Shireen: Dr. Hugh Montgomery discusses the relationship between climate change and diabetes. Dr. Montgomery details how environmental factors of health affect diabetes, and why we should consider issues of environmental diabetes as a public health crisis. Tune in to find out what effects of climate change impact diabetes and what policy interventions are needed to address changing global environments. 

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week. 

Dr. Hugh Montgomery is a biology professor of Intensive Care Medicine and Director of the Centre for Human Health and Performance at UCL (University College London). He Co-leads The Lancet Countdown on Health and Climate Change. Welcome Dr.Montgomery!

Dr.Montgomery: Thanks for having me.

Shireen: Absolutely. Dr. Montgomery diving right in, how did you get involved in medicine? And when did you become interested in environmental impacts? 

Dr.Montgomery: Well, I started at medical school, I guess, in the early 1980s and graduated I think 1987. And I was following a fairly conventional clinical academic path and that's in the 1990s, not that I was doing research, it was just mainly genetic, molecular biology and so forth. And so my involvement in the environmental side of things was somewhat accidental in the late nineties, certainly in the United Kingdom. There was much talk about climate change, but there was also an awful lot of discussion in the press saying it wasn't real. It wasn't happening. Maybe the world was getting colder.

But when I was looking up the science papers of interest to me in the molecular biology world, in the big journals, nature science and so forth, there were often papers relating to climate change and they looked very, very worrying to me. So there was a discrepancy between them – the popular press that is and the scientific press.

So I decided that the thing to do would be to spend a year or two, trying to understand the science, trying to understand the implications and work out whether it was a problem or not. And if it wasn't, then I could ignore it. And if it was like the science papers seem to be pointing, then I need to do something about it.

And essentially, I suppose, by the year 2000 or so, it was obvious that we were terrible. Under this was a very, very real problem. So that's really, when I started working on it in parallel with my other academic work. 

Shireen: Can you help us understand what are the environmental factors of health?

Dr.Montgomery: Well, of course there are many. I mean, our bodies are pretty much entirely dependent for their health on the external and internal environment we expose them to. So that relates to the air. We breathe the food we eat The drugs we consume and so forth in terms of the global environment. The impacts of course are huge because we are part of an ecosystem. We like to think we're not, we've got this idea that we live in houses and cars and we buy food or supermarket shelves, but we are just animals in a very, very complicated ecosystem. And we also are dependent for our survival upon clean air access to water. Access to food and the right thermal environment, we essentially came out of Africa, were adapted to live in an African climate.

We can't have that access externally. So we make it with central heating and clothing or cooling and whatever. So if we exceed the planetary boundaries for air, water, food, or our ecosystems, then our survival of humans is threatened  And the survival of our species and of our civilization is threatened. And we have reached that point very quickly.

We've destroyed over 70% of all the vertebra animals on the planet since 1970, when I was eight years old, so seven out of 10 animals have disappeared with gated monocultures, 72% of all birds on the planet. Now farmed poultry we've destroyed land for land use. We now graze cattle on land surface area, the size of the whole, of the continent of Africa.

We have run out of land and water for the things that we need and want. So in our chopping down of rainforests, we are destroying ecosystems and environments, which animals can live in. Now giving us up to eight species and becoming extinct is the biggest mass extinction this planet has ever seen. And on top of the sorts of impacts, we can add to pollution, whether it be plastics or chemicals. And we might also add the impacts of climate change, which are now very, very grave. Indeed. We've added around 2.8 billion Hiroshima bombs worth of energy to our atmosphere since 1995. We've added multiple times that to the oceans because the oceans absorb 90% of the energy we're trapping. We're currently adding five Hiroshima bombs of energy, a second to our atmosphere. And that's driving ever rising temperatures, increasing ice from land Berman, expansion of oceans as well, leading to sea level rise. And if you add. Energy to an atmosphere, you get weather. So we're getting more and more extreme weather events.

All of which are more and more extreme. We've seen the fires in California and Canada and Indonesia, the floods in Germany in England, in China, just this year, for instance, and we've now tapped into positive feedback loops. So the rainforest is now emitting carbon, rather than drawing it down, we're now melting ice quickly so that it's reflecting less heat back. So energy gain doubled in only the last 14 years. The fires themselves are contributing colossal amounts of carbon dioxide to the atmosphere. The Eastern Australian fires a year ago added three-quarters of a billion tons of carbon dioxide to the atmosphere. We've got methane hydrates, melting carbonate rocks releasing methane. And we've got tons of warming creating the thing, which is 87 times as powerful as greenhouse gases, carbon dioxide in its first 20 years. And there are multiple other positive feedback loops. So we are now really without immediate action to stop permitting greenhouse gases drawing down carbon dioxide. So I very, very quickly,  we're in the last few decades of civilization as we know it. So,  That's a short precis of, of the gravity of the situation we've had. 

Shireen: What did you think about the recent meetings where different countries all over the world, global developed countries pledged to bring down some of those emissions. How do you see the impact of that? 

Dr.Montgomery: They haven't actually pledged to do that. And the negotiations. Now these are the cup or the conference of the parties negotiations. This is, this year is the 26th such negotiation and they have failed to deliver. Any change at all in greenhouse gas emissions in the whole of that time.

So the so-called Paris agreement in 2015 made not a, not a dent on the increase in emissions, even with the 5.8% reduction emissions from the, the worldwide lockdown with COVID we've bounced back again this year to even higher emissions without. And there won't be a meaningful deal to bring down carbon dioxide from the cop negotiations.

I don't think there's ever been one before and I don't think it will happen this time. And that's partly because everyone's got an excuse for why they want to continue and, lots of countries and we do need a binding deal across all countries. A lot of countries don't want to deal with it. Russia is dependent for its economy on oil and gas.

Many other countries dependent on chopping down trees. We've got many others dependent on coal on tar sands, uh, on oil, for instance, in the Arab states, none of them want to deal. I's very shortsighted because that makes them more money for another decade or two. And then it will be, oh, you have as a human civilization, but no one is prepared to jump and lead first.

Shireen:  I do want to connect these environmental issues to what our viewers of ours, excuse me, our listeners. And in the topics that we talk about specifically addressing chronic illness, including diabetes. Can you help us understand the implications there?

Dr.Montgomery: It's very interesting. In fact, because in a very brief sentence, What's good for the body also by chance happens to be really, really good for the planet and what's harmful for the planet turns out to be very, very harmful for us. So let's think about transport. If we exercise, that's good for us. It increases glucose transporters in our muscle, which means we get better glucose uptake into muscle and improves our glycaemic control. We burn the calories we eat. So we don't become fat, which means we don't become diabetic with all of the plethora of complications that brings with it. We improve our cardiovascular health and so forth where you get less common disease, less peripheral, vascular disease, less stroke, improved cardiac function, improve lung function, less dementia, less cancer, less obesity, diabetes, osteoarthritis, uh, muscle weakness, and so forth.

So exercise is really good for us. If we don't say, well, we're not going to burn those calories by active movement. We're going to burn oil instead in our cars or coal in a power station to provide electricity for electric cars, we're using fossil fuel energy and we're not using our own, which if it comes from food and we can talk about that in a minute, which can be unhealthy food, it isn’t very sustainable. 

Then. So instead we drive a car that releases carbon dioxide as a greenhouse gas. It releases multiple pollutants. It produces road dust and brake disc wear and tire wear and hating. Those products are bad for us. It is linked with dementia now, but it's also linked with cancer and with respiratory disease, asthma, um, we can kill people indeed with asthma in these particular places. So it's terribly harmful for us to be doing those things. And actually the alternative is active exercise, which is really, really good for us. None of the bad things happen and the planet is better off too. If we then think about our diet and people often say, well, how do I lower my carbon footprint?

Well, the first thing actually is to consume, buy, and use less. Rather than trying to be more efficient in what one does, if you just buy 50% less stuff, your carbon footprint is reduced by 50% straight away. And we all me included over consume, and that includes food. So if we eat more sensibly in terms of the amounts we eat, that reduces the carbon footprint better for the planet, better for our obesity, best for our health.

Let's look at the food we eat too. Highly energy intensive process food production, again has a massive carbon footprint, but it's also very toxic for us. You are an educated individual in this sphere and your listeners will be too. You'll know the dangers of processed food. You'll know that it's corn syrup, fructose and so forth that are particularly bad reasons. We're now understanding they affect the gut absorptive area. They affect gut leak, their fat liver function, detrimentally and. We know that red meat is bad for us from ruminants, um, because it's associated with cancer and a bunch of other things too. And the animal fats. Likewise, we know that, you know, many of these other high carbohydrate diets and so forth are bad.

Meanwhile, the cattle are belching methane. As I say, 28, 87 times apart as greenhouse gases come out in the first 20 years. So if you move away meats, rainforests aren't being chopped down to graze the cattle rainforests, aren't being chopped down to grow the soil, to feed the cattle. There aren't so many cattle belching methane out, and we have a lower risk of cancer and other diseases. 

So if we then say, well, that's the avoidance, what do we have in state? Well, it's quite simple, isn't it? We know that if we eat a diet that is largely based on vegetables and some nuts and seeds where the bitter fruit is healthier, our metabolic function is better on physical performance and our brains work better, but local seasonal vegetable products are also very low carbon.

If they're seasonal, it means they're not being stored in refrigerators, which is a big. If they're local, it means they're not being flown around the world or shipped around the world. So the carbon footprint of locally produced seasonal vegetables is good for our planet as well. So it's a, it's it doesn't really matter which way you come at the problem.

And rather peculiarly, I eat very, very little red meat now. I never buy it. If someone serves it to me, if I'm at a dinner party, I'm not rude, I'll eat it. And I enjoy it, but I don't buy it anymore. And I did that for climate change reasons and it was only several years into it. And I thought, oh, this is quite interesting. I've just lowered my risk of bowel cancer amongst other things. And it's odd. You just sort of a doctor, I would have done it the other way round wouldn't you. But, I didn't say there were lots of reasons for the planet and for ourselves to eat the sorts of healthy diets that you I'm sure you have.

Shireen: Can you help us understand and just elaborate a bit more about the importance of agriculture and food production patterns specifically, again, looking at diabetes and chronic conditions?

Dr.Montgomery: Yes. Again, it relates to the amount of food we can see when the sorts of foods we consume. So energy intensive food production is very bad for our planet. So every time you, till soil mechanically, 1% of the top soil global. So, if you tell us all twice a year, you're only going to have 50 years of top soil and then you've run out. We're consuming 4,000 cubic kilometers of water a year as humans. And there isn't enough of that. So we're having to drain groundwater and fossil aquifers, which are going to run out as well.

And we're now having to expand areas we're using like chopping down rainforest. So, we need to consume less and our agriculture needs to be less intensive as well. And again, the really the link is what, what, how are you growing the food? Where are you growing it, which you need to have locally, but also what are you growing?

If you're growing vegetable products? You are drawing down carbon dioxide from the atmosphere. And when you eat those vegetable products, you'll burn some of that carbohydrate that's in them and release that carbon dioxide to get in, breathe it out. But that's fine because that's an entirely sustainable cycle, but those diets we know are rich in vegetable products are far less obesogenic.

If we move to the actual vegetable based products, as I'm sure you and your listeners will all know. I mean, you can eat a colossal amount of fresh vegetables, really without putting on a great deal of weight. And I suppose my clearest example of that for myself was that back in the days, when I used to take flights, I was asked to go and do some filming in Japan for a TV series.

And I'd also gone out to China on a separate occasion, oddly enough, for work and. On both occasions. I was the honored guest, which meant that I was fed vast amounts of food for breakfast, lunch, and supper. And I looked at it and thought, I don't normally eat anywhere near this amount of food, but I came back many pounds lighter and I was surprised until I thought about what I was eating and I was eating virtually no carbohydrates.

It's a bit of a myth that the Chinese diet is a huge mountain of fried rice or whatever. It really isn't. At the end of a meal, you might get one scoop of rice to mop up the juice and the bowl. But otherwise it's pretty much entirely vegetables, mushrooms, maybe a little bit of protein, like check-in or bits of fish, but it's predominantly a vegetable based diet.

And then you'd find very much the same, the light absolutely delicious vegetable based products. mostly vegetable, with a little bit of protein and a small amount of brown. I suppose it's worth commenting on it. I suppose, for people who don't have a largely vegetable based art, it sounds dreadful. Doesn't it? It sounds like eating cardboard all day. And how many salads can you eat in your life before you just want to throw the salad bowl out the window? The thing that transformed my engagement in it was a book I'd commend to you. It's called Eat and Run by an American scholar called Scott Jury who was a world or was the world ultra marathon champion. So this means he was running races of well over a hundred miles. And he had a girlfriend who was a vegetarian. So he tried to conform a little bit with what she was doing, and he noticed that he was running faster. So he increasingly started modifying his diet and found that as he did, he got faster and faster and quicker and quicker and better and better until he ended up actually winning the world ultra series as a raw vegan.

But the book is interesting because he makes the point. If you're burning that many calories and you want to be an elite athlete, you've got to have all the right nutrients in there, the right free fatty acids, the right of minor acids, but you've also got to have enough calories and you've also got something really, really tasty that you're really looking forward to when you're eating your meals. Something that you're really oh, wow. That's going to taste great. So the book is full of recipes and ingredients. I'd never heard of shelled, hemp seeds, yeast flakes, various sorts of soy products. And I bought them and they're fantastic. East lakes, for instance, tastes like grilled cheese, your favorite grilled cheese.

They're just delicious. So if you want to add that sort of really nice, almost sort of to your dishes, you can Chuck that in and the fermented soy products. Again, really, they give you that sort of meaty flavor that you sometimes crave. So, um, that really made a different semester only command there. It made a big difference to my ability to switch.

You know, the less healthy diet I used to eat is one that's much more planetary, sensible. And of course it's now much easier, too. Isn't it. If you go out for dinner, it's easy to get vegan or vegetarian dishes. Delicious. It's really easy to buy oatmeal now, isn't it. Instead of cow's milk, again, it might frighten you to know who here's my coffee cup, that if I make an instant cup of coffee, and do you think of the carbon cost of all the hot water, the pumping of the water, the chlorination, or the electricity to boil the water. The beans that are transported roast ground up solid extracted turned into instant coffee, put in a glass jar for melting sound, with a plastic lid on shipped to my grocery store. And I make the coffee. The carbon cost of a splash of milk is greater than all of that in the coffee cup because the cows belts. You've got to use electricity to pump the milk. You've then got to flash heat it to 72 degrees and then flash Coolidge, cause that's pasteurization. And then for the rest of his life, it's refrigerated. So again, a nice, easy switch. That's healthy switching to, in my case, oat milk. I know there are lots of other choices.

I think it is just to change your palette, it took a couple of weeks. But now that's, I'm very happy with it and my fridge is stored there. So again, if we don't have to beat ourselves up being healthy, it doesn't have to be painful and horrible diabetes and, or even chronic disease at large and climate change seem to have. No major global risks, but then I really analyze or consider them together. Right? Why is it so important? We treat climate change as perhaps a medical and public health crisis and really combat climate change in these chronic illnesses through integrated policies.

Shireen: You are so right. You are absolutely right. 

Dr.Montgomery: And the reason it doesn't happen, I'm sure it's the same in North America. It's certainly true that each element of policy is siloed within our government. So we have energy, we have transport, we have education, we have health, we have agriculture. We, you know, and they're all fighting each other for a share of one budget. And the treasury trades them all off against each other. No one is stitching the things together in the round. So let's take America and Britain. And consider what might happen if you were to take an integrated policy. So let's suppose we said we want economic growth. We want a healthy, lean, happy disease free population. And we don’t want climate change. The sense of policies are the same. 

If we move to renewable energies – suppose that America and Britain go straight over to a hundred percent renewables. Geopolitically, we're now secure. And our defense of our nations is secure. We're no longer dependent on nations that we might not want to deal with. We're no longer over an oil barrel or a gas pipeline for people that can threaten us or cut off our fuel supplies. We've got military security. We've got energy security. You've got. If you change the transport policies, you're less dependent on those and that energy as well. So your infrastructure costs go down.

If you're driving fewer cars, you're not having to maintain the roads to the same sorts of extent as well. So transport gets better. Air quality improves, noise in neighborhoods falls, asthma rates fall. As we move into those healthy darts, our agriculture becomes secure as well. And we also of course get all the other benefits from the exercise.

So health care costs for, because somewhere down the line, someone has to pay when you reel in Britain, we all pay. And so we have a free health system, which is, I have to say, absolutely fantastic. I work in it and it's brilliant. We're top in the world for nine out of 10 metrics on health as a health service.

But if I look at most of my patients in an intensive care unit, I would say 14 out of 15 would disappear. If we took action on those measures about which I'd been speaking. So if we dealt with alcohol, drugs, cigarettes, poverty, air quality, transport, obesity, and so forth, most of those patients would disappear huge savings in terms of health care costs, massive benefits to the economy. People are no longer consuming money to prop up their diseases. They're able to continue working, which is good for their families. They've got an income they're able to pay their taxes. That's good for all of us. So actually these sorts of policies should be integrated. 

You're absolutely right. They shouldn't be separated out and it needs a visionary government somewhere to start saying, well, let's, let's join these things up and create that sort of almost utopian vision of a world where the planet is sustainable. We aren't destroying our ecosystems and that we have military energy, fiscal and health security, and it's all perfectly possible to do, to do now. So spot on.

Shireen: Until then, and last question for you, Dr. Montgomery, um, what are things that our listeners can do today? So you talked about a few things that can be done almost immediately to reduce footprint, any other action items for us listening here today to understand this is what I can do to reduce my footprint, and that will leave me to better help.

Dr.Montgomery: Great. So there are a few things. The first of course is, go online. If you want to, if you've got a computer and an internet, I suppose most people listening to this must have, and find a carbon calculator. There's a very good one. I can register it for which country you're in, the US or  UK, and it takes about 20 minutes and you can work out what your carbon footprint is and where the big ticket items are that you can address.

Now if you're rich and you're flying, that's an obvious one. You can tell that I cut those things out. That's tons of carbon and inside. If you look at your heating bill, for instance, and it's crazy high, you might say, well, if I stick a jumper on, for every degree, I lower my heating. I save seven to 11% of my energy costs and that's a lot of money saved.

It's also a lot of carbon. So it will point out where, where you can take action most readily. If you've got access to a hundred percent renewable electricity supplier in Britain. That's very easy. We've got many of them. I'm with a company called, uh, good energy. 

There's another called Ecotricity over here. There may well be that your listeners in whichever state or city they're in, they've got access. Just switch over. It may be marginally more expensive than mine isn't um, but that's something you can readily do. Then when you get your lights on or your freezer or your TV, you're not polluting the planet. So that's a quick and easy one to do.

Moving over to food, the meat issue is, is true. And I know some people will listen to this and will love their red meat. Well, I'm not going to say go cold Turkey straight away. If you can, cut down on the amount of ruminant meat you're eating. Try to move your diet through and look when you're going into shops and think, I wonder what the carbon footprint of that is.

And if you can find a local seasonable set of vegetables. Start buying them because you're supporting your local community and your local farmers, those in your state for instance, will be very grateful for the products, choices that you're making. 

So, I think those are key. Think about your transport. So first thing is in order to choose to walk or cycle, if you can, if you can't walk or cycle, you use public transport because mass transport is better, more energy efficient. If you can't use mass transport and you have to use a car. Use a cost share, try to marry up your visits to supermarkets or whatever with other people at the same time and put forward in the carnal one and try not to take care of air transport, if at all possible.

So the transport issues are there. And then I suppose the other bit of course is waht governments are saying, I don't think you're going to solve this problem. Um, and businesses are hampered unless we steer them. So that's a rather positive message to end on. Isn't it? That actually, if we're going to save ourselves and our planet, it's down to us and if we will do this together, so talk to your friends, talk to your family, talk to your neighbors, bring them along with it too. And if you make it clear to you, whether you're Republican or Democrat or any other way, if you make it clear to them that you're voting on this issue, it's very important. And if you vote with your money, you start purchasing the low carbon things and actually, you know, drop a line to your supermarket and say, by the way, this is what I'm doing. I don't approve of these things anymore. And I move it. Then the market will change too. So the power to change is in our hands. If we all join together and specifically on the dice and otherwise we will all be healthier and happier too. As a result it will be Lena. Um, and happier and healthier as well as our planet will think it is for it as well.

Shireen: No, win-win all around. Win-win. I  did lie, so I do have one last question for you, Dr.Montgomery. How can our listeners connect with you and learn more about your work after this podcast? 

Well, I guess I'm, I'm pretty much all over the place online. So I'm Hugh Montgomery. If you put that in an UCL, you will find that there's stuff there, there are publications, we publish the Lancet, it counts down and that's freely available online.

You may have to register with the Lancet, but you can read that if you like it addresses each year where we are with climate change, where we are with energy use, where we are with technology, where we are with finance and policy. Every year is getting more and more doomsday. I have to say, but if you want to price it, you could just read the executive summaries of the Lancet countdown on health and climate change.

That's probably the quickest and easiest way, um, to see what we're up to, at least in those spheres, it's a reasonable digest, I think. 

Shireen: Thank you so very much for your time, Dr. Montgomery was an absolute pleasure. 

DrMontgomery: No, it's been my pleasure. Thanks. 

SHireen: Absolutely. And for our listeners out there, um, head over to our social media after this episode and answer this question, how has your environment altered your diet in the way you eat? And now that you know better, help us also know how, tell us about your carbon footprint. So head over to our social media, let us know what you think there. Thank you again so much for your time, Dr. Montgomery.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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