Psychology .

 

well a warm welcome to this blog now so many people have asked me to do a blog where i include vitamin d and vitamin k and especially vitamin k 2 so that's what this is about now if you haven't got time to read it i'll try and give you a bit of a bottom line although it's very difficult on this kind of blog because it's a bit complicated really but um if you've been read this blog you'll be in no doubt about the potential benefits of vitamin d and the fact that in the cold overcast and northern latitudes we're often deficient of it because the vast majority of it comes from the sunshine so uh vitamin d that's what we're talking about we'll look at a couple of guidelines on that as well because there's some interesting things on that but then the other question is should we be taking vitamin k 2 with it the answer to this seems to be the vitamin k2 is associated with quite a few beneficial effects so it should certainly be part of a healthy diet but taking moderate amounts of vitamin d as i do i'm currently taking 4 000 units a day actually the evidence is not suggesting that it is necessary for me to take vitamin k2 with my three or four thousand international units of vitamin d that i take a day over the winter but it may be beneficial for other things there's a more of a sort of a gray area with higher levels of vitamin d but of course you wouldn't be taking high levels of vitamin d you'd only be self-medicating on lower doses you'd only be taking high levels if you're supervised by your own doctor in which case he would be advising you and supervising you and of course it goes without saying that you never take medical advice from me you always go to your own doctor now i haven't got that out the way let's move swiftly on so here we see um uh um covered 19 rapid guideline to vitamin d from the national institute of health and care excellence now this obviously is excellent because it's got excellence in the title so uh called nice of course and basically it's still saying so i read this with some excitement i thought oh they've got their act together published on the 17th of december 2020 but basically it's saying same old same old it's talking about the 400 units a day and slightly different amounts for different age groups and things so do peruse that with disappointment as i did um so um latest on vitamin d national institute of health thinking excellence on that one basically basically it's saying consider 400 international units 10 micrograms per day very low dose so consider taking that and it gives a few provisos but that's basically it's still saying take the same amount but then i looked at uh there's various nhs sites this one happens to be from mid essex check it out for yourself it's in the on the web it's publicly available and let's look at that now this one slightly more interesting it's actually written for uh prescribers and doctors and people like that primarily um but it's talking about vitamin d deficiency and prescription guidelines um now um it talks there about lifestyle you can read this for yourself but here we have these flow charts now these flow charts are really popular in in modern healthcare and i must say they are remarkably useful um because you can kind of follow them through without knowing too much about the subject and and get to a good result so um patients with high risk factors that may increase risk of vitamin d deficiency or a patient at a higher risk of having low vitamin d status at risk group right so if they're in that group basically they're saying here does the patient have symptoms indicative of rickets osteomalacia sort of bone thing in thinning or symptomatic low blood calcium levels or symptoms of rickets including tetany leg bowing knock knees anterior bowing of the thigh bone of the femur painful wrist swelling softening of the skull spinal curvature bones i mean i could go on but but basically it's um it's focusing on on rickettsia which we've known about for about 100 years now no measure mention of reduced immunity or autoimmunity or heart disease or cancer of the colon or cancer of the prostate or depression or unexplained aches or pains or multiple sclerosis or the other correlates that may well be associated with vitamin d none of that um they're just focusing on those things there and then it does go on to make recommendations and it says here if the vitamin d uh this is the uh this is the serum vitamin d the vitamin d in the blood if it's less than 30 nano moles per liter it gives a treatment option here of all what captures 40 000 units kohli can't give a weekly for seven weeks and there's various other flow charts with what to do and the other ones work out giving if if the levels are higher it basically it works at giving the the 400 units one that we know about so um routine screening of vitamin d levels and prescribing a vitamin d is not advised advisable according to this so it's not too it's not too worried about it as a routine let me give you my view on this i think everyone in the country should have their vitamin d levels uh measured as a measure of some urgency actually i think and and their their vitamin d levels should be titrated according according to those according to those levels that's what that's what i would that's what i would think but but that's not what this protocol is saying both clinical symptoms and risk factors must be present before measuring vitamin d levels in other words this appears to be actually discouraging gps from checking vitamin d levels so if i was the teacher marking this i think i'd probably give that across and i'd probably give that a cross having said that people reading these guidelines have to do it they don't have any choice because these are the official guidelines and if a doctor was in contravention of the guidelines that then potentially that's not a good situation for him or her so there are the guidelines as yet there is no clear evidence to prove the risk from non-symptomatic vitamin d deficiency okay proves a big word but i'm not sure i would agree with that i think there's evidence that suggests to the contrary in academic essays we always tell students to be tentative it could be suggested that from this it could be reasonably inferred a possible implication of this is because until we have definitive answers we don't have definitive answers and i'm afraid we don't have answers that that definitive i believe with vitamin d which suffers accumulation of evidence anyway um adults uh adults if their vitamin d is less than 30 nano moles per liter which is 12 nanograms per mil or what capsules are 40 000 units that's 40 000 units that's the thousand micrograms or one milligram of cholecalciferol and that's the way they spell it that's vitamin d3 they're spent in a strange way i wouldn't i've just spelt it with an h but there you go um weekly for seven weeks it is what that is what they're saying very similar to um colleagues in india um whose doctors have been prescribing them uh 60 000 units a week for six weeks to top them up difference being in india they've been doing that without measuring the blood levels but i agree measuring the blood levels is good so so that makes sense if it's very low but to me these are really remarkably low levels less than 30 nano moles per liter or 12 nanograms per mil very low levels i would be very uncomfortable with patients or meet me at that level so it's talking about giving these doses um in contrast the nice guidelines are saying 2 800 units per week so the treatment dose there is 40 000 units the nice guidelines for maintenance is 2 800 which many would think is very low now vitamin d levels are 30 to 50 that's 12 to 29 grams more basically it's saying buy your own which is quite reasonable 400 units per day to say buy your own i mean we we did this on a neal all the time the patient needed um ibuprofen and paracetamol such as going to take paracetamol and ibuprofen you might tell them the best way to take it but but um you wouldn't need to give it to them because it's readily available OTC over the counter so that's reasonable albeit the recommended dose could be considered low vitamin d levels of um greater than 50 or that's so that's greater than 29 grams per mil buy your own and again just consider the 400 units per day depending is is is this rather crude summary of what that is what of what this flow diagram is um is saying but it's there click on it um put a copy on your bedroom wall it's there do whatever you want with it so that's that's vitamin d now i think basically what we're saying is here that there's no change in government uh protocol and policy against uh for vitamin d and uh it's only advising people doctors to treat vitamin d with fairly high doses it must be said but only if their vitamin d levels are really quite low and actually getting the test requires getting through that flowchart so it's a bit difficult so that's vitamin d disappointing to say the least from from the uk government no real change there and yet we know there's correlations and and some trial data okay the trial the trials are being argued about now but um there's many correlations and observational studies that meet what we've called the bradford hill criteria that we've looked at before that indicate a lot of us are short of vitamin d and that is important but but that's the government hasn't moved on that um national institute for health and care excellence has not moved on that so we could argue now about whether it's excellent or not but you get the idea right right right now moving on to vitamin k um now two source vitamin k really K12 and k2 now K12 um we've known about for a long long time uh philo quin one phylloquinone is the chemical name for that phylloquinone uh discovered in 1929 and of course since then we've known it's important for blood coagulation in fact the reason it's called k it's for the german it's a german discovery so uh coagulate coagu in german it's something like co angular vitamin or something um in german but but it's spelt with the k so therefore we have the vitamin k uh quite reasonable k for coagulation in german um so quite sensible name found in plants like leafy greens um so uh vitamin k deficiency can be a problem in newborn babies in adults not usually um  so that's vitamin k one fairly fairly well known about lack of it causes uh problems with blood clotting uh not common at all in uh in children and adults past the past the baby stage um but let's go into vitamin k2 now which really is quite a bit different now vitamin k2 uh the the information i'm going to get from the national institutes of health so it's mischiefs from there and this is an excellent article i thought on health line so um click on that read it for yourself see if your interpretation is the same as mine now the vitamin K2 s are the men O'Quinn ones so it's a different uh chemical and there are subdivisions within that that's why i've called it s-menoquinones there's not just one of them now these are mostly from bacterial origin animal-based and fermented food so a fermented food is a food on which which there's been bacterial action i'd say i'm actually a bit peckish just a minute i'm gonna um just gonna stop and have a quick snack i'll be back with you in a minute um i've just got this recently sauerkraut tell you the truth how far are you i'm quite used to it yet it's better with things of course sauerkraut is a is a fermented food this is cabbage and there's been some bacterial action on that cabbage which is generated sauerkraut it's actually quite nice in the right i i use this in germany and loved it actually but of course in in in um i don't know what's like in the us but in the uk we don't eat many fermented foods so um the vitamin k2 mostly bacterial origin so it's the action of the bacteria on the cabbage that produce the vitamin k 2. um animal-based and fermented foods so um we'll look at some other foods that it's in in a minute um adult uh vitamin k now the adequate intake this this concept of adequate intakes this i'm pretty sure this is from the national institutes of health site i got that um now this is for vitamin k that's sort of the adult female that's the adult male range but this is vitamin k it's not subdivided into vitamin uh K12 and k2 so basically we don't have published guidelines on on the appropriate dose now a lot of people are saying um you know that this supplement here for example is 600 is 600 micrograms which seems quite a high which seems quite a high dose you know i mean a lot of supplements are recommending about 100 micrograms a day so that seems quite high so that might be more of a weekly dose not that i'm prescribing um ask your doctor if you want to know how much to take but so 100 micrograms a day seems to be roughly the the range that people are talking about but um you can't really find well i haven't yet found any specific evidence for that that's why i was a bit reluctant to do this because there's a bit of a lack of firm evidence so how much vitamin k two should we be taking a day uh that's the amount of vitamin that that's did i say d then the amount of vitamin k2 should we be taking a day um well that's the amount of vitamin k we should be taking how much k2 i don't really know i don't really find published figures on that although around about 100 micrograms a day seems to be what people are talking about but what that is based on i don't know you see there's things people saying you've always got to go back to the evidence this is why it's frustrating this is what i'm trying to do here trying to relate to the evidence because i don't know i don't know what i don't want to know what he said she said they said you know we want to know what the evidence is based on in empiricism so anyway it's in fermented food sauerkraut natatorium i think is a fermented soya bean thing um high fat uh high fat dairy high fat cheese milk from grass-fed cows power needs to be grass-fed cows presumably the reason for that is the grass will be acted on in the um i don't know what you call them the ruminants is it the stomachs of the cow and um the vitamin k2 will be produced uh there um egg yolks especially animal origin um animal animal organs rather so hearts livers um the the what we call the offal of the animal gut bacteria in you and me which of course might be decreased with antibiotics because the antibiotics will kill off gut bacteria now the reason that this does kind of make sense um is that in so so we see that the vitamin k2 mostly comes from fermented products like sauerkraut fermented soybeans and animal organs like liver and hearts and kidneys of animals but of course in western countries very often we tend to eat the animal skeletal muscle and feed the rest to dogs and things um so why we eat one particular part of the animal not the other is a bit strange but if you can imagine in the evolution situation when we were hunter-gatherers then um we would kill an animal and we would eat every bit of it because you might not get them the young men might not make another kill for another month you would eat the whole animal uh if we're in on the savannah 30 40 000 years ago or whatever it was um and also when we were storing foods it's not surprising that they could become fermented as we stored them with bacterial action so if you imagine the hunter gathers hunter-gatherer situation probably eating stored fermented foods and certainly eating animal organs much more than we do now so we might end up with much less of it um in the modern western diet having said that in korea they eat a lot of kimchi i work with koreans in you know when i was teaching in cambodia and that they have kimchi with every meal it's like a crunchy vegetable stuff even breakfast i remember asking what it was and they said you don't eat kimchi with every meal you know they eat kimchi over the meal which which which presumably provides them with lots of vitamin k2 so it does kind of make sense and it's this you know at the same time when we were out there on the savannah um we wouldn't be as wearing as many clothes and we'd be producing lots of vitamin d so it does make sense that the vitamin d from the sun and the vitamin k2 from animal organs and from fermented food aren't that present in in the thing either so it would make sense that we could be short of them right let's go on to look at some of the evidence now um and i've put in the links you peruse the evidence see what you think vitamin k might play a role in preventing osteoporosis and coronary heart disease so osteoporosis is very common especially in women basically it's it's um thinning of the bone loss of bone mass which leads to pathological fractures so very very common in older people they come in with a with a broken neck of femur we call it a north neck of femur fracture very very common as the neck of femur demineralization  and that's often where the bone breaks first or wrist fractures um before arm fractures especially in older people very very common related to osteoporosis causes a lot of pain and suffering a lot of pain and suffering um so lack of vitamin k2 especially this is k2 we're talking about um can be associated with osteoporosis and currently heart disease i think you probably know this but um if you think about a heart i won't draw a whole it's kind of a heart like this isn't it's got a it's got a these are the bottom pumping chambers like that they would be the valves they would be the valves there going off to the arteries then there's valves going down the way like that and then there's the the top chambers with the veins uh the veins going in uh like this um top chambers of the heart the atrium and again the valves pointing uh pointing down the way there like that so so that's the left side so that would be the aorta and that's the pulmonary arteries going off to the lungs and that's the pulmonary veins and that's the vena cava anyway never mind that but all this is the heart muscle the myocardium so in order for these chambers to pump in order for the heart chambers to pump the blood out you must have contractile myocardium and the myocardium depends on it because it's it's always active very active muscle of course it's contracting 60 70 80 times a minute so its blood supply depends on these coronary arteries and these break down into smaller branches they're called coronary arteries because they look a bit like a crown surrounding the heart but the trouble is these get fired up and so the blood doesn't get through to an area of tissue so i suppose suppose that's an area of tissue supplied by that arterial branch if that's getting fired up then there's less blood getting through to that that's called ischemia and then if there's a blood clot there plus all that bit dies there that's called an infection and because it's the myocardium it's a myocardial infarction so this coronary heart disease really really very very common still the most common cause of death in the uk i think um so very very common um so it's associated with these two diseases the lack of vitamin k2 but what's the level of evidence well it does kind of make sense because there's vitamin k dependent proteins now what vitamins do are is vitamins are coenzymes that they work with vitamins work with enzymes so the enzyme won't work on its own it needs the vitamin to make the enzyme work so if there's if there's like calcium in the blood then um vitamin k2 is needed for enzymes that put calcium from the blood into the bones which is where you want it to to prevent the osteoporosis and there's also other um proteins which require vitamin k2 that prevent the prevent the calcium going into the tissues because you don't want tissue and arterial calcification and what we find is when when this these arteries start clogging up at the same time there's deposition of calcium in the walls of the arteries that the two processes go hand in hand they go side by side so as the arteries clog up they also calcify or as they calcify they also clog up their concomitant processes that go on together they've associated of course which is cause and effect is interesting so with this with this k2 idea it could be that the furring up that the atheroma is is more caused by the calcification in which case you want the k2 to to take the calcium from the tissues back into the blood where the k2 can put it from the blood into the bones to give your strong bones where it's supposed to be now having said that of course i've known for 30 or more years that the atherosclerosis the furring up of the arteries is associated with calcification but i always assumed it was the calcification that came after the uh the the uh the atherosclerosis the atheroma formation so this is kind of hinting that it might be the other way around i'm going to need quite a lot of evidence to just to prove that but that's you know it's interesting it's just an interesting idea um which is the chicken and which is the egg sort of thing which is the cause and which is the effect anyway vitamin k2 supplement may improve bone health and heart health while vitamin K12 has no significant effect no significant benefit so that is suggested by this evidence here um so check that one out so in other words this is clearly differentiating between the effects of vitamin K12 and the effects of vitamin k2 vitamin K12 for the blood clotting vitamin k2 to promote calcification of bones and reduce calf calcification of tissues is the is the hypothesis there um now this study here uh gives evidence that it promotes bone calcification um three year low dose uh men O'Quinn one seven that's the type of vitamin k2 involved supplement helps decrease bone loss in healthy post-menopausal women sounds good to me of course you need to evaluate the validity of this because some people would disagree but these these are the studies that are providing the evidence for this sort of hypothesis that is being um that is being developed around the world um the ultimate answer yes of course we don't know may prevent tissue calcification so preventing the calcification of the arteries especially you get this quite a lot in um in the peripheral arteries as well i remember the first time i haven't got a copy but i looked at an x-ray and you could see the bones and then there was like these other two bones going up and down through the top of the legs and the hip joints and of course they weren't bones at all they were calcified femoral arteries so it can't it can be quite pronounced calcification of arteries which of course we don't want so this um that this article is saying may prevent tissue calcification tissue specific utilization of me thi quin I've that's another type of vitamin k 2 results in the prevention of arterial calcification in warfarin treated rat so that's an animal study but there you go that's this is the way the evidence develops uh another study k2 reduces blood vessel calcification whereas again vitamin k1 did not so again differentiating between the k1 and the k2 dietary intakes of vitamin k2 is associated with the juice we reduce risk of coronary heart disease from the rotterdam study so quite a few studies accumulating  that do seem to be strengthening this link between adequate amounts of vitamin k2 increased bone mineralization giving stronger bones which is what we want but at the same time preventing calcification of the soft tissues which we don't want we don't want calcified soft tissues i mean an artery you know if you feel your pulse in your wrist you know just just feel your pulsing on the wrong way around can i do it on that one so if it feel the knobbly bone there feel your pulse just in there um just on that that you'll feel the elasticity it's going like this as the pulse goes through it well there's one in your neck the pulse is all over the place cautery carotid artery in the neck and the whole point is that once it's moved out with a pulse pressure wave the arterial wall contracts again and that maintains the pressure during what we call distillate the time when the heart is not contracting so systole when the heart is contracting and then the arterial elastic wall pushes down on that and that maintains blood perfusion of the tissue during diastole but of course if the ala if the artery is calcified and hardened it can't do that so it messes things up so it's exactly what we don't want um as well as being associated with it with atherosclerosis the clogging up of the arteries which of course is associated with thrombosis the cloetter the pathological clotting of the blood which blocks off the blood supply to the tissues causes infarction such as a myocardial infarction or if it occurs in the arteries that go to the brain a cerebral infarction that would be a stroke this is the basis of a lot of pathology a vitamin k2 may help with dental health which makes sense strong bones and teeth do tend to go together don't they especially with vitamin d so the vitamin d and the k2 have been particularly associated with good dental health and strong bones links between low levels of vitamin k2 and uh liver cancer well who knows maybe this indicates it's true the liver cancer here is is is called a hepatocellular carcinoma it's the primary form of liver cancer it's when the liver when the cancer actually starts in the liver so you probably know with cancers you get a primary site which is where the cancer starts and then it can metastasize it can spread to another site there's a whole problem with cancer of course it metastasizes spreads around the body the patient can end up with carcinomatosis with cancer everywhere so the hepatocellular carcinoma is the start that the form of cancer that starts in the liver very often we do see cancer that spread from the colon for example to the liver the liver as a secondary site but this is talking about the primary form of liver cancer more data needed of course as with all of these studies but interesting links with preventing advanced prostate cancer so that paper there check it out if you're interested in prostate cancer and i have been looking at uh not surprising really for my stage of life prostate cancer is the most common cancer immense i've been looking at it lately it gets more common with age of course and the the um the links between increased levels of prostate cancer and low levels of vitamin d seem to be accumulating so the evidence that good levels of vitamin d are helping to prevent prostate cancer and the prevention of prostate cancer are accumulating are accumulating but here the link is with vitamin k 2. so that is that link there so from this it would indicate that maybe good levels of vitamin d and levels of vitamin k2 combined um might help reduce the incidence of prostate cancer you see dietetics it's so frustrating what we know is so limited it's so hard to do proper clinical trials on this you know for for about 30 years i i taught this idea that eating fatty food increases your cholesterol now we're much more worried about sugar you know um and yeah i always followed the guidelines but the guidelines it turns out weren't as accurate as would have liked them to be so so dietetics is very frustratingly um uncertain in many respects but anyway we're doing the video now so let's get on with it we've committed ourselves uh synergistic effects uh with vitamin d so this is saying synergistic effects with a vitamin k2 especially and vitamin d so synergistic synergy um two two plus two equals seven sort of thing thingthing that's it's not an additive effect it's a it's a it's an enhanced effect they can't enhance each other vitamin vitamin d and vitamin k as a pleleotrophic now that that that actually means more than one so um and that means action really or movement so basically it's saying that the two together paleo actually is greek for more i think so there's more so it's not just the vitamin k on its own it's not just the vitamin d on its own it's the two together making more than one and that has an additional effect it's a bit it's a bit like saying a synergistic effect uh the Paleo trophic nutrients they work well together is what it's saying clinical importance to the skeletal and cardiovascular systems and preliminary evidence for synergy so this paper claims interesting now going on a bit long today but i'm just i'm just going to quickly go through um one of the things that people are very worried about the vitamin d supplement and is increased blood calcium levels and it looks like you have to have very high vitamin d levels for that to be a problem let's just have a look at the evidence for that prevalence of hypercalcemia related to hypervitaminosis d in clinical practice this paper here check it out don't take my word for anything the papers are all there um determine the concept you want to determine the concentrations of vitamin d at which the risk of hyper high calcium em my  in the blood calcium high high purse high the reason i'm hesitating is in the in the UK with spelling in the states you don't bother with the a which of course is much more sensible but too old to change really so hyper high cal calcium Emmy a in the blood right um number in the study good number in the study 25 000 hyper hypervitaminosis d was defined at uh vitamin d levels of greater than 160 nano moles per liter not that high actually that's 64 nanograms per mil now on my vitamin d thing that i got from the nhs when i did my test it actually says there that um total vitamin d levels above 220 nano moles per liter are considered high so this was this this study was setting a much lower threshold than this particular nhs lab does but but this is the result we have so results um 382 samples were identified as the first recorded hyper d so that's just 382 as the first occurrence out of the 25 000 samples taken 39 of those presented with high levels of calcium in the blood 10.2 but these are people with abnormally high levels of vitamin d remember some had vitamin d levels between 161 and 375 but most they were much higher most of them there were 375 nano moles per meal which is 150 nanograms per ml which i think everyone would agree is high although they are saying we can't get away from the fact that paper is saying 161 is is uh high they define it as above 160 which is high in 15 subjects hyper hypercalcemia could be attributed to vitamin d so basically that's 15 out of that many altogether and i love the calcium level and to tell you the truth i would be uncomfortable with the patient at these calcium levels but this to use their words uh it didn't reach critical values the high calcium levels didn't reach critical values so this paper seems to be saying that even though the vitamin d levels were high the calcium levels didn't reach critical values abnormally high yes critically high they are saying not conclusion hypercalcemia hypercalcemia due to vitamin d represented less than four percent of the total hypervitaminosis d detected but of course this is people with abnormally high levels of vitamin d the problem in most northern latitudes is people that are low in vitamin d these are people with particularly high levels a very low percentage of the test performed so um to conclude from that paper um can high levels of vitamin d be associated with high levels of calcium yes they can that's what it's saying but they're people with very high levels and just to remind ourselves the NHS level i have here so my level here was uh 84.4 nano moles per liter um whereas that they're saying it's only high when it gets to 229 per liter uh and that was with me taking about 3000 units per day but of course i can't tell you what to take because and this is just not i mean i am trying to cover myself obviously i can't i can't prescribe for you but um apart from that two people can take the same amount of vitamin d and end up with very different blood levels that's just the way it is so the only correct way to do this is to go to your doctor get your vitamin d levels checked because remember i tested myself on that and i did another test and they both came out different and uh ideally i tried you titrate your vitamin d levels but there's no likelihood of nice doing that at the moment that's why i'm still taking my 4 000 units a day over winter anyway um let's leave the last word to health line no strong evidence proves that moderate amounts of vitamin d are harmful without an adequate intake of vitamin k so there we go if you're taking moderate levels of vitamin d there's no evidence that you need to take vitamin k with that according to health line however research is ongoing and the picture might become clearer in the near future well let's hope so so what they're saying is moderate levels of vitamin d supplement do not there's no evidence um that moderate amounts of vitamin d are harmful without an adequate intake of vitamin k so this is saying basically people taking moderate amounts of vitamin d just because they're on vitamin d need not take extra vitamin k they don't need to take extra vitamin k is what that is saying having said that the evidence we've looked at does indicate that quite a few of us might be short of vitamin k and that this shortage of vitamin k vitamin k2 that this because we don't get enough organs and we don't need enough fermented food this may be associated with osteoporosis and it may be associated with calcification of the tissues and that is as strongly as i can put it because that is all the evidence that we have so that's why i was a bit reluctant to do that because i know the evidence is not conclusive but that is my review of the current evidence and they are my conclusions so personally i'm going to carry on taking my vitamin d until i still get some overall sun exposure and i am considering taking some um some vitamin k too so talk it over with your health care provider and see what they think okay that is that video i hope that created more clarity than confusion but it is confusing because we don't have definitive answers you know the the this human body is just so complicated it interacts with so many things who can understand it um and yet there are some things that we can do that we know are harmful and there's some things that we can do that we know are beneficial um some things are beneficial some things are harmful it's not always clear which is which um but that's the ongoing process and if more evidence comes to light i will certainly be uh discussing it but i'm not holding my breath for anything too definitive at the moment yep that i'm waffling now that means that means i've said everything so thank you of course for watching

seriously i hope

Share: