March 27, 2025 • 45 mins
In this episode of the Gladden Longevity Podcast, Dr. Jeffrey Gladden interviews Charles Nduka, a plastic surgeon specializing in facial reconstruction. They discuss the profound impact of facial paralysis on patients' lives, the importance of psychological support in recovery, and the innovative technologies being developed to aid rehabilitation. The conversation highlights the interconnectedness of facial expression, emotional health, and social engagement, emphasizing the need for a holistic approach to treatment. In this conversation, Charles Nduka discusses innovative research in mood disorders, the use of technology for diet monitoring, and the implications of eating behaviors on weight management. He emphasizes the importance of empowering individuals with information to make better health decisions and explores the intersection of health, longevity, and joy. The conversation also touches on the future of wearable technology and its potential to enhance quality of life by measuring emotional and physical well-being.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:02):
Welcome everybody to this edition of the Gladden Longevity Podcast.
I'm your host, Dr.
Jeffrey Gladden, and I'm here with Charles Ndewka.
Did I get that right?
Am I close?
All right.
Good.
All right.
So Charles, tell us a little bit about how you got into facial recognition and joy.
(00:22):
I like this joy span as a term for longevity.
I don't know if you've seen any of the work that we've done, but we're really big on thelife energy.
elements, one of which is joy, of course.
So tell us a little bit about that.
How do you how do you happen into this space?
Well, thanks very much for having me on.
My name is Charles Nduka.
(00:44):
I'm a plastic surgeon in my background and I've been specializing in facial reconstructionand plastic surgery for the last 25 years.
I specialize in facial palsy, facial paralysis, which can be due to Bell's palsy, you mayhave heard of.
Also many causes, tumors, accidents, strokes, et cetera.
And it causes tremendous devastation to patients, not only physically,
(01:07):
unable to smile, close your eye, just do normal things we expect to be able to do likespeaking clearly, interacting, eating, but also just that natural thing you do when you
meet somebody for the first time, you smile.
And being unable to smile causes tremendous distress to patients.
The surgery I do is to help to restore patients' expressions, help to restore theirmovements as far as one can, and to help...
(01:36):
do that?
How do you, how do you restore that if they have a nerve palsy?
Are you actually kind of working with the nerve itself or are you kind of restructuringthe face to where it hangs in a more useful emotional state or a functional state?
Yeah.
So it depends on the cause.
Facial paralysis can be due to an accident.
(01:59):
So a surgeon has cut the nerve by accident.
In those cases, we would aim to find the cut ends and repair them quickly and accuratelyas possible.
Sometimes we don't get referred to patients early enough, in which case the muscles havewasted away.
And so you have to then restore movement by transferring nerves and muscles fromelsewhere.
(02:19):
And it really depends on the cause.
If the patient is very young, they often do much better.
if the patient is very elderly, nerve regeneration is less reliable in those cases so youtend to use more local techniques either static or dynamic.
So you can for example move the muscle that moves the jaw, the temporalis muscle that's onthe temple and reroute that and turn it into a smiling muscle so you can give patients.
(02:43):
So do you, do you work with pediatrics as well?
Like people of all ages or is it, is your practice more 18 and above or how does thatwork?
so I do see children, most of my practice is adults because the larger surgeries, we don'thave a dedicated pediatric unit.
So I often get consulted with younger patients and very often, especially these days,patients are actually often choosing to have surgery and be involved in decision-making,
(03:10):
which often is when they're older.
Mm-hmm.
Got it.
Well, that's interesting.
And you're noticing that younger people heal faster, heal better, heal more completelythan the elderly people is what you're saying, right?
So do you have any strategies to help the older people catch up?
Well, I mean, this is one of the big failings of healthcare because we often try toaddress things after the fact.
(03:34):
And obviously you know well, but it's not that commonly known amongst many doctors howmuch difference lifespan and sorry, lifestyle has on patients' abilities to recover.
So things like smoking, such as metabolic diseases, diabetes, for example, have a bigimpact.
(03:55):
Obviously, I'm quite strict about smoking.
I don't let patients smoke in the lead-up to surgery because it does have a very badeffect on wound healing and recovery.
And they shouldn't give up smoking too soon before surgery because otherwise they canoften have a rebound respiratory infection.
So it's important to give a good deal of time to get over the...
(04:15):
for all forms of tobacco or predominantly smoking?
Predominantly smoking, be honest, probably smoking.
So, yeah, and so the surgery is really to try to help patients reintegrate, to help themto do that one thing that we do every morning, go to the bathroom, you look yourself in
mirror and you see what you're expecting for patients with facial paralysis.
They often see something that they find distressing.
(04:38):
It often makes them feel embarrassed, shy to go out.
They often isolate themselves.
And I did a study just about a dozen years ago.
looking at a series of patients in our service and just found a really high incidence ofdepression and anxiety as measured in standardised assessment scales, hospital and anxiety
(04:59):
depression scale.
And that really led me down this pathway to see, you know, what can we do to help thesepatients?
Because it's not just about restoring muscles, it's not just about restoring nerves, it'snot even just about restoring smiles, it's about helping patients to express themselves,
to interact with each other and to socialize essentially.
Mm Yeah, absolutely.
(05:20):
It's yeah, the face is it's critical.
It's for better or worse, it becomes part of people's identity.
Right.
In a way.
And so when it's disfigured in their eye, I suppose other people's as well, particularlytheir eye, then it's something that they're very self-conscious about.
(05:40):
So do you have a psychological team that works with these folks as well?
Yes, I'm really lucky.
have a fantastic team, psychological therapists who sees all patients before I see themactually.
And that's something that we set up at the very start.
I set up the service in 2007 and it was always very important to me to have amultidisciplinary team.
(06:02):
The unit is in a hospital called the Queen Victoria Hospital, which was made famousbecause of the work done in second world war.
The burnt airmen who oftentimes again were disfigured.
often themselves away from life and the surgeon that's also called a mechander, plasticsurgeon, he set up a service where he very much worked in partnership with his patients
(06:23):
and it's something I try to do.
So I have a great team of facial therapists, psychological therapists and then wecollaborate with other surgeons as well.
Nice.
Yeah, that's great.
think integrating, treating that the whole individual as opposed to just the anatomy,right, is really the key.
(06:44):
And so with that sort of team approach, how does it work out?
What percentage of your people kind of get restored to a point where they feel likethey've reclaimed, let's say, 90 plus percent of their life or 85 percent plus of their
life?
How does that work?
Well, one of the things that was really quite surprising for me was, so in 2012 we didthis study, we found this incidence of depression and anxiety, which we kind of knew
(07:12):
intuitively, but it's good to document that in a rigorous peer reviewed study.
But as a doctor, patients don't always tell you how they're doing, how they're feeling.
They feel often very grateful, sometimes with the operations that take four or six hours.
sometimes in two stages.
And so you don't really get a good impression by asking patients, know, how was it?
(07:35):
You know, I set up a charity, Facial Palsy UK with colleagues, and that gave me the mostvaluable insight that I could get around the role of facial palsy in patient interactions,
because very often patients would have surgery, but they wouldn't necessarily...
go out in the world and interact, they still felt that there were issues they weren'tdealing with and this is why we have this peer support group.
(08:01):
And that's the charity.
Its focus is to actually help those people reintegrate or work through the trauma, so tospeak.
Yeah.
Okay.
So I discovered that, and this is what's been really, really valuable.
There was, we did a further study, which we found the correlation between the degree ofseverity of the paralysis and the patient's psychological impact wasn't that well
(08:22):
correlated because, and I'm sure you've seen it in your own life, some people have a veryhigh degree of focus on their appearance and other people, not so much.
have two patients, one patient with a very dense paralysis who,
you know, they said, okay, well, doctor, does help me to stop dribbling or help my eyesclose.
Another patient with a very smart, very subtle asymmetry in their smile for whom they feeltheir life is over and they can't go out.
(08:48):
So that's an element that was really, really important.
And it made me realize really that as doctors, we don't really get trained aroundunderstanding what matters to patients.
This is why we set up the company and the strap line is measuring what matters becauseultimately it's what matters to patients that we should be focusing on, not necessarily
what's important to the doctor.
I think that's right.
(09:09):
I think there's a couple of levels there.
I think it's a question of what matters and then why it matters to them, right?
To go a little deeper.
So, Yeah, no, it's exactly right.
It's very rich, sort of fertile ground to kind of go into, particularly with something assort of obvious as this, right?
So.
Yeah, I often say to patients or certainly to colleagues who sort of, they sometimesconsider it as being a cosmetic subspecialty, but actually it isn't, you know, because the
(09:36):
face's form is its function.
Its function is its form.
So the two are together.
And unless you've experienced facial paralysis, you really can't comprehend what an impactit has to lose your identity to literally overnight in some cases, to not recognize
yourself in the mirror.
And they say if discover water last,
you know, until you've lost the ability to express yourself as you intend, it's hard tofully comprehend it.
(10:03):
Yeah, no, it's I agree.
I'm sure it's stunning.
Absolutely stunning.
Depending on the level of disability and your perception of it.
So, again, back to what percentage of people end up making good progress here.
it with the team approach, are you able to get the majority or minority or how does thatactually work out?
(10:25):
So thankfully the majority of patients make a good recovery both in terms of theirself-perception.
We do obviously objective assessments using scoring systems, but also we ask patients asyou'd expect.
There are patients who despite objectively having significant improvements, they stillwant to get...
(10:50):
back to where they were before.
And sometimes, know, one way street, you can't do that.
Added to that is the fact that people are often experiencing secondary issues such asaging.
if they are, so one patient, know, she had a terrible accident when in her twenties, I'vebeen seeing her for 15 years because as the face ages, the side that wasn't affected will
(11:14):
age.
And so the reconstructed side needs to kind of be adjusted to keep up.
because it doesn't act in same way because it's not moving as much.
So it's important to kind of recognize that and tell patients upfront that your face willchange over time and there will necessarily be some balancing procedures that are
required.
I'm really glad to say that many patients, not only are they, they end up being happier,but certainly those who carried on by getting involved in the charity, they actually can
(11:43):
pay that forward by helping those new patients who've also been affected to help them torealize that.
Right.
in your face, that yes, the face is important, but it doesn't mean that you aren't a wholeperson.
Yeah, I was involved peripherally with a charity called in the US here called Oscar Mike,which is basically devoted to military veterans who have been, you know, could have
(12:12):
suffered any injury, but they have some sort of disability.
And they put together this charity and it's saved the lives of many people, because as youprobably are aware, it's probably true in the UK.
Well, military service personnel who are damaged have a very high rate of depression andsuicide, and they have over a thousand members.
(12:33):
And to date, the last I checked, which was a few months ago, nobody had committed suicide.
And it's all yeah, it's all built around social engagement with each other playing gameslike they're playing wheelchair rugby and they're playing, you know, checkers and whatever
they're playing.
Right.
But they're they're going outside.
They're.
They're climbing a mountain in the wheelchair.
(12:54):
They're doing all kinds of things that stimulate the ability to participate in life withpeople that get you, right?
And that are cheering for you, right?
And that's such a strong thing.
And so I just wonder in the charity that you have, if it mirrors some of those sameprinciples where you get people up on stage and they tell jokes and other people laugh and
(13:17):
things like that, is it that kind of charity or, yeah?
we had a comedy diet just before the pandemic.
had a comedy dinner which was great.
We have family days when we get kids.
You've never met anybody else affected in the same way.
And many of them become, know, bosom buddies, pen pals, you interact beyond that day.
(13:39):
you know, lot of people, you know, there's a psychologist called John Cassioppo who sadlypassed away quite recently, who did some amazing work.
actually initially on facial EMG, which we'll probably come to later on, but he did.
EMG for the audience, just describe EMG.
yeah, EMG stands for electromyography and you can consider it like an EKG for the face,yeah, muscles.
(14:08):
So he was a researcher psychologist, but he did some really interesting work on the impactof loneliness on health.
And if you get asked to have a watch of his TED talk on loneliness, you know, he showedthat loneliness has a bigger impact on your longevity.
then smoking, high blood pressure.
(14:28):
It's extraordinary.
yeah, we're social beings.
So there are people who are not ill, they're not service people, but who will take theirown lives because they just feel desperately lonely.
And even if they're not doing it directly like that, they can do it indirectly throughbehaviors, through drugs, alcohol, et cetera.
(14:54):
Yeah, that's right.
So it comes down to a question of, think, acceptance, self-acceptance, acceptance by apeer group on some level and then finding meaning, right?
A way to contribute, a way to participate, a way to learn and grow.
These are all vital to us as humans throughout our entire lives, quite honestly.
(15:14):
It's just that they've been put into a situation where the typical avenues don'tnecessarily always work for them.
And so the charity is focused on
creating those avenues, right?
Where they can reclaim that ability to live and grow and have meaning in relationship,right?
So, yeah.
Yeah.
it was really interesting, because as a surgeon, didn't set out to do a charity, but itmade me realize that surgery is inherently unscalable.
(15:40):
You I love surgery, but you help one person at a time.
You have a charity, you're able to help multiple people over time.
That's right.
Yeah, no, that's very cool.
It's very cool that you did that.
I think you also developed a set of glasses.
I saw something.
Tell us a little bit about that.
I see you're wearing glasses.
(16:01):
I'm wearing glasses, but I don't think these are the glasses you're talking about.
aren't the glasses, actually I have a pair down here to show you.
One of the things that we all are affected by as clinicians, as doctors, is that you canhelp the patient within this thin slice of time, that consultation, you know, you're with
(16:22):
them for whatever, 15, 20 minutes, 60 minutes even.
But very often, even though the patient knows what they need to do, they sometimes just...
don't do it for whatever reason.
And I found with facial paralysis, patients, when they've restored the muscles and nerves,they need to do the exercises to rehabilitate those muscles.
They need to now learn how to synchronize and symmetrize the smile.
(16:47):
Otherwise things become scarred and entethered and they don't get an optimal outcome.
Now, one of the difficulties is that patients after an operation, especially like this,they don't often like looking in the mirror.
And so...
getting guidance on the expressions as they're making them is very difficult.
actually a patient said this, we use EMG, we use this device in the clinic to givepatients better feedback around what the muscles are doing, because unless you're sort of
(17:18):
walking around all day with a mirror, it's very hard to learn what the muscles are doing.
And he said, well, why can't I have one of these machines to take home with me so I canpractice my expressions as I go around my day-to-day life?
And obviously that's not practical, but it did get me thinking.
You know, what if there was a way of developing a wearable device gives a person theability to get feedback on their expressions as they go about their life?
(17:38):
Because in addition to that, the clinician could get information about how the person'sdoing.
If they're not making progress, they could call them in earlier.
You know, very often as doctors, whatever specialty, I think you're a cardiologist and youyou to be able to understand the patients.
They tell you that they're feeling a bit tired, fatigued.
You think, what may have they got AF?
Are they having arrhythmias and you know,
(18:00):
It's great.
You can give them a device.
They can take a whole two months at the blood pressure or a, sorry, look at the ECG or, orambulatory blood pressure.
But we don't really have that for the face.
There is nothing that you can use to get real time, real world information.
And so, yeah.
America.
Yeah, and because patients wouldn't look in the mirror, they weren't making more progress.
(18:24):
And so we started down this pathway of developing a system for measuring facialexpressions in a real world setting.
And that was the beginning of the company.
That's awesome.
Yeah.
Because what you're really doing is lowering the threshold for somebody to be able toparticipate in their own rehab.
Because even if you have a mirror, even if you're willing to look in the mirror, you don'talways have a mirror.
(18:46):
Right.
And so with the glasses, I assume you can walk around and live your life and then sort ofmonitor yourself in your daily activities, which would be like, okay.
This is cool.
I can say hi to somebody in a grocery store and I can
you know, smile a small child, can do, whatever you would do, right.
And you're getting feedback all the time, which is reinforcing.
(19:07):
that's, yeah, that's fantastic.
Yeah.
One thing that's really interesting about facial paralysis is that because patients don'twant to express asymmetrically, they'll very often suppress their expressions of the core.
And in doing so, they're actually having a negative impact on their mood.
(19:28):
So a series of studies done in the 1980s and later replicated a few years ago thatdemonstrate this facial feedback process, whereby if you make an expression,
you'll reinforce the emotion that it's portraying.
So the original research is quite funny.
So what the researchers did was to get people to put a stylus between the teeth andbetween their lips.
(19:49):
So between their teeth was to trick them into activating the smile muscles because thestylus was going across their teeth or held it between their lips as if they were blown
through a straw.
And they told me it was a study on human computer interaction for the disabled.
But what they were doing is tricking them into activating their smile muscles and thenshowing them
some videos that were ambiguous in terms of whether they were positive or negative andthey found that basically, and this is replicated numerous times, when viewing something
(20:18):
that was ambiguous but while smiling he tended to interpret it more positively thannegatively.
Then subsequently they did a subsequent study where they got people to, they glued golftees onto their foreheads and asked them whether they could bring them together.
Again they were tricking them into furrowing their eyebrows.
right.
suddenly they found that when you follow your eyebrows, you tend to interpret ambiguousinformation more negatively.
(20:42):
this study has been replicated multiple times and it's backed up by the work that's beendone with Botox.
So for example, it's been used to manage depression.
And you know this, that patients, people who express negatively, they often willexperience negativity from those around them.
(21:02):
And again,
this person that was part of the feedback system with those around them in the society.
Yeah, it's interesting, isn't it?
I mean, you sort of think of that it starts in the brain, the brain's perception, butthere is a direct link to the mechanics of what we do, right?
Yeah, that's an interesting feedback loop.
So you're starting with the face and then looping it back into the brain.
(21:25):
Yeah, very, very cool.
So do you have a prescription?
Are these like prescription lenses that somebody can walk around and read a book and seewhere they're going?
Is that how it works?
yeah, yeah.
So I mean, our systems are quite, they are still prototypes.
And so we're doing some studies with them, I can show you them.
They don't look too dissimilar to regular glasses.
(21:46):
There's a slight thicker on the
There we go.
Yeah.
yeah, yeah.
They're a little bit thicker on the side there.
Lenses pop in and out, so we have prescription lenses for them.
(22:08):
So is it the frame that's actually doing all the sensing?
Nothing to do with the lens, is that the idea?
We developed some new sensing technology called Optomyography, which essentially allows usto sample facial movements with very high fidelity, high sensitivity, but using very low
power and with a very small sensor footprint.
(22:28):
So it's pretty small.
It's modeled a bit on how a fly sees basically what's called optical flow, where the tinytexture changes across the lens, sorry, across the sensor are detected.
across in the xy plane.
Okay.
And is there a little battery then in the frame?
Okay.
(22:50):
So do you charge up your glasses at night?
Is that what happens?
Okay.
Got it.
Very cool.
And so is this something that's, you know, you go to a website and buy it, or is itsomething that's being studied in research only now, or how does that work?
So we did some research published in Frontiers in Psychiatry where we demonstrated thatyou can detect differences between depressed versus non-depressed people just purely from
(23:16):
their facial data which was fascinating and we see this in future as being a way to enablepsychologists to study mood disorders in the wild and say you can do with you know a CGM
or but looking at glucose or or amblytric ECG.
In terms of the glasses as they are now, we're using them mostly for research and we'reworking with some partners.
(23:41):
So the main use case we're using just now is around diet monitoring because we see that asbeing a potential to help a lot of people.
Diet monitoring.
tell us about diet monitoring with facial expression.
So if you're laughing, you eat less or you eat more.
(24:01):
Well, actually, one of our developers, whilst he was doing some debugging, was having hisbreakfast.
And he noticed that every time he took a chew, he could see the signals very clearly.
Now the glasses weren't designed to measure eating behaviors, they're designed to measureemotional expressions, but because there are sensors in the temple that are there to kind
of calibrate for different movements of the glasses, they were picking up the muscleactivations at the temples.
(24:24):
And so I got talking to one of our colleagues who's a researcher, but he's also abariatric surgeon.
He said, well, that's amazing because, dieticians, they're big bug players and they tryand get people to change their eating habits before they undergo bariatric surgery to
reduce the stomach.
We try to get them to eat smaller amounts, to chew more thoroughly and to give a gapbetween mouthfuls.
(24:48):
They call it 20, 20, 20, where it's 20 pence piece, a piece of food, chew at least 20times and have a 20 second gap between.
But patients often don't do it because a lot of you are overweight.
actually grown up just learning how to eat very quickly.
They get it from their parents.
So retraining that is very, very tough.
And he said, well, you know, taught some dieticians, which we did, and got really positivefeedback and said, well, here's a way for us to produce something that's relatively
(25:18):
simple, will be quite low cost to enable people to, first of all, to log their food.
So the glasses contain a downward looking camera.
So you start eating, capture the image of what you're eating.
Mm-hmm.
AI, food analysis of the calories, macros and micros.
And then the glasses measures your eating rate as you're eating.
(25:38):
And if you start eating quickly, it gives you this subtle vibration feedback to slow downyour eating.
It also can monitor when you're eating while distracted, because we know that people whoeat distracted tend to eat more.
So you're watching TV whilst eating, or if you're team scrolling on social media whilsteating.
you're not really focusing on the food and eating mindfully, which we know is importantfor weight management.
(26:04):
people choose their level of electric shock?
Yes, it's a subtle vibration, but yes, absolutely.
It's configurable within the app.
Some people might need a little stronger nudge.
right.
Yeah.
Right.
absolutely.
And actually, we know that if somebody is very, very active, as measured by the, so it hasan IMU, it has a motion sensor as well.
(26:28):
And if you're very active, then obviously you would likely require more of a, more of afeedback buzz.
We actually have done some user testing about it to work out what level was satisfactory.
And it does vary from person to person.
But what was really interesting that we found that
by lowering the threshold.
So if a person has an eating rate of say, you know, 1.7 chews per second, you can, you canlower it down by 80 % and the person will slow down their eating.
(26:57):
And by doing so you're actually having a direct impact on the GLP ones in the stomachbecause we know that.
Yeah.
slower, slower chewing increases GOP one.
So, so one of the mechanisms by which GLP-1s are released are through the stretching ofthe stomach.
and so one of reasons why people often struggle with their weight is that if you eatquickly, you're going to ingest more calories per unit time.
(27:23):
The mechanism by which this, satisfaction or fullness signals, get signals is not throughneural, but it's from hormonal.
So it's often takes like a 20 minute lag between eating the food and signaling that you'refull.
And if you eat.
quickly, you're going to stretch the stomach and it's too late by that stage you'veovereaten.
it.
Yeah, can out can out eat the response to the feedback loop, so to speak, right?
(27:47):
as if you interesting.
By slowing down your eating, you give a chance for the brain to recognize that it's fullfaster.
That's fascinating.
So have you done some weight or body composition studies to kind of demonstrate whathappens for people like this?
Is it done in conjunction with bariatric surgery or is it now standalone or how does thatwork?
(28:10):
So this, our work on diet is ongoing.
So we have just completed one clinical study on patients just to prove that technologyworks in the wild where people are using the app.
It's capturing all their, all their meals, giving them feedback.
And it was quite surprising how patients were finding it really valuable.
So one, one of the patients she had been seeing a dietician for years, or for months, Ishould say, with a really bad heartburn and her dietician had told her to
(28:40):
stop eating tomatoes and these acid rich foods, eat more bread because it can soak up thestomach acids and the like, and her symptoms weren't getting better.
But because the app was showing her what she was eating and she was able to relate to thesymptoms, she realized actually it wasn't that at all.
The bread was the thing that causing it.
She had a wheat intolerance.
(29:00):
And so we see the glasses as having this role in weight management, which almost certainlywill be beneficial.
We know that logging food,
by whatever mechanism will help people to lose weight.
But being able to identify the causal relationships between what you've done, i.e.
what you've eaten, and your bodily symptoms later on, will be really powerful.
(29:22):
Cool.
So it's really an educational tool, quite honestly.
It's also a training and educational tool in a way.
Yeah.
Very cool.
Yeah, that's awesome.
So what's, what are the plans for this?
Do you plan to make it generally available or, um, mean, is there's, doesn't sounddangerous.
It doesn't sound like there's, you know, contraindications to it.
I suppose there's a contraindication to everything, but
(29:44):
Yeah, I mean, it's a very low risk technology because it's just providing you withinformation.
And the idea being that if you can empower people with better information, they can makebetter decisions.
you know, it's glasses and so glasses are there to help you to see.
In this case, you're seeing better what things you're doing today that will lead to anegative outcome tomorrow.
(30:06):
The route to market will likely be via dietitians or through platforms who are managingpeople's health.
To be honest, given the scale of metabolic diseases, given the impact of what people areeating on their health, I think people would be quite surprised.
I when I was wearing the glasses myself as part of the testing, it's really interesting tofind out how often I was snacking without realising because you do it mindlessly, you
(30:34):
know, are the things that...
Yeah.
So there should be somebody outside of every all you can eat at a restaurant and it'shanding them out.
Right.
So, yeah, we'll probably get probably chased away by the proprietor, though.
So maybe not.
Maybe they're going to pay one price and eat less.
So everybody wants.
(30:57):
Right.
That's funny.
Very cool.
Very cool.
So
How do people find out more about you and what you're doing if they'd like to connect orlearn more?
What's the best way to do that?
So our company is called M-Tech Labs, that's E-M-T-E-Q labs.com.
And basically we have a lot of information about our technology, our research, ourbackground.
(31:21):
We've done a lot of work on the various health parameters that can be measured viaeyewear.
You one of the things that I'm really passionate about is that we enable people to havebetter information around what they're doing and how it can impact the future.
And also the fact that some of the things that we measure in medicine and in longevityscience for that matter are the after effects of some kind of behavior.
(31:49):
So, you you can measure blood biomarkers or you can measure assays or imaging, but veryoften what you're looking at are the net effects of an accumulation of behaviors.
And that is very, very interesting because it gives you really unique data.
Apart from around mood and emotions, which obviously is pretty powerful.
(32:09):
You know, we know this from studies published by Harvard and others about the impact ofvarious factors on longevity and the most important one being about being grateful and
sociable.
And obviously you can measure all those things with glasses because people who aresociable tend to interact more, they smile more, more positive and people want to be
(32:31):
around them.
But also on things such as subtle things such as one's posture.
uh, once gates.
So being worn on the head means that you actually can measure gates in ways you can't dofor a risk-based device, such as an Apple watch or a FitBit.
You're getting, you're getting much better information around asymmetries, for example.
So before you, develop problems in your hip or your knee, it may well be in the data as adigital signal.
(32:58):
Um, people's posture changes very, very slowly so much so they don't notice it.
And so you can measure these things over time and actually give an indication that thisperson is no longer as upright and as upright as they used to be.
It seems like I might have a general application in any physical therapy setting andalmost any psychological setting as well.
(33:18):
If you're sort of training people on this, you know, smile and you'll feel happier kind ofthing or, you know, pay attention to your gait or whatever it is.
Right.
So it seems like it has broad application.
You know, you had a you had a statement about I think was the longevity of joy or orsomething.
Tell us a little bit about.
(33:38):
Tell us a little bit about your connection to joy.
What's your thought there?
So one of the things that was quite interesting to me is that there's an old saying, Ithink it was Peter Drucker who said, we can manage what we can measure.
And for a long time in medicine, and actually most hospitals today, they focus on makingpeople live longer.
(34:00):
As a plastic surgeon, I often get involved in managing people who are very elderly, notonly doing facial paralysis, but doing things such as skin cancers, et cetera.
Sometimes people are being kept alive, but have no quality of life.
And that's a terrible thing.
(34:21):
And so, you know, the focus on health span, think is great.
It's wonderful.
But then you see some people who are going at this, this health span drive, but they'reliving miserably.
they spend four hours in the morning, you know, sort of having to prepare specializedmeals, have a routine that is so arduous and tedious that, you know, it may not be that
(34:48):
they live longer, but they may feel longer because of the difficult work.
a calorie deprivation, right?
It's chronic.
exactly.
Exactly.
So, so if we could think about how can we optimize for not just the length of life, notjust the length of healthy life, but the length of healthy and joyful life.
(35:09):
And that will hopefully make life worth living.
And how do you measure that?
Well, you can measure that by looking at things such as emotions, things such asinteractions, that decisions that are perhaps a little bit more informed.
Yeah, I think that's think that's fascinating.
You know, in the book that I wrote, 100 is a new 30.
(35:31):
I was about living young for a lifetime.
And we've kind of gone on to really the target for us with longevity is when we're 100,we're going to have a 30 year old body, but we want to have a 300 to 3000 year old mind,
right, which is all the equanimity, all the joy, all the love, all the perspective and,you know, the ability to actually suffer a trauma and.
be minimally impacted by it because of the perspective and sense of wellbeing that we haveinnate to us.
(35:56):
It's not external validation, it's internal assurance, if you will, right?
So yeah, so we love that because we find that so many people not only destroy their healthwith stress and worry and things like that, but they also are just exceedingly unhappy.
And so if you're not addressing that, what I call the life energy circle to talk about allthose different.
(36:17):
and healing traumas and all the things that go on there and feeling safe and feeling lovedand having great relationships and and also being open minded, right, to grow and learn.
Then, you know, it's it's what's the point really.
And I think you're right.
What's the point?
But beyond that, the flip side of the what's the point conversation is if we step intothis new concept of longevity where we truly are youthful and can do whatever we want, but
(36:41):
we also have this wisdom and perspective.
my gosh, I think humanity could really elevate itself.
beyond this kind of binary thinking that we seem to be caught in, Kind of move into moreof a quantum perspective on where are the best solutions as opposed to we're right and
you're wrong kind of thing, which leads to all kinds of conflicts.
So anyway, that's kind of where we're pointed.
(37:03):
Yeah.
that.
I mean, you we can see it today, can't we?
We can see, you know, some of the richest people in the world, and I'm not mentioning anynames here, but clearly are not very happy.
So money won't buy happiness.
And the research backs it up, you as you all know, the research that showed that, youknow, the household income required for people to feel happy, it tops out at this level
(37:25):
that's much lower than people would imagine.
I think
study was published it was $80,000 it may be higher now but the fact is that
you know, I see this in impatience of mine, having more money isn't necessarily the routeto being happier.
so, if you can't measure certain things, you can't make decisions.
(37:47):
So if you're going on your journey on a map, you've got two routes to go by.
One route is going to go via the freeway and the other one is going to go via thecountryside.
If you have no way of being able to judge the value of that journey in terms of what it'sgoing to give to you.
You may just choose one or the other based on time.
(38:07):
But if you knew that journey along the countryside is going to be useful and you'll seelovely fields and nature, you may choose a journey that may take longer, but it's filled
with more joy.
But it's actually quite hard to measure that because there aren't the tools there to,enjoy in the wild.
We have systems that we can use to kind of past experiences of other people, ratingsystems.
(38:33):
For example, can say, okay, well, that restaurant is good because it's got the ratings,that hotel's good, good ratings.
What if we could map emotional experiences across the map that we can actually work outbased on the crowd?
Yeah, it would be great to be able to measure joy.
don't know if you can do it just with facial expressions or if you need to look at, youknow, dopamine and oxytocin levels or what exactly you need to be measuring.
(38:58):
Right.
But certainly, you know, for me, joy is really becoming North Star.
It's like if if I'm not feeling joy, then maybe I need to rethink how I'm approaching thisor maybe I shouldn't be doing this.
Right.
So those are my two things.
Yeah, for sure.
Now, I think, yeah, we're we're we're
(39:19):
You know, one of the insights I've had recently is that when we were born here on planetEarth, we're actually born into a giant escape room.
Yeah.
And the goal is to actually work our way out of all the constructs that we're laden with,right?
Epigenetic and social to find our freedom where we're actually unencumbered by thesethings.
(39:40):
And we actually connect to source energy and we're actually just self actualized, if youwill, where we reference against source.
There's no external validation required, and yet we're free to have many lovingrelationships and
And we're not attached to outcomes, which is really the source of stress, right?
We identify with an outcome.
We attach to that.
It's like, there's no need for that, quite honestly, right?
(40:01):
What if I just love and care and connect, but I don't have to be attached to it?
I can, it frees you up.
All of a sudden you're emancipated.
It's like, okay, now this is joyous, right?
I want to live this life for a long time, right?
Instead of like all the drudgery of, you know, am going to lose my money?
Is my, you know, this or that, you know, all the things that people worry about.
So anyway, that's to give you a little bit of a taste to kind of.
(40:22):
we're up to over here.
No, that's fascinating.
It's funny, I'm actually reading a book at the moment called, I am a strange loop byDouglas Hostader.
And there's a section in there, he talks about the relationship between us as individualsand our place in the world and how we are, you the optimal position is that we become one
(40:43):
with the world ultimately.
Because there is no mechanism by which one's actions can't have an impact on the wholeuniverse.
if you think about it to its extent.
So yeah, it's a really...
more powerful than we realize, quite honestly.
That's other thing.
So it's an escape room.
(41:04):
The idea is to work your way out of that to get there.
So anyway, so let's see an analogy I'm using at the moment.
Well, I love the work that you're doing.
I think it's really refreshing to meet any physician that's really thinking about thingsfrom a greater perspective, if you will.
(41:24):
You know, no pun intended, but particularly a surgeon, right?
So you have your reputation still live up to like interventional cardiologists or not, youknow, we're kind of in the same boat, but yeah.
So anyway, that's, that's really lovely to see the work you're doing.
So what's next for you?
Do you have other, other devices, other plans, other charity activity?
(41:45):
the main plan is to get this technology.
So this is going to be Sensei where we're launching a dev kit for developers to get accessto technology to build apps on top of our platform.
Imagine that, for example, someone who has a specific issue, it perimenopausal health,somebody with a specific gut disorder who may need to manage it with a specific kind of
(42:12):
diet.
or somebody who has lifestyle related issues, it can really provide them with informationthey need to make actionable decisions.
More information, the right kind of information will hopefully lead to better outcomes.
so that's Northstar.
So we're looking forward to partnering with organizations, companies, clinics who want totake this technology to their clients to give them this really
(42:44):
previously unavailable information.
Mm hmm.
Yeah, we're building a longevity coaching app right now.
It might be great to actually collaborate with you and bring the glasses into that arena.
That would be super cool.
yeah.
Yeah, awesome.
Well, Charles, thank you for taking the time.
think where are you speaking to us from?
(43:05):
Are you in England or someplace close?
I'm in Britain on the south coast of the UK.
yeah, so it's, what time is it now?
I don't know, it's 20 past 10.
past 10.
OK, well, you need your sleep, so I'll let you go.
Thanks for taking the time out.
Really a pleasure.
Thank you.
No problem.
(43:26):
Thanks, Jeffrey.
Love to talk to you.
Welcome everybody to this edition of the Gladden Longevity Podcast.
I'm your host, Dr.
Jeffrey Gladden, and I'm here with Charles Ndewka.
Did I get that right?
Am I close?
All right.
Good.
All right.
So Charles, tell us a little bit about how you got into facial recognition and joy.
(00:22):
I like this joy span as a term for longevity.
I don't know if you've seen any of the work that we've done, but we're really big on thelife energy.
elements, one of which is joy, of course.
So tell us a little bit about that.
How do you how do you happen into this space?
Well, thanks very much for having me on.
My name is Charles Nduka.
(00:44):
I'm a plastic surgeon in my background and I've been specializing in facial reconstructionand plastic surgery for the last 25 years.
I specialize in facial palsy, facial paralysis, which can be due to Bell's palsy, you mayhave heard of.
Also many causes, tumors, accidents, strokes, et cetera.
And it causes tremendous devastation to patients, not only physically,
(01:07):
unable to smile, close your eye, just do normal things we expect to be able to do likespeaking clearly, interacting, eating, but also just that natural thing you do when you
meet somebody for the first time, you smile.
And being unable to smile causes tremendous distress to patients.
The surgery I do is to help to restore patients' expressions, help to restore theirmovements as far as one can, and to help...
(01:36):
do that?
How do you, how do you restore that if they have a nerve palsy?
Are you actually kind of working with the nerve itself or are you kind of restructuringthe face to where it hangs in a more useful emotional state or a functional state?
Yeah.
So it depends on the cause.
Facial paralysis can be due to an accident.
(01:59):
So a surgeon has cut the nerve by accident.
In those cases, we would aim to find the cut ends and repair them quickly and accuratelyas possible.
Sometimes we don't get referred to patients early enough, in which case the muscles havewasted away.
And so you have to then restore movement by transferring nerves and muscles fromelsewhere.
(02:19):
And it really depends on the cause.
If the patient is very young, they often do much better.
if the patient is very elderly, nerve regeneration is less reliable in those cases so youtend to use more local techniques either static or dynamic.
So you can for example move the muscle that moves the jaw, the temporalis muscle that's onthe temple and reroute that and turn it into a smiling muscle so you can give patients.
(02:43):
So do you, do you work with pediatrics as well?
Like people of all ages or is it, is your practice more 18 and above or how does thatwork?
so I do see children, most of my practice is adults because the larger surgeries, we don'thave a dedicated pediatric unit.
So I often get consulted with younger patients and very often, especially these days,patients are actually often choosing to have surgery and be involved in decision-making,
(03:10):
which often is when they're older.
Mm-hmm.
Got it.
Well, that's interesting.
And you're noticing that younger people heal faster, heal better, heal more completelythan the elderly people is what you're saying, right?
So do you have any strategies to help the older people catch up?
Well, I mean, this is one of the big failings of healthcare because we often try toaddress things after the fact.
(03:34):
And obviously you know well, but it's not that commonly known amongst many doctors howmuch difference lifespan and sorry, lifestyle has on patients' abilities to recover.
So things like smoking, such as metabolic diseases, diabetes, for example, have a bigimpact.
(03:55):
Obviously, I'm quite strict about smoking.
I don't let patients smoke in the lead-up to surgery because it does have a very badeffect on wound healing and recovery.
And they shouldn't give up smoking too soon before surgery because otherwise they canoften have a rebound respiratory infection.
So it's important to give a good deal of time to get over the...
(04:15):
for all forms of tobacco or predominantly smoking?
Predominantly smoking, be honest, probably smoking.
So, yeah, and so the surgery is really to try to help patients reintegrate, to help themto do that one thing that we do every morning, go to the bathroom, you look yourself in
mirror and you see what you're expecting for patients with facial paralysis.
They often see something that they find distressing.
(04:38):
It often makes them feel embarrassed, shy to go out.
They often isolate themselves.
And I did a study just about a dozen years ago.
looking at a series of patients in our service and just found a really high incidence ofdepression and anxiety as measured in standardised assessment scales, hospital and anxiety
(04:59):
depression scale.
And that really led me down this pathway to see, you know, what can we do to help thesepatients?
Because it's not just about restoring muscles, it's not just about restoring nerves, it'snot even just about restoring smiles, it's about helping patients to express themselves,
to interact with each other and to socialize essentially.
Mm Yeah, absolutely.
(05:20):
It's yeah, the face is it's critical.
It's for better or worse, it becomes part of people's identity.
Right.
In a way.
And so when it's disfigured in their eye, I suppose other people's as well, particularlytheir eye, then it's something that they're very self-conscious about.
(05:40):
So do you have a psychological team that works with these folks as well?
Yes, I'm really lucky.
have a fantastic team, psychological therapists who sees all patients before I see themactually.
And that's something that we set up at the very start.
I set up the service in 2007 and it was always very important to me to have amultidisciplinary team.
(06:02):
The unit is in a hospital called the Queen Victoria Hospital, which was made famousbecause of the work done in second world war.
The burnt airmen who oftentimes again were disfigured.
often themselves away from life and the surgeon that's also called a mechander, plasticsurgeon, he set up a service where he very much worked in partnership with his patients
(06:23):
and it's something I try to do.
So I have a great team of facial therapists, psychological therapists and then wecollaborate with other surgeons as well.
Nice.
Yeah, that's great.
think integrating, treating that the whole individual as opposed to just the anatomy,right, is really the key.
(06:44):
And so with that sort of team approach, how does it work out?
What percentage of your people kind of get restored to a point where they feel likethey've reclaimed, let's say, 90 plus percent of their life or 85 percent plus of their
life?
How does that work?
Well, one of the things that was really quite surprising for me was, so in 2012 we didthis study, we found this incidence of depression and anxiety, which we kind of knew
(07:12):
intuitively, but it's good to document that in a rigorous peer reviewed study.
But as a doctor, patients don't always tell you how they're doing, how they're feeling.
They feel often very grateful, sometimes with the operations that take four or six hours.
sometimes in two stages.
And so you don't really get a good impression by asking patients, know, how was it?
(07:35):
You know, I set up a charity, Facial Palsy UK with colleagues, and that gave me the mostvaluable insight that I could get around the role of facial palsy in patient interactions,
because very often patients would have surgery, but they wouldn't necessarily...
go out in the world and interact, they still felt that there were issues they weren'tdealing with and this is why we have this peer support group.
(08:01):
And that's the charity.
Its focus is to actually help those people reintegrate or work through the trauma, so tospeak.
Yeah.
Okay.
So I discovered that, and this is what's been really, really valuable.
There was, we did a further study, which we found the correlation between the degree ofseverity of the paralysis and the patient's psychological impact wasn't that well
(08:22):
correlated because, and I'm sure you've seen it in your own life, some people have a veryhigh degree of focus on their appearance and other people, not so much.
have two patients, one patient with a very dense paralysis who,
you know, they said, okay, well, doctor, does help me to stop dribbling or help my eyesclose.
Another patient with a very smart, very subtle asymmetry in their smile for whom they feeltheir life is over and they can't go out.
(08:48):
So that's an element that was really, really important.
And it made me realize really that as doctors, we don't really get trained aroundunderstanding what matters to patients.
This is why we set up the company and the strap line is measuring what matters becauseultimately it's what matters to patients that we should be focusing on, not necessarily
what's important to the doctor.
I think that's right.
(09:09):
I think there's a couple of levels there.
I think it's a question of what matters and then why it matters to them, right?
To go a little deeper.
So, Yeah, no, it's exactly right.
It's very rich, sort of fertile ground to kind of go into, particularly with something assort of obvious as this, right?
So.
Yeah, I often say to patients or certainly to colleagues who sort of, they sometimesconsider it as being a cosmetic subspecialty, but actually it isn't, you know, because the
(09:36):
face's form is its function.
Its function is its form.
So the two are together.
And unless you've experienced facial paralysis, you really can't comprehend what an impactit has to lose your identity to literally overnight in some cases, to not recognize
yourself in the mirror.
And they say if discover water last,
you know, until you've lost the ability to express yourself as you intend, it's hard tofully comprehend it.
(10:03):
Yeah, no, it's I agree.
I'm sure it's stunning.
Absolutely stunning.
Depending on the level of disability and your perception of it.
So, again, back to what percentage of people end up making good progress here.
it with the team approach, are you able to get the majority or minority or how does thatactually work out?
(10:25):
So thankfully the majority of patients make a good recovery both in terms of theirself-perception.
We do obviously objective assessments using scoring systems, but also we ask patients asyou'd expect.
There are patients who despite objectively having significant improvements, they stillwant to get...
(10:50):
back to where they were before.
And sometimes, know, one way street, you can't do that.
Added to that is the fact that people are often experiencing secondary issues such asaging.
if they are, so one patient, know, she had a terrible accident when in her twenties, I'vebeen seeing her for 15 years because as the face ages, the side that wasn't affected will
(11:14):
age.
And so the reconstructed side needs to kind of be adjusted to keep up.
because it doesn't act in same way because it's not moving as much.
So it's important to kind of recognize that and tell patients upfront that your face willchange over time and there will necessarily be some balancing procedures that are
required.
I'm really glad to say that many patients, not only are they, they end up being happier,but certainly those who carried on by getting involved in the charity, they actually can
(11:43):
pay that forward by helping those new patients who've also been affected to help them torealize that.
Right.
in your face, that yes, the face is important, but it doesn't mean that you aren't a wholeperson.
Yeah, I was involved peripherally with a charity called in the US here called Oscar Mike,which is basically devoted to military veterans who have been, you know, could have
(12:12):
suffered any injury, but they have some sort of disability.
And they put together this charity and it's saved the lives of many people, because as youprobably are aware, it's probably true in the UK.
Well, military service personnel who are damaged have a very high rate of depression andsuicide, and they have over a thousand members.
(12:33):
And to date, the last I checked, which was a few months ago, nobody had committed suicide.
And it's all yeah, it's all built around social engagement with each other playing gameslike they're playing wheelchair rugby and they're playing, you know, checkers and whatever
they're playing.
Right.
But they're they're going outside.
They're.
They're climbing a mountain in the wheelchair.
(12:54):
They're doing all kinds of things that stimulate the ability to participate in life withpeople that get you, right?
And that are cheering for you, right?
And that's such a strong thing.
And so I just wonder in the charity that you have, if it mirrors some of those sameprinciples where you get people up on stage and they tell jokes and other people laugh and
(13:17):
things like that, is it that kind of charity or, yeah?
we had a comedy diet just before the pandemic.
had a comedy dinner which was great.
We have family days when we get kids.
You've never met anybody else affected in the same way.
And many of them become, know, bosom buddies, pen pals, you interact beyond that day.
(13:39):
you know, lot of people, you know, there's a psychologist called John Cassioppo who sadlypassed away quite recently, who did some amazing work.
actually initially on facial EMG, which we'll probably come to later on, but he did.
EMG for the audience, just describe EMG.
yeah, EMG stands for electromyography and you can consider it like an EKG for the face,yeah, muscles.
(14:08):
So he was a researcher psychologist, but he did some really interesting work on the impactof loneliness on health.
And if you get asked to have a watch of his TED talk on loneliness, you know, he showedthat loneliness has a bigger impact on your longevity.
then smoking, high blood pressure.
(14:28):
It's extraordinary.
yeah, we're social beings.
So there are people who are not ill, they're not service people, but who will take theirown lives because they just feel desperately lonely.
And even if they're not doing it directly like that, they can do it indirectly throughbehaviors, through drugs, alcohol, et cetera.
(14:54):
Yeah, that's right.
So it comes down to a question of, think, acceptance, self-acceptance, acceptance by apeer group on some level and then finding meaning, right?
A way to contribute, a way to participate, a way to learn and grow.
These are all vital to us as humans throughout our entire lives, quite honestly.
(15:14):
It's just that they've been put into a situation where the typical avenues don'tnecessarily always work for them.
And so the charity is focused on
creating those avenues, right?
Where they can reclaim that ability to live and grow and have meaning in relationship,right?
So, yeah.
Yeah.
it was really interesting, because as a surgeon, didn't set out to do a charity, but itmade me realize that surgery is inherently unscalable.
(15:40):
You I love surgery, but you help one person at a time.
You have a charity, you're able to help multiple people over time.
That's right.
Yeah, no, that's very cool.
It's very cool that you did that.
I think you also developed a set of glasses.
I saw something.
Tell us a little bit about that.
I see you're wearing glasses.
(16:01):
I'm wearing glasses, but I don't think these are the glasses you're talking about.
aren't the glasses, actually I have a pair down here to show you.
One of the things that we all are affected by as clinicians, as doctors, is that you canhelp the patient within this thin slice of time, that consultation, you know, you're with
(16:22):
them for whatever, 15, 20 minutes, 60 minutes even.
But very often, even though the patient knows what they need to do, they sometimes just...
don't do it for whatever reason.
And I found with facial paralysis, patients, when they've restored the muscles and nerves,they need to do the exercises to rehabilitate those muscles.
They need to now learn how to synchronize and symmetrize the smile.
(16:47):
Otherwise things become scarred and entethered and they don't get an optimal outcome.
Now, one of the difficulties is that patients after an operation, especially like this,they don't often like looking in the mirror.
And so...
getting guidance on the expressions as they're making them is very difficult.
actually a patient said this, we use EMG, we use this device in the clinic to givepatients better feedback around what the muscles are doing, because unless you're sort of
(17:18):
walking around all day with a mirror, it's very hard to learn what the muscles are doing.
And he said, well, why can't I have one of these machines to take home with me so I canpractice my expressions as I go around my day-to-day life?
And obviously that's not practical, but it did get me thinking.
You know, what if there was a way of developing a wearable device gives a person theability to get feedback on their expressions as they go about their life?
(17:38):
Because in addition to that, the clinician could get information about how the person'sdoing.
If they're not making progress, they could call them in earlier.
You know, very often as doctors, whatever specialty, I think you're a cardiologist and youyou to be able to understand the patients.
They tell you that they're feeling a bit tired, fatigued.
You think, what may have they got AF?
Are they having arrhythmias and you know,
(18:00):
It's great.
You can give them a device.
They can take a whole two months at the blood pressure or a, sorry, look at the ECG or, orambulatory blood pressure.
But we don't really have that for the face.
There is nothing that you can use to get real time, real world information.
And so, yeah.
America.
Yeah, and because patients wouldn't look in the mirror, they weren't making more progress.
(18:24):
And so we started down this pathway of developing a system for measuring facialexpressions in a real world setting.
And that was the beginning of the company.
That's awesome.
Yeah.
Because what you're really doing is lowering the threshold for somebody to be able toparticipate in their own rehab.
Because even if you have a mirror, even if you're willing to look in the mirror, you don'talways have a mirror.
(18:46):
Right.
And so with the glasses, I assume you can walk around and live your life and then sort ofmonitor yourself in your daily activities, which would be like, okay.
This is cool.
I can say hi to somebody in a grocery store and I can
you know, smile a small child, can do, whatever you would do, right.
And you're getting feedback all the time, which is reinforcing.
(19:07):
that's, yeah, that's fantastic.
Yeah.
One thing that's really interesting about facial paralysis is that because patients don'twant to express asymmetrically, they'll very often suppress their expressions of the core.
And in doing so, they're actually having a negative impact on their mood.
(19:28):
So a series of studies done in the 1980s and later replicated a few years ago thatdemonstrate this facial feedback process, whereby if you make an expression,
you'll reinforce the emotion that it's portraying.
So the original research is quite funny.
So what the researchers did was to get people to put a stylus between the teeth andbetween their lips.
(19:49):
So between their teeth was to trick them into activating the smile muscles because thestylus was going across their teeth or held it between their lips as if they were blown
through a straw.
And they told me it was a study on human computer interaction for the disabled.
But what they were doing is tricking them into activating their smile muscles and thenshowing them
some videos that were ambiguous in terms of whether they were positive or negative andthey found that basically, and this is replicated numerous times, when viewing something
(20:18):
that was ambiguous but while smiling he tended to interpret it more positively thannegatively.
Then subsequently they did a subsequent study where they got people to, they glued golftees onto their foreheads and asked them whether they could bring them together.
Again they were tricking them into furrowing their eyebrows.
right.
suddenly they found that when you follow your eyebrows, you tend to interpret ambiguousinformation more negatively.
(20:42):
this study has been replicated multiple times and it's backed up by the work that's beendone with Botox.
So for example, it's been used to manage depression.
And you know this, that patients, people who express negatively, they often willexperience negativity from those around them.
(21:02):
And again,
this person that was part of the feedback system with those around them in the society.
Yeah, it's interesting, isn't it?
I mean, you sort of think of that it starts in the brain, the brain's perception, butthere is a direct link to the mechanics of what we do, right?
Yeah, that's an interesting feedback loop.
So you're starting with the face and then looping it back into the brain.
(21:25):
Yeah, very, very cool.
So do you have a prescription?
Are these like prescription lenses that somebody can walk around and read a book and seewhere they're going?
Is that how it works?
yeah, yeah.
So I mean, our systems are quite, they are still prototypes.
And so we're doing some studies with them, I can show you them.
They don't look too dissimilar to regular glasses.
(21:46):
There's a slight thicker on the
There we go.
Yeah.
yeah, yeah.
They're a little bit thicker on the side there.
Lenses pop in and out, so we have prescription lenses for them.
(22:08):
So is it the frame that's actually doing all the sensing?
Nothing to do with the lens, is that the idea?
We developed some new sensing technology called Optomyography, which essentially allows usto sample facial movements with very high fidelity, high sensitivity, but using very low
power and with a very small sensor footprint.
(22:28):
So it's pretty small.
It's modeled a bit on how a fly sees basically what's called optical flow, where the tinytexture changes across the lens, sorry, across the sensor are detected.
across in the xy plane.
Okay.
And is there a little battery then in the frame?
Okay.
(22:50):
So do you charge up your glasses at night?
Is that what happens?
Okay.
Got it.
Very cool.
And so is this something that's, you know, you go to a website and buy it, or is itsomething that's being studied in research only now, or how does that work?
So we did some research published in Frontiers in Psychiatry where we demonstrated thatyou can detect differences between depressed versus non-depressed people just purely from
(23:16):
their facial data which was fascinating and we see this in future as being a way to enablepsychologists to study mood disorders in the wild and say you can do with you know a CGM
or but looking at glucose or or amblytric ECG.
In terms of the glasses as they are now, we're using them mostly for research and we'reworking with some partners.
(23:41):
So the main use case we're using just now is around diet monitoring because we see that asbeing a potential to help a lot of people.
Diet monitoring.
tell us about diet monitoring with facial expression.
So if you're laughing, you eat less or you eat more.
(24:01):
Well, actually, one of our developers, whilst he was doing some debugging, was having hisbreakfast.
And he noticed that every time he took a chew, he could see the signals very clearly.
Now the glasses weren't designed to measure eating behaviors, they're designed to measureemotional expressions, but because there are sensors in the temple that are there to kind
of calibrate for different movements of the glasses, they were picking up the muscleactivations at the temples.
(24:24):
And so I got talking to one of our colleagues who's a researcher, but he's also abariatric surgeon.
He said, well, that's amazing because, dieticians, they're big bug players and they tryand get people to change their eating habits before they undergo bariatric surgery to
reduce the stomach.
We try to get them to eat smaller amounts, to chew more thoroughly and to give a gapbetween mouthfuls.
(24:48):
They call it 20, 20, 20, where it's 20 pence piece, a piece of food, chew at least 20times and have a 20 second gap between.
But patients often don't do it because a lot of you are overweight.
actually grown up just learning how to eat very quickly.
They get it from their parents.
So retraining that is very, very tough.
And he said, well, you know, taught some dieticians, which we did, and got really positivefeedback and said, well, here's a way for us to produce something that's relatively
(25:18):
simple, will be quite low cost to enable people to, first of all, to log their food.
So the glasses contain a downward looking camera.
So you start eating, capture the image of what you're eating.
Mm-hmm.
AI, food analysis of the calories, macros and micros.
And then the glasses measures your eating rate as you're eating.
(25:38):
And if you start eating quickly, it gives you this subtle vibration feedback to slow downyour eating.
It also can monitor when you're eating while distracted, because we know that people whoeat distracted tend to eat more.
So you're watching TV whilst eating, or if you're team scrolling on social media whilsteating.
you're not really focusing on the food and eating mindfully, which we know is importantfor weight management.
(26:04):
people choose their level of electric shock?
Yes, it's a subtle vibration, but yes, absolutely.
It's configurable within the app.
Some people might need a little stronger nudge.
right.
Yeah.
Right.
absolutely.
And actually, we know that if somebody is very, very active, as measured by the, so it hasan IMU, it has a motion sensor as well.
(26:28):
And if you're very active, then obviously you would likely require more of a, more of afeedback buzz.
We actually have done some user testing about it to work out what level was satisfactory.
And it does vary from person to person.
But what was really interesting that we found that
by lowering the threshold.
So if a person has an eating rate of say, you know, 1.7 chews per second, you can, you canlower it down by 80 % and the person will slow down their eating.
(26:57):
And by doing so you're actually having a direct impact on the GLP ones in the stomachbecause we know that.
Yeah.
slower, slower chewing increases GOP one.
So, so one of the mechanisms by which GLP-1s are released are through the stretching ofthe stomach.
and so one of reasons why people often struggle with their weight is that if you eatquickly, you're going to ingest more calories per unit time.
(27:23):
The mechanism by which this, satisfaction or fullness signals, get signals is not throughneural, but it's from hormonal.
So it's often takes like a 20 minute lag between eating the food and signaling that you'refull.
And if you eat.
quickly, you're going to stretch the stomach and it's too late by that stage you'veovereaten.
it.
Yeah, can out can out eat the response to the feedback loop, so to speak, right?
(27:47):
as if you interesting.
By slowing down your eating, you give a chance for the brain to recognize that it's fullfaster.
That's fascinating.
So have you done some weight or body composition studies to kind of demonstrate whathappens for people like this?
Is it done in conjunction with bariatric surgery or is it now standalone or how does thatwork?
(28:10):
So this, our work on diet is ongoing.
So we have just completed one clinical study on patients just to prove that technologyworks in the wild where people are using the app.
It's capturing all their, all their meals, giving them feedback.
And it was quite surprising how patients were finding it really valuable.
So one, one of the patients she had been seeing a dietician for years, or for months, Ishould say, with a really bad heartburn and her dietician had told her to
(28:40):
stop eating tomatoes and these acid rich foods, eat more bread because it can soak up thestomach acids and the like, and her symptoms weren't getting better.
But because the app was showing her what she was eating and she was able to relate to thesymptoms, she realized actually it wasn't that at all.
The bread was the thing that causing it.
She had a wheat intolerance.
(29:00):
And so we see the glasses as having this role in weight management, which almost certainlywill be beneficial.
We know that logging food,
by whatever mechanism will help people to lose weight.
But being able to identify the causal relationships between what you've done, i.e.
what you've eaten, and your bodily symptoms later on, will be really powerful.
(29:22):
Cool.
So it's really an educational tool, quite honestly.
It's also a training and educational tool in a way.
Yeah.
Very cool.
Yeah, that's awesome.
So what's, what are the plans for this?
Do you plan to make it generally available or, um, mean, is there's, doesn't sounddangerous.
It doesn't sound like there's, you know, contraindications to it.
I suppose there's a contraindication to everything, but
(29:44):
Yeah, I mean, it's a very low risk technology because it's just providing you withinformation.
And the idea being that if you can empower people with better information, they can makebetter decisions.
you know, it's glasses and so glasses are there to help you to see.
In this case, you're seeing better what things you're doing today that will lead to anegative outcome tomorrow.
(30:06):
The route to market will likely be via dietitians or through platforms who are managingpeople's health.
To be honest, given the scale of metabolic diseases, given the impact of what people areeating on their health, I think people would be quite surprised.
I when I was wearing the glasses myself as part of the testing, it's really interesting tofind out how often I was snacking without realising because you do it mindlessly, you
(30:34):
know, are the things that...
Yeah.
So there should be somebody outside of every all you can eat at a restaurant and it'shanding them out.
Right.
So, yeah, we'll probably get probably chased away by the proprietor, though.
So maybe not.
Maybe they're going to pay one price and eat less.
So everybody wants.
(30:57):
Right.
That's funny.
Very cool.
Very cool.
So
How do people find out more about you and what you're doing if they'd like to connect orlearn more?
What's the best way to do that?
So our company is called M-Tech Labs, that's E-M-T-E-Q labs.com.
And basically we have a lot of information about our technology, our research, ourbackground.
(31:21):
We've done a lot of work on the various health parameters that can be measured viaeyewear.
You one of the things that I'm really passionate about is that we enable people to havebetter information around what they're doing and how it can impact the future.
And also the fact that some of the things that we measure in medicine and in longevityscience for that matter are the after effects of some kind of behavior.
(31:49):
So, you you can measure blood biomarkers or you can measure assays or imaging, but veryoften what you're looking at are the net effects of an accumulation of behaviors.
And that is very, very interesting because it gives you really unique data.
Apart from around mood and emotions, which obviously is pretty powerful.
(32:09):
You know, we know this from studies published by Harvard and others about the impact ofvarious factors on longevity and the most important one being about being grateful and
sociable.
And obviously you can measure all those things with glasses because people who aresociable tend to interact more, they smile more, more positive and people want to be
(32:31):
around them.
But also on things such as subtle things such as one's posture.
uh, once gates.
So being worn on the head means that you actually can measure gates in ways you can't dofor a risk-based device, such as an Apple watch or a FitBit.
You're getting, you're getting much better information around asymmetries, for example.
So before you, develop problems in your hip or your knee, it may well be in the data as adigital signal.
(32:58):
Um, people's posture changes very, very slowly so much so they don't notice it.
And so you can measure these things over time and actually give an indication that thisperson is no longer as upright and as upright as they used to be.
It seems like I might have a general application in any physical therapy setting andalmost any psychological setting as well.
(33:18):
If you're sort of training people on this, you know, smile and you'll feel happier kind ofthing or, you know, pay attention to your gait or whatever it is.
Right.
So it seems like it has broad application.
You know, you had a you had a statement about I think was the longevity of joy or orsomething.
Tell us a little bit about.
(33:38):
Tell us a little bit about your connection to joy.
What's your thought there?
So one of the things that was quite interesting to me is that there's an old saying, Ithink it was Peter Drucker who said, we can manage what we can measure.
And for a long time in medicine, and actually most hospitals today, they focus on makingpeople live longer.
(34:00):
As a plastic surgeon, I often get involved in managing people who are very elderly, notonly doing facial paralysis, but doing things such as skin cancers, et cetera.
Sometimes people are being kept alive, but have no quality of life.
And that's a terrible thing.
(34:21):
And so, you know, the focus on health span, think is great.
It's wonderful.
But then you see some people who are going at this, this health span drive, but they'reliving miserably.
they spend four hours in the morning, you know, sort of having to prepare specializedmeals, have a routine that is so arduous and tedious that, you know, it may not be that
(34:48):
they live longer, but they may feel longer because of the difficult work.
a calorie deprivation, right?
It's chronic.
exactly.
Exactly.
So, so if we could think about how can we optimize for not just the length of life, notjust the length of healthy life, but the length of healthy and joyful life.
(35:09):
And that will hopefully make life worth living.
And how do you measure that?
Well, you can measure that by looking at things such as emotions, things such asinteractions, that decisions that are perhaps a little bit more informed.
Yeah, I think that's think that's fascinating.
You know, in the book that I wrote, 100 is a new 30.
(35:31):
I was about living young for a lifetime.
And we've kind of gone on to really the target for us with longevity is when we're 100,we're going to have a 30 year old body, but we want to have a 300 to 3000 year old mind,
right, which is all the equanimity, all the joy, all the love, all the perspective and,you know, the ability to actually suffer a trauma and.
be minimally impacted by it because of the perspective and sense of wellbeing that we haveinnate to us.
(35:56):
It's not external validation, it's internal assurance, if you will, right?
So yeah, so we love that because we find that so many people not only destroy their healthwith stress and worry and things like that, but they also are just exceedingly unhappy.
And so if you're not addressing that, what I call the life energy circle to talk about allthose different.
(36:17):
and healing traumas and all the things that go on there and feeling safe and feeling lovedand having great relationships and and also being open minded, right, to grow and learn.
Then, you know, it's it's what's the point really.
And I think you're right.
What's the point?
But beyond that, the flip side of the what's the point conversation is if we step intothis new concept of longevity where we truly are youthful and can do whatever we want, but
(36:41):
we also have this wisdom and perspective.
my gosh, I think humanity could really elevate itself.
beyond this kind of binary thinking that we seem to be caught in, Kind of move into moreof a quantum perspective on where are the best solutions as opposed to we're right and
you're wrong kind of thing, which leads to all kinds of conflicts.
So anyway, that's kind of where we're pointed.
(37:03):
Yeah.
that.
I mean, you we can see it today, can't we?
We can see, you know, some of the richest people in the world, and I'm not mentioning anynames here, but clearly are not very happy.
So money won't buy happiness.
And the research backs it up, you as you all know, the research that showed that, youknow, the household income required for people to feel happy, it tops out at this level
(37:25):
that's much lower than people would imagine.
I think
study was published it was $80,000 it may be higher now but the fact is that
you know, I see this in impatience of mine, having more money isn't necessarily the routeto being happier.
so, if you can't measure certain things, you can't make decisions.
(37:47):
So if you're going on your journey on a map, you've got two routes to go by.
One route is going to go via the freeway and the other one is going to go via thecountryside.
If you have no way of being able to judge the value of that journey in terms of what it'sgoing to give to you.
You may just choose one or the other based on time.
(38:07):
But if you knew that journey along the countryside is going to be useful and you'll seelovely fields and nature, you may choose a journey that may take longer, but it's filled
with more joy.
But it's actually quite hard to measure that because there aren't the tools there to,enjoy in the wild.
We have systems that we can use to kind of past experiences of other people, ratingsystems.
(38:33):
For example, can say, okay, well, that restaurant is good because it's got the ratings,that hotel's good, good ratings.
What if we could map emotional experiences across the map that we can actually work outbased on the crowd?
Yeah, it would be great to be able to measure joy.
don't know if you can do it just with facial expressions or if you need to look at, youknow, dopamine and oxytocin levels or what exactly you need to be measuring.
(38:58):
Right.
But certainly, you know, for me, joy is really becoming North Star.
It's like if if I'm not feeling joy, then maybe I need to rethink how I'm approaching thisor maybe I shouldn't be doing this.
Right.
So those are my two things.
Yeah, for sure.
Now, I think, yeah, we're we're we're
(39:19):
You know, one of the insights I've had recently is that when we were born here on planetEarth, we're actually born into a giant escape room.
Yeah.
And the goal is to actually work our way out of all the constructs that we're laden with,right?
Epigenetic and social to find our freedom where we're actually unencumbered by thesethings.
(39:40):
And we actually connect to source energy and we're actually just self actualized, if youwill, where we reference against source.
There's no external validation required, and yet we're free to have many lovingrelationships and
And we're not attached to outcomes, which is really the source of stress, right?
We identify with an outcome.
We attach to that.
It's like, there's no need for that, quite honestly, right?
(40:01):
What if I just love and care and connect, but I don't have to be attached to it?
I can, it frees you up.
All of a sudden you're emancipated.
It's like, okay, now this is joyous, right?
I want to live this life for a long time, right?
Instead of like all the drudgery of, you know, am going to lose my money?
Is my, you know, this or that, you know, all the things that people worry about.
So anyway, that's to give you a little bit of a taste to kind of.
(40:22):
we're up to over here.
No, that's fascinating.
It's funny, I'm actually reading a book at the moment called, I am a strange loop byDouglas Hostader.
And there's a section in there, he talks about the relationship between us as individualsand our place in the world and how we are, you the optimal position is that we become one
(40:43):
with the world ultimately.
Because there is no mechanism by which one's actions can't have an impact on the wholeuniverse.
if you think about it to its extent.
So yeah, it's a really...
more powerful than we realize, quite honestly.
That's other thing.
So it's an escape room.
(41:04):
The idea is to work your way out of that to get there.
So anyway, so let's see an analogy I'm using at the moment.
Well, I love the work that you're doing.
I think it's really refreshing to meet any physician that's really thinking about thingsfrom a greater perspective, if you will.
(41:24):
You know, no pun intended, but particularly a surgeon, right?
So you have your reputation still live up to like interventional cardiologists or not, youknow, we're kind of in the same boat, but yeah.
So anyway, that's, that's really lovely to see the work you're doing.
So what's next for you?
Do you have other, other devices, other plans, other charity activity?
(41:45):
the main plan is to get this technology.
So this is going to be Sensei where we're launching a dev kit for developers to get accessto technology to build apps on top of our platform.
Imagine that, for example, someone who has a specific issue, it perimenopausal health,somebody with a specific gut disorder who may need to manage it with a specific kind of
(42:12):
diet.
or somebody who has lifestyle related issues, it can really provide them with informationthey need to make actionable decisions.
More information, the right kind of information will hopefully lead to better outcomes.
so that's Northstar.
So we're looking forward to partnering with organizations, companies, clinics who want totake this technology to their clients to give them this really
(42:44):
previously unavailable information.
Mm hmm.
Yeah, we're building a longevity coaching app right now.
It might be great to actually collaborate with you and bring the glasses into that arena.
That would be super cool.
yeah.
Yeah, awesome.
Well, Charles, thank you for taking the time.
think where are you speaking to us from?
(43:05):
Are you in England or someplace close?
I'm in Britain on the south coast of the UK.
yeah, so it's, what time is it now?
I don't know, it's 20 past 10.
past 10.
OK, well, you need your sleep, so I'll let you go.
Thanks for taking the time out.
Really a pleasure.
Thank you.
No problem.
(43:26):
Thanks, Jeffrey.
Love to talk to you.
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