Rethinking Health: Connection, Purpose, and Joy w/Lifestyle Medicine Dr. Jasdeep Saluja

Episode Transcript
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Speaker 1 (00:03):
Hello. My name is Skippy Mesereau, coach, former
elected official, and lifetimepublic servant. Welcome to
Healing Our Politics, the showthat shows you, the heart
centered public servant andpolitical leader, how to heal
our politics by starting withthe human in the mirror. It is
my job to sit down or stand upwith the best experts in all

(00:25):
areas of human development,thought leaders, coaches,
therapists, authors, scientists,and more, to take the best of
what they have learned andtranslate it specifically for
the public service experience,Providing you actionable,
practical, tactical tools thatyou can test out today in your
life and with your teams. I willalso talk to leaders across the

(00:47):
globe with a self care practice,getting to know them at a deeply
human and personal level, sothat you can learn from their
challenges and journey.
Warning, this is a post partisanspace. Yes, I have a bias. You
have a bias. We all have a bias.Everybody gets a bias.
And I will be stripping out allof the unconscious cues of bias

(01:10):
from this space. No politics,partisanship or policy here
because well-being belongs toall of us. And we will all be
better served if every human inleadership, regardless of party,
ideology, race, or geography,are happier, healthier, and more
connected. This show is aboutresourcing you, the human doing

(01:34):
leadership, and trusting you tomake up your own damn mind about
what to do with it and what'sbest for your community. So as
always, with love,

Speaker 2 (01:44):
here we go.

Speaker 1 (01:47):
Welcome to the Healing Our Politics podcast,
the show that shows you, theheart centered leader, how to
heal our politics by startingwith that human in the mirror.
In this episode, I sit sit downwith expert in lifestyle
medicine, doctor Jasdeep Saluja.Doctor Saluja is widely regarded
as a preeminent leader in hisfield, serving as a diplomat at

(02:09):
the American Board of ObesityMedicine, an advisory council
member of the Global PositiveHealth Institute, an advisory
board member of the AmericanBoard of Lifestyle Medicine, and
at the Elected LeadersCollective. After seeing his own
dad underserved by traditionalmedicine and watching his own

(02:30):
health decline in his earlythirties as a doctor, doctor
Saluja's eyes were opened to amore integrated way to do
medicine. He cofounded the ArogaInstitute, which has served over
10,000 individual patientsanchored in the 6 pillars of
lifestyle medicine, which arenutrition, fun physical

(02:50):
activity, stress management,avoidance of risky substances,
restorative sleep, socialconnections, and his 7th pillar,
purpose and meaning.
So what do any of these have todo with medicine, you ask? Well,
ask, listen, and you will learnbecause this integrative and
preventative approach tomedicine drives life saving and

(03:13):
changing behavioral and healthoutcomes. So if you are
struggling with your weight, ifyou have hypertension or high
blood pressure, if you areprediabetic, or if you simply
just want to feel better in yourbody, remove the brain fog, this
episode is for you and I really,really nerd out in this one. We

(03:36):
dig into Jazz's journey intolifestyle medicine, the
difference between lifespan andhealth span, what tools or
evaluations you can use tounderstand your own state of
health and health risks, andalso take control of your health
future. What wearable or techdevices can improve your life
and fitness?

(03:56):
How to use or not use those?Something that was very cool for
me, Aroga's journal club, theirmonthly meeting discussing new
data, studies, and research, andhow they or you with your team
can integrate and process newempirical information,
understanding what is the signalbetween the noise, what to

(04:17):
listen to and not to driveresults for your team. We talk
about how language choicesinfluence outcomes. For
instance, why framing movementas patient directed fun physical
activity creates better lifeoutcomes predictably than
mandating exercise and what youcan learn about these insights

(04:38):
in your own leadership. We diginto blue zones, the places on
earth with the highestconcentration of centenarians,
those 100 plus year old humanson earth, and what we can learn
from them in our own communitiesand, frankly, so so so much
more.
Without further ado, I hope youenjoy this wide ranging, very,

(05:00):
very nerdy, and possibly lifealtering conversation with
doctor Jasdeep Saluja. I'm soexcited to dive into medicine in
a way that our listeners haveprobably never experienced it.
Something that they want toengage with. Basically the

(05:21):
opposite of a root canal is whatI imagine here. But I wanna
start with you because whilethere's plenty out there about
Aroga and your work and theboards that you sit on, I want
to know who you are as a human,as a man, and what led you to
this work.
I wonder if you could talk alittle bit about when you were

(05:41):
first inspired to pursue a lifeof medicine.

Speaker 2 (05:45):
So, I grew up in a Punjabi Sikh household in
Toronto, and the joke is usuallyif you grow up in a Punjabi
household, you're either gonnaturn out to be a doctor, lawyer,
engineer, accountant, one ofthem. My cousins and family all
joke that my dad probably usedto whisper medicine in my ear
when I was sleeping, which couldactually be true because my

(06:06):
earliest memories as a kidwanted to be a doc, And when
people would ask me why? Where'sthat come from? I wasn't sure.
And I till this day, thatinitial spark, I actually don't
know where that came from.
So I think, potentially, he waswhispering it in my ears.

Speaker 1 (06:20):
Wow. So I come from a Jewish family, which is a
similar stereotype. Mygrandfather is still to this day
my idol, the one person in myfamily that I just deify, and he
was a doctor. So I grew up withan admiration of the profession
in a similar way.

Speaker 2 (06:36):
But that said, I also had, like, thoughts of doing
other things as well. Like, atone point, I think I wanted to
be a clown because, you know,they made people laugh and I had
fun with that, so I used to saythat for a bit. From the ages of
4 to 7, lived in an apartmentbuilding in in their city, and I
used to think the superintendentof the building was the coolest
person in the world, was had allthe answers. I used to tell my

(06:57):
mom I'm gonna be asuperintendent. But I would say
probably by the time I was,like, in mid elementary school,
even before high school, I knewthis is what I wanted to do.

Speaker 1 (07:05):
As someone who wants to do everything and then
sometimes falls in the trap ofdoing nothing as a result, I
have so much admiration forpeople who have known for that
long what their calling is. Ijust I just think it's so cool,
and I just really admire you forit.

Speaker 2 (07:19):
For me, it was this perfect meeting point of things
that I enjoy. I enjoy hangingout with my patients. Clinical
care, it's a lot of fun. Eventhough I sit on these boards, do
all those other stuff, the vastmajority of my work is always
clinical care, and I alwaysvalue that relationship I get to
build with patients. And thenhaving studied biology and all
that in the human body, medicineallows you to dip into the

(07:40):
evidence part of things and thescience part of things, but also
continue formulating an approachto relating to others, because
that's what it's really about atthe end of the day if we're
gonna talk about, you know,medicine as a healing science or
as a healing field.
And it's allowed me to continuelearning. Like, I'm always
learning every day. It's one ofthose things where you can
continue evolving as part ofyour journey.

Speaker 1 (08:01):
Would you say that you are a person who's inspired
by people more so than, like,deeds or actions or both?

Speaker 2 (08:09):
I think I remember the people. Yeah. Deeds and
actions, they come from people.The deeds and actions that move
us are also coming becausesomeone is inspired to do
something. Right?
And so I connect to thatinspiration more.

Speaker 1 (08:21):
Yeah. Yeah. Who in your upbringing inspired you or
implanted the thought that youhad a role to help others?

Speaker 2 (08:31):
My parents probably do that together. We grew up in
a house with a lot ofmeditation. We belong to a
sangha or sangha, which means acompany of others who are on a
meditative journey. Mhmm. Myparents had met a spiritual
master, and he has been aguiding an overarching guidance
in our lives.
And one of the things that heused to say was that from a

(08:51):
career perspective, he alwaysfelt that teachers and doctors
had an opportunity to make ahuge difference in the community
that they live in, especially ifthey were working on their own
journeys. It's just because theamount of interactions that
teachers have in the community.Every year, there's another
cohort of students, so thatteacher's got so much
opportunity to connect withyoung minds. And if that teacher

(09:13):
is themselves on a prettyspecial journey, that'll carry
over with the students. And samething with doctors, just because
we have so much opportunity totalk to people and people come
in this place of openness, ofvulnerability, and trust that if
you're on your own journey, youcould continue to help others.
That was something I used to bein the back of my mind as well.
And, part of our SICK ethoscomes down to 3 principles. Live

(09:36):
a meditative life or areflective life. Mhmm. Earn an
honest living, and share whatyou have with others when you
get the opportunity to do so.
And to me, earn honest living,it's an interesting concept.
It's something I keep divinginto, and I always thought
medicine was an honest living.As long as you're doing your
work and you're not cheatinganybody for what they're
supposed to have. You're you'rehonest living. For years, I

(09:58):
thought I was in an honestliving, and then at one point,
that point came when I startedwhen I started thinking I'm not
earning an honest livinganymore.
Mhmm. And that started to beatat me, and That's when I knew I
had to kinda make some changesin my professional career, so
that I could realign with mymost current understanding or
approach to what's an honestliving.

Speaker 1 (10:17):
I really appreciate that. My partner's mom, Jamie,
her mother is a teacher. And soI kind of get to see that up
close and personal. I think thatmost people who get into
teaching or medicine get inbecause they really want to help
people and be with them. That'sa significant driver for them.
And yet, the systems that wehave set up, however,

(10:38):
intentionally or unintentionallycreate incentives for the
opposite. And certainly, in herworld, the behavioral and mental
health issues that are in theclassroom, the lack of oversight
from the parents, the impact ofCOVID, the number of students
per classroom because of fundingdeficits, and all of those
things conspire in such a waythat there is not the time and

(10:59):
the day to meet each student,even if you want to. And when
you go home after finishinghomework, you have a few hours
of sleep and you're back. Andhow can one do the job well? And
I think we'll find that medicinesuffers from many of the same
issues.
And I think it's a good time tointroduce the topic of lifestyle
medicine so people know whatwe're referencing. What is it?

(11:21):
And how is it different orsimilar from what people might
think of as traditionalmedicine?

Speaker 2 (11:27):
So lifestyle medicine, I think, should just
be called medicine at the end ofthe day. Yeah. And I can't wait
until the day that we stopreferring to it as lifestyle
medicine, and that's a paththat's being walked and being
led by many leaders in thefield. But really, lifestyle
medicine is a specialty ofmedicine where we aim to
prevent, treat, and potentiallyreverse or, put in diseases into

(11:48):
remission through the 6 pillarsof lifestyle change that we
refer to. So nutrition, so it'slike healthy, tasty food,
maximizing joyful movement.
Most people call it activity andexercise. I kinda feel those
words are sometimes heavy, and Idon't like heavy words. You
know, stress management, butwhich I also think is, like,
stress release because I don'tthink every stress we need to

(12:09):
manage. Some of them we justneed to get rid of. Positive,
loving social connections,restorative sleep, and then
avoidance of risky substances.
So this is like, these form the6 pillars of lifestyle medicine.
More recently, there's been astudy called positive psychology
or positive health, which is nota separate pillar, but aims to
infuse positive psychologywithin all the pillars. There's

(12:30):
more and more research coming upon how we approach all these
areas of our lifestyle. Goingfrom a shame based or negative
standpoint, you're not reallygonna make the changes that are
gonna be sustainable. If you canhelp patients and and our
community members inculcatethings like zest for life,
enthusiasm, kindness,generosity, it actually carries
over in all the differentpillars of lifestyle and really

(12:51):
changes their morbidity andmortality.
We're learning more and moreabout that, and that's a
evolving field. Another pillarthat was introduced to me back
in 2021 at the LifestyleMedicine Conference, Darren
Morton did a presentation on howhaving meaning in your life is
actually the upstream pillar.Mhmm. And so you can have these
6 pillars of lifestyle changesfor optimization, but having a

(13:14):
reason to be alive, having thatmeaning in your life, finding
that sense of purpose is whatfeeds the real motivation for
actually making changes.

Speaker 1 (13:24):
Do you view meaning and purpose as synonymous?

Speaker 2 (13:28):
I think it can be in times, and I think it depends on
where someone's at. If theirpurpose is aligned with their
sense of meaning is, then, yeah,I guess it is the same, but then
there could be times when it'snot right. And that's okay too.
It's a moving sort of target.It's not one thing in stone.
Right?

Speaker 1 (13:43):
I find in my own wellness journey, my own
spiritual journey that gettingvery clear and precise about
what I mean about things hasbeen super helpful because my
purpose, like, personally is toheal our politics. That's what
drives me. That's what gets meon this podcast and talking to
you. I get excited about thatevery day, and I know it's
something that I will neverfulfill, as the great rabbi

(14:04):
says, neither may I desist indoing my part. And yet I could
go outside today and walkthrough a forest and find deep
meaning and connection in that.

Speaker 2 (14:14):
For sure.

Speaker 1 (14:15):
And that feels very different to me, but also super
life affirming.

Speaker 2 (14:18):
Oh, absolutely. Yeah. And so lifestyle medicine, so it
takes these pillars and puts asystem around it and empower
patients to approach theirhealth in a different way.

Speaker 1 (14:26):
Yeah. And upstream as well as in stream, which I
really appreciate. I'm sure thatthe path to becoming a doc and
then a lifestyle doc andstarting your own company was
far from linear. And I imaginethere were some roadblocks. So
were there any times when youquestioned that path?

Speaker 2 (14:46):
Oh, all the time. Right? I remember, you know,
even being an undergrad, becausethe way the system works in
North America, you end up takinga science based program, which
may or may not actually serveyour needs and serve the needs
of your career later on. You'reslogging away in these courses
and you have no guaranteewhether or not you're gonna get
into medical school because alot of times, truth is those

(15:08):
degrees don't lead to any jobsor any careers. It's then then
you're trying to figure out,okay, what do I do?
I go to graduate school, do I dosomething else? And I remember,
like, early in my 1st year ofundergrad, I had an opportunity
to apply to a pharmacy program.I put my application in, wrote
the exam, got into pharmacyschool, and then I was like, but
it's not what I wanna do. Mhmm.And these are little, like, sort

(15:30):
of decision points, you know,challenges along the way that
kind of say, okay, you know, howfocused are you on your end goal
and how much faith do you havein your, like, the universe.

Speaker 1 (15:40):
Mhmm.

Speaker 2 (15:40):
So luckily, got into school, went to Queen's, and got
into residency at UBC. And thenit hasn't been a straight line
because, like, I was working fora few years in Toronto. I was an
internal medicine doc at thehospital. I was, you know, doing
a lot of night shifts. Didn'tsee my family that often.
I was doing but, really, I wasjust putting out fires in acute

(16:01):
care, which is important worktoo, and don't get me wrong.
That's super important. But itwasn't doing good for me on my
own health level. I was gainingweight. I was tired all the
time.
Mhmm. I started in my earlythirties having back pain
issues. I remember, like, havingthe weight loaded up on pain
pills to be able to go and do acall shift and emerge. Calling
in a physiotherapist, like, 5hours before my work shift

(16:23):
started. Can you get me in?
I need some help here. But thosewere times when you're like,
well, this doesn't make sense.

Speaker 1 (16:28):
Yeah. I mean, these stories are so common. And I
think about, you know, myfriends who are surgeons. Yeah,
sometimes they're on 16 hourshifts. I'm like, that's not the
person that I would like doingsurgery on me.
Yeah.

Speaker 2 (16:41):
Yeah. Like No. For sure. And then even getting into
life, some medicine, leaving thehospital, starting your own
organization, that came with alot of challenges. I mean,
having zero business background,I was very fortunate that, you
know, our CEO and cofounder, AmrMeghann, happened to have a
background in entrepreneurship,but it was still came with these
challenges, especially withinthe medical community.

(17:01):
Yeah. Not everybody ispracticing medicine in this way.
That's why we still call itsomething else instead of just
medicine. And not everyone isconvinced that this is stuff
that is worth putting effort,time, resources towards. So that
comes with its own challenges.
Right? When you have to not onlyconvince community members and
patients that this is worth it,but you also just convincing

(17:22):
your colleagues that this issomething that we should be
spending resources on.

Speaker 1 (17:25):
Was there an initial point, maybe it's the one you
just described, where yourealize that maybe you're not
fulfilling the initial intentionor goal of why you got into this
in the first place and from thepatient perspective?

Speaker 2 (17:37):
For sure. So this journey really starts with my
pops. In 2012, I happened to bedoing a month in Toronto,
staying at my parents' place,and he was getting ready for
work, and he's like, I can'tbrush my teeth. He had lost,
like, his fine motor skills inhis in his head, and I and I was
like, he'd had always had, like,you know, some kind of, you
know, spinal issues. I I thoughtmaybe it's just cervical spine,

(17:59):
maybe it's a nerve impingement,hoping it wasn't a stroke, and
trying to, like, keep an openmind what got him to the
hospital, and it turned out hedid have a stroke.
And it was a minor stroke,because, you know, his symptoms
improved literally within theday, and he never had, like,
recurrence of that symptom.

Speaker 1 (18:16):
How old was he at that time?

Speaker 2 (18:17):
He was in his late fifties. Okay. You know, he's in
the hospital. He had excellentcare. You know, he end up at one
of his carotids who was, like,99% blocked, and so he required
surgery.
He had surgery, went flewthrough that with flying colors,
and walked out of the hospitalas if nothing ever happened, but
he was on a, you know, a set ofmedications. Mhmm. And at that
time, he had great medical care.Nobody asked him anything about

(18:39):
his lifestyle and neither did I.And I remember no none of our
family members, I remember ourfriends did.
It was just one friend who livesin San Diego. He was on his case
saying, hey, Azad. What are yougonna do differently now? Are
you gonna start exercising thisand that? And my dad kept on
making commitments saying, yeah,we're gonna do this, but nobody
really followed up on it.
I mean, we all knew in the backof your mind that something's
gotta change, but we reallydon't know either because it's

(19:01):
not like it's front and centerfor even us docs in medical
school or residency. And then afew years later in 2015, I came
home from a trip and I had beentold that he had been
complaining of chest painovernight. And so I drove him to
the hospital and he had had aheart attack. And, again, he got
admitted. He was amazing carethen too.

(19:22):
He had a couple of stentsplaced, came out of that, no
issues. And it was at thatpoint, I was like, this doesn't
make any sense. He's on the bestmedications money can buy. He's
a nonsmoker. He doesn't drinkany alcohol.
What's going on? Knowing that heis sedentary, he was an
electrical engineer, so it's adesk job for the most part
unless you're walking on-site.So I'm thinking about my

(19:43):
family's history and my dad's 2oldest brothers that passed on
from early cardiac disease. HereI am in my early thirties. My
cholesterol is living on thehigh side.
I'm overweight, and I'm tiredall the time. And at that point,
I was like, well, maybe it's allgenetics, And that bugged me so
much. I was like, it can't beall genetics. But I remember
reading somewhere that, youknow, family recipes, family

(20:03):
attitudes, family trauma, getpassed on just as much as your
family genes. And somehowsomehow I started, you know, I
just searching searching online.
It literally was just a Googlesearch going online saying,
okay, what else can we do? And Ifound the work of doctor Dean
Ornish, doctor CaldwellEsselstyn, luminaries in the
field of lifestyle medicine. Ididn't even know this word
existed. These words existedtogether, lifestyle medicine,

(20:25):
and just started reading whatthey had to say, and it turned
out, you know, there was a studypublished by doctor Ornish in
1990 showing amazingimprovements in cardiac patients
after going through a lifestylemedicine program that was when I
knew I had to kinda make somechanges in my professional
career, so that I could realignwith my most current
understanding or or approach towhat's an honest living.

Speaker 1 (20:47):
Can I just pause for a second just to highlight? It's
not a judgment or anything likethat, but it's it's shocking to
hear, you know, someone who is atrained accredited doctor. And
even though you've been throughmedical school, you've been
practicing as a doctor, thetotality of your training led

(21:10):
Google to be the best resourcethat you had to answer a
question.

Speaker 2 (21:14):
Pretty much. I mean, it's shocking. He was already on
everything. Like, he was on thebest medications money could
buy. He had the best specialist.
Like, there was nothing lackingas far as I was concerned in the
medical care that he wasgetting.

Speaker 1 (21:26):
And I've heard you talk about this where it's like
they gave him this pocket fullof pills to treat the system,
but there was zero talk abouteverything that contributed to
or may have contributed to thecondition in the first place.
How is that possible? If you goback to your medical school
training, how much time do youspend on diet, for instance?

(21:49):
Like, you know, can how is thatpossible?

Speaker 2 (21:52):
When I was in school, the nutrition lecture, I think
it wasn't more than, like, 10hours in the entire 4 years of
curriculum. Wow. Maybe it'schanged now. I don't know, but
it was minimal amounts. Like,the thing is even if there's a
little bit more nutrition inyour curriculum, when we're
going out and spending time withour attending physicians, it's
in clinic, you're dealing withheavy patient lows like 20, 30

(22:14):
patients, 40 patients a day typeof thing.
They're trying to make surethey're not running behind. It's
not something that's fullyaddressed. And then again, even
on our examinations, you tend toremember what you're gonna be
tested on, right, and whatyou're gonna be assessed on. And
I can't ever remember anybody inmy entire training, testing me
or assessing me on my ability totake a history about someone's

(22:38):
lifestyle, assess whether or notit makes helpful living versus
disease promoting living, andwhether or not I could even give
any evidence basedrecommendations. I was never
tested on this.
So if I'm not tested on this,I'm not assessed on this. It's
not going to be the basis of mygetting a job or the basis of me
getting a promotion or making aliving for my family, then it's
kind of tossed out.

Speaker 1 (22:58):
You're being implicitly and explicitly told
this stuff isn't important. Inthe meantime, most of us are
born into healthy, normal on thebell curve functioning bodies.
You know, it's like we gethanded a key to a new Ferrari.
They're like, have fun, kid. Andnobody tells you what fuel you
need to put in.
And people are sitting around,like, trying to shove wood chips
into Yeah. The filler tank. Andsomeone else is putting Jell O

(23:20):
in there, and someone else isputting diesel fuel. Yeah. And
you're, like, wondering why thisthing isn't performing.
It's just it's wild. How do youthink we have, as a society,
gotten to a point where we sounderappreciated the fuel we put
into our body as part of ourhealth?

Speaker 2 (23:38):
I think a lot of people are trying to figure that
out. One way of thinking aboutthat is actually looking at
places in the world that aren'tnecessarily dealing with the
same epidemic that we aredealing with here in a lot of
the developed world. Places thatare called blue zones having a
health span far greater thanmost other places where they're
living till a 100.

Speaker 1 (23:56):
I have a passing knowledge of these, Did some
work with Dan Buettner back inthe day briefly. And there are
some elements of those that Iwould argue, yeah, probably part
of all traditional societies,regular, light exercise, social,
kin groups from birth to death,whole food diets, like no
question. However, at the timethose things were happening, we

(24:19):
were also living in tribalsocieties that were engaged in
regular warfare and raiding.Average lifespan was 30
something years old. Yeah.
You didn't have modern medicine,so you were dying of a little
cut that you got in your armwhen you were out harvesting.
And so a lot of the things thatwe focus on now are actually
diseases of old age. And sowe've kind of traded one problem

Speaker 2 (24:44):
set for the other. What how you define health span,
and what you value from thatperspective changes how you look
at it. Nice to think that we gotto get people living longer. I
actually don't care how long Ilive. I care about how I live
during the time that I live.
Right? How many years do youactually get to enjoy robust
living in vitality?

Speaker 1 (25:02):
And that's what health span means?

Speaker 2 (25:04):
In North America, we've had these increases in our
lifespan. But on average, thelast 10 to 15 years of a
person's life, they're notreally of high quality. You
usually lose a lot ofindependence. Rates of dementia
are high. You know, it's notsomething people are enjoying
life and a lot of people,they're like, they're just
waiting for the day.
Yeah. And I don't wanna wait forthe day.

Speaker 1 (25:25):
Yeah. And I don't want to wait for the day. Yeah.
You want to extend theenjoyable, fruitful part of
life. I was at a Aspen Institutetalk years ago, and it was just
something that stuck with me.
It was a talk about health span.I don't think that was a term at
that time, but the opening slidewas after millennium of research
and study mortality rates stillstubbornly stuck at a 100%. It's

(25:45):
like Yeah.

Speaker 2 (25:46):
Well, that's the thing. That's your only
guarantee. Yeah. Right? Yeah.
To your question, like, we doput a lot of the health in,
like, the lifestyle part ofthings. We make that a very
personal responsibility forpeople. And sometimes it's a
criticism on lifestyle medicinesaying, hey. You're you're
blaming people in this inindividuals for not making the
the most optimal choices. Imean, it might be the case in

(26:07):
some people.
I think it's not helpful toengage in that approach, but the
approach is that health is asocietal concern. Yeah. And it's
about setting up societies wherethe healthy choices are the easy
choices, and they're the choicesthat can be facilitated the
best. When I'm talking to asingle mom who's got 3 kids,
it's about how can we get youaccess now, asking ourselves a

(26:29):
question of how we set oursociety up in a way that people
have the tools available to themin an accessible and an
equitable fashion.

Speaker 1 (26:38):
I love that point. In my mind, what makes the Blue
Zones work is, as you've said,the default decisions are the
healthy decisions. From asocietal structure or social
expectation, you are going toopt into those things. And I
wonder what we can learn fromthose that could be implemented.

(27:01):
But then also, if we assume thatthe individual, like me or you,
doesn't have the opportunity totop down make societal change,
what little incremental thingscould we do individually that
would encourage that shift?

Speaker 2 (27:16):
Sometimes I think by these societies where they've
intentionally, you know, madeavenues and access to healthy
activity, eating, you know,social connection with the
purpose of maintaining goodhealth, or is it just something
else that they're enjoying thatleads to overall better health?
Right? And I don't think I havethe answer to that, but I think
a lot of these places are wherethey're actually prioritizing

(27:38):
joy in their in their community.

Speaker 1 (27:41):
Mhmm.

Speaker 2 (27:41):
And to really experience joy, you actually
have to have all your faculties.You have to have the ability to
participate together, you haveto have those social
connections, you have to havehealthy, tasty foods to eat.
When you look at Dan Buettner'sresearch and others who have
researched Blue Zones, beyond,like, just, you know, the
statistics of, like, or the dataof, like, how healthy they are,

(28:02):
When you see those communities,you just see a lot of smiles,
and you see a lot ofsatisfaction. Yeah. You see a
lot of contentment.
You see a lot of laughter. Ithink that's a big thing that we
can, as a society, start toponder about and reflect upon
when we do look at theseexamples of places that are
living healthier. It's not justthe data of, like, yes, no

(28:23):
disease, no dementia. That'sgreat. But beyond that Mhmm.
Why is that important?

Speaker 1 (28:27):
And I've heard you say, like, a health care goal
could be bringing back laughter.I mean, it's on one hand so
obvious, on the other hand soprovocative and out of the box.
Granted that correlation is notcausation, and my brain is
clearly cherry picking data. Butif I think about, like, on a

(28:47):
country level, places that havereally poor health outcomes,
America, Saudi Arabia, tend tobe very isolated, spread out
individualist cultures where allthe places you're talking about
blue zones have a strongcommunitarian connection that
can serve as purpose.

Speaker 2 (29:05):
For sure. And I think that that community sense of
purpose can be developed in allsorts of societies. Like, when
we look at these community,like, the sharing and the love
and the laughter, that doesn'tmean that we have to set up
every society in one economicmodel, right, or a political
model or any of these things. Ithink this can occur across the
entire spectrum of approaches tohow you set up your communities

(29:26):
and your countries and all that.Right?
Yeah.

Speaker 1 (29:28):
So I wanna come back to some of your initial
inspiration and maybe point tosome places that people could
find their own without having tochange their doctor or whatever.
You mentioned Doctor Ornish. Youalso I think the first time we
talked, you recommended the bookHeart of Wellness to me, and I
read it. Can you say more abouteither of those, but also any

(29:49):
other resources, books, thingsthat you found in your early
part of your journeyparticularly insightful that
others might wanna check out?

Speaker 2 (29:58):
For sure. I I think doctor Ornish, his book that he
wrote with his wife, AnneOrnish, called Undo It is a
fantastic read for healthcareprofessionals as well as
patients and communities. It's,written in a friendly way and
really sums up a lot of theresearch. It shows that there's
actually commonality in theselifestyle changes amongst
various types of illness fromprostate cancer to heart disease

(30:19):
to dementia. And so while wehave these different phenotypes
of change showing up disease indifferent ways, there's a lot of
common pathways.
So I think that's a great book.The Heart of Wellness, it's
incredible. Doctor. KavithaChenain, her book was Beyond
Traditional Lifestyle Medicines.It really gets into that sense
of purpose.
It really gets into that. Wejust kinda get socialized in a

(30:40):
certain way of thinking and acertain way of having to set up
our lives. And then she shekinda proposes that they're
actually, you know, when youlook at older wisdom, it doesn't
matter which tradition, but, thegreat thinkers and masters, they
actually went beyond just whatyour day to day needs setup
needs to be. That there'sactually an area within yourself
that where you can find yourbliss and you can find your

(31:01):
purpose and you can find yourcontentment. And she talks about
how that actually does affectyour health experience and your
outcomes.
Another book that I really foundvery helpful was is actually is
called the lifestyle medicinehandbook written by Doctor. Beth
Frates. She's actually thecurrent president of the
American College of LifestyleMedicine. She's become a close
friend and a mentor over thelast few years. That book for

(31:25):
from a provider standpoint, froma healthcare professional
standpoint, it's amazing.
But also for patients, it's gottons of evidence in terms of how
each of these pillars makes adifference, but also spends a
lot of time on actually justlike actually how to connect
with each other as people. Findout what's really motivating and
what's making them tick and thenhelp them align their actions
and their words with thosemotivations.

Speaker 1 (31:48):
Mhmm. Yeah. That's awesome. I've certainly found
that starting in a booksomewhere safe, no one has to
watch me, I don't have to doanything, is a good place to
just open the aperture of thepossible. So hopefully people
check some of those out.
So you have this experience withdad, and now you introduce some
lifestyle changes. And what Ihaven't heard you talk about is,

(32:09):
like, as a human being, as aanimate higher primate, what was
dad like in the phase with themedicine, but before the
lifestyle changes? And then whatis his quality of life, his
demeanor, his energy like now?And how old is he now? Because
he's also quite a bit older.

Speaker 2 (32:29):
Yeah. He's in his early seventies now. Yeah. It
wasn't as easy as, like, I foundsomething out and therefore we
changed it all.

Speaker 1 (32:35):
Like Never is.

Speaker 2 (32:36):
I I don't want I don't want anyone thinking that
that's not the case. In fact,that should happen was initially
I had to change my ownlifestyle. Style. I mean, I did
talk to him, but it wasn'teffective because I was telling
him to do something that Iwasn't doing. Yes.
And so quickly realized that ifthis is gonna be helpful for my
father, I'm gonna have to dothis and have to model it, show

(32:56):
that it actually works, youknow, end up taking like the,
you know, a 6 month onlinecourse to learn how to like cook
professionally in plant basedfoods. I'm really spoiled. And,
so made the changes, or is itmyself and started feeling the
difference, started losingweight, More than just losing
weight, it was getting moreenergy. The back pain went away.
All of that stuff startedgetting stronger.

(33:17):
I joke, I started seeing musclesfor the first time. So that was
kinda fun. It's a

Speaker 1 (33:21):
good feeling.

Speaker 2 (33:21):
Oh, it's great. It's fantastic. Then got my parents
and my dad doing this. So hedad's you know, his lifestyle
has changed. We lost my mom afew years ago, to metastatic
cancer in 2020.
But prior to that, she was youknow, just to give you an
example with these lifestylechanges, even with metastatic
lung cancer, she was hiking upuntil like 6 months before she
passed away. Having a life ofmeditation, having a life of

(33:44):
purpose, I never once saw herbeing upset with the fact that
she had cancer. She in fact toldme not to be upset about it.
This is just part of thejourney. You know, I have ton of
learning from her experience.
And And then my dad, he'sretired. He travels the world a
lot. Like, in January, he's inMexico and then in Albuquerque,
and then he's in Dallas. Mhmm.Comes home in between.
We always joke in our familythat he comes home and do his

(34:06):
laundry, hang out with us a fewdays, and then he takes off
again. So right now, he'sactually in India. But when he's
at home, he, you know, he worksout 1 or 2 times a week with
trainer. He's usually, like,walking 8 to 10 kilometers a
day. Mhmm.
It's just normal for him. I'veactually seen other uncles and
aunts, other elders in thecommunity asking him why he's
looking and feeling youngerwhile they're getting older.

Speaker 1 (34:28):
Mhmm. And

Speaker 2 (34:29):
it's been fun to see him sort of, like, share some
of, you know, the learnings withcommunity members, and other
people are starting making smallchanges in their lifestyle to
just get more vitality. So Iwould say a gentleman in his mid
seventies, he's got vitality.He's lifting huge pots and pans
because when he's going to thesemeditation retreats, he also
volunteers and helps with thecooking. And so he got these

(34:50):
pots and pans that weigh like 50to £100. Oh, wow.
And he's in there in the mixwith the all the young guys
getting that all done anddoesn't show any signs of
slowing down there

Speaker 1 (34:58):
at all. I mean, I've seen this in such stark relief
having lived in a bunch ofdifferent worlds and traveled to
different places. The way ourexpectations around aging and
the stories we tell ourselvesaround aging manifest in
reality, but are certainly notpredetermined. I'm 37 years old.
I am unquestionably, like, I'min the best shape I've ever been

(35:22):
in, and I've been an athletegrowing up.
And I I absolutely get healthierevery year. I can run farther. I
can run faster. I have less bodyfat. I have better energy.
It's taking a lot of work. A lotof work. But it's true. And then
I will go back to where I grewup and meet friends who I went

(35:42):
to high school with who have anoffice job and are not
physically active. Yep.
And the main form of socialconnection is restaurants and
alcohol, and they're all veryoverweight and they're all
tired. Yeah. And when you talkto them about it, it's like,

(36:03):
well, of course, I'm getting fatbecause I'm in my thirties now
as if that's what's supposed tohappen or some sort of
biological requirement. And thenI, you know, know people who are
in their sixties who, like yousaid, kind of preparing for the
end and think of themselves asold. Yeah.
And I see people here in theirmid seventies running 50 mile

(36:23):
races and have no intention ofstopping anytime soon. And like
these things aren'tpredetermined.

Speaker 2 (36:28):
Yeah. No. A 100%. Even those friends you're seeing
back home, I put very littleresponsibility on them. It's
just the way their thecommunities are set up.

Speaker 1 (36:35):
A 100%.

Speaker 2 (36:36):
It's what set up refer someone. Right? What
thoughts are we keeping companywith? What words are we keeping
company with? What people are wekeeping company with?
And what approaches to life arewe keeping company with? Right?

Speaker 1 (36:47):
Yeah. You know, I used to be in that place in my
early twenties when arguably Ishould have been in better
shape.

Speaker 2 (36:53):
I mean, I

Speaker 1 (36:53):
was £240 +0. I was eating horrendously. I was
taking all kinds of substancesthat were poisoning my body.
Yeah.

Speaker 2 (37:02):
I mean,

Speaker 1 (37:02):
I could barely ski a run without doubling over at
that time. So, yeah, not from aplace of blame or anything else,
just an observation about thedifferential characteristics
that are available to us as ashumans. So I I appreciate that.
Thinking about the differencebetween traditional medicine and

(37:25):
lifestyle medicine, I heard youand your partner talking about
the focus on throughput intraditional medicine. Right?
Turnover, how many patients canyou get in? How many hours can
you bill to make the thing work?And I began to think about the
distinction between the 2 asthroughput versus you put. So
not focusing on how many peoplewe can get through, but how can

(37:46):
we really focus on what's bestfor you? And I think that's a
distinction that makes sense inmy brain.
I don't know if it does to you.You can amend it if you think
it's otherwise. But if you agreethat that's a good framework, I
wanna understand how this youput model actually works. Like,
how does it work financially?Who's opting in and not opting

(38:09):
in?
Like, who's against it? And canit work? Can it scale? Is it
financially and viable for theamount of time that you need per
person?

Speaker 2 (38:20):
Traditionally speaking, the payment model,
Lisa, I can speak for Canadamore than the states. Payment
model for doctors has been feefor service. Right?

Speaker 1 (38:27):
Right.

Speaker 2 (38:27):
So you see a patient, you get paid a certain fee
regardless of the outcome,regardless of how long you spent
with them, almost like piecemealfrom a remuneration standpoint.
And when doctors have officesand they've got staff that
they've employed and they'repaying leases and all of that,
you have to make sure thatyou're getting a certain amount
of earnings. That payment modelforces people to have to see

(38:49):
more patients. 30, 40 years ago,you'd have doctors that work
till 8 PM in the evening thatwere available for their
patients in the weekends. Inlast 15, 20 years, people are
saying, well, we actually wantmore of a balance in our
personal lives.
You know, by 5 PM, I do wanna behome. I do wanna spend time with
my kids. I wanna spend time withmy family. On the weekends, I
wanna go skiing. I wanna dosomething else.
I wanna build out vacation. Soif you're cutting the time

(39:10):
that's available in a modelwhere it's still fee for service

Speaker 1 (39:14):
Mhmm.

Speaker 2 (39:15):
Then you're cutting the time that you have with
patients. You've got enough timeto address their most immediate
concern and say, okay. Here, youknow, this will take you till
the next time I see. And again,I don't think it's a fault to
the patient or the doctor. It'sjust the system that's been set
up and you kinda get bogged downthat there's a lot of paperwork.
There's tons of results comingin and you're expected to do a
lot of this and there's a lot ofunpaid work that doctors do as

(39:36):
well. With reviewing labs,writing letters to other
specialists, this and that. Soin that model, it makes it
really hard to actually focus onthese lifestyle changes. Right?
And it's not that people don'tthink that lifestyle change is
important necessarily.
It's just that they're stuck inthis model. And then in that
model, nobody is really spendingtime with patients with team
based care. So they're onlyseeing sick patients. They're

(39:58):
only seeing people get sickerand sicker and sicker. And they
may actually have said tosomeone like, hey, you need to
work on your diet.
And thought that 5, 7 minutesthat I have with the patient you
know, the fact that I said thissentence, like, hey. You need to
go work on your diet. Thatthat's I've done my job and I've
done what I can do for thispatient when it comes to that.
But you need to work on yourdiet is the most useless
statement Mhmm. Anyone's everheard because that gives them

(40:21):
someone no guidance.
It gives them no support. Itgives them no options. It gives
them no empowerment. So thatpatient doesn't make any
changes. They keep being worse.
And what sometimes getsreinforced in the in the mind of
the doctor that's seeing thispatient over time saying, well,
I did say in one of my notesthat you gotta change your diet.
Nothing's changed. So behaviorchange doesn't happen. That
turns into a belief system wherepeople can't change. Right?

(40:44):
We do the best we can. We givethem medications. And if they
end up with a heart attack,we've got amazing technology
where we can do invasiveinterventions, and that stuff
is, like, it's a godsend. Theseare beautiful things that we
have available for ourcommunities. Like, I'm not
against medication use andinvasive interventions, all of
that.
They've saved my family members'lives. It becomes a sole
reliance on medication andtesting and invasive

(41:07):
interventions because the modelthat's been set up originally
wasn't a model that's been setup for success. I think in the
American system, because it'snot a universal healthcare
system necessarily, There'sdifferent models that can be set
up. I think the American system,they have, like, different value
based care models where now yourremuneration actually, I think,
is affected by how well yourpatients do. So there's that

(41:28):
model as well.
And that's something that'staken off. We're not really
seeing it in Canada much. Thenyou have models like the VA
system. Right? The VA system isessentially a universal health
care system, one of the largestsystems in the states.
And because they ensure theirmembers, they take care of their
members, they're actuallyfinding out that it makes sense
to do more holistic lifestyleevidence based team based care

(41:51):
for their members. So there'sI've I've colleagues and friends
that work in that system who areable to spend more time with
patients who are able to dogroup medical visits, and
they're getting paid on salary.So it doesn't really matter how
long. They're they're seeingsavings on the back end for
that. Kaiser Permanente, one ofthe largest HMOs in the country,
is now heavily invested inpromoting lifestyle medicine

(42:13):
amongst their professionals aswell.
They're sponsoring a bunch oftheir doctors to actually get
certified by the American Boardof Lifestyle Medicine. The
systems are coming on board andsaying, okay, wait a minute.
What we've been doing all thistime hasn't really worked,
hasn't worked for our society,hasn't worked economically.
There's actually a really coollike groundswell of change

(42:33):
that's happening, right? TheAmerican College of Lifestyle
Medicine even has a healthsystems council where they have,
I think it's over 50 differenthealth systems now that are
actually engaging inconversation with the American
College of Lifestyle Medicine,but also with each other and
say, how do we continue toimplement these learnings in
creating different models ofcare so that our physicians and

(42:54):
our allied health professionalsare nurses, nurse practitioners,
dietitians, clinical counselors,health coaches, exercise
physiologists, like everybodyyou need on a team to kind of
focus on different parts of carecan be employed and be utilized
for patient empowerment.
People are working on it. Idon't know if anyone's getting
it a 100%. Right? And it'siterative change. Right?

Speaker 1 (43:15):
Help me understand the financial like, from a from
a ROGA standpoint, is it thatyou have this baseline number of
patients? They're paying yousomething on a regular basis,
even if they're not sick toprovide guidance to not become
sick, which provides a baselinefinancial flow that then in some

(43:38):
way mitigates for those otherfactors and allows you to spend
more. Is that is that roughlyit?

Speaker 2 (43:43):
So the majority of our care is all publicly funded
care. I see. So patients aren'tpaying anything. At Arroga,
we've we still work in a fee forservice model.

Speaker 1 (43:50):
Mhmm.

Speaker 2 (43:51):
However, because we're our internal medicine
docs, we get a consultation feeto see patients Mhmm. And we get
follow-up patients, a follow-upfee. One of the nice things that
British Columbia has donebecause every province has a
different payment model, but oneof the nice things that BC has
done is they've actually putmoney and resources towards
funding group medical visits orshared medical visits where you
can actually a physician canspend, you know, an hour and a

(44:13):
half, 2 hours with a group ofpatients discussing their
illness, their diagnosis, and,you know, using that time to
even bring in a dietitian or acounselor to help work on some
aspect of lifestyle optimizationto help their illness, and we
actually get paid for that. Soat Eroga, we use you know, we're
we're doing our physician 1 on 1consultations, 1 on 1 falls. We

(44:34):
we make a lot of use of sharedmedical visits that are publicly
funded to get patients access tocare.

Speaker 1 (44:39):
Almost like a workshop kind of thing.

Speaker 2 (44:41):
Yeah. It's exactly what it is. There's guidance
around how these visits need tooccur so that they qualify for
the payment and qualify as amedical visit. Mhmm. But the
other thing that we found atROGA is we've been investing
heavily in technology from day 1and investing in team members
known as physician extenders sothat basically, we actually do
see more patients in a day, butwe're seeing them in a way that

(45:03):
they're seeing multiple teammembers so that the patient's
not getting shortchanged at allin terms of the amount of
attention and conversationthat's happening.
We're able to, at the same time,keep up with the remuneration
model where the lights can stayon, the doors can stay open.

Speaker 1 (45:17):
What's the range of patient types that you have,
like, on a scale of healthy toacutely sick, young to old,
like, presenting condition, whatare your patient base look like?

Speaker 2 (45:31):
So it was interesting, when we first
opened up doors so in Canada tosee an internal medicine doc,
you have to be referred fromyour primary care physician,
which is different than thestates because internal medicine
is not known as primary care inin Canada. It's specialty. It's
a referred base. When we openedup, we had kinda marketed to the
doctors in our community, and alot of the initial referrals
were for patients who areslightly on the older side,

(45:52):
maybe in their sixtiesseventies, looking at
optimizing, you know, theirdiabetes, their people have been
diagnosed with fatty liverinfiltration, hypertension, high
cholesterol, obesity. Nowadays,you know, since from 2017 to
now, I guess 7 years in, we'reseeing the entire spread.
On our team, we have internalmedicine physicians, we have
endocrinologists, we havepediatrician, we have family

(46:13):
doctors, we have nursepractitioners, we have clinical
counseling, dietitian, healthcoaches, patients under the age
of 18 who are getting referredfor Actually, the same type of
illnesses that we see in theadult population. So type 2
diabetes, fatty liverinfiltration, weight management,
high cholesterol, and then I'mprobably seeing patients on any
given day. I could be seeing an80 year old who is working on

(46:35):
weight management to seeing a 23year old, helping them manage
their newly diagnosed type 2diabetes. Mhmm. So I get a full
spread.
We do a lot of chronic diseasemanagement, so my patients are
not necessarily acutely ill.This is usually after they've
been to the hospital and they'vedone acute care, Then they're
being referred to us to say,okay. How can we maybe prevent
that next acute care admission?You know, we've got a

(46:56):
relationship with our communitydoctors where they're diagnosing
someone with, like, sleep apneaor type 2 diabetes or fatty
liver, and the doctors will havea conversation with the patient.
Hey.
Do you wanna be seen by a clinicwhere they have bit of more of a
team based approach to help younot only with the medication
management, but also makinglifestyle changes? And then if
the patient seems like they'reinterested or wants to know

(47:17):
more, then that patient will bereferred to us.

Speaker 1 (47:20):
Can a primary care physician refer someone who's
presenting as healthy, doesn'thave any of those symptoms of
hypertension, high bloodpressure, they have normal labs,
etcetera?

Speaker 2 (47:31):
No. So that's the thing within a universal health
care system is we pay fordisease, we pay for diagnoses,
we don't pay for health, and wedon't pay for preventative
health. Interesting. Whathappens is when a patient or a
person in the community wants tobasically do a preventative
comprehensive health assessment,lifestyle preventative
comprehensive health assessment,they can actually self refer
themselves, and that's actuallyprivately remunerated. So the

(47:55):
patient will either pay for thator if they have a health
spending account or theiremployers or their employer
might pay for that.
But right now in the Canadiansystem, preventative care solely
to actually get a in this fullassessment of here's where your
current health status is, hereare some of the risks that you,
you know, have going forward,here's some of the opportunities

(48:15):
you have to optimize this sothat, you know, the next time
you do this comprehensive healthassessment, let's say a year or
2 or 3 years from now, that it'sactually an improvement than
your current status. Right?Those are not considered
medically necessary care. And soif it's not medically said
necessary care, it's not aninsured service by the
provincial payer. That's when itis a private service.

Speaker 1 (48:38):
So recognizing that people listening to this are
gonna be from differentcountries, different states,
different provinces, They'regonna have different places to
go. Let's just operate under theassumption that they either
don't have insurance orwhatever. They have to do it on
their own. What would be thetests, the evaluations, the

(48:58):
leading indicators that youwould look to, like, that you
would recommend these peopleeither take or measure that
would be the best upstreamindicator of their current
health? And that could beanything from their weight or
BMI to a food sensitivity testor a, you know, continuous

(49:18):
glucose monitor, a VO 2 mat.
Like, what would you look to asthe most upstream things to
evaluate, who? Do I need somesupport or am I in a good spot?

Speaker 2 (49:28):
You're gonna get so many different answers on that
depending on who you're talkingto.

Speaker 1 (49:31):
Literally.

Speaker 2 (49:32):
You don't necessarily need a 1000000 tests. If you go
down the testing rabbit hole,you could start testing
everything. But in our sort ofmodel of care, like, you know,
we have an underlying sort of,like, battery of tests that we
do for our metabolic health.Where where I really focus on is
cardiometabolic health. That'swhere my training lies in.
Right? So I think from aphysical standpoint, like, just
checking your blood pressure,your blood pressure will tell
you a ton. Your resting heartrate is gonna tell you a lot.

(49:54):
BMI is not necessarily always agreat indicator of health, to be
honest with you. It'snonetheless an indicator, but
it's not the best indicator.
I'm gonna put it up, put thatout there.

Speaker 1 (50:03):
I guess maybe describe why or in what
circumstances it wouldn't bealternatives to get at the same
core information.

Speaker 2 (50:12):
The limitations of BMI is like if someone is
heavily muscular, BMI isbasically a ratio of, you know,
height and weight. So if they'reheavily heavier muscular, their
BMI is gonna be higher andthat's not necessarily gonna
give us any, best indication ofwhat their health status or
health risks are. The secondthing is that a BMI doesn't
really tell us what fatdistribution is. So someone may

(50:33):
have more fat mass, not bemuscular, and have a higher BMI.
But depending on where that fatis distributed, it may or may
not lead to actual health risks.
Right? And I think that's animportant message. Not everyone
that's overweight is actuallyunhealthy.

Speaker 1 (50:48):
Say more about that distinction.

Speaker 2 (50:50):
We have subcutaneous fat stores. We have, you know,
visceral adipose visceral fatstores. Right? And so visceral
adipose tissue is really the fatthat's in and surrounding our
internal organs. That's reallythe fat distribution that causes
the most amount ofcardiometabolic arrangements in
our health.
Right? So I'm a big fan ofdoing, like, body composition
analysis Mhmm. And that can bedone through a DEXA scan, that

(51:11):
can be done by a bioimpedancescan. DEX scan, I think, is the
gold standard. I think the goldcenter is actually dunking in a
in a water tank, but that'sreally not practical on a
clinical basis.
So bio impedance or DXA usuallydoes a good amount. A good scan
like that will actually not onlytell you your fat percentage,
it'll tell you where your fat'sdistributed. And it'll also tell
you about your non fat mass,like your muscle mass. Right?

(51:33):
And if you don't have enoughmuscle, there's actually a term
called sarcopenic obesity whereit's actually you don't look
like you're overweight at all,but you don't have enough
muscle.
And that's actually sarcopeniaor sarcopenic obesity, which
also carries its own healthrisks.

Speaker 1 (51:46):
I think on the street, we call that skinny fat.

Speaker 2 (51:49):
Yeah. So I think getting, like, a body
composition test is isimportant. And then your
baseline labs, your metaboliclabs, like your fasting glucose
is, I think, is importantindicator. Your a one c, you
know, that gives you anindicator of what your average
blood sugars have been like overthe last few months. Mhmm.
But in addition to that, a testthat not all doctors, not all
clinics have been doing is is afasting insulin level test. A

(52:09):
fasting insulin level isactually very important because
someone's blood sugars and theira one c may be completely
normal, so they'll be told thatyou don't have any diabetes.
That's great. But if they don'thave a fasting insulin level
test, you don't actually know,do they have insulin resistance?
And insulin resistance isactually the tree of
cardiometabolic disease.
It has like different brancheslike fatty liver, car corneal

(52:30):
disease, stroke, dementia,diabetes, high cholesterol, all
of that. The trunk of that treeis actually insulin resistance.
If you feel like you're healthybecause you don't see the
branches and the leaves, butthere may be the trunk going.
Right? And it's important to seethat trunk.
So, for example, if, say, youhave normal blood sugar, you
have no a one c, but yourfasting insulin level is sky
high, what that tells me isthat, yes, you don't have

(52:51):
diabetes right now, but yourpancreas is having to work
really, really hard to keep yoursugars low. And that is insulin
resistance. And then we startthen and that allows someone to
say, okay. You have a little bitof insulin resistance, signs of
it. Now let's go let's go workon the underlying, risk factors
for that.
Then you go into yourcholesterol profile, your total
cholesterol, your triglyceridesare important, your LDL, and and

(53:14):
more importantly, yourapolipoprotein b, because LDL is
a calculated value, so it's notalways as accurate because it
depends on your triglyceridesnot being super high. But
apolipoprotein b is a directlymeasured lab test that gives you
a good understanding of whatyour cholesterol is like. These
days, I'm recommending thatevery patient just get a
lipoprotein little a test done.Lipoprotein little a a is a very

(53:38):
genetically related lipidmolecule. And so that tells us
the bit be shining a bit morelight on what your genetic risk
may be.
If someone's lipoprotein a isnot very high, that's quite
reassuring, but if it is ishigh, then it just tells us that
we actually have to be that muchmore aggressive with your lipid
management. Mhmm. Looking atsigns of inflammation, I think
are important. Let's do an, youknow, an h s c r p gives us some

(53:59):
indication there.

Speaker 1 (54:00):
Does that stand for or how does one?

Speaker 2 (54:02):
The c reactive protein. Mhmm. So it's just a
it's a very, very sensitivetest, nonspecific for
inflammation. Then we look atyour liver enzymes, a few
different liver enzymes likeALT, AST. If these liver enzymes
are elevated, they that mightindicate that someone has
inflammation in their liver,which in a lot of cases in North
America are likely due to fattyliver infiltration.

(54:24):
So if your fatty liverinfiltration and liver enzymes
go up, that means your liver isundergoing low grade
inflammation, and it's actuallyimportant to shut that off
because low grade inflammationof the liver over time will
actually start to replacehealthy liver tissue with scar
tissue. Mhmm. And over time, ifthere's enough scar tissue,
they're replacing healthytissue, your liver actually puts
in a state called cirrhosis. Weusually in North America have

(54:46):
always thought of cirrhosis as acomplication of alcohol related
liver issues or a viralhepatitis related issues or
toxin related liver issues. Moreand more often time, actually
cirrhosis in North America ishappening just simply because of
fatty liver infiltration.
So Wow. Something that we didn'tactually pay too much attention
to do it 20, 30 years ago now issomething that we're seeing as

Speaker 1 (55:06):
a a real health risk. And when you see fatty liver
come up on a panel, that is theearly stages of the onset of
that effectively, or is that thesame

Speaker 2 (55:15):
thing? It's on like a, on a spectrum. If I saw
someone has liver enzymeelevation, the next step would
be actually getting anultrasound to confirm that they
actually have fatty liverinfiltration. If they have
significant amounts of alcoholin their life, then they may be
related to alcohol related fattyliver. If that's not really an
issue, then it's more likely ametabolically associated liver
disease or nonalcoholic fattyliver disease.

(55:35):
And then you also wanna makesure that there's that you've
ruled out other reasons forhaving that liver inflammation.
So you usually will do the viraland the autoimmune test just to
make sure that that's all fine.And most times in my practice,
those are all normally fine, andit's just it it is a
metabolically associated fattyliver infiltration. And then you
can do further scans of, like,fibrosis scans, which actually

(55:56):
tell us if your liver's alreadystarted to undergo the process
of fibrosis, which is thereplacement of healthy tissue
with scar tissue. And that canactually tell you what stage of
that is where you're at.
And with lifestyle changes,weight management, you can stop
it in its tracks.

Speaker 1 (56:11):
So I'm gonna do a little recap because that's a
lot just to try to put somebuckets around this and you tell
me if I'm getting this correct.But you're looking first at
cardiovascular health, simpleblood pressure and resting heart
rate test. You're looking atbody composition, potentially
with a DEXA scan or somethingelse. You're looking at your
glucose or insulin response, andyou suggested a few things,

(56:33):
including a one c or a fastinginsulin test. You are looking at
your cholesterol, and so this isin, like, blood work now.
Cholesterol, you'll get that,but you're also looking at APOB
and lipoprotein as leadingindicators. And then the last
two things you're looking at areinflammation. An HSCRP test will

(56:53):
take care of that, and thenliver enzymes for liver health.
Yeah.

Speaker 2 (56:58):
Yeah. That's that's good. And then, like, you can
look at your renal function aswell. I think that's always good
to look at. Right?
And you're creatinine, makingsure you're not spilling any
protein in your urine. An ECG, Ithink is, it should be a part of
that preventative assessmentjust to look at your cardiogram.
In our office, in ourcomprehensive health
assessments, we may even putsomeone through a treadmill
stress test to look at theirunderlying cardiac risk

(57:18):
stratification, right? Look forany signs of ischemia and
ischemia is basically the statewhere your heart's not your
heart muscle is not gettingenough blood flow for what it
needs.

Speaker 1 (57:28):
And now, a quick break from our sponsors and
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(57:52):
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(58:13):
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(58:33):
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(58:54):
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(59:14):
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and starting today. That'swww.electedleaderscollective.com
and starting today. What is youropinion about wearable devices?

(01:00:22):
Are they useful, not useful?Things like an Oura ring, an
Apple watch, a Woop, so many ofthem now, where are they useful
or not useful in your mind?

Speaker 2 (01:00:31):
Great question. As I wear 2 wearables right now.

Speaker 1 (01:00:34):
I'm with you, man.

Speaker 2 (01:00:35):
So I got my I got my Oura ring. I got my Apple Watch.
I think wearables are fantasticin the right context. Mhmm. I
think it depends on a fewdifferent things.
Like, for me, I'm a dataoriented person. Someone asks me
a question about something, thefirst thing I ask is, okay, I
need more information. I tell Iwas telling people don't I don't
expect my answer on something ifI if I don't have more
information to work with. And solike when I get when I see like,

(01:00:56):
what am I active calories forthe day? It's not because I have
a calorie goal.
It just gives me an indicationthat you've hit certain amount
of active calories means youweren't sitting around all day.
I look at my sleep. Did I getenough REM sleep? Did I get
enough deep sleep last night?Because it's something that I
was trying to optimize.
So I think if the data isserving for a specific goal,
those wearables are great. Youknow, CGMs, I think, are in the

(01:01:17):
right context or fantasticpeople, especially if they're
trying to they're working on,you know, difficult to manage
type 2 diabetes. I don't alwaysnecessarily recommend them to
patients. Mhmm. I always tellpatients, if you think it's
gonna help you, that's great.
Right now, a lot of times withpeople, the studies have been
showing is that people will dothe wearables, but they may not
engage with them after a certainamount of time.

Speaker 1 (01:01:37):
Mhmm.

Speaker 2 (01:01:38):
You while you'll see some initial engagement, you see
some initial changes in behaviorover time that goes away. And
that, to me, that's not afailure on the wearable, it's
failure in the context of howare we using them. Right?

Speaker 1 (01:01:50):
I'll make it real right now. I mean, so I've got
an Oura ring on at this moment.That's what I'm using in the
past. I've used other devices.But it's funny.
I think about the person andI've done this right where you
put, like, an affirmation onyour window or your mirror in
your bathroom. And for the 1st 3days, 5 days, you read it.
You're really present with it.You take it into your day. You

(01:02:10):
do something.
But if it doesn't move, likeeverything, it goes into the
background because the mindwants to be efficient with its
energy and you literally kind ofdon't see it anymore. It becomes
invisible. You if you want tokeep seeing that message, you
need to continue to move it orderive a reason for it. And so I
keep going back to my Oura ringevery day because I'm focused on

(01:02:32):
being healthy enough to do arace, to be acute enough for the
pot. So I have, like, a reasonto go back to it.

Speaker 2 (01:02:38):
No. For patients, if I had a wearable for them that
was connected back to a systemwhere that data could be shared
Mhmm. And then they actually gotreal time feedback Mhmm. And
outreach, then that wearablebecomes a really nice tool for
a, fostering a greaterrelationship with the patient
Mhmm. But also in in infostering that, hey.
Someone's invested in your careand wants to make sure that

(01:03:02):
you're getting usableinformation with these wearable
technology. Right?

Speaker 1 (01:03:06):
I've done this for myself. So I have a general care
physician, which is, by the way,in the US is not super common.
And I started building thisstuff out in my mid twenties
because I was super overweightfor a while. I was unhealthy.
And when I got back in shape, Iwanted to maintain that.
And so some of the things I did,I started doing annual blood
panels, for instance, measuringa lot of the things that you're

(01:03:28):
talking about, having my annualphysical, which, again, some of
the things that you're talkingabout, weighing myself every
day. And obviously, it's a veryblunt instrument, but for body
composition, just to have, youknow, it's not accurate, but
it's accurate to its owninaccuracy. So, you have a trend
line. And then, I've got mysleep, my Oura ring, my
exercises on there, and I'vecreated a shared document where

(01:03:49):
all of that is there that mygeneral practitioner has. So
they can see that now over,like, 11 years.
And if I were to ever get sick,they could go back and find the
baseline of what's normal,what's out. And so what you're
talking about, I think, which isthe future is automating that
process and then providing realtime feedback, which in some

(01:04:11):
ways, you know, the Oura Ringdoes. Right? It says like, hey,
your sleep was shit last night.Get back in bed.

Speaker 2 (01:04:17):
It's about putting that back into context as well.
Like, why for you specificallyfor Skippy, why does that, you
know, for your sleep for thelast 4 days has been off, how is
that actually affecting yourgoals and your health care right
now in the moment? Tying thatback to conversation you may
have had with your health careprovider. Personalizing,
contextualizing, like, even withthe Oura rings and all these

(01:04:38):
things, the commentary is notpersonal to Skippy. So it's what
the algorithm has shown, but Ithink there are AI technologies
and software has been built thatactually can personalize it way
more and, you know, give, like,prompts to your health care
provider.
Mhmm. Technology that are stillevolving, software that's still
evolving. That's the hope.

Speaker 1 (01:04:57):
Okay. So that's a great bridge to something I I
really wanna talk about, whichis how you follow evidence based
care and the evolution ofevidence based care because it's
pouring in faster and faster andwill continue to. But just a
closed loop on that, are thereuse cases or particular
wearables that you don't findhelpful or that are misused that

(01:05:17):
people are wasting their time,energy, or money on?

Speaker 2 (01:05:20):
It's interesting because, like, a lot of people
really love the CGMs.

Speaker 1 (01:05:24):
Continuous glucose monitor for anyone who's like,
what are you guys talking about?

Speaker 2 (01:05:28):
Yeah. No. In the right context, they're they're
fantastic for people. There aretimes when I think the
information needs to be taken aspart of other information as
well. Like, for example,patients who wear these monitors
on their own, they'll startavoiding healthy foods because
they saw a spike in the sugar.
Right?

Speaker 1 (01:05:46):
Like a strawberry. Like, they're like, oh, I can't
use strawberries anymore.

Speaker 2 (01:05:50):
Yeah. A strawberry or or a banana. And they'll start
to avoid these. It actuallysometimes makes it harder for me
to convince actually this is notthe case. This is not a bad
thing.
My my dream would be if weactually had a a fast like, if
you had a continuous insulinmonitor because that's one level
before the sugar. Right? Thelevel of the sugar you're seeing
is actually a consequence of therelationship between insulin and
the body cells and liver andmuscle cells, specifically,

(01:06:12):
what's their interaction. So I'mtrying to say, if we could look
at continuously looking at thatrelationship at a more
underlying level rather than theoutcome level, we might actually
have more clarity on that. Butsometimes just looking at the
sugar alone can send people inthe wrong direction.
It's

Speaker 1 (01:06:27):
easy to misinterpret data.

Speaker 2 (01:06:29):
So I just think it's important that with all these
wearables to have somebody thatthey can turn to and say here's
what this data is leading me tothink, what are your thoughts on
this? Using that to be more of aconversation point first before
jumping straight to action.Yeah. Because the action that
you may jump to may be superhelpful, but it also may lead
you down a path that may not beas helpful.

Speaker 1 (01:06:51):
Yeah. That makes a ton of sense. So I really wanna
nerd out on these meetings. Sofirst off, do you still have
these I had read that your team,and like you said, it's a
multifaceted team, a lot ofdifferent specialties,
subspecialties, does a monthlyevidence based care meeting
where you're discussing the mostrecent research, what's coming
up as a means of co learning. Isthat something that you still

(01:07:13):
do?

Speaker 2 (01:07:13):
Yeah. So it's called Eroga journal club. Most
residency programs, most medicalschools, a lot of hospitals will
have a journal club fordifferent divisions, right?
It'll be a periodic meeting ofyou know, division members. The
person who's presenting is theirchoice of what they wanna
present.

Speaker 1 (01:07:28):
So you rotate the presenter?

Speaker 2 (01:07:30):
A 100%. Yeah. Okay.

Speaker 1 (01:07:31):
So it's not like everyone has to show up every
meeting with something tocontribute. You know ahead of
time that your job for thatmonth is to research?

Speaker 2 (01:07:39):
Yeah. So what happens is journal club runs every month
except we take a break for JulyAugust, and then December is
always off. We do it the lastFriday of the month at 7 AM PST,
and it's actually open to likenon erogues tasks.

Speaker 1 (01:07:52):
Oh, interesting.

Speaker 2 (01:07:52):
We just anyone that says they want in, you just get
added to the email list. You getan email sometime in the middle
of the month. It tells you who'spresenting, what's the journal
or topic that we're covering. Ifthere's a journal article that
asks you is being presented,that journal gets sent out to
team members so you can meet inadvance. So you can actually
come up with your own questionsand thoughts and contribution
after the presentation.

(01:08:13):
And so one member will take iton to present a recent article
or study that came out. They'llpresent the study. They'll
present what they think of thestudy.

Speaker 1 (01:08:22):
1st, what are the rules or requirements of the
presenter, if there are any?

Speaker 2 (01:08:28):
So really aren't much. We're limited to peer
reviewed literature. So it's notjust someone's, like, thoughts
on a random website. And most ofthe time, we really focus on
studies that shine a light onvarious aspects of lifestyle
medicines. That said, sometimesthere's actually a medication
that is really highly applicableto our patients.
And so there might be a studypresented on one of the

(01:08:49):
medications that's recently comeout that we think might be
helpful for our patients.

Speaker 1 (01:08:52):
Does every team member have to present at some
point?

Speaker 2 (01:08:56):
We sort of said that, but then we haven't really
imposed it. It's really like forthe next few months who wants to
sign up to present and if weknow someone hasn't, we
encourage it, but it's not likebecause because not everybody
wants to present and it's notfair to team members to always
like put them in these zoneswhere they may not be ready to
go. That's it. Right? But weencourage everybody.

(01:09:16):
Do you

Speaker 1 (01:09:16):
get a good diversity of presenters or do you find 10%
of people wanting to do 90% ofthe presentations?

Speaker 2 (01:09:22):
Oh, no. We have good diversity. We got like to a
point where we even had like ouradmin team and so patient
coordinators who traditionallyare never asked to do these
things. Oh, cool. In mostmedical settings, we've had
front desk team members, like,look up papers and present them
to the rest of us, and and it'sbeen such a fun experience.

Speaker 1 (01:09:37):
That's awesome. I wanna know, like, the review
process in the room. Like, whatis the mood? Someone present
something, do we sit around andnod our heads in affirmation? Is
there a gentle q and a?
Is it like the house of commonsand people are throwing tomatoes
and saying bullshit? Like, howdo how do we do this?

Speaker 2 (01:09:55):
I've seen general clubs operate in every single
way you just described. Okay. Iremember in, like, when I was in
my residency, particularly ourcardiology rounds of the
university, you would wonder,like, are these people gonna be
able to talk to each other afterthis round? Like, I was afraid
to even say anything because Iwas like, it's very tense.
Right?
Then there's places where, like,you know, times when someone
presents and everyone's like,oh, yeah, that makes amazing

(01:10:15):
sense and everyone's all for it.At ROGO, we encourage robust
discussion. Mhmm. But it'ssetting the intention. The
intention is, hey, is theresomething that we can take back
for our patients?
Is there something here that wecan incorporate into our care?
There's no it's not intention ofone person looking smarter than
the other. It's about helpingeach other see different angles
and questioning how is thisgonna affect potentially the

(01:10:39):
care of our patients at Rota,right? And so we put our egos
aside for this and it's actuallya lot of fun. So it's usually an
hour long.
The presentation part isprobably 35 to 40 minutes at max
and we have 20 minutes usuallyof discussion. We We probably
don't get into any hard likeyeses or hard nos. In the social
media world that we're in,everything gets presented as a
hard no as a hard yes or this isright and this is wrong. And in

(01:11:02):
science, it's just more evidenceof yes, this may work or this
probably doesn't work and it'skinda moving the needle of which
way we're swinging on certaintopics and certain
interventions. Right.
And just keeping in mind, like,at this point in time, the
available information to usshows us this, keep in mind that
maybe there's probably like 10studies that are going on

(01:11:22):
somewhere in the world about thesame topic that may now weight
the evidence in a year or 2 or 3or 4 from now may show that the
opposite conclusion actually hasmore evidence for it. Right? And
so, you know, I got intolifestyle medicine for my dad's
health and all that and I wascompletely, you know, won over
by the evidence for plant basednutrition in terms of cardiac

(01:11:43):
and metabolic health. Yes. Butthen I started hearing about all
these doctors that are talkingto patients about low carb diets
and ketogenic diets and in thisand that.
And initially, we were like, oh,no. No. That that's that's just
that's gotta be wrong. And thenactually what happened is you
met a few of these doctors, andI was like, oh my god. These
these doctors are some of thesmartest people I've met.

Speaker 1 (01:12:00):
Right.

Speaker 2 (01:12:00):
Some of the most caring physicians, and we have
the exact same goal of patientempowerment and moving health.
So I'm like, there's gotta besomething here. So I started
looking at the evidence. Theystarted looking at research. And
you're like, you know what?
There's actually a lot ofevidence for a variety of ways
of eating healthy and we stoppedto continue. So it just it's to
me, it's like the answers arenot in stone. And that was my

(01:12:23):
personal sort of journey fromgoing from being a little bit,
you know, like, close minded tosomething and saying, okay, wait
a minute. I have to continueletting the studies happen and
and and honoring those that areactually engaging in doing
clinical studies. Clinicalstudies are like not the easiest
thing in the world to do.
They're really hard. You runinto lots of red tape with your

(01:12:45):
ethics boards and all of that,which are they serve an
important purpose. Gatheringdata takes lots of hours then
interpreting it. So I just havea ton and ton of respect for
anyone that does research. If wecan just honor those that are
engaging and then actually justbeing able to assess all of
that, It keeps us humble.
And then the more humble we are,the more open minded we can be.
The more open minded we can be,the the closer we can kind of

(01:13:08):
align ourselves with the truth,which is sometimes a moving
target, oftentimes movingtarget. Mhmm. But that also
allows us to connect withpatients. Right?

Speaker 1 (01:13:15):
Yeah. I mean, as a coach who's working with people
in public service, it's nosurprise that confrontation and
argument come up a lot. And yousaid a few things that to me are
the key to healthy discussion,the move from what I like to
call confrontation tocarefrontation, which is you are

(01:13:36):
de identifying with thepresentation.

Speaker 2 (01:13:40):
For sure.

Speaker 1 (01:13:41):
The presenter is no longer their their worth. Their
value is no longer tied to thething. If we're critiquing the
work product, we're notcritiquing them as a person.
We're not saying there'sanything wrong with them. And
you've done that by orientingtowards a shared outcome in the
patient that you are now linkedby.

(01:14:02):
And so the disagreements aboutthings are no longer
disagreements between people,but they are a means of moving
towards a shared goal. You dothat. You mentioned setting
intention. Like, what do youphysically do in the meeting?

Speaker 2 (01:14:15):
From an intention step when it's not necessarily,
like, as over. It's presented tobe, like, an opportunity for us
to connect again. 1st 3, 4minutes, usually, as people are
coming in, it's just, hey. How'sit going? What's going on here?
And so you set a stage forcolleagues and friends who are
actually connecting after awhile, and this has happened to
be what we're talking abouttoday. Mhmm. The other thing
that I think is fun with us isthat because we have a wide

(01:14:36):
variety of specialists fromfamily medicine to endocrinology
to pediatrics, internalmedicine, clinical counseling,
dietitians, sleep health,psychedelic medicine, all of
that that when you're presentingon a paper, it's not you're not
presenting on a subject that Ihappen to be an expert in. I'm
actually in a very much in alearner mindset.

Speaker 1 (01:14:55):
Mhmm. Beginner's mind.

Speaker 2 (01:14:57):
And so I think the fun part of having such a
variety of journals or a varietyof studies that we cover is that
almost in every one of thosesettings, there's a large
portion of the audience that'sactually in a learner mindset.
We're actually already comingwith a bunch of questions, not
necessarily even about the studyitself, but just about the
topic. Mhmm. Right? And so thatI think changes the dynamics a

(01:15:20):
little bit at least.

Speaker 1 (01:15:21):
Yeah. That's great. So last kind of question around
this area, and then I'll I'llhave satisfies my nerd for the
day. I wonder how you indiscussion avoid what I think of
as like this single studysensationalism that takes over
the media. It's like there's astudy with an end of 20 that
it's non controlled, and all ofa sudden it sweeps across the

(01:15:44):
media.
Blueberries cure cancer. Andyou're like, oh my god. All we
should eat is blueberries. Andthen 3 weeks later, there's a
different study and they'retransmitting some neurovirus and
oh my God, well, blueberrieswill kill us all. There's no
stepping back and having abroader scope or interrogating
the veracity of the study or therigor of the study.
And although you're controllingfor this by only looking at peer

(01:16:06):
reviewed studies, I wonder howyou guys sort of internally
control for the value of thisstudy versus the sensationalism
of the finding.

Speaker 2 (01:16:17):
There's a lot of EBM like evidence based medicine
literature on how to assessdifferent studies, whether it's
a cohort study or if it's arandomized control trial, and
you're looking at the validityof the study, the internal
validity, you're looking at howapplicable this is to a wider
you know, patient population ora wider audience. Mhmm. I guess
we're lucky because one of ourteam members, Josh Levin, who's
a family doctor that works withus, he, sits on, like, the UBC

(01:16:40):
Therapeutics Initiative. And sohe's our mister evidence based
medicine at all times. You know,prior to the generals going out,
he actually will help withgiving us the evidence based
tools for assessing a study.
Mhmm. And so you have adifferent tool to assess a
different type of study. Andthat tool actually go not just
go to the presenter, but also goto everybody that's reading the
study in preparation. So peoplewill go through it themselves.

(01:17:01):
Right?
And our hope is usually bysticking to evidence based tools
to assess evidence basedliterature, then that helps us
kinda put in place where thingsstand with from that study.
Sometimes we actually look atthese studies and be like, look,
you know, truth is there's not alot of evidence for this, right?
Sure. But I would say a lack ofevidence for is not evidence

(01:17:21):
against. It just means that itjust it affects the amount of
confidence that I can recommendsomething with.
And then also like looking atour patient experiences like
this, you know, this this studymay say this, but I have a ton
of patients where where thishappens and this happens. Right?
Mhmm. I think those anecdotesare also important in the
discussion of evidence basedliterature. Right?
And kind of putting things intocontext, assessing it based on

(01:17:42):
criteria, you know, checkingoff, checking off, then you can
actually score and say, okay,how when the grand scheme of
things, how much is this gonnachange my practice, right? And
that usually is like one of themain discussion points at the
end is like, is this gonna isthis applicable to our practice?
Is this gonna change ourpractice in any way, shape,
form? Do we need moreinformation?

Speaker 1 (01:17:59):
And is the checking off that you're describing sort
of an informal thing you'redoing in your head, or do you
guys have a little bingoscorecard that you're actually
following along and comparingnotes on?

Speaker 2 (01:18:07):
So some people do it in their head, but we have,
like, the documents that areguiding it.

Speaker 1 (01:18:11):
Yeah. Wow. Super cool. I really appreciate you
sharing all that. And I thinkthat there's so much
applicability across other areasof knowledge finding and sense
making that would benefit fromprocess similar.
So hopefully people draw, someinspiration from that. I'm gonna
take us in the way back machine.At the beginning of this

(01:18:31):
session, you talked about notsaying exercise, but fun
physical activity. While thatcould seem trivial, I imagine
that when the end goal isbehavior change, the way that we
talk about things and framethings probably have a
significant impact on uptake anduse. So I wonder if you could

(01:18:54):
talk a little bit more aboutthat, either the deviations that
you find, the delta that youfind in behavior change based on
language, if you have a specificexample or 2 to point to.
And then what are some of theand I don't wanna devalue them
by calling them tricks, but,like, linguistic techniques or
approaches that you have foundto be you know, nomenclature

(01:19:17):
that you found to beparticularly helpful or harmful
as weighted against patientactions and outcomes?

Speaker 2 (01:19:26):
Language is so important. When you don't know
people that well, your wordsmatter, and they can hit, like,
a ton of bricks. Mhmm.Especially when you're dealing
with patients who may bevulnerable sort of situations in
in socioeconomic come fromcommunities that have may have
been marginalized or whatevertheir specific experience with
healthcare has been. It's soimportant to be sensitive to

(01:19:48):
where someone's coming from andwords, you know, matter a lot.
And I learned this notnecessarily from reading books
and not as much. I actually Idid go back and read books on it
after I learned from experience.So because what I was finding in
the early days is when I startedincorporating lifestyle changes
into my practice of medicine, Iwas still very much approaching
it as a health expert. I'm thedoctor. Here's what's best for

(01:20:11):
you.
So instead of saying, okay, youhave diabetes, you got your
cholesterol is up, I'm gonna putyou on Metformin, I put you on
statin. Right now, I would startsaying, hey, you got diabetes.
You need to before we go to medform, you you need to start
doing this. You need to do this.These are specific things I want
you to do for the next fewmonths.
We'll check your blood work.We'll do this right. That
approach was working for maybe,like, 3% of people. Wow. I'm

(01:20:33):
probably being generous to thatbecause nobody likes to be told
what to do from some randomperson you're meeting for the
first time who hasn't taken thetime to get to know you as an
individual.
Mhmm. Don't know anything aboutyour house circumstances. I know
nothing about you. But yet I'mmaking these assumptions and I'm
telling you what's best for you.Right?
None of us ever like that.

Speaker 1 (01:20:50):
Do you guys ever use any form of personality
evaluation on your patients suchthat you have insights on how to
most effectively communicate tothem?

Speaker 2 (01:21:00):
Anyone that's referred to me gets a set of
questionnaires sent out to them.Mhmm. We're asking everything
from like, what are your currentdietary patterns? Are you
working right now? What's youryou know, who's living at home?
Who's doing the shopping athome? Who are you cooking for?
We're looking about, you know,what is your what is your
current level of activities inin different places, like in in
resistance training and toaerobics and to stretching and

(01:21:22):
balance? What is your currentlevels of stress? How are you
managing stress?
Mhmm. Do you feel loved byothers right now? Do you feel,
like, that you belong to thecommunity that you live in? All
those I get a lot ofinformation, but not necessarily
personality. That's that'ssomething that's gonna go and
I'm gonna go look into.

Speaker 1 (01:21:38):
The reason that I bring it up is it's something
that I use in the coachingpractice, and I use the
Enneagram test, although youcould use Myers Briggs. I mean,
it's not highly technical. Butif someone is stuck at an
impasse, say someone is has agoal that they really want to
get to and they're not takingaction on it, if I know that
they are 3 achiever on thepersonality test, I know how to

(01:21:59):
speak to them in such a way thatcan orient them towards that
externalized goal and how theymay be perceived or not by
others that is motivating, butmaybe completely crippling and
destabilizing to someone who's,say, a 5 investigator who really
needs to go and find out forthemselves. And the different
ways of approaching that tendto, and certainly don't
guarantee, better followthrough. So that's where I was

(01:22:22):
curious, but continue.

Speaker 2 (01:22:23):
No. I think you've identified an amazing
opportunity for us to, like,optimize care. Thank you. I love
it. I've kinda learned thatthrough through the hard knocks.
Right? You got some patients whoare like, oh, thanks. This is
amazing. So this is what I waslooking for. Thank you so much.
I'm gonna go run and do this.The other people are like, what
are you talking? Why are wedoing this? This doesn't make
any sense. Mhmm.
So through time, I've just kindof changed the way I spoke about

(01:22:44):
things. Early on in the in themeeting, we spoke about, you
know, one of the resources Irecommend, like doctor Beth
Fady's book, lifestyle medicinehandbook. Mhmm. And something
that she talked about wasknowing when to take off your
health expert hat or turban andput on the health coach and how
health coach is very, verydifferent interaction than the
health expert. In chronicdisease management, it's a

(01:23:08):
strong calling to physicians toactually not be the health
expert, but maybe the healthcoach in that situation.
Or if you can't be, make sureyou have a team of people that
you can refer to. And readingthe book and learning about the
model that was represented,like, you know, the the
motivation of interviewing,letting patients come up with
their own answers, all thesethings, to me made no sense.

(01:23:28):
We're never gonna move theneedle on health changes with
anybody by doing this. I didn'teven believe it, but I started
testing it because I was like,what do I have to lose? And it
started working and it was I canliterally feel like a kid every
time with this because I'm like,oh, this is magic happening.
Yes. And it's not necessarilymagic, but what it but to me, it
feels magical.

Speaker 1 (01:23:45):
I can so relate to this.

Speaker 2 (01:23:47):
Skip, you've done your research. You could tell me
why this all works. But to me,it's always gonna be magic
because that's something that Ibelieve could work, and it just
works. Learning and gettingfeedback from patients about
what actually works for them andwhat doesn't work for them is
important. So my ideals of whatis evidence based, what is the
right way of doing things matterless than the experience that my
patient's having, theinspiration that they're walking

(01:24:08):
out of the door with, and theempowerment that they're walking
out the door and to fallthrough.
And so I started payingattention to the words am I
using. Are they actually causingsomeone to have some upliftment
in the moment? Is it are theyfeeling lighter with these words
or are they actually feelingheavier with stress with these
words? Mhmm. My colleagues willtalk about plant based diets and
this and or ketogenic or lowcarb is.

(01:24:29):
I actually have stopped usingall of those terms completely
with my patients. Oh,interesting. I don't actually
use any because I find all ofthem will cause some type of
stress with my patients.

Speaker 1 (01:24:39):
They're polarizing.

Speaker 2 (01:24:41):
As soon as you term something, you almost start to
create an ideal.

Speaker 1 (01:24:45):
Yeah. Now there's a perfection that has to be
reached that's unattainable andI'm gonna fail and so why even
start?

Speaker 2 (01:24:51):
So I would just talk about like, from a nutrition
standpoint, I just say, hey, eatwhatever eating pattern you

Speaker 1 (01:24:56):
want. Interesting.

Speaker 2 (01:24:57):
Let's try to build on a couple of principles that are
first principles such as let'sreally focus on eating whole
foods as much as possiblebecause these are foods that you
get to have the opportunity tomake with your family have fun
while you're making them. Youget to engage with your kids or
your partner, you get to choosethe ingredients that go in, you
get to put what you want in it,what you don't want in it,
Right? You're gonna be winningmore often and it's gonna be

(01:25:20):
more helpful to the goals thatyou have set up. Right? It's
important for you to get theirgoals first and foremost.
Right? When patients ask menowadays, what are the good
foods and the bad foods? As Isaid, there's no such thing as
good foods and bad foods. I saythey're all foods.

Speaker 1 (01:25:32):
So good.

Speaker 2 (01:25:32):
There some foods depending on your goals are
gonna help you get to your goalsand some foods are not gonna
help you get your goals if youif they show up every day. And I
give the example, I say allfoods are your friends.

Speaker 1 (01:25:41):
Mhmm.

Speaker 2 (01:25:42):
So I say all foods are your friends. You just gotta
choose which friends show upevery day and which friends show
up every now and then. It's agreat time nonetheless, and you
never feel bad about spendingtime with your friends.

Speaker 1 (01:25:53):
I just feel it evoking a different emotion in
me versus the other. And I amwired for that. Like, tell me
what to do, tell me how to doit. If you tell me it's
effective, I'm gonna do it. Andthen if you're wrong, I'm gonna
be pissed at you, but like, I'mgonna go.
But that's not, that's not howmost of us are are wired. And
what you're doing is you'repainting a picture of what
people actually want and what'spossible, and then opening the

(01:26:16):
door for them to have the toolsto achieve that.

Speaker 2 (01:26:19):
And so that carries over into, like, what you talked
about, like, you know, joyfulmovement versus physical
activity. Physical activitybecomes a daunting task. I
started having a lot of fun withworking out when I sign up for
personal training because I justhad a lot of fun with my
personal trainer, but that wasfun for me. But that same exact
experience is not gonna be funfor someone else. So I just ask
people, what's a fun thing youdo that happens to include some

(01:26:41):
movement?
Whether it's dancing, whetherit's playing with your
grandkids. Is there a reallycool tree in your in your
neighborhood that you like?Could you walk to it instead of
driving to it today? Things likethat. Right?
And so just lowering the barrierof entry into healthy behaviors,
I think is super importantbecause I think a lot of people
are wired to build upon success.I tell people, let's not try to

(01:27:03):
define your success based onyour number on the scale. Let's
not define it by the bloodsugars. I mean, these are all
things that are gonna happen anddon't worry about them, but
let's define it by, like, how doyou feel every day? What's your
level of vitality today?
Do you feel like your weight oryour diabetes or or or any of
your health clinicians areseparating your current state of

(01:27:24):
participation in life in the wayyou imagined you participating
in life to, to to to yourreality. Right? If there's a
separation, then it makes senseto address these. But let's say
your weight doesn't actuallyseparate you from your imagined
participation in life the wayyou imagined you wanted to
participate, then it's not anissue for me. I actually I've

(01:27:44):
almost gone to an extreme withit where you gotta convince me
Yeah.
Why these health conditions areworth addressing. It's

Speaker 1 (01:27:51):
patient led. What do you want? Yeah.

Speaker 2 (01:27:52):
Like, I even asked, like, why do you care about your
diabetes? I don't wanna have aheart attack. Why don't you
wanna have a heart attack? Idon't wanna die. Why don't you
wanna die?
And then I get these amazing,beautiful, heart led reasons of
why they wanna live. Every oneof them is different. They know
someone wants to walk the Caminoand, like, let's get you there.
Right? Someone wants to walk thekid down the aisle.
Let's do that. Okay. Well, theseare the reasons why you're here.

(01:28:14):
Yeah. The health conditions arejust some things that are
getting in the way of that.
Let's just let's focus on thatand start working on these
health conditions so that theydon't become a barrier to what
your actual goals are. Andthat's where I think medicine
has to go is it's not merelyabout our diabetes and this and
that and all of that. What'syour life experience right now
and how you want your lifeexperience to go? And relating

(01:28:35):
these health conditions or anyobstructions to that in a way
that makes sense to the patientand say, okay. Let's I do wanna
I do wanna work on this becauseof this.
Right? And I'm hoping that thiswill start to change more as we
as a lifestyle medicinecommunity starts exerting more
influence. Yeah. You know,getting away from just simply
looking at mortality benefit ofa of an intervention to actually

(01:28:58):
what's the health span benefitin this intervention. You know,
one of the things that KavithaChenain writes about in heart of
wellness is that in olden times,people did not define health as
simply an absence of disease.

Speaker 1 (01:29:11):
So good. So so good. I love all of that and find it
super inspiring, useful,tangible, all of that. And I
wanna kind of come back to youand maybe look at some of the
more challenging parts of thiswork because, yes, someone's
gonna go do the camino, andsomeone's gonna pick up their

(01:29:31):
grandkid again, and that's ahuge joy. But I've also heard
you say that really only, like,a 5th to 2 5ths of people
actually take the advice and dosomething with it.
I wonder if that's still true orif that number has come up.

Speaker 2 (01:29:46):
The number has come up as I've learned more. Yes. I
had a member having aconversation with some
colleague, an amazing colleague,good friend of mine said, Jazz,
I know there's evidence forlifestyle interventions. Yes. We
all see the studies, not a bigdeal, but nobody changes.
So then my retort to him was,well, which class in medical
school taught us how to helppeople change? We haven't had

(01:30:06):
one. Right? Mhmm. And at the2020 ACLM conference, which is
done virtually because ofpandemic, there was a physician
there who presented, and hisname was Ed Torrey.
He had gone through medicalschool and early on had the
epiphany that medical school isgreat. It made me an expert in
all fields related to medicine,but I'd I learned 0. I'd learned
nothing about behavior change.So he didn't actually do a

(01:30:28):
residency right away. Mhmm.
He went and took an entry leveljob with an ad agency. And he
spent the next few yearslearning everything about
behavior change from the peoplewho are experts at behavior
change with the marketers. Andthen came back into medicine,
did his residency, and he runs,like, an an influence center
down in the eastern states andteaches doctors now how to

(01:30:48):
infuse behavior change intotheir clinical care, but also
but not also in clinical care,but in in their administrative
work as well. So I would say thepercentage of patients making
changes is a lot higher. Theexpectation of perfection from
my side has evolved.

Speaker 1 (01:31:04):
Say more about that.

Speaker 2 (01:31:06):
Perfection in changing for me is actually, if
you what you're doing today isleading to a happier tomorrow,
then that's perfect for you inyour current context. Someone
who doesn't have the money tobuy fresh vegetables and does
not have the money to join agym, doesn't have the time to go
and spend with the clinicalcounselor once a week. If that

(01:31:27):
person is just taking a nicewalk in their neighborhood, is
now buying frozen vegetablesinstead of frozen TV meals,
that's perfect change.

Speaker 1 (01:31:38):
And for someone who is in a perfectionistic or a
fight mindset who hears that andmisinterprets it as maybe short
changing or giving up. How wouldyou respond to that critique?

Speaker 2 (01:31:53):
It's not giving up because we're not saying that
this is the end of journey.Right? Perfection is not
necessarily an an endpoint. It'sa perfect journey. Mhmm.
So there's perfection in thestep of that journey, but the
journey is not done. Right? Andand it's not just saying that,
hey, that you've done this.That's great. Let's rest on
this.
Right? It's saying this isamazing. Do you think now
there's some opportunity foranother one to 2 wins over the

(01:32:16):
next few weeks? How do you getthe biggest snow ball?

Speaker 1 (01:32:18):
Literally in my head. Yeah.

Speaker 2 (01:32:20):
Think about it. If we asked every single kid, you
wanna have a big snowball,you're gonna have to take all
the snow from the bottom of thehill and walk up to the top of
the hill and put it alltogether. Nobody no. We would
have no snowballs. Right?
But the fact that it starts atthe top of the hill and it's
just a small amount and it as itas as it rotates and as it
cycles through the ups anddowns, it by the end of the
hill, there's this hugesnowball.

Speaker 1 (01:32:41):
Yeah. It's such a good analogy. It's so visual,
and I just so appreciate youdescribing it. And I think at
the end of the day, we have torecognize that from an
evidentiary standpoint, theresults are better this way.
They're better for the person,they're better for the person's
experience.
And this is something that I, asa coach, fight against sometimes

(01:33:02):
in my days where I struggle, Imake the results about me. Yeah.
And then I have to remind myselfthat's not what the job is. The
job is to empower someone elseso that they don't ever need me
in the future, and they can onlymove at the pace of the
possible. They can only learnfrom the reality of where they
are.

(01:33:22):
And it can be criticized, butit's such an empowered position.
And it's just so cool to hear itentering the field of
healthcare. I just think that'sbeautiful.

Speaker 2 (01:33:32):
It's such an interesting dichotomy because in
medicine, you know, we we talkabout whether or not something's
worth doing based on outcomes.And so we're always looking at
hard outcomes, like, oh, howmany percentage of your patients
have gone diabetes remission?And it's something that I cared
about a lot, but that it'sreally more about me and my
priorities and less about thepatient's priorities and less

(01:33:54):
about the community. Right? Andwhile I do think those are
important outcomes to measureand those outcomes that need to
be studied, we have to recognizethat in medicine and a lot of
areas of health, there areoutcomes that we have denied
that are outcomes and we'veignored them and we haven't
measured them yet.
And if we started to measure allthose other outcomes, we'd
actually realize how small someof the outcomes that we're

(01:34:15):
measuring making so big in ourheads are compared to the other
outcomes. And that may be partof where we are. We haven't gone
right. And so in lifestylemedicine, we as an organized
specialty focused on proving topayers that this is economically
viable and doing all this. Atthe same time, we can't lose
sight of that.
There's other outcomes that arenot gonna contribute to the

(01:34:35):
economics as much. They're gonnacontribute in ways that are hard
for us to capture. Right? Right?Like, all these outcomes that we
measure are important.
Right? There are other outcomesthat are not currently being
measured that we may not havethe best tools developed yet or
just innovative ways of thinkingabout it and approaching it.

Speaker 1 (01:34:54):
It reminds me in so many ways of the study of
cosmology where, you know, forthe entirety of human history
until roughly the early 1970s,we exclusively focused our hard
measurement on visible matterand oriented everything towards

(01:35:14):
that and based all of ouractions and assumptions off of
that. And then we come to findout over the intervening decades
that that comprises probablyabout 3% of the entire universe
and is deminimis compared toeverything else. But we still,
to this day, don't reallyunderstand dark energy. And
we're still trying to figure outhow do we measure this stuff and

(01:35:36):
interpret it. And this is sortof the human incarnation of that
as I hear you talk about it.

Speaker 2 (01:35:41):
You know, to know that lifestyle medicine is by
one of the fastest growingfields in health care in the
states, many of the institutionsthat are are providing health
care in the states are nowstarting to incorporate
lifestyle medicine into theirtraining. It's coming into
residency programs. Harvard hasan Institute of Lifestyle
Medicine. This is a boardcertified specialty. People

(01:36:03):
actually get educated, like theyget training on it, they have
exams on it.
It should be a lot easier now tofind lifestyle medicine
physicians within your owncommunity if you wanna engage
with them. For physicians andproviders that might be
listening, the American Collegeof Lifestyle Medicine actually
has a 5 and a half hour CME, onthe fundamentals and basics of
lifestyle medicine that as partof their kind of contribution to

(01:36:26):
healthcare, they're providing itfully free of cost. You can
start off with 5 and a halfhours of free CME that actually
go towards, your certificationanyways. So providers can get
access to that just by going tothe ACLM website. Patients can
learn more about it and and getaccess to providers through the
ACLM website.
There's actually a listingdirectory listing of doctors
Mhmm. And health careprofessionals.

Speaker 1 (01:36:47):
That's awesome. And we'll put some of that stuff in
the show notes so that peoplecan navigate to it. If they
wanna navigate to youpersonally, a rogue, I'd
generally find you guys online,social media, etcetera. Where
would they find you?

Speaker 2 (01:36:59):
So our website's aroga.com. My email is
jazdeep@aroga.com.

Speaker 1 (01:37:04):
Oh, that's a brave share. That's that's great.
Closing question, same for everyguest, but our audience are not
passive observers. These are thehumans in the arena. In many
cases, they're the humanscreating or carrying out
policies serving the publicinterest.

(01:37:25):
And if you could leave them withjust one thing, it could be a
quote, a book, an anecdote, aconcept, anything at all that
would best resource them to be avector for healing our politics,
what would you leave them with?

Speaker 2 (01:37:41):
I think it's important for people to
experience health in their ownlives first and foremost, and
whatever dimensions that is.Right? So if it's, you know,
physical mind, body, spirit, allthat, take your own time aside,
treat yourself well. Puttingyourself first in your health is
not necessarily selfish, it'sself full. And people in
political arena probably aregetting into that arena because

(01:38:02):
they wanna do something forothers.
Yeah.

Speaker 1 (01:38:04):
And

Speaker 2 (01:38:04):
they're always giving of their energy, giving of their
time. Just like, you know, theheart is one of our most
important organs because itpumps and it gives blood to the
rest of the body. Mhmm. If theheart stopped relaxing and
filling itself up first beforeevery pump, we would die within
minutes. Mhmm.
Right? So stop. Fill yourselfup.

Speaker 1 (01:38:23):
Yeah. That's as beautiful of a place to end as
anything, Jazdeep. Thank you somuch for your time, your wisdom.
You channeled your mentor andpastime well here today.

Speaker 2 (01:38:34):
Thank you so much for having me and for the political
arena. I think this is amazing.Anyone I've ever talked to about
Elective Leaders Collective islike, wow, that's incredible.
It's an honor to just beassociated with you and the work
that you do.

Speaker 1 (01:38:45):
Ditto. Ditto.

Speaker 2 (01:38:47):
Take care.

Speaker 1 (01:38:51):
Thank you so much for joining us today. If you wanna
put what you've heard here todayinto practice, sign up for our
newsletter, the leader'shandbook, where each month
you'll receive just one emailwith a curated selection of the
most useful tools and practicesdiscussed on this podcast today
and over the course of the lastmonth, delivered in simple how

(01:39:13):
to worksheets, videos, and audioguides so you and your teams can
try and test these out in yourown life and see what best
serves you. And lastly, if youwanna be a vector for healing
our politics, if you wanna doyour part, take out your phone
right now and share this podcastwith life, in your community,

(01:39:47):
and in your world. Have abeautiful day. The Healing Hour
Politics Podcast is brought toyou by the Elected Leaders
Collective, the first leadingand most highly recognized name

(01:40:10):
in mental health, well-being,and performance coaching for
elected leaders and publicservants designed specifically
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Now don't be fooled by the name.The Elected Leaders Collective
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(01:40:31):
organizations. This is for you.If you are filled with passion
for improving your community andworld but are tired as I am of
the anger, stress, and betrayal,if you find yourself banging
your head against that samewall, struggling with the
incoming criticism and threats,arguing with colleagues who are

(01:40:52):
supposed to be on your team andquestioning if it's even worth
it any more than the ElectedLeaders Collective programming
is specifically for you.
With the Elected LeadersCollective, you will learn to
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(01:41:15):
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