome.

Lisa: Yeah.

Dr Matthew Phillips: But as you say, you've got to focus on whatever the path is, the programme or whatever it is, get that right. If you want to get strong, you don't go to a gym like crazy and look at yourself in a month. You create a good programme, you do a good programme and just commit to it and let the outcome occur. And then suddenly six months later it's like, "Oh yeah, I'm a lot stronger, faster, blah blah." But it's the process that one must embrace.

Lisa: Yeah. And the last thing, because I want to respect your time and I've taken up way too much of your time, but it's just an absolutely fabulous conversation, and when I get a chance to speak to someone like you it's just so lucky and so privileged.

Lisa: The sport — like, the athlete I come from — I have a lot of athletes who listen to the show. I've been an ultramarathoner, I've done extreme sports, because everything I did in my life was pretty much extreme in what I do, and that has advantages and that has some big disadvantages as well, as I've learned to temper that a little bit over time. And when I look back at the extreme amounts of exercise, I don't believe now that that was a conducive thing for my health. It was great for my mental health, it was great for the sporting achievements, it was great for the things that I learned by pushing my body to the absolute limits.

Lisa: But I wonder now, because I wasn't keto and fat adapted or anything like that, what sort of benefit could have been derived out of being a keto-adapted athlete. Have you got any sort of rounding-out thoughts for athletes listening to this about keto? I listened to your episode with Professor Grant Schofield, who I've had on the show.

Dr Matthew Phillips: Yeah, this is reminiscent of that conversation.

Lisa: Yeah, yeah, because I love his work and I think he's fabulous.

Dr Matthew Phillips: Yeah, he's an awesome guy. I think — so keep in mind my goal is health, not fitness — and I think we just have to understand that there's a blend between health and fitness. They certainly overlap to a large degree, but there are areas where they don't, and at some point fitness can be in excess, fitness can be unhealthy. And we see that with some ultra athletes, as you know, in the scientific literature.

Dr Matthew Phillips: So my goal is health, because I see patients that are certainly not most of them ultra athletes, although I do see some. Most of them want to be healthy, from a disorder or disease, whatever you want to call it. And so health, part of it, is that balance between anabolism and catabolism. And you can look at that balance from multiple perspectives — yin yang. So using exercise as an example, exercise does one thing to the body; what's its opposite? It's a proper resting protocol, sufficient rest. And I

Dr Matthew Phillips: think where a lot of ultra athletes go wrong from a health perspective is insufficient resting protocols, including sleep, but not just sleep. But they have to, because they're competing, right? So if you're competing for an event, or maybe you're doing it for the extreme mental health benefits, that feeling of euphoria and so on, fine, that's a good enough reason to excel. But if you're aiming for that, as long as you understand there's probably going to be a cost to your health in the longer term, then it's okay.

Dr Matthew Phillips: Where ultra athletes have trouble with ketosis, I would say, is when you adopt metabolic strategies, therapies, whatever you want to call it — you do fasting, keto diet protocols — it takes most people a few months to actually get, not just, you decline in strength and speed a little bit. Just a little bit, maybe five percent tops or something like that, but for a few months. Now if you're really unfit at the start, you probably won't decline much, if at all. If you're fit, you'll decline for a few months. At an ultra athletic level, it could be one or two years before your body can really get you back to that apex of fitness. And I don't think ultra athletes who are competing can afford to do that. You can't afford to have one or two years of not being your best and missing out on a whole bunch of comps.

Dr Matthew Phillips: So it's hard for ultra athletes to make this conversion. I do think once you do — you look at guys like Zach Bitter, for example, world record 100 mile runners and so on — then it's great. But it's the conversion that can be difficult, because remember, fasting and keto are designed to stress the body, make life a little harder in the short term to make you better in the long term.

Dr Matthew Phillips: So I don't know what to say. I would say if you're competing at that high level, you've got to decide, well, what's more important? To win comps for the next five years? Probably don't go keto, fasting, or not all the way. If you've got 20 years of comps ahead of you, maybe it's worth doing that at an earlier age to get yourself keto adapted, and then you're all good, and then you go for it. If the comps aren't as important as your long-term health, maybe you should just focus on health rather than fitness per se, but recognising that one can be very healthy and still be very fit, but not at that extreme level where you're pushing your body outside of that metabolic balance. That's what I would say in a nutshell, I suppose.

Lisa: That's pretty spot on. Yeah, and there are stages of life, and there are things that we're doing for other reasons other than health. And I'm certainly glad I did a lot of the things that I got to experience, but for me, where I'm at now, it's not conducive for me to be doing that type of stuff. And I understand also the genetic factors that come into play. Do you handle inflammation well? Do you have good glutathione genes? Different aspects. And then I think also the hormonal aspect for women is something that's also not always taken into consideration in some of these — even with the fasting, with keto. What's your take on that actually for women in their cycle? Is it safe for women to fast in their childbearing years, who want to preserve their fertility?

Dr Matthew Phillips: Yeah, so it is safe, I believe. I don't have too many women who are — I have some premenopausal doing these strategies, but to my knowledge I haven't had any problem, seen any problems with it. But I can't say I've delved into the literature too much on the effects of fasting and keto in premenopausal women.

Dr Matthew Phillips: I would say that, again, remember health is about optimising mitochondrial function. So the problem with the long running and insufficient rest, or long anything for hours — if you're exercising several hours a day — is you're producing massive inflammation. You're forcing your mitochondria to produce tons of free radicals, reactive oxygen species. That's going to damage them in the long term. You need a massive rest for them to recover. And again, if you throw in a bunch of nutrients, say you're drinking some power drink throughout the run, or you're having a high carbohydrate meal afterwards, you're hitting them again with a nutrient overload. They've got to recover from that, because that's going to generate reactive oxygen species. So again, that's where the whole being fat adapted, having fasting periods and so on, can be — it's sort of like you're running on diesel rather than petrol, and you're creating a nicer environment for your mitochondria, helping them recover quicker with adequate rest periods. So that harks back to the original conversation a bit. But to answer your question on premenopausal women, I'm going to hold off getting into that one too much, because I think there are other people who know more than me about that.

Lisa: Yeah, I think it's definitely a very — we just need a lot more work and a lot more studies on it. Hey, Dr Matt, you've just been absolutely wonderful today. I'm so grateful for you. I love the way you think. I love listening to your lectures. It's been challenging in preparing for this interview, challenged the way I've thought about a few things, and solidified the way that I've been thinking, and just some other and new information that I've gained out of this learning that I've been on since discovering you.

Dr Matthew Phillips: Well, thank you. It's been a great pleasure.

Lisa: It's been absolutely wonderful. Do you do any social media or anything like that, or is there any way that people can contribute to your work, any way that they can help?

Dr Matthew Phillips: I try to do as little social media as possible. I don't think it's good for your brain processing, but that's a different thing. I do have Twitter, so you can find me — the handle is, or it's not Twitter anymore, it's X, isn't it? So I think it's @DrMCLPhillips, I think, from memory. I might be wrong. But if in doubt, I have a website that a patient, a wonderful patient and a very close friend of mine now, Sarah Rameka, started for me. So that's metabolicneurologist.com, and you can get me through there on email too, and it's got most of our videos and stuff.

Lisa: And I'll put it up there too, absolutely. So there's a lot of education on there, and Sarah's story, which I didn't even get into, which I wanted to talk to, but all of those sorts of the clinical research that they're doing. So go to the Metabolic Neurologist. I'll put the links down below, everybody. Dr Matt, thank you so much for your time. It's been an honour.

Dr Matthew Phillips: My pleasure. Thank you very much.