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Guest:
Dr. Jasdeep Saluja is the Chief Medical officer and Co-Founder of the Aroga Institute, which has served over 10,000 patients through the six pillars of lifestyle medicine: nutrition, fun physical activity, stress management, avoidance of risky substances, restorative sleep, and social connections, and his seventh pillar, purpose and meaning. With this integrative approach, he helps patients improve their lifespan and healthspan while reclaiming their joy and impact in the world. Dr. Saluja is widely regarded as a preeminent leader in his field, serving as a diplomat at the American Board of Obesity Medicine, an advisory council member of the Global Positive Health Institute, an advisory board member of the American Board of Lifestyle Medicine, and at the Elected Leaders Collective.
About the Episode:
In this episode, we explore Dr. Jasdeep Saluja’s deeply personal path to discovering Lifestyle Medicine. This journey began with changing his habits to support his father and evolved into transforming the health of thousands. Dr. Saluja shares how Lifestyle Medicine bridges the gap between lifespan and healthspan, empowering you to take control of your health future. We discuss the six pillars of Lifestyle Medicine and actionable steps to improve your well-being—whether you’re struggling with weight, hypertension, pre-diabetes, brain fog, or want to feel better in your body and mind. We explore how to integrate these tools effectively, from the essential health screenings and evaluations you should consider to wearable technology for tracking fitness. We also dive into the critical role of mindset, language, and culture in shaping health outcomes—like why framing movement as “fun physical activity” leads to better results than mandated “exercise.” Jasdeep introduces Aroga's Journal Club process, a collaborative method for evaluating new research and integrating evidence-based decisions into your health and leadership. Additionally, we uncover lessons from Blue Zones, regions with the highest concentrations of centenarians, and how their insights can inspire healthier, more connected communities. Dr. Saluja shares practical resources, books, and tools to help you create the mind, body, and life you want—while uplifting those around you. If you’re ready to make small changes that deliver big impacts, this insightful and applicable conversation with Dr. Jasdeep Saluja is for you.
Key Topics Discussed:
· [00:01:57] Guest Introduction
· [00:02:28] Episode Overview
· [00:03:34] Get ready to nerd out with us!
· [00:03:50] Summary of Tools/Practices we discuss
· [00:05:25] Origin Story: What made Jasdeep want to be Dr. Saluja
· [00:07:19] The meeting point of caring and learning
· [00:08:02] Deeds and actions come from people
· [00:08:22] Who inspired your drive to help others?
· [00:08:50] Teachers & Doctors
· [00:09:33] 3 Sikh Principles
· [00:09:46] An Honest Living
· [00:10:19] The Systems do not incentivize or support.
· [00:11:15] What is Lifestyle Medicine?
· [00:11:29] (It should just be called “Medicine”)
· [00:11:50] The 6 Pillars of Lifestyle Change.
· [00:12:20] Positive Psychology
· [00:12:57] The “7th Pillar”
· [00:13:24] Meaning vs. Purpose
· [00:13:43] Clarity of purpose & meaning in the everyday
· [00:14:32] The winding path, the obstacles, and trusting the universe.
· [00:15:52] Putting out fires - at a price.
· [00:15:52] Not the person I want doing surgery!
· [00:17:00] Convincing the Medical Community
· [00:17:27] The pivotal point: “My Pops.”
· [00:18:19] He had “excellent care”
· [00:18:44] That one friend.
· [00:18:56] We all knew: something’s got to change.
· [00:19:17] Heart Attack
· [00:19:17] This does not make sense.
· [00:19:40] Not just genetics
· [00:20:09] Literally a Google Search
· [00:20:15] Dr. Dean Ornish & Dr. Caldwell B. Esselstyn
· [00:21:07] Wait, you said Google?
· [00:21:22] There was nothing lacking in his standardized medical care.
· [00:21:49] HOW. IS. THAT. POSSIBLE?
· [00:21:52] Nutrition study in medical school was minimal.
· [00:22:04] Nutrition and Lifestyle are not given time.
· [00:22:22] Nutrition and Lifestyle is not Assessed, aka unimportant.
· [00:23:02] In the meantime, we are ruining our Ferraris!!
· [00:23:41] Learning from Blue Zones
· [00:24:15] We’ve traded one set of problems for another.
· [00:24:43] Healthspan vs. Lifespan
· [00:25:51] We make healthspan a personal responsibility
· [00:26:11] Health is a societal concern.
· [00:26:40] The healthy decision should be easy
· [00:27:35] Prioritizing joy
· [00:28:27] Bring back laughter
· [00:28:45] Community sense of purpose
· [00:29:43] ‘Heart of Wellness’ by Kavitha Chinnaiyan
· [00:30:00] ‘Undo It’ by Anne Ornish & Dr. Dean Ornish
· [00:31:10] ‘The Lifestyle Medicine Handbook’ by Dr. Beth Frates
· [00:32:10] What was Dad like pre & post Lifestyle Changes?
· [00:32:40] I had to change first.
· [00:33:06] Feeling the difference!
· [00:33:54] Dad is now a world traveler.
· [00:34:20] Dad is getting younger!
· [00:35:06] The stories we tell ourselves about aging.
· [00:36:29] Our communities inform our stories
· [00:37:27] Through-Put vs. YOU-put
· [00:37:58] How does the You-put model actually work?
· [00:38:20] The Fee-For-Service Model
· [00:38:50] Patients become numbers.
· [00:39:23] The system is at fault, not the Patient or the Doctor.
· [00:39:56] “I’ve done my job”
· [00:40:30] A belief system based on a bad system: People can’t change.
· [00:41:13] Models/Systems in the USA
· [00:41:44] Big organizations are starting to get on board.
· [00:42:30] Groundswell of Change: How do we implement these findings?
· [00:43:16] What is Aroga’s financial system?
· [00:44:00] Group Medical Visits
· [00:44:50] Physician Extenders
· [00:45:17] Aroga’s patient demographic
· [00:47:19] Can a healthy person get referred to Aroga?
· [00:48:38] Medical tests for baseline health
· [00:49:43] Cardiometabolic health: Blood pressure & Resting Heart Rate
· [00:49:54] BMI can be useful but not the best indicator of health.
· [00:50:47] Not everyone that’s overweight is unhealthy: Fat distribution is key.
· [00:50:05] Body Composition Analysis: Dexa Scan or Bioimpedance Scan
· [00:50:52] Baseline Metabolic Labs: Fasting Glucose, A1C, & Fasting Insulin Level Test
· [00:52:09] Fasting Insulin Level Test & the Tree of Cardiometabolic Disease.
· [00:53:07] Total Cholesterol, Triglycerides, LDL, Apolipoprotein B & Lipoprotein a
· [00:53:55] Tests for inflammation: HSCRP, Liver Enzymes, Cirrhosis, & Fibrosis Scans
· [00:56:11] RECAP OF RECOMMENDED TESTS for BASELINE HEALTH !!!!
· [00:57:00] Further Tests: Renal Function, Creatinine, ECG, Stress Test
· [00:57:29] ELC Foundation donors Bill + Wendy Spatz, and Joshua Haning
· [01:00:18] Wearable Devices
· [01:01:10] Is the data serving us?
· [01:01:50] Wearables need a Reason.
· [01:02:40] Dr. Saluja’s dream for wearables: Professional Feedback
· [01:04:17] Algorithmic feedback is not Personal (yet!)
· [01:05:10] Closing the loop on Wearables: Data NEEDS Context.
· [01:06:58] The Aroga Journal Club
· [01:08:23] What are the rules and requirements for the presented material?
· [01:08:52] Does every team member have to present?
· [01:09:16] Is the pool of presenters diverse?
· [01:09:38] What is the review process like?
· [01:10:17] Setting the Intention
· [01:10:53] Evidence over Absolutes
· [01:11:14] Keeping an Open Mind
· [01:12:32] Honoring the Studies
· [01:13:30] Confrontation to Care-frontation
· [01:14:12] What does setting intention look like?
· [01:14:35] The Learner’s Mindset
· [01:15:30] How does Aroga avoid sensationalist studies?
· [01:16:17] EBM: Evidence-Based Medical Literature
· [01:17:02] Evidence-based Tools to Assess Evidence-based Literature
· [01:17:27] Honoring Patient Experience
· [01:18:31] The weight of words.
· [01:20:50] Considering personality tests for patients.
· [01:22:40] Health Expert vs.Health Coach
· [01:24:13] Are the words I’m using creating patient stress?
· [01:24:51] Reframing the conversation to win more often.
· [01:26:36] Lowering the barrier of entry to healthy behaviors
· [01:29:00] Health is not simply an absence of disease.
· [01:29:37] We weren’t taught to help people change.
· [01:30:12] Dr. Ed Tori
· [01:31:00] Perfection is in the Journey
· [01:33:33] Hard Outcomes & Ignored Outcomes
· [01:35:43] Lifestyle Medicine is becoming more Accessible
· [01:36:13] American College of Lifestyle Medicine CME
· [01:37:10] Final question: It’s not Selfish, it’s Self-full
· [01:38:54] “The Leader’s Handbook” Newsletter
· [01:40:00] Sponsor: ELC
Key References and Resources Mentioned:
· [00:11:15] “Lifestyle Medicine”
· [00:15:45] UBC College
· [00:23:40] Blue Zones
· [00:23:59] Dan Buettner - Blue Zones
· [00:24:43] “Health span”
· [00:29:41] The Heart of Wellness; Dr. Kavitha M Chinnaiyan
· [00:41:12] Healthcare models
· [00:44:57] Doctors and health team specialists
· [00:48:50] Self-diagnostic tests (https://en.wikipedia.org/wiki/Judaism)
· Heart
· Body composition
· Bloodwork indicators
· APOB
· Inflammation
· HSCRP
· Liver health
· [00:57:30] ELC Foundation donors
· [01:00:19] Wearable devices
· Continuous Glucose Monitor (CGM)
· [01:11:39] Diet types
· Low carb
· [01:16:35] Josh Levin family doctor
· [01:30:12] Dr. Ed Tori, behavior change physician
· [01:36:50] Dr. Jasdeep Saluja’s links + resources (listed below)
· [01:38:54] “The Leader’s Handbook” Newsletter
Where to Find Dr. Jasdeep Saluja:
Where to Find Host Skippy Mesirow:
- Receive Support at the Elected Leaders Collective
- Follow on Instagram
- Book a free Clarity Call to see if coaching is right for you
Episode Sponsor:
Helping You Heal Our Politics
The Elected Leaders Collective (ELC) organization is the leading US-based provider of mental well-being training for public servants, conducted by public servants and the world's best mental health and human optimization professionals. With ELC Training, you will learn to rise above and become the political healer you were meant to be, improving your well-being in the process.
Contact the HOP Team:
Do you have an episode idea?
Want to suggest a guest?
Can you provide critical feedback?
We'd love to hear from you!
Contact our team at jesse@healingourpolitics.com
Your input helps us create content that matters.
Creators and Guests
Host
Skippy Mesirow
Skippy Mesirow is a prominent leader, certified Master Coach, and founder of the Elected Leaders Collective (ELC) and ELC Foundation. ELC leads the US in mental health and well-being training for public servants, recognized in The Apolitical Foundation's Mere Mortals report, and named as one of 26 worldwide political well-being "Trailblazer Organizations." A transformational leader in political innovation and wellness, Skippy serves on Gov. Polis’s Natural Medicine Advisory. Skippy’s work has been featured in numerous podcasts and publications, as well as main-stage speaking engagements for organizations NLC, YEO, CML, MT2030, Bridging Divides, and Fulcrum, highlighting his significant contributions to mental health, community, and policy reform. Alongside his professional achievements, Skippy lives in Aspen, CO. with his partner Jamie where he enjoys running ultra-marathons, road biking, motorcycling, international travel, culinary arts, Burning Man, and lifelong learning.
Producer
Aaron Calafato
Aaron’s stories are currently heard by millions around the globe on his award-winning Podcast 7 Minute Stories and on YouTube. Aaron is a co-host of Glassdoor's new podcast (The Lonely Office) and serves as a podcast consultant for some of the fastest-growing companies in the world.
Editor
Jesse Link
Jesse is a strategy, research and partnership consultant and podcast enthusiast. A 2x founder, former Goldman Sachs Vice President and advisor to 25+ businesses, Jesse brings a unique and diverse background to HoP, helping to elevate the range, depth and perspective of HoP's conversations and strategy.
What is Civic Courage Lab?
Hello,
I’m Skippy Mesirow, host of “Civic Courage Lab”, the show that shows you, the heart-centered public servants and political leaders, how to heal our politics by starting with the human in the mirror.
Civic Courage Lab, “CCL,” is a first-of-its-kind show that provides tools and practices for mental well-being, health, and balance, specifically for public servants so we can do good by feeling good and safe in our jobs.
CCL brings together experts, scientists, doctors, thought leaders, healers, and coaches to share their insights in practical, tactical, actionable ways specifically tailored to the public service experience for you to test and implement with yourself and your teams. Episodes feature intimate conversations with global leaders about their self-care practices and personal challenges, providing insights for a more holistic, connected approach to leadership. Whether you're a Mayor, teacher, police officer, or staffer, this podcast will guide you to be the best version of yourself in service to yourself and the world!
Sign up for our once-per-month Leader’s Handbook newsletter to receive an actionable toolkit of how-to guides on topics discussed on the podcast that month to test and implement in your life and with your team: https://leadershandbook.substack.com/
Hello. My name is Skippy Mesereau, coach, former elected official, and lifetime public servant. Welcome to Healing Our Politics, the show that shows you, the heart centered public servant and political leader, how to heal our politics by starting with the human in the mirror. It is my job to sit down or stand up with the best experts in all areas of human development, thought leaders, coaches, therapists, authors, scientists, and more, to take the best of what they have learned and translate it specifically for the public service experience, Providing you actionable, practical, tactical tools that you can test out today in your life and with your teams. I will also talk to leaders across the globe with a self care practice, getting to know them at a deeply human and personal level, so that you can learn from their challenges and journey.
Speaker 1:Warning, this is a post partisan space. Yes, I have a bias. You have a bias. We all have a bias. Everybody gets a bias.
Speaker 1:And I will be stripping out all of the unconscious cues of bias from this space. No politics, partisanship or policy here because well-being belongs to all of us. And we will all be better served if every human in leadership, regardless of party, ideology, race, or geography, are happier, healthier, and more connected. This show is about resourcing you, the human doing leadership, and trusting you to make up your own damn mind about what to do with it and what's best for your community. So as always, with love,
Speaker 2:here we go.
Speaker 1:Welcome to the Healing Our Politics podcast, the show that shows you, the heart centered leader, how to heal our politics by starting with that human in the mirror. In this episode, I sit sit down with expert in lifestyle medicine, doctor Jasdeep Saluja. Doctor Saluja is widely regarded as a preeminent leader in his field, serving as a diplomat at the American Board of Obesity Medicine, an advisory council member of the Global Positive Health Institute, an advisory board member of the American Board of Lifestyle Medicine, and at the Elected Leaders Collective. After seeing his own dad underserved by traditional medicine and watching his own health decline in his early thirties as a doctor, doctor Saluja's eyes were opened to a more integrated way to do medicine. He cofounded the Aroga Institute, which has served over 10,000 individual patients anchored in the 6 pillars of lifestyle medicine, which are nutrition, fun physical activity, stress management, avoidance of risky substances, restorative sleep, social connections, and his 7th pillar, purpose and meaning.
Speaker 1:So what do any of these have to do with medicine, you ask? Well, ask, listen, and you will learn because this integrative and preventative approach to medicine drives life saving and changing behavioral and health outcomes. So if you are struggling with your weight, if you have hypertension or high blood pressure, if you are prediabetic, or if you simply just want to feel better in your body, remove the brain fog, this episode is for you and I really, really nerd out in this one. We dig into Jazz's journey into lifestyle medicine, the difference between lifespan and health span, what tools or evaluations you can use to understand your own state of health and health risks, and also take control of your health future. What wearable or tech devices can improve your life and fitness?
Speaker 1:How to use or not use those? Something that was very cool for me, Aroga's journal club, their monthly meeting discussing new data, studies, and research, and how they or you with your team can integrate and process new empirical information, understanding what is the signal between the noise, what to listen to and not to drive results for your team. We talk about how language choices influence outcomes. For instance, why framing movement as patient directed fun physical activity creates better life outcomes predictably than mandating exercise and what you can learn about these insights in your own leadership. We dig into blue zones, the places on earth with the highest concentration of centenarians, those 100 plus year old humans on earth, and what we can learn from them in our own communities and, frankly, so so so much more.
Speaker 1:Without further ado, I hope you enjoy this wide ranging, very, very nerdy, and possibly life altering conversation with doctor Jasdeep Saluja. I'm so excited to dive into medicine in a way that our listeners have probably never experienced it. Something that they want to engage with. Basically the opposite of a root canal is what I imagine here. But I wanna start with you because while there's plenty out there about Aroga and your work and the boards that you sit on, I want to know who you are as a human, as a man, and what led you to this work.
Speaker 1:I wonder if you could talk a little bit about when you were first inspired to pursue a life of medicine.
Speaker 2:So, I grew up in a Punjabi Sikh household in Toronto, and the joke is usually if you grow up in a Punjabi household, you're either gonna turn out to be a doctor, lawyer, engineer, accountant, one of them. My cousins and family all joke that my dad probably used to whisper medicine in my ear when I was sleeping, which could actually be true because my earliest memories as a kid wanted to be a doc, And when people would ask me why? Where's that come from? I wasn't sure. And I till this day, that initial spark, I actually don't know where that came from.
Speaker 2:So I think, potentially, he was whispering it in my ears.
Speaker 1:Wow. So I come from a Jewish family, which is a similar stereotype. My grandfather is still to this day my idol, the one person in my family that I just deify, and he was a doctor. So I grew up with an admiration of the profession in a similar way.
Speaker 2:But that said, I also had, like, thoughts of doing other things as well. Like, at one 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 say that for a bit. From the ages of 4 to 7, lived in an apartment building in in their city, and I used to think the superintendent of the building was the coolest person in the world, was had all the answers. I used to tell my mom I'm gonna be a superintendent. But I would say probably by the time I was, like, in mid elementary school, even before high school, I knew this is what I wanted to do.
Speaker 1:As someone who wants to do everything and then sometimes falls in the trap of doing nothing as a result, I have so much admiration for people who have known for that long what their calling is. I just I just think it's so cool, and I just really admire you for it.
Speaker 2:For me, it was this perfect meeting point of things that I enjoy. I enjoy hanging out with my patients. Clinical care, it's a lot of fun. Even though I sit on these boards, do all those other stuff, the vast majority of my work is always clinical care, and I always value that relationship I get to build with patients. And then having studied biology and all that in the human body, medicine allows you to dip into the evidence part of things and the science part of things, but also continue formulating an approach to relating to others, because that's what it's really about at the end of the day if we're gonna talk about, you know, medicine as a healing science or as a healing field.
Speaker 2:And it's allowed me to continue learning. Like, I'm always learning every day. It's one of those things where you can continue evolving as part of your journey.
Speaker 1:Would you say that you are a person who's inspired by people more so than, like, deeds or actions or both?
Speaker 2:I think I remember the people. Yeah. Deeds and actions, they come from people. The deeds and actions that move us are also coming because someone is inspired to do something. Right?
Speaker 2:And so I connect to that inspiration more.
Speaker 1:Yeah. Yeah. Who in your upbringing inspired you or implanted the thought that you had a role to help others?
Speaker 2:My parents probably do that together. We grew up in a house with a lot of meditation. We belong to a sangha or sangha, which means a company of others who are on a meditative journey. Mhmm. My parents had met a spiritual master, and he has been a guiding an overarching guidance in our lives.
Speaker 2:And one of the things that he used to say was that from a career perspective, he always felt that teachers and doctors had an opportunity to make a huge difference in the community that they live in, especially if they were working on their own journeys. It's just because the amount of interactions that teachers have in the community. Every year, there's another cohort of students, so that teacher's got so much opportunity to connect with young minds. And if that teacher is themselves on a pretty special journey, that'll carry over with the students. And same thing with doctors, just because we have so much opportunity to talk to people and people come in this place of openness, of vulnerability, and trust that if you're on your own journey, you could continue to help others.
Speaker 2:That was something I used to be in the back of my mind as well. And, part of our SICK ethos comes down to 3 principles. Live a meditative life or a reflective life. Mhmm. Earn an honest living, and share what you have with others when you get the opportunity to do so.
Speaker 2:And to me, earn honest living, it's an interesting concept. It's something I keep diving into, and I always thought medicine was an honest living. As long as you're doing your work and you're not cheating anybody for what they're supposed to have. You're you're honest living. For years, I thought I was in an honest living, and then at one point, that point came when I started when I started thinking I'm not earning an honest living anymore.
Speaker 2:Mhmm. And that started to beat at me, and That's when I knew I had to kinda make some changes in my professional career, so that I could realign with my most current understanding or approach to what's an honest living.
Speaker 1:I really appreciate that. My partner's mom, Jamie, her mother is a teacher. And so I kind of get to see that up close and personal. I think that most people who get into teaching or medicine get in because they really want to help people and be with them. That's a significant driver for them.
Speaker 1:And yet, the systems that we have set up, however, intentionally or unintentionally create incentives for the opposite. And certainly, in her world, the behavioral and mental health issues that are in the classroom, the lack of oversight from the parents, the impact of COVID, the number of students per classroom because of funding deficits, and all of those things conspire in such a way that there is not the time and the day to meet each student, even if you want to. And when you go home after finishing homework, you have a few hours of sleep and you're back. And how can one do the job well? And I think we'll find that medicine suffers from many of the same issues.
Speaker 1:And I think it's a good time to introduce the topic of lifestyle medicine so people know what we're referencing. What is it? And how is it different or similar from what people might think of as traditional medicine?
Speaker 2:So lifestyle medicine, I think, should just be called medicine at the end of the day. Yeah. And I can't wait until the day that we stop referring to it as lifestyle medicine, and that's a path that's being walked and being led by many leaders in the field. But really, lifestyle medicine is a specialty of medicine where we aim to prevent, treat, and potentially reverse or, put in diseases into remission through the 6 pillars of lifestyle change that we refer to. So nutrition, so it's like healthy, tasty food, maximizing joyful movement.
Speaker 2:Most people call it activity and exercise. I kinda feel those words are sometimes heavy, and I don't like heavy words. You know, stress management, but which I also think is, like, stress release because I don't think every stress we need to manage. Some of them we just need to get rid of. Positive, loving social connections, restorative sleep, and then avoidance of risky substances.
Speaker 2:So this is like, these form the 6 pillars of lifestyle medicine. More recently, there's been a study called positive psychology or positive health, which is not a separate pillar, but aims to infuse positive psychology within all the pillars. There's more and more research coming up on how we approach all these areas of our lifestyle. Going from a shame based or negative standpoint, you're not really gonna make the changes that are gonna be sustainable. If you can help patients and and our community members inculcate things like zest for life, enthusiasm, kindness, generosity, it actually carries over in all the different pillars of lifestyle and really changes their morbidity and mortality.
Speaker 2:We're learning more and more about that, and that's a evolving field. Another pillar that was introduced to me back in 2021 at the Lifestyle Medicine Conference, Darren Morton did a presentation on how having meaning in your life is actually the upstream pillar. Mhmm. And so you can have these 6 pillars of lifestyle changes for optimization, but having a reason to be alive, having that meaning in your life, finding that sense of purpose is what feeds the real motivation for actually making changes.
Speaker 1:Do you view meaning and purpose as synonymous?
Speaker 2:I think it can be in times, and I think it depends on where someone's at. If their purpose is aligned with their sense of meaning is, then, yeah, I guess it is the same, but then there could be times when it's not right. And that's okay too. It's a moving sort of target. It's not one thing in stone.
Speaker 2:Right?
Speaker 1:I find in my own wellness journey, my own spiritual journey that getting very clear and precise about what I mean about things has been super helpful because my purpose, like, personally is to heal our politics. That's what drives me. That's what gets me on this podcast and talking to you. I get excited about that every day, and I know it's something that I will never fulfill, as the great rabbi says, neither may I desist in doing my part. And yet I could go outside today and walk through a forest and find deep meaning and connection in that.
Speaker 2:For sure.
Speaker 1:And that feels very different to me, but also super life affirming.
Speaker 2:Oh, absolutely. Yeah. And so lifestyle medicine, so it takes these pillars and puts a system around it and empower patients to approach their health in a different way.
Speaker 1:Yeah. And upstream as well as in stream, which I really appreciate. I'm sure that the path to becoming a doc and then a lifestyle doc and starting your own company was far from linear. And I imagine there were some roadblocks. So were there any times when you questioned that path?
Speaker 2:Oh, all the time. Right? I remember, you know, even being an undergrad, because the way the system works in North America, you end up taking a science based program, which may or may not actually serve your needs and serve the needs of your career later on. You're slogging away in these courses and you have no guarantee whether or not you're gonna get into medical school because a lot of times, truth is those degrees don't lead to any jobs or any careers. It's then then you're trying to figure out, okay, what do I do?
Speaker 2:I go to graduate school, do I do something else? And I remember, like, early in my 1st year of undergrad, I had an opportunity to apply to a pharmacy program. I put my application in, wrote the exam, got into pharmacy school, and then I was like, but it's not what I wanna do. Mhmm. And these are little, like, sort of decision points, you know, challenges along the way that kind of say, okay, you know, how focused are you on your end goal and how much faith do you have in your, like, the universe.
Speaker 1:Mhmm.
Speaker 2:So luckily, got into school, went to Queen's, and got into residency at UBC. And then it hasn't been a straight line because, like, I was working for a few years in Toronto. I was an internal medicine doc at the hospital. I was, you know, doing a lot of night shifts. Didn't see my family that often.
Speaker 2:I was doing but, really, I was just putting out fires in acute care, which is important work too, and don't get me wrong. That's super important. But it wasn't doing good for me on my own health level. I was gaining weight. I was tired all the time.
Speaker 2:Mhmm. I started in my early thirties having back pain issues. I remember, like, having the weight loaded up on pain pills to be able to go and do a call shift and emerge. Calling in a physiotherapist, like, 5 hours before my work shift started. Can you get me in?
Speaker 2:I need some help here. But those were times when you're like, well, this doesn't make sense.
Speaker 1:Yeah. I mean, these stories are so common. And I think about, you know, my friends who are surgeons. Yeah, sometimes they're on 16 hour shifts. I'm like, that's not the person that I would like doing surgery on me.
Speaker 1:Yeah.
Speaker 2:Yeah. Like No. For sure. And then even getting into life, some medicine, leaving the hospital, starting your own organization, that came with a lot of challenges. I mean, having zero business background, I was very fortunate that, you know, our CEO and cofounder, Amr Meghann, happened to have a background in entrepreneurship, but it was still came with these challenges, especially within the medical community.
Speaker 2:Yeah. Not everybody is practicing medicine in this way. That's why we still call it something else instead of just medicine. And not everyone is convinced that this is stuff that is worth putting effort, time, resources towards. So that comes with its own challenges.
Speaker 2:Right? When you have to not only convince community members and patients that this is worth it, but you also just convincing your colleagues that this is something that we should be spending resources on.
Speaker 1:Was there an initial point, maybe it's the one you just described, where you realize that maybe you're not fulfilling the initial intention or goal of why you got into this in the first place and from the patient perspective?
Speaker 2:For sure. So this journey really starts with my pops. In 2012, I happened to be doing a month in Toronto, staying at my parents' place, and he was getting ready for work, and he's like, I can't brush my teeth. He had lost, like, his fine motor skills in his 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 thought maybe it's just cervical spine, maybe it's a nerve impingement, hoping it wasn't a stroke, and trying to, like, keep an open mind what got him to the hospital, and it turned out he did have a stroke.
Speaker 2:And it was a minor stroke, because, you know, his symptoms improved literally within the day, and he never had, like, recurrence of that symptom.
Speaker 1:How old was he at that time?
Speaker 2:He was in his late fifties. Okay. You know, he's in the hospital. He had excellent care. You know, he end up at one of his carotids who was, like, 99% blocked, and so he required surgery.
Speaker 2:He had surgery, went flew through that with flying colors, and walked out of the hospital as if nothing ever happened, but he was on a, you know, a set of medications. Mhmm. And at that time, he had great medical care. Nobody asked him anything about his lifestyle and neither did I. And I remember no none of our family members, I remember our friends did.
Speaker 2:It was just one friend who lives in San Diego. He was on his case saying, hey, Azad. What are you gonna do differently now? Are you gonna start exercising this and that? And my dad kept on making commitments saying, yeah, we're gonna do this, but nobody really followed up on it.
Speaker 2:I mean, we all knew in the back of your mind that something's gotta change, but we really don't know either because it's not like it's front and center for even us docs in medical school or residency. And then a few years later in 2015, I came home from a trip and I had been told that he had been complaining of chest pain overnight. And so I drove him to the hospital and he had had a heart attack. And, again, he got admitted. He was amazing care then too.
Speaker 2:He had a couple of stents placed, came out of that, no issues. And it was at that point, I was like, this doesn't make any sense. He's on the best medications money can buy. He's a nonsmoker. He doesn't drink any alcohol.
Speaker 2:What's going on? Knowing that he is sedentary, he was an electrical engineer, so it's a desk job for the most part unless you're walking on-site. So I'm thinking about my family's history and my dad's 2 oldest brothers that passed on from early cardiac disease. Here I am in my early thirties. My cholesterol is living on the high side.
Speaker 2:I'm overweight, and I'm tired all the time. And at that point, I was like, well, maybe it's all genetics, And that bugged me so much. I was like, it can't be all genetics. But I remember reading somewhere that, you know, family recipes, family attitudes, family trauma, get passed on just as much as your family genes. And somehow somehow I started, you know, I just searching searching online.
Speaker 2:It literally was just a Google search going online saying, okay, what else can we do? And I found the work of doctor Dean Ornish, doctor Caldwell Esselstyn, luminaries in the field of lifestyle medicine. I didn't even know this word existed. These words existed together, lifestyle medicine, and just started reading what they had to say, and it turned out, you know, there was a study published by doctor Ornish in 1990 showing amazing improvements in cardiac patients after going through a lifestyle medicine program that was when I knew I had to kinda make some changes in my professional career, so that I could realign with my most current understanding or or approach to what's an honest living.
Speaker 1:Can I just pause for a second just to highlight? It's not a judgment or anything like that, but it's it's shocking to hear, you know, someone who is a trained accredited doctor. And even though you've been through medical school, you've been practicing as a doctor, the totality of your training led Google to be the best resource that you had to answer a question.
Speaker 2:Pretty much. I mean, it's shocking. He was already on everything. Like, he was on the best medications money could buy. He had the best specialist.
Speaker 2:Like, there was nothing lacking as far as I was concerned in the medical care that he was getting.
Speaker 1:And I've heard you talk about this where it's like they gave him this pocket full of pills to treat the system, but there was zero talk about everything that contributed to or may have contributed to the condition in the first place. How is that possible? If you go back to your medical school training, how much time do you spend on diet, for instance? Like, you know, can how is that possible?
Speaker 2:When I was in school, the nutrition lecture, I think it wasn't more than, like, 10 hours in the entire 4 years of curriculum. Wow. Maybe it's changed now. I don't know, but it was minimal amounts. Like, the thing is even if there's a little bit more nutrition in your curriculum, when we're going out and spending time with our attending physicians, it's in clinic, you're dealing with heavy patient lows like 20, 30 patients, 40 patients a day type of thing.
Speaker 2:They're trying to make sure they're not running behind. It's not something that's fully addressed. And then again, even on our examinations, you tend to remember what you're gonna be tested on, right, and what you're gonna be assessed on. And I can't ever remember anybody in my entire training, testing me or assessing me on my ability to take a history about someone's lifestyle, assess whether or not it makes helpful living versus disease promoting living, and whether or not I could even give any evidence based recommendations. I was never tested on this.
Speaker 2:So if I'm not tested on this, I'm not assessed on this. It's not going to be the basis of my getting a job or the basis of me getting a promotion or making a living for my family, then it's kind of tossed out.
Speaker 1:You're being implicitly and explicitly told this stuff isn't important. In the meantime, most of us are born into healthy, normal on the bell curve functioning bodies. You know, it's like we get handed a key to a new Ferrari. They're like, have fun, kid. And nobody tells you what fuel you need to put in.
Speaker 1:And people are sitting around, like, trying to shove wood chips into Yeah. The filler tank. And someone else is putting Jell O in there, and someone else is putting diesel fuel. Yeah. And you're, like, wondering why this thing isn't performing.
Speaker 1:It's just it's wild. How do you think we have, as a society, gotten to a point where we so underappreciated the fuel we put into our body as part of our health?
Speaker 2:I think a lot of people are trying to figure that out. One way of thinking about that is actually looking at places in the world that aren't necessarily dealing with the same epidemic that we are dealing with here in a lot of the developed world. Places that are called blue zones having a health span far greater than most other places where they're living till a 100.
Speaker 1:I have a passing knowledge of these, Did some work with Dan Buettner back in the day briefly. And there are some elements of those that I would 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 time those things were happening, we were also living in tribal societies that were engaged in regular warfare and raiding. Average lifespan was 30 something years old. Yeah.
Speaker 1:You didn't have modern medicine, so you were dying of a little cut that you got in your arm when you were out harvesting. And so a lot of the things that we focus on now are actually diseases of old age. And so we've kind of traded one problem
Speaker 2:set for the other. What how you define health span, and what you value from that perspective changes how you look at it. Nice to think that we got to get people living longer. I actually don't care how long I live. I care about how I live during the time that I live.
Speaker 2:Right? How many years do you actually get to enjoy robust living in vitality?
Speaker 1:And that's what health span means?
Speaker 2:In North America, we've had these increases in our lifespan. But on average, the last 10 to 15 years of a person's life, they're not really of high quality. You usually lose a lot of independence. Rates of dementia are high. You know, it's not something people are enjoying life and a lot of people, they're like, they're just waiting for the day.
Speaker 2:Yeah. And I don't wanna wait for the day.
Speaker 1:Yeah. And I don't want to wait for the day. Yeah. You want to extend the enjoyable, fruitful part of life. I was at a Aspen Institute talk years ago, and it was just something that stuck with me.
Speaker 1:It was a talk about health span. I don't think that was a term at that time, but the opening slide was after millennium of research and study mortality rates still stubbornly stuck at a 100%. It's like Yeah.
Speaker 2:Well, that's the thing. That's your only guarantee. Yeah. Right? Yeah.
Speaker 2:To your question, like, we do put a lot of the health in, like, the lifestyle part of things. We make that a very personal responsibility for people. And sometimes it's a criticism on lifestyle medicine saying, hey. You're you're blaming people in this in individuals for not making the the most optimal choices. I mean, it might be the case in some people.
Speaker 2:I think it's not helpful to engage in that approach, but the approach is that health is a societal concern. Yeah. And it's about setting up societies where the healthy choices are the easy choices, and they're the choices that can be facilitated the best. When I'm talking to a single mom who's got 3 kids, it's about how can we get you access now, asking ourselves a question of how we set our society up in a way that people have the tools available to them in an accessible and an equitable fashion.
Speaker 1: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 a societal structure or social expectation, you are going to opt into those things. And I wonder what we can learn from those that could be implemented. But then also, if we assume that the individual, like me or you, doesn't have the opportunity to top down make societal change, what little incremental things could we do individually that would encourage that shift?
Speaker 2:Sometimes I think by these societies where they've intentionally, you know, made avenues and access to healthy activity, eating, you know, social connection with the purpose of maintaining good health, or is it just something else that they're enjoying that leads to overall better health? Right? And I don't think I have the answer to that, but I think a lot of these places are where they're actually prioritizing joy in their in their community.
Speaker 1:Mhmm.
Speaker 2:And to really experience joy, you actually have to have all your faculties. You have to have the ability to participate together, you have to have those social connections, you have to have healthy, tasty foods to eat. When you look at Dan Buettner's research and others who have researched Blue Zones, beyond, like, just, you know, the statistics of, like, or the data of, like, how healthy they are, When you see those communities, you just see a lot of smiles, and you see a lot of satisfaction. Yeah. You see a lot of contentment.
Speaker 2:You see a lot of laughter. I think that's a big thing that we can, as a society, start to ponder about and reflect upon when we do look at these examples of places that are living healthier. It's not just the data of, like, yes, no disease, no dementia. That's great. But beyond that Mhmm.
Speaker 2:Why is that important?
Speaker 1: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 so provocative and out of the box. Granted that correlation is not causation, and my brain is clearly cherry picking data. But if I think about, like, on a country level, places that have really poor health outcomes, America, Saudi Arabia, tend to be very isolated, spread out individualist cultures where all the places you're talking about blue zones have a strong communitarian connection that can serve as purpose.
Speaker 2:For sure. And I think that that community sense of purpose can be developed in all sorts of societies. Like, when we look at these community, like, the sharing and the love and the laughter, that doesn't mean that we have to set up every society in one economic model, right, or a political model or any of these things. I think this can occur across the entire spectrum of approaches to how you set up your communities and your countries and all that. Right?
Speaker 2:Yeah.
Speaker 1:So I wanna come back to some of your initial inspiration and maybe point to some places that people could find their own without having to change their doctor or whatever. You mentioned Doctor Ornish. You also I think the first time we talked, you recommended the book Heart of Wellness to me, and I read it. Can you say more about either of those, but also any other resources, books, things that you found in your early part of your journey particularly insightful that others might wanna check out?
Speaker 2:For sure. I I think doctor Ornish, his book that he wrote with his wife, Anne Ornish, called Undo It is a fantastic read for healthcare professionals as well as patients and communities. It's, written in a friendly way and really sums up a lot of the research. It shows that there's actually commonality in these lifestyle changes amongst various types of illness from prostate cancer to heart disease to dementia. And so while we have these different phenotypes of change showing up disease in different ways, there's a lot of common pathways.
Speaker 2:So I think that's a great book. The Heart of Wellness, it's incredible. Doctor. Kavitha Chenain, her book was Beyond Traditional Lifestyle Medicines. It really gets into that sense of purpose.
Speaker 2:It really gets into that. We just kinda get socialized in a certain way of thinking and a certain way of having to set up our lives. And then she she kinda proposes that they're actually, you know, when you look at older wisdom, it doesn't matter which tradition, but, the great thinkers and masters, they actually went beyond just what your day to day needs setup needs to be. That there's actually an area within yourself that where you can find your bliss and you can find your purpose and you can find your contentment. And she talks about how that actually does affect your health experience and your outcomes.
Speaker 2:Another book that I really found very helpful was is actually is called the lifestyle medicine handbook written by Doctor. Beth Frates. She's actually the current president of the American College of Lifestyle Medicine. She's become a close friend and a mentor over the last few years. That book for from a provider standpoint, from a healthcare professional standpoint, it's amazing.
Speaker 2:But also for patients, it's got tons of evidence in terms of how each of these pillars makes a difference, but also spends a lot of time on actually just like actually how to connect with each other as people. Find out what's really motivating and what's making them tick and then help them align their actions and their words with those motivations.
Speaker 1:Mhmm. Yeah. That's awesome. I've certainly found that starting in a book somewhere safe, no one has to watch me, I don't have to do anything, is a good place to just open the aperture of the possible. So hopefully people check some of those out.
Speaker 1:So you have this experience with dad, and now you introduce some lifestyle changes. And what I haven't heard you talk about is, like, as a human being, as a animate higher primate, what was dad like in the phase with the medicine, but before the lifestyle changes? And then what is 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:Yeah. He's in his early seventies now. Yeah. It wasn't as easy as, like, I found something out and therefore we changed it all.
Speaker 1:Like Never is.
Speaker 2: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 own lifestyle. Style. I mean, I did talk to him, but it wasn't effective because I was telling him to do something that I wasn't doing. Yes.
Speaker 2:And so quickly realized that if this is gonna be helpful for my father, I'm gonna have to do this and have to model it, show that it actually works, you know, end up taking like the, you know, a 6 month online course to learn how to like cook professionally in plant based foods. I'm really spoiled. And, so made the changes, or is it myself and started feeling the difference, started losing weight, More than just losing weight, it was getting more energy. The back pain went away. All of that stuff started getting stronger.
Speaker 2:I joke, I started seeing muscles for the first time. So that was kinda fun. It's a
Speaker 1:good feeling.
Speaker 2:Oh, it's great. It's fantastic. Then got my parents and my dad doing this. So he dad's you know, his lifestyle has changed. We lost my mom a few years ago, to metastatic cancer in 2020.
Speaker 2:But prior to that, she was you know, just to give you an example with these lifestyle changes, even with metastatic lung cancer, she was hiking up until like 6 months before she passed away. Having a life of meditation, having a life of purpose, I never once saw her being upset with the fact that she had cancer. She in fact told me not to be upset about it. This is just part of the journey. You know, I have ton of learning from her experience.
Speaker 2:And And then my dad, he's retired. He travels the world a lot. Like, in January, he's in Mexico and then in Albuquerque, and then he's in Dallas. Mhmm. Comes home in between.
Speaker 2:We always joke in our family that he comes home and do his laundry, hang out with us a few days, and then he takes off again. So right now, he's actually in India. But when he's at home, he, you know, he works out 1 or 2 times a week with trainer. He's usually, like, walking 8 to 10 kilometers a day. Mhmm.
Speaker 2:It's just normal for him. I've actually seen other uncles and aunts, other elders in the community asking him why he's looking and feeling younger while they're getting older.
Speaker 1:Mhmm. And
Speaker 2:it's been fun to see him sort of, like, share some of, you know, the learnings with community members, and other people are starting making small changes in their lifestyle to just get more vitality. So I would say a gentleman in his mid seventies, he's got vitality. He's lifting huge pots and pans because when he's going to these meditation retreats, he also volunteers and helps with the cooking. And so he got these pots and pans that weigh like 50 to £100. Oh, wow.
Speaker 2:And he's in there in the mix with the all the young guys getting that all done and doesn't show any signs of slowing down there
Speaker 1:at all. I mean, I've seen this in such stark relief having lived in a bunch of different worlds and traveled to different places. The way our expectations around aging and the stories we tell ourselves around aging manifest in reality, but are certainly not predetermined. I'm 37 years old. I am unquestionably, like, I'm in the best shape I've ever been in, and I've been an athlete growing up.
Speaker 1:And I I absolutely get healthier every year. I can run farther. I can run faster. I have less body fat. I have better energy.
Speaker 1:It's taking a lot of work. A lot of work. But it's true. And then I will go back to where I grew up and meet friends who I went to high school with who have an office job and are not physically active. Yep.
Speaker 1:And the main form of social connection is restaurants and alcohol, and they're all very overweight and they're all tired. Yeah. And when you talk to them about it, it's like, well, of course, I'm getting fat because I'm in my thirties now as if that's what's supposed to happen or some sort of biological requirement. And then I, you know, know people who are in their sixties who, like you said, kind of preparing for the end and think of themselves as old. Yeah.
Speaker 1:And I see people here in their mid seventies running 50 mile races and have no intention of stopping anytime soon. And like these things aren't predetermined.
Speaker 2:Yeah. No. A 100%. Even those friends you're seeing back home, I put very little responsibility on them. It's just the way their the communities are set up.
Speaker 1:A 100%.
Speaker 2:It's what set up refer someone. Right? What thoughts are we keeping company with? What words are we keeping company with? What people are we keeping company with?
Speaker 2:And what approaches to life are we keeping company with? Right?
Speaker 1:Yeah. You know, I used to be in that place in my early twenties when arguably I should have been in better shape.
Speaker 2:I mean, I
Speaker 1:was £240 +0. I was eating horrendously. I was taking all kinds of substances that were poisoning my body. Yeah.
Speaker 2:I mean,
Speaker 1:I could barely ski a run without doubling over at that time. So, yeah, not from a place of blame or anything else, just an observation about the differential characteristics that are available to us as as humans. So I I appreciate that. Thinking about the difference between traditional medicine and lifestyle medicine, I heard you and your partner talking about the focus on throughput in traditional medicine. Right?
Speaker 1:Turnover, how many patients can you get in? How many hours can you bill to make the thing work? And I began to think about the distinction between the 2 as throughput versus you put. So not focusing on how many people we can get through, but how can we really focus on what's best for you? And I think that's a distinction that makes sense in my brain.
Speaker 1:I don't know if it does to you. You can amend it if you think it's otherwise. But if you agree that that's a good framework, I wanna understand how this you put model actually works. Like, how does it work financially? Who's opting in and not opting in?
Speaker 1:Like, who's against it? And can it work? Can it scale? Is it financially and viable for the amount of time that you need per person?
Speaker 2:Traditionally speaking, the payment model, Lisa, I can speak for Canada more than the states. Payment model for doctors has been fee for service. Right?
Speaker 1:Right.
Speaker 2: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 piecemeal from a remuneration standpoint. And when doctors have offices and they've got staff that they've employed and they're paying leases and all of that, you have to make sure that you're getting a certain amount of earnings. That payment model forces people to have to see more patients. 30, 40 years ago, you'd have doctors that work till 8 PM in the evening that were available for their patients in the weekends. In last 15, 20 years, people are saying, well, we actually want more of a balance in our personal lives.
Speaker 2:You know, by 5 PM, I do wanna be home. I do wanna spend time with my kids. I wanna spend time with my family. On the weekends, I wanna go skiing. I wanna do something else.
Speaker 2:I wanna build out vacation. So if you're cutting the time that's available in a model where it's still fee for service
Speaker 1:Mhmm.
Speaker 2:Then you're cutting the time that you have with patients. You've got enough time to address their most immediate concern and say, okay. Here, you know, 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's just the system that's been set up and you kinda get bogged down that there's a lot of paperwork.
Speaker 2:There's tons of results coming in and you're expected to do a lot of this and there's a lot of unpaid work that doctors do as well. With reviewing labs, writing letters to other specialists, this and that. So in that model, it makes it really hard to actually focus on these lifestyle changes. Right? And it's not that people don't think that lifestyle change is important necessarily.
Speaker 2:It's just that they're stuck in this model. And then in that model, nobody is really spending time with patients with team based care. So they're only seeing sick patients. They're only seeing people get sicker and sicker and sicker. And they may actually have said to someone like, hey, you need to work on your diet.
Speaker 2:And thought that 5, 7 minutes that I have with the patient you know, the fact that I said this sentence, like, hey. You need to go work on your diet. That that's I've done my job and I've done what I can do for this patient when it comes to that. But you need to work on your diet is the most useless statement Mhmm. Anyone's ever heard because that gives them someone no guidance.
Speaker 2:It gives them no support. It gives them no options. It gives them no empowerment. So that patient doesn't make any changes. They keep being worse.
Speaker 2:And what sometimes gets reinforced in the in the mind of the doctor that's seeing this patient over time saying, well, I did say in one of my notes that you gotta change your diet. Nothing's changed. So behavior change doesn't happen. That turns into a belief system where people can't change. Right?
Speaker 2:We do the best we can. We give them medications. And if they end up with a heart attack, we've got amazing technology where we can do invasive interventions, and that stuff is, like, it's a godsend. These are beautiful things that we have available for our communities. Like, I'm not against medication use and invasive interventions, all of that.
Speaker 2:They've saved my family members' lives. It becomes a sole reliance on medication and testing and invasive interventions because the model that's been set up originally wasn't a model that's been set up for success. I think in the American system, because it's not a universal healthcare system necessarily, There's different models that can be set up. I think the American system, they have, like, different value based care models where now your remuneration actually, I think, is affected by how well your patients do. So there's that model as well.
Speaker 2:And that's something that's taken off. We're not really seeing it in Canada much. Then you have models like the VA system. Right? The VA system is essentially a universal health care system, one of the largest systems in the states.
Speaker 2:And because they ensure their members, they take care of their members, they're actually finding out that it makes sense to do more holistic lifestyle evidence based team based care for their members. So there's I've I've colleagues and friends that work in that system who are able to spend more time with patients who are able to do group medical visits, and they're getting paid on salary. So it doesn't really matter how long. They're they're seeing savings on the back end for that. Kaiser Permanente, one of the largest HMOs in the country, is now heavily invested in promoting lifestyle medicine amongst their professionals as well.
Speaker 2:They're sponsoring a bunch of their doctors to actually get certified by the American Board of Lifestyle Medicine. The systems are coming on board and saying, okay, wait a minute. What we've been doing all this time hasn't really worked, hasn't worked for our society, hasn't worked economically. There's actually a really cool like groundswell of change that's happening, right? The American College of Lifestyle Medicine even has a health systems council where they have, I think it's over 50 different health systems now that are actually engaging in conversation with the American College of Lifestyle Medicine, but also with each other and say, how do we continue to implement these learnings in creating different models of care so that our physicians and our allied health professionals are nurses, nurse practitioners, dietitians, clinical counselors, health coaches, exercise physiologists, like everybody you need on a team to kind of focus on different parts of care can be employed and be utilized for patient empowerment.
Speaker 2:People are working on it. I don't know if anyone's getting it a 100%. Right? And it's iterative change. Right?
Speaker 1:Help me understand the financial like, from a from a ROGA standpoint, is it that you have this baseline number of patients? They're paying you something on a regular basis, even if they're not sick to provide guidance to not become sick, which provides a baseline financial flow that then in some way mitigates for those other factors and allows you to spend more. Is that is that roughly it?
Speaker 2:So the majority of our care is all publicly funded care. I see. So patients aren't paying anything. At Arroga, we've we still work in a fee for service model.
Speaker 1:Mhmm.
Speaker 2:However, because we're our internal medicine docs, we get a consultation fee to see patients Mhmm. And we get follow-up patients, a follow-up fee. One of the nice things that British Columbia has done because every province has a different payment model, but one of the nice things that BC has done is they've actually put money and resources towards funding group medical visits or shared medical visits where you can actually a physician can spend, you know, an hour and a half, 2 hours with a group of patients discussing their illness, their diagnosis, and, you know, using that time to even bring in a dietitian or a counselor to help work on some aspect of lifestyle optimization to help their illness, and we actually get paid for that. So at Eroga, we use you know, we're we're doing our physician 1 on 1 consultations, 1 on 1 falls. We we make a lot of use of shared medical visits that are publicly funded to get patients access to care.
Speaker 1:Almost like a workshop kind of thing.
Speaker 2:Yeah. It's exactly what it is. There's guidance around how these visits need to occur so that they qualify for the payment and qualify as a medical visit. Mhmm. But the other thing that we found at ROGA is we've been investing heavily in technology from day 1 and investing in team members known as physician extenders so that basically, we actually do see more patients in a day, but we're seeing them in a way that they're seeing multiple team members so that the patient's not getting shortchanged at all in terms of the amount of attention and conversation that's happening.
Speaker 2:We're able to, at the same time, keep up with the remuneration model where the lights can stay on, the doors can stay open.
Speaker 1:What's the range of patient types that you have, like, on a scale of healthy to acutely sick, young to old, like, presenting condition, what are your patient base look like?
Speaker 2:So it was interesting, when we first opened up doors so in Canada to see an internal medicine doc, you have to be referred from your primary care physician, which is different than the states because internal medicine is not known as primary care in in Canada. It's specialty. It's a referred base. When we opened up, we had kinda marketed to the doctors in our community, and a lot of the initial referrals were for patients who are slightly on the older side, maybe in their sixties seventies, looking at optimizing, you know, their diabetes, their people have been diagnosed with fatty liver infiltration, hypertension, high cholesterol, obesity. Nowadays, you know, since from 2017 to now, I guess 7 years in, we're seeing the entire spread.
Speaker 2:On our team, we have internal medicine physicians, we have endocrinologists, we have pediatrician, we have family doctors, we have nurse practitioners, we have clinical counseling, dietitian, health coaches, patients under the age of 18 who are getting referred for Actually, the same type of illnesses that we see in the adult population. So type 2 diabetes, fatty liver infiltration, weight management, high cholesterol, and then I'm probably seeing patients on any given day. I could be seeing an 80 year old who is working on weight management to seeing a 23 year old, helping them manage their newly diagnosed type 2 diabetes. Mhmm. So I get a full spread.
Speaker 2:We do a lot of chronic disease management, so my patients are not necessarily acutely ill. This is usually after they've been to the hospital and they've done 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 relationship with our community doctors where they're diagnosing someone with, like, sleep apnea or type 2 diabetes or fatty liver, and the doctors will have a conversation with the patient. Hey.
Speaker 2:Do you wanna be seen by a clinic where they have bit of more of a team based approach to help you not only with the medication management, but also making lifestyle changes? And then if the patient seems like they're interested or wants to know more, then that patient will be referred to us.
Speaker 1:Can a primary care physician refer someone who's presenting as healthy, doesn't have any of those symptoms of hypertension, high blood pressure, they have normal labs, etcetera?
Speaker 2:No. So that's the thing within a universal health care system is we pay for disease, we pay for diagnoses, we don't pay for health, and we don't pay for preventative health. Interesting. What happens is when a patient or a person in the community wants to basically do a preventative comprehensive health assessment, lifestyle preventative comprehensive health assessment, they can actually self refer themselves, and that's actually privately remunerated. So the patient will either pay for that or if they have a health spending account or their employers or their employer might pay for that.
Speaker 2:But right now in the Canadian system, preventative care solely to actually get a in this full assessment of here's where your current health status is, here are some of the risks that you, you know, have going forward, here's some of the opportunities you have to optimize this so that, you know, the next time you do this comprehensive health assessment, let's say a year or 2 or 3 years from now, that it's actually an improvement than your current status. Right? Those are not considered medically necessary care. And so if it's not medically said necessary care, it's not an insured service by the provincial payer. That's when it is a private service.
Speaker 1:So recognizing that people listening to this are gonna be from different countries, different states, different provinces, They're gonna have different places to go. Let's just operate under the assumption that they either don't have insurance or whatever. They have to do it on their own. What would be the tests, the evaluations, the leading indicators that you would look to, like, that you would recommend these people either take or measure that would be the best upstream indicator of their current health? And that could be anything from their weight or BMI to a food sensitivity test or a, you know, continuous glucose monitor, a VO 2 mat.
Speaker 1:Like, what would you look to as the most upstream things to evaluate, who? Do I need some support or am I in a good spot?
Speaker 2:You're gonna get so many different answers on that depending on who you're talking to.
Speaker 1:Literally.
Speaker 2: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 of model 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's where my training lies in.
Speaker 2:Right? So I think from a physical standpoint, like, just checking your blood pressure, your blood pressure will tell you a ton. Your resting heart rate is gonna tell you a lot. BMI is not necessarily always a great indicator of health, to be honest with you. It's nonetheless an indicator, but it's not the best indicator.
Speaker 2:I'm gonna put it up, put that out there.
Speaker 1:I guess maybe describe why or in what circumstances it wouldn't be alternatives to get at the same core information.
Speaker 2:The limitations of BMI is like if someone is heavily muscular, BMI is basically a ratio of, you know, height and weight. So if they're heavily heavier muscular, their BMI is gonna be higher and that's not necessarily gonna give us any, best indication of what their health status or health risks are. The second thing is that a BMI doesn't really tell us what fat distribution is. So someone may have more fat mass, not be muscular, and have a higher BMI. But depending on where that fat is distributed, it may or may not lead to actual health risks.
Speaker 2:Right? And I think that's an important message. Not everyone that's overweight is actually unhealthy.
Speaker 1:Say more about that distinction.
Speaker 2:We have subcutaneous fat stores. We have, you know, visceral adipose visceral fat stores. Right? And so visceral adipose tissue is really the fat that's in and surrounding our internal organs. That's really the fat distribution that causes the most amount of cardiometabolic arrangements in our health.
Speaker 2:Right? So I'm a big fan of doing, like, body composition analysis Mhmm. And that can be done through a DEXA scan, that can be done by a bioimpedance scan. DEX scan, I think, is the gold standard. I think the gold center is actually dunking in a in a water tank, but that's really not practical on a clinical basis.
Speaker 2:So bio impedance or DXA usually does a good amount. A good scan like that will actually not only tell you your fat percentage, it'll tell you where your fat's distributed. And it'll also tell you about your non fat mass, like your muscle mass. Right? And if you don't have enough muscle, there's actually a term called sarcopenic obesity where it's actually you don't look like you're overweight at all, but you don't have enough muscle.
Speaker 2:And that's actually sarcopenia or sarcopenic obesity, which also carries its own health risks.
Speaker 1:I think on the street, we call that skinny fat.
Speaker 2:Yeah. So I think getting, like, a body composition test is is important. And then your baseline labs, your metabolic labs, like your fasting glucose is, I think, is important indicator. Your a one c, you know, that gives you an indicator of what your average blood sugars have been like over the last few months. Mhmm.
Speaker 2:But in addition to that, a test that not all doctors, not all clinics have been doing is is a fasting insulin level test. A fasting insulin level is actually very important because someone's blood sugars and their a one c may be completely normal, so they'll be told that you don't have any diabetes. That's great. But if they don't have a fasting insulin level test, you don't actually know, do they have insulin resistance? And insulin resistance is actually the tree of cardiometabolic disease.
Speaker 2:It has like different branches like fatty liver, car corneal disease, stroke, dementia, diabetes, high cholesterol, all of that. The trunk of that tree is actually insulin resistance. If you feel like you're healthy because you don't see the branches and the leaves, but there may be the trunk going. Right? And it's important to see that trunk.
Speaker 2:So, for example, if, say, you have normal blood sugar, you have no a one c, but your fasting insulin level is sky high, what that tells me is that, yes, you don't have diabetes right now, but your pancreas is having to work really, really hard to keep your sugars low. And that is insulin resistance. And then we start then and that allows someone to say, okay. You have a little bit of insulin resistance, signs of it. Now let's go let's go work on the underlying, risk factors for that.
Speaker 2:Then you go into your cholesterol profile, your total cholesterol, your triglycerides are important, your LDL, and and more importantly, your apolipoprotein b, because LDL is a calculated value, so it's not always as accurate because it depends on your triglycerides not being super high. But apolipoprotein b is a directly measured lab test that gives you a good understanding of what your cholesterol is like. These days, I'm recommending that every patient just get a lipoprotein little a test done. Lipoprotein little a a is a very genetically related lipid molecule. And so that tells us the bit be shining a bit more light on what your genetic risk may be.
Speaker 2:If someone's lipoprotein a is not very high, that's quite reassuring, but if it is is high, then it just tells us that we actually have to be that much more aggressive with your lipid management. Mhmm. Looking at signs of inflammation, I think are important. Let's do an, you know, an h s c r p gives us some indication there.
Speaker 1:Does that stand for or how does one?
Speaker 2:The c reactive protein. Mhmm. So it's just a it's a very, very sensitive test, nonspecific for inflammation. Then we look at your liver enzymes, a few different liver enzymes like ALT, AST. If these liver enzymes are elevated, they that might indicate that someone has inflammation in their liver, which in a lot of cases in North America are likely due to fatty liver infiltration.
Speaker 2:So if your fatty liver infiltration and liver enzymes go up, that means your liver is undergoing low grade inflammation, and it's actually important to shut that off because low grade inflammation of the liver over time will actually start to replace healthy liver tissue with scar tissue. Mhmm. And over time, if there's enough scar tissue, they're replacing healthy tissue, your liver actually puts in a state called cirrhosis. We usually in North America have always thought of cirrhosis as a complication of alcohol related liver issues or a viral hepatitis related issues or toxin related liver issues. More and more often time, actually cirrhosis in North America is happening just simply because of fatty liver infiltration.
Speaker 2:So Wow. Something that we didn't actually pay too much attention to do it 20, 30 years ago now is something that we're seeing as
Speaker 1:a a real health risk. And when you see fatty liver come up on a panel, that is the early stages of the onset of that effectively, or is that the same
Speaker 2:thing? It's on like a, on a spectrum. If I saw someone has liver enzyme elevation, the next step would be actually getting an ultrasound to confirm that they actually have fatty liver infiltration. If they have significant amounts of alcohol in their life, then they may be related to alcohol related fatty liver. If that's not really an issue, then it's more likely a metabolically associated liver disease or nonalcoholic fatty liver disease.
Speaker 2:And then you also wanna make sure that there's that you've ruled out other reasons for having that liver inflammation. So you usually will do the viral and the autoimmune test just to make sure that that's all fine. And most times in my practice, those are all normally fine, and it's just it it is a metabolically associated fatty liver infiltration. And then you can do further scans of, like, fibrosis scans, which actually tell us if your liver's already started to undergo the process of fibrosis, which is the replacement of healthy tissue with scar tissue. And that can actually tell you what stage of that is where you're at.
Speaker 2:And with lifestyle changes, weight management, you can stop it in its tracks.
Speaker 1:So I'm gonna do a little recap because that's a lot just to try to put some buckets around this and you tell me if I'm getting this correct. But you're looking first at cardiovascular health, simple blood pressure and resting heart rate test. You're looking at body composition, potentially with a DEXA scan or something else. You're looking at your glucose or insulin response, and you suggested a few things, including a one c or a fasting insulin test. You are looking at your cholesterol, and so this is in, like, blood work now.
Speaker 1:Cholesterol, you'll get that, but you're also looking at APOB and lipoprotein as leading indicators. And then the last two things you're looking at are inflammation. An HSCRP test will take care of that, and then liver enzymes for liver health. Yeah.
Speaker 2:Yeah. That's that's good. And then, like, you can look at your renal function as well. I think that's always good to look at. Right?
Speaker 2:And you're creatinine, making sure you're not spilling any protein in your urine. An ECG, I think is, it should be a part of that preventative assessment just to look at your cardiogram. In our office, in our comprehensive health assessments, we may even put someone through a treadmill stress test to look at their underlying cardiac risk stratification, right? Look for any signs of ischemia and ischemia is basically the state where your heart's not your heart muscle is not getting enough blood flow for what it needs.
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Speaker 1:Use code hashtag political healer by going to www.electedleaderscollective.com and starting today. That's www.electedleaderscollective.com and starting today. What is your opinion about wearable devices? Are they useful, not useful? Things like an Oura ring, an Apple watch, a Woop, so many of them now, where are they useful or not useful in your mind?
Speaker 2:Great question. As I wear 2 wearables right now.
Speaker 1:I'm with you, man.
Speaker 2:So I got my I got my Oura ring. I got my Apple Watch. I think wearables are fantastic in the right context. Mhmm. I think it depends on a few different things.
Speaker 2:Like, for me, I'm a data oriented person. Someone asks me a question about something, the first thing I ask is, okay, I need more information. I tell I was telling people don't I don't expect my answer on something if I if I don't have more information to work with. And so like when I get when I see like, what am I active calories for the day? It's not because I have a calorie goal.
Speaker 2:It just gives me an indication that you've hit certain amount of active calories means you weren't sitting around all day. I look at my sleep. Did I get enough REM sleep? Did I get enough deep sleep last night? Because it's something that I was trying to optimize.
Speaker 2:So I think if the data is serving for a specific goal, those wearables are great. You know, CGMs, I think, are in the right context or fantastic people, especially if they're trying to they're working on, you know, difficult to manage type 2 diabetes. I don't always necessarily recommend them to patients. Mhmm. I always tell patients, if you think it's gonna help you, that's great.
Speaker 2:Right now, a lot of times with people, the studies have been showing is that people will do the wearables, but they may not engage with them after a certain amount of time.
Speaker 1:Mhmm.
Speaker 2:You while you'll see some initial engagement, you see some initial changes in behavior over time that goes away. And that, to me, that's not a failure on the wearable, it's failure in the context of how are we using them. Right?
Speaker 1: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.
Speaker 1:I think about the person and I've done this right where you put, like, an affirmation on your window or your mirror in your bathroom. And for the 1st 3 days, 5 days, you read it. You're really present with it. You take it into your day. You do something.
Speaker 1:But if it doesn't move, like everything, it goes into the background because the mind wants to be efficient with its energy and you literally kind of don't see it anymore. It becomes invisible. You if you want to keep seeing that message, you need to continue to move it or derive a reason for it. And so I keep going back to my Oura ring every day because I'm focused on being healthy enough to do a race, to be acute enough for the pot. So I have, like, a reason to go back to it.
Speaker 2:No. For patients, if I had a wearable for them that was connected back to a system where that data could be shared Mhmm. And then they actually got real time feedback Mhmm. And outreach, then that wearable becomes a really nice tool for a, fostering a greater relationship with the patient Mhmm. But also in in in fostering that, hey.
Speaker 2:Someone's invested in your care and wants to make sure that you're getting usable information with these wearable technology. Right?
Speaker 1: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 this stuff out in my mid twenties because I was super overweight for a while. I was unhealthy. And when I got back in shape, I wanted to maintain that.
Speaker 1:And so some of the things I did, I started doing annual blood panels, for instance, measuring a lot of the things that you're talking about, having my annual physical, which, again, some of the things that you're talking about, weighing myself every day. And obviously, it's a very blunt instrument, but for body composition, just to have, you know, it's not accurate, but it's accurate to its own inaccuracy. So, you have a trend line. And then, I've got my sleep, my Oura ring, my exercises on there, and I've created a shared document where all of that is there that my general practitioner has. So they can see that now over, like, 11 years.
Speaker 1: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 is the future is automating that process and then providing real time feedback, which in some ways, you know, the Oura Ring does. Right? It says like, hey, your sleep was shit last night. Get back in bed.
Speaker 2:It's about putting that back into context as well. Like, why for you specifically for Skippy, why does that, you know, for your sleep for the last 4 days has been off, how is that actually affecting your goals and your health care right now in the moment? Tying that back to conversation you may have had with your health care provider. Personalizing, contextualizing, like, even with the Oura rings and all these things, the commentary is not personal to Skippy. So it's what the algorithm has shown, but I think there are AI technologies and software has been built that actually can personalize it way more and, you know, give, like, prompts to your health care provider.
Speaker 2:Mhmm. Technology that are still evolving, software that's still evolving. That's the hope.
Speaker 1:Okay. So that's a great bridge to something I I really wanna talk about, which is how you follow evidence based care and the evolution of evidence based care because it's pouring in faster and faster and will continue to. But just a closed loop on that, are there use cases or particular wearables that you don't find helpful or that are misused that people are wasting their time, energy, or money on?
Speaker 2:It's interesting because, like, a lot of people really love the CGMs.
Speaker 1:Continuous glucose monitor for anyone who's like, what are you guys talking about?
Speaker 2:Yeah. No. In the right context, they're they're fantastic for people. There are times when I think the information needs to be taken as part of other information as well. Like, for example, patients who wear these monitors on their own, they'll start avoiding healthy foods because they saw a spike in the sugar.
Speaker 2:Right?
Speaker 1:Like a strawberry. Like, they're like, oh, I can't use strawberries anymore.
Speaker 2:Yeah. A strawberry or or a banana. And they'll start to avoid these. It actually sometimes makes it harder for me to convince actually this is not the case. This is not a bad thing.
Speaker 2:My my dream would be if we actually had a a fast like, if you had a continuous insulin monitor because that's one level before the sugar. Right? The level of the sugar you're seeing is actually a consequence of the relationship between insulin and the body cells and liver and muscle cells, specifically, what's their interaction. So I'm trying to say, if we could look at continuously looking at that relationship at a more underlying level rather than the outcome level, we might actually have more clarity on that. But sometimes just looking at the sugar alone can send people in the wrong direction.
Speaker 2:It's
Speaker 1:easy to misinterpret data.
Speaker 2:So I just think it's important that with all these wearables to have somebody that they can turn to and say here's what this data is leading me to think, what are your thoughts on this? Using that to be more of a conversation point first before jumping straight to action. Yeah. Because the action that you may jump to may be super helpful, but it also may lead you down a path that may not be as helpful.
Speaker 1:Yeah. That makes a ton of sense. So I really wanna nerd out on these meetings. So first off, do you still have these I had read that your team, and like you said, it's a multifaceted team, a lot of different specialties, subspecialties, does a monthly evidence based care meeting where you're discussing the most recent research, what's coming up as a means of co learning. Is that something that you still do?
Speaker 2:Yeah. So it's called Eroga journal club. Most residency programs, most medical schools, a lot of hospitals will have a journal club for different divisions, right? It'll be a periodic meeting of you know, division members. The person who's presenting is their choice of what they wanna present.
Speaker 1:So you rotate the presenter?
Speaker 2:A 100%. Yeah. Okay.
Speaker 1:So it's not like everyone has to show up every meeting with something to contribute. You know ahead of time that your job for that month is to research?
Speaker 2:Yeah. So what happens is journal club runs every month except we take a break for July August, and then December is always off. We do it the last Friday of the month at 7 AM PST, and it's actually open to like non erogues tasks.
Speaker 1:Oh, interesting.
Speaker 2:We just anyone that says they want in, you just get added to the email list. You get an email sometime in the middle of the month. It tells you who's presenting, what's the journal or topic that we're covering. If there's a journal article that asks you is being presented, that journal gets sent out to team members so you can meet in advance. So you can actually come up with your own questions and thoughts and contribution after the presentation.
Speaker 2:And so one member will take it on to present a recent article or study that came out. They'll present the study. They'll present what they think of the study.
Speaker 1:1st, what are the rules or requirements of the presenter, if there are any?
Speaker 2:So really aren't much. We're limited to peer reviewed literature. So it's not just someone's, like, thoughts on a random website. And most of the time, we really focus on studies that shine a light on various aspects of lifestyle medicines. That said, sometimes there's actually a medication that is really highly applicable to our patients.
Speaker 2:And so there might be a study presented on one of the medications that's recently come out that we think might be helpful for our patients.
Speaker 1:Does every team member have to present at some point?
Speaker 2:We sort of said that, but then we haven't really imposed it. It's really like for the next few months who wants to sign up to present and if we know someone hasn't, we encourage it, but it's not like because because not everybody wants to present and it's not fair to team members to always like put them in these zones where they may not be ready to go. That's it. Right? But we encourage everybody.
Speaker 2:Do you
Speaker 1:get a good diversity of presenters or do you find 10% of people wanting to do 90% of the presentations?
Speaker 2:Oh, no. We have good diversity. We got like to a point where we even had like our admin team and so patient coordinators who traditionally are never asked to do these things. Oh, cool. In most medical settings, we've had front desk team members, like, look up papers and present them to the rest of us, and and it's been such a fun experience.
Speaker 1:That's awesome. I wanna know, like, the review process in the room. Like, what is the mood? Someone present something, do we sit around and nod our heads in affirmation? Is there a gentle q and a?
Speaker 1:Is it like the house of commons and people are throwing tomatoes and saying bullshit? Like, how do how do we do this?
Speaker 2:I've seen general clubs operate in every single way you just described. Okay. I remember in, like, when I was in my residency, particularly our cardiology rounds of the university, you would wonder, like, are these people gonna be able to talk to each other after this round? Like, I was afraid to even say anything because I was like, it's very tense. Right?
Speaker 2:Then there's places where, like, you know, times when someone presents and everyone's like, oh, yeah, that makes amazing sense and everyone's all for it. At ROGO, we encourage robust discussion. Mhmm. But it's setting the intention. The intention is, hey, is there something that we can take back for our patients?
Speaker 2:Is there something here that we can incorporate into our care? There's no it's not intention of one person looking smarter than the other. It's about helping each other see different angles and questioning how is this gonna affect potentially the care of our patients at Rota, right? And so we put our egos aside for this and it's actually a lot of fun. So it's usually an hour long.
Speaker 2:The presentation part is probably 35 to 40 minutes at max and we have 20 minutes usually of discussion. We We probably don't get into any hard like yeses 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 is right and this is wrong. And in science, it's just more evidence of yes, this may work or this probably doesn't work and it's kinda moving the needle of which way we're swinging on certain topics and certain interventions. Right.
Speaker 2:And just keeping in mind, like, at this point in time, the available information to us shows us this, keep in mind that maybe there's probably like 10 studies that are going on somewhere in the world about the same topic that may now weight the evidence in a year or 2 or 3 or 4 from now may show that the opposite conclusion actually has more evidence for it. Right? And so, you know, I got into lifestyle medicine for my dad's health and all that and I was completely, you know, won over by the evidence for plant based nutrition in terms of cardiac and metabolic health. Yes. But then I started hearing about all these doctors that are talking to patients about low carb diets and ketogenic diets and in this and that.
Speaker 2:And initially, we were like, oh, no. No. That that's that's just that's gotta be wrong. And then actually what happened is you met a few of these doctors, and I was like, oh my god. These these doctors are some of the smartest people I've met.
Speaker 1:Right.
Speaker 2:Some of the most caring physicians, and we have the exact same goal of patient empowerment and moving health. So I'm like, there's gotta be something here. So I started looking at the evidence. They started looking at research. And you're like, you know what?
Speaker 2:There's actually a lot of evidence for a variety of ways of eating healthy and we stopped to continue. So it just it's to me, it's like the answers are not in stone. And that was my personal sort of journey from going from being a little bit, you know, like, close minded to something and saying, okay, wait a minute. I have to continue letting the studies happen and and and honoring those that are actually engaging in doing clinical studies. Clinical studies are like not the easiest thing in the world to do.
Speaker 2:They're really hard. You run into lots of red tape with your ethics boards and all of that, which are they serve an important purpose. Gathering data takes lots of hours then interpreting it. So I just have a ton and ton of respect for anyone that does research. If we can just honor those that are engaging and then actually just being able to assess all of that, It keeps us humble.
Speaker 2: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 align ourselves with the truth, which is sometimes a moving target, oftentimes moving target. Mhmm. But that also allows us to connect with patients. Right?
Speaker 1:Yeah. I mean, as a coach who's working with people in public service, it's no surprise that confrontation and argument come up a lot. And you said a few things that to me are the key to healthy discussion, the move from what I like to call confrontation to carefrontation, which is you are de identifying with the presentation.
Speaker 2:For sure.
Speaker 1:The presenter is no longer their their worth. Their value is no longer tied to the thing. If we're critiquing the work product, we're not critiquing them as a person. We're not saying there's anything wrong with them. And you've done that by orienting towards a shared outcome in the patient that you are now linked by.
Speaker 1:And so the disagreements about things are no longer disagreements between people, but they are a means of moving towards a shared goal. You do that. You mentioned setting intention. Like, what do you physically do in the meeting?
Speaker 2:From an intention step when it's not necessarily, like, as over. It's presented to be, like, an opportunity for us to connect again. 1st 3, 4 minutes, usually, as people are coming in, it's just, hey. How's it going? What's going on here?
Speaker 2:And so you set a stage for colleagues and friends who are actually connecting after a while, and this has happened to be what we're talking about today. Mhmm. The other thing that I think is fun with us is that because we have a wide variety of specialists from family medicine to endocrinology to pediatrics, internal medicine, clinical counseling, dietitians, sleep health, psychedelic medicine, all of that that when you're presenting on a paper, it's not you're not presenting on a subject that I happen to be an expert in. I'm actually in a very much in a learner mindset.
Speaker 1:Mhmm. Beginner's mind.
Speaker 2:And so I think the fun part of having such a variety of journals or a variety of studies that we cover is that almost in every one of those settings, there's a large portion of the audience that's actually in a learner mindset. We're actually already coming with a bunch of questions, not necessarily even about the study itself, but just about the topic. Mhmm. Right? And so that I think changes the dynamics a little bit at least.
Speaker 1:Yeah. That's great. So last kind of question around this area, and then I'll I'll have satisfies my nerd for the day. I wonder how you in discussion avoid what I think of as like this single study sensationalism that takes over the media. It's like there's a study with an end of 20 that it's non controlled, and all of a sudden it sweeps across the media.
Speaker 1:Blueberries cure cancer. And you're like, oh my god. All we should eat is blueberries. And then 3 weeks later, there's a different study and they're transmitting some neurovirus and oh my God, well, blueberries will kill us all. There's no stepping back and having a broader scope or interrogating the veracity of the study or the rigor of the study.
Speaker 1:And although you're controlling for this by only looking at peer reviewed studies, I wonder how you guys sort of internally control for the value of this study versus the sensationalism of the finding.
Speaker 2:There's a lot of EBM like evidence based medicine literature on how to assess different studies, whether it's a cohort study or if it's a randomized control trial, and you're looking at the validity of the study, the internal validity, you're looking at how applicable this is to a wider you know, patient population or a wider audience. Mhmm. I guess we're lucky because one of our team members, Josh Levin, who's a family doctor that works with us, he, sits on, like, the UBC Therapeutics Initiative. And so he's our mister evidence based medicine at all times. You know, prior to the generals going out, he actually will help with giving us the evidence based tools for assessing a study.
Speaker 2:Mhmm. And so you have a different tool to assess a different type of study. And that tool actually go not just go to the presenter, but also go to everybody that's reading the study in preparation. So people will go through it themselves. Right?
Speaker 2:And our hope is usually by sticking to evidence based tools to assess evidence based literature, then that helps us kinda put in place where things stand with from that study. Sometimes we actually look at these studies and be like, look, you know, truth is there's not a lot of evidence for this, right? Sure. But I would say a lack of evidence for is not evidence against. It just means that it just it affects the amount of confidence that I can recommend something with.
Speaker 2:And then also like looking at our patient experiences like this, you know, this this study may say this, but I have a ton of patients where where this happens and this happens. Right? Mhmm. I think those anecdotes are also important in the discussion of evidence based literature. Right?
Speaker 2:And kind of putting things into context, assessing it based on criteria, you know, checking off, checking off, then you can actually score and say, okay, how when the grand scheme of things, how much is this gonna change my practice, right? And that usually is like one of the main discussion points at the end is like, is this gonna is this applicable to our practice? Is this gonna change our practice in any way, shape, form? Do we need more information?
Speaker 1:And is the checking off that you're describing sort of an informal thing you're doing in your head, or do you guys have a little bingo scorecard that you're actually following along and comparing notes on?
Speaker 2:So some people do it in their head, but we have, like, the documents that are guiding it.
Speaker 1:Yeah. Wow. Super cool. I really appreciate you sharing all that. And I think that there's so much applicability across other areas of knowledge finding and sense making that would benefit from process similar.
Speaker 1:So hopefully people draw, some inspiration from that. I'm gonna take us in the way back machine. At the beginning of this session, you talked about not saying exercise, but fun physical activity. While that could seem trivial, I imagine that when the end goal is behavior change, the way that we talk about things and frame things probably have a significant impact on uptake and use. So I wonder if you could talk a little bit more about that, either the deviations that you find, the delta that you find in behavior change based on language, if you have a specific example or 2 to point to.
Speaker 1:And then what are some of the and I don't wanna devalue them by calling them tricks, but, like, linguistic techniques or approaches that you have found to be you know, nomenclature that you found to be particularly helpful or harmful as weighted against patient actions and outcomes?
Speaker 2:Language is so important. When you don't know people that well, your words matter, and they can hit, like, a ton of bricks. Mhmm. Especially when you're dealing with patients who may be vulnerable sort of situations in in socioeconomic come from communities that have may have been marginalized or whatever their specific experience with healthcare has been. It's so important to be sensitive to where someone's coming from and words, you know, matter a lot.
Speaker 2:And I learned this not necessarily from reading books and not as much. I actually I did 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 started incorporating lifestyle changes into my practice of medicine, I was still very much approaching it as a health expert. I'm the doctor. Here's what's best for you.
Speaker 2:So instead of saying, okay, you have diabetes, you got your cholesterol is up, I'm gonna put you on Metformin, I put you on statin. Right now, I would start saying, hey, you got diabetes. You need to before we go to med form, you you need to start doing this. You need to do this. These are specific things I want you to do for the next few months.
Speaker 2:We'll check your blood work. We'll do this right. That approach was working for maybe, like, 3% of people. Wow. I'm probably being generous to that because nobody likes to be told what to do from some random person you're meeting for the first time who hasn't taken the time to get to know you as an individual.
Speaker 2:Mhmm. Don't know anything about your house circumstances. I know nothing about you. But yet I'm making these assumptions and I'm telling you what's best for you. Right?
Speaker 2:None of us ever like that.
Speaker 1:Do you guys ever use any form of personality evaluation on your patients such that you have insights on how to most effectively communicate to them?
Speaker 2: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 current dietary patterns? Are you working right now? What's your you know, who's living at home?
Speaker 2:Who's doing the shopping at home? Who are you cooking for? We're looking about, you know, what is your what is your current level of activities in in different places, like in in resistance training and to aerobics and to stretching and balance? What is your current levels of stress? How are you managing stress?
Speaker 2:Mhmm. Do you feel loved by others right now? Do you feel, like, that you belong to the community that you live in? All those I get a lot of information, but not necessarily personality. That's that's something that's gonna go and I'm gonna go look into.
Speaker 1:The reason that I bring it up is it's something that I use in the coaching practice, and I use the Enneagram test, although you could use Myers Briggs. I mean, it's not highly technical. But if someone is stuck at an impasse, say someone is has a goal that they really want to get to and they're not taking action on it, if I know that they are 3 achiever on the personality test, I know how to speak to them in such a way that can orient them towards that externalized goal and how they may be perceived or not by others that is motivating, but maybe completely crippling and destabilizing to someone who's, say, a 5 investigator who really needs to go and find out for themselves. And the different ways of approaching that tend to, and certainly don't guarantee, better follow through. So that's where I was curious, but continue.
Speaker 2:No. I think you've identified an amazing opportunity for us to, like, optimize care. Thank you. I love it. I've kinda learned that through through the hard knocks.
Speaker 2:Right? You got some patients who are like, oh, thanks. This is amazing. So this is what I was looking for. Thank you so much.
Speaker 2:I'm gonna go run and do this. The other people are like, what are you talking? Why are we doing this? This doesn't make any sense. Mhmm.
Speaker 2:So through time, I've just kind of changed the way I spoke about things. Early on in the in the meeting, we spoke about, you know, one of the resources I recommend, like doctor Beth Fady's book, lifestyle medicine handbook. Mhmm. And something that she talked about was knowing when to take off your health expert hat or turban and put on the health coach and how health coach is very, very different interaction than the health expert. In chronic disease management, it's a strong calling to physicians to actually not be the health expert, but maybe the health coach in that situation.
Speaker 2:Or if you can't be, make sure you have a team of people that you can refer to. And reading the 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 these things, to me made no sense. We're never gonna move the needle on health changes with anybody by doing this. I didn't even 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 can literally feel like a kid every time with this because I'm like, oh, this is magic happening.
Speaker 2:Yes. And it's not necessarily magic, but what it but to me, it feels magical.
Speaker 1:I can so relate to this.
Speaker 2: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 I believe could work, and it just works. Learning and getting feedback from patients about what actually works for them and what doesn't work for them is important. So my ideals of what is evidence based, what is the right way of doing things matter less than the experience that my patient's having, the inspiration that they're walking out of the door with, and the empowerment that they're walking out the door and to fall through.
Speaker 2:And so I started paying attention to the words am I using. Are they actually causing someone to have some upliftment in the moment? Is it are they feeling lighter with these words or are they actually feeling heavier with stress with these words? Mhmm. My colleagues will talk about plant based diets and this and or ketogenic or low carb is.
Speaker 2:I actually have stopped using all of those terms completely with my patients. Oh, interesting. I don't actually use any because I find all of them will cause some type of stress with my patients.
Speaker 1:They're polarizing.
Speaker 2:As soon as you term something, you almost start to create an ideal.
Speaker 1:Yeah. Now there's a perfection that has to be reached that's unattainable and I'm gonna fail and so why even start?
Speaker 2:So I would just talk about like, from a nutrition standpoint, I just say, hey, eat whatever eating pattern you
Speaker 1:want. Interesting.
Speaker 2:Let's try to build on a couple of principles that are first principles such as let's really focus on eating whole foods as much as possible because these are foods that you get to have the opportunity to make with your family have fun while you're making them. You get to engage with your kids or your partner, you get to choose the 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 winning more often and it's gonna be more helpful to the goals that you have set up. Right? It's important for you to get their goals first and foremost.
Speaker 2:Right? When patients ask me nowadays, what are the good foods and the bad foods? As I said, there's no such thing as good foods and bad foods. I say they're all foods.
Speaker 1:So good.
Speaker 2:There some foods depending on your goals are gonna help you get to your goals and some foods are not gonna help you get your goals if you if they show up every day. And I give the example, I say all foods are your friends.
Speaker 1:Mhmm.
Speaker 2:So I say all foods are your friends. You just gotta choose which friends show up every day and which friends show up every now and then. It's a great time nonetheless, and you never feel bad about spending time with your friends.
Speaker 1:I just feel it evoking a different emotion in me versus the other. And I am wired for that. Like, tell me what to do, tell me how to do it. If you tell me it's effective, I'm gonna do it. And then if you're wrong, I'm gonna be pissed at you, but like, I'm gonna go.
Speaker 1:But that's not, that's not how most of us are are wired. And what you're doing is you're painting a picture of what people actually want and what's possible, and then opening the door for them to have the tools to achieve that.
Speaker 2:And so that carries over into, like, what you talked about, like, you know, joyful movement versus physical activity. Physical activity becomes a daunting task. I started having a lot of fun with working out when I sign up for personal training because I just had a lot of fun with my personal trainer, but that was fun for me. But that same exact experience is not gonna be fun for someone else. So I just ask people, what's a fun thing you do that happens to include some movement?
Speaker 2:Whether it's dancing, whether it's playing with your grandkids. Is there a really cool tree in your in your neighborhood that you like? Could you walk to it instead of driving to it today? Things like that. Right?
Speaker 2:And so just lowering the barrier of entry into healthy behaviors, I think is super important because I think a lot of people are wired to build upon success. I tell people, let's not try to define your success based on your number on the scale. Let's not define it by the blood sugars. I mean, these are all things that are gonna happen and don't worry about them, but let's define it by, like, how do you feel every day? What's your level of vitality today?
Speaker 2:Do you feel like your weight or your diabetes or or or any of your health clinicians are separating your current state of participation in life in the way you imagined you participating in life to, to to to your reality. Right? If there's a separation, then it makes sense to address these. But let's say your weight doesn't actually separate you from your imagined participation in life the way you imagined you wanted to participate, then it's not an issue for me. I actually I've almost gone to an extreme with it where you gotta convince me Yeah.
Speaker 2:Why these health conditions are worth addressing. It's
Speaker 1:patient led. What do you want? Yeah.
Speaker 2:Like, I even asked, like, why do you care about your diabetes? I don't wanna have a heart attack. Why don't you wanna have a heart attack? I don't wanna die. Why don't you wanna die?
Speaker 2:And then I get these amazing, beautiful, heart led reasons of why they wanna live. Every one of them is different. They know someone wants to walk the Camino and, like, let's get you there. Right? Someone wants to walk the kid down the aisle.
Speaker 2:Let's do that. Okay. Well, these are the reasons why you're here. Yeah. The health conditions are just some things that are getting in the way of that.
Speaker 2:Let's just let's focus on that and start working on these health conditions so that they don't become a barrier to what your actual goals are. And that's where I think medicine has to go is it's not merely about our diabetes and this and that and all of that. What's your life experience right now and how you want your life experience to go? And relating these health conditions or any obstructions to that in a way that makes sense to the patient and say, okay. Let's I do wanna I do wanna work on this because of this.
Speaker 2:Right? And I'm hoping that this will start to change more as we as a lifestyle medicine community starts exerting more influence. Yeah. You know, getting away from just simply looking at mortality benefit of a of an intervention to actually what's the health span benefit in this intervention. You know, one of the things that Kavitha Chenain writes about in heart of wellness is that in olden times, people did not define health as simply an absence of disease.
Speaker 1: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 you and maybe look at some of the more challenging parts of this work because, yes, someone's gonna go do the camino, and someone's gonna pick up their grandkid again, and that's a huge joy. But I've also heard you say that really only, like, a 5th to 2 5ths of people actually take the advice and do something with it.
Speaker 1:I wonder if that's still true or if that number has come up.
Speaker 2:The number has come up as I've learned more. Yes. I had a member having a conversation with some colleague, an amazing colleague, good friend of mine said, Jazz, I know there's evidence for lifestyle interventions. Yes. We all see the studies, not a big deal, but nobody changes.
Speaker 2:So then my retort to him was, well, which class in medical school taught us how to help people change? We haven't had one. Right? Mhmm. And at the 2020 ACLM conference, which is done virtually because of pandemic, there was a physician there who presented, and his name was Ed Torrey.
Speaker 2:He had gone through medical school and early on had the epiphany that medical school is great. 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 residency right away. Mhmm.
Speaker 2:He went and took an entry level job with an ad agency. And he spent the next few years learning everything about behavior change from the people who are experts at behavior change with the marketers. And then came back into medicine, did his residency, and he runs, like, an an influence center down in the eastern states and teaches doctors now how to infuse behavior change into their clinical care, but also but not also in clinical care, but in in their administrative work as well. So I would say the percentage of patients making changes is a lot higher. The expectation of perfection from my side has evolved.
Speaker 1:Say more about that.
Speaker 2:Perfection in changing for me is actually, if you what you're doing today is leading to a happier tomorrow, then that's perfect for you in your current context. Someone who doesn't have the money to buy fresh vegetables and does not have the money to join a gym, doesn't have the time to go and spend with the clinical counselor once a week. If that person is just taking a nice walk in their neighborhood, is now buying frozen vegetables instead of frozen TV meals, that's perfect change.
Speaker 1:And for someone who is in a perfectionistic or a fight mindset who hears that and misinterprets it as maybe short changing or giving up. How would you respond to that critique?
Speaker 2: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's a perfect journey. Mhmm.
Speaker 2:So there's perfection in the step of that journey, but the journey is not done. Right? And and it's not just saying that, hey, that you've done this. That's great. Let's rest on this.
Speaker 2:Right? It's saying this is amazing. Do you think now there's some opportunity for another one to 2 wins over the next few weeks? How do you get the biggest snow ball?
Speaker 1:Literally in my head. Yeah.
Speaker 2: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 the hill and walk up to the top of the hill and put it all together. Nobody no. We would have no snowballs. Right?
Speaker 2:But the fact that it starts at the top of the hill and it's just a small amount and it as it as as it rotates and as it cycles through the ups and downs, it by the end of the hill, there's this huge snowball.
Speaker 1:Yeah. It's such a good analogy. It's so visual, and I just so appreciate you describing it. And I think at the end of the day, we have to recognize that from an evidentiary standpoint, the results are better this way. They're better for the person, they're better for the person's experience.
Speaker 1:And this is something that I, as a coach, fight against sometimes in my days where I struggle, I make the results about me. Yeah. And then I have to remind myself that's not what the job is. The job is to empower someone else so that they don't ever need me in the future, and they can only move at the pace of the possible. They can only learn from the reality of where they are.
Speaker 1:And it can be criticized, but it's such an empowered position. And it's just so cool to hear it entering the field of healthcare. I just think that's beautiful.
Speaker 2:It's such an interesting dichotomy because in medicine, you know, we we talk about whether or not something's worth doing based on outcomes. And so we're always looking at hard outcomes, like, oh, how many percentage of your patients have gone diabetes remission? And it's something that I cared about a lot, but that it's really more about me and my priorities and less about the patient's priorities and less about the community. Right? And while I do think those are important outcomes to measure and those outcomes that need to be studied, we have to recognize that in medicine and a lot of areas of health, there are outcomes that we have denied that are outcomes and we've ignored them and we haven't measured them yet.
Speaker 2:And if we started to measure all those other outcomes, we'd actually realize how small some of the outcomes that we're measuring making so big in our heads are compared to the other outcomes. And that may be part of where we are. We haven't gone right. And so in lifestyle medicine, we as an organized specialty focused on proving to payers that this is economically viable and doing all this. At the same time, we can't lose sight of that.
Speaker 2:There's other outcomes that are not gonna contribute to the economics as much. They're gonna contribute in ways that are hard for us to capture. Right? Right? Like, all these outcomes that we measure are important.
Speaker 2:Right? There are other outcomes that are not currently being measured that we may not have the best tools developed yet or just innovative ways of thinking about it and approaching it.
Speaker 1:It reminds me in so many ways of the study of cosmology where, you know, for the entirety of human history until roughly the early 1970s, we exclusively focused our hard measurement on visible matter and oriented everything towards that and based all of our actions and assumptions off of that. And then we come to find out over the intervening decades that that comprises probably about 3% of the entire universe and is deminimis compared to everything else. But we still, to this day, don't really understand dark energy. And we're still trying to figure out how do we measure this stuff and interpret it. And this is sort of the human incarnation of that as I hear you talk about it.
Speaker 2:You know, to know that lifestyle medicine is by one of the fastest growing fields in health care in the states, many of the institutions that are are providing health care in the states are now starting to incorporate lifestyle medicine into their training. It's coming into residency programs. Harvard has an Institute of Lifestyle Medicine. This is a board certified specialty. People actually get educated, like they get training on it, they have exams on it.
Speaker 2:It should be a lot easier now to find lifestyle medicine physicians within your own community if you wanna engage with them. For physicians and providers that might be listening, the American College of Lifestyle Medicine actually has a 5 and a half hour CME, on the fundamentals and basics of lifestyle medicine that as part of their kind of contribution to healthcare, they're providing it fully free of cost. You can start off with 5 and a half hours of free CME that actually go towards, your certification anyways. So providers can get access to that just by going to the ACLM website. Patients can learn more about it and and get access to providers through the ACLM website.
Speaker 2:There's actually a listing directory listing of doctors Mhmm. And health care professionals.
Speaker 1:That's awesome. And we'll put some of that stuff in the show notes so that people can navigate to it. If they wanna navigate to you personally, a rogue, I'd generally find you guys online, social media, etcetera. Where would they find you?
Speaker 2:So our website's aroga.com. My email is jazdeep@aroga.com.
Speaker 1:Oh, that's a brave share. That's that's great. Closing question, same for every guest, but our audience are not passive observers. These are the humans in the arena. In many cases, they're the humans creating or carrying out policies serving the public interest.
Speaker 1:And if you could leave them with just one thing, it could be a quote, a book, an anecdote, a concept, anything at all that would best resource them to be a vector for healing our politics, what would you leave them with?
Speaker 2:I think it's important for people to experience health in their own lives first and foremost, and whatever dimensions that is. Right? So if it's, you know, physical mind, body, spirit, all that, take your own time aside, treat yourself well. Putting yourself first in your health is not necessarily selfish, it's self full. And people in political arena probably are getting into that arena because they wanna do something for others.
Speaker 2:Yeah.
Speaker 1:And
Speaker 2:they're always giving of their energy, giving of their time. Just like, you know, the heart is one of our most important organs because it pumps and it gives blood to the rest of the body. Mhmm. If the heart stopped relaxing and filling itself up first before every pump, we would die within minutes. Mhmm.
Speaker 2:Right? So stop. Fill yourself up.
Speaker 1:Yeah. That's as beautiful of a place to end as anything, Jazdeep. Thank you so much for your time, your wisdom. You channeled your mentor and pastime well here today.
Speaker 2: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 is like, wow, that's incredible. It's an honor to just be associated with you and the work that you do.
Speaker 1:Ditto. Ditto.
Speaker 2:Take care.
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