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0:00 your mission at the moment to myth bust and call out disinformation as it relates to Health Care let's get into that okay Dr Mike verski he's the actively practicing medicine doctor with over 25 million followers who's created one of the largest health education Platforms in the world Dr Mike what's the key to finding a diet that's going to stick there's two real things that you need to think about one calories in and calories out is true second and this is important you need to have what about the prevailing narrative that if you want to lose weight you got to get on a running machine nutrition that's where the majority of the change will come from what's the Medical Advantage if I go to the gym every day literally everything else is vaping dangerous yes and no one knows this by the way this is why I do what I do but the more dangerous part of it is what's your p on
0:46 supplements they will make you skip on doing things that are healthy for you and supplements have side effects you have too many of them we notice that they but no one talks about that because you can't really sell that and then considering you care so much about your health why would a doctor to choose boxing cuz I unfortunately lost my mom to cancer to ask the doctors to stop doing chest compressions on your mom that is not something that I wish on anyone and I got into a very unhealthy mental state so boxing chose me instead of me choosing boxing in the circumstances that you lost your mother where she was giv the all clear yeah did that experience change your perspective of the medical industry in any way
1:33 we've just hit 6 million subscribers on the D Co um so me and my team would like to do something we've never done before as little thank you and we're calling it The dire coo subscriber raffle and here is how it works every episode this month we're going to pick three current subscribers at random and we'll send one of you a 1,000 voucher one of you tickets to come and watch the D behind the scenes live with our team and one of you will have a 10-minute phone call with me to discuss whatever you want to talk about if you're a subscriber you're in the raffle thank you from the bottom of my heart for allowing me to do something that me and my team love doing so much it is the greatest honor of my lifetime and I hope it I hope it continues uh off into the Future Let's get to the [Music] episode Dr Mike considering everything you do from
2:20 your podcast to all of the content you produce across your channels to the stuff you do in TV everything social media all of it how do you summarize the overarching mission that you're on at this in this phase of your life the mission is largely to make sure that in the sea of misinformation my patients my viewers are getting the most honest transparent and engaging information so that hopefully they can make the best decisions Healthcare wise for themselves and their family members why do you care when I was a medical student I would go into rooms with patients and they would
3:05 be being seen by some of the top doctors in the world I mean experts upon experts credentials published work and the second the doctor would walk out after presenting all this accurate evidence-based information the patient would look at me as the med student and say what did he say or what did she say and I realized that the message wasn't hitting home and I realized we need to do a better job as communicators in the healthcare space and then I said well TV must be the answer media training must be the answer and then as I became a practicing physician in my residency program I started seeing people being influenced by those TV physicians in the wrong ways they would be promising Miracle solutions to any problem they
3:52 would be having snake oil being sold to them they would think that they can skip out on taking their medications or going for treatments or making Lifestyle Changes because of a solution proposed to them for three easy payments of 1999 and I said oh man not only are we not great communicators but we're being edged by people who are trying to make a profit in that in this Health Care space and I viewed it as a mega problem I remember in 2017 I wrote a blog post for the American Academy of family physicians and I said the lack of evidence-based Physicians Online is is going to create a world of a difference in our patients lives it's going to allow misinformation to come in especially in this section I call the
4:39 gray Zone where modern science doesn't yet have an answer to certain medical problems to certain medical conditions and they're going to come in and promise you Solutions and they're going to be quite successful at it what happened three years later covid-19 pandemic misinformation pandemic people confused not knowing who to seek out for information and for some very strange reason a doctor with only 5 years of experience uh after a residency was the number one channel on YouTube being watched and giving the answers when people were not watching the CDC they weren't listening to True experts in said they were falling for misinformation online and I had to be there to set the record straight I couldn't believe that that happened for people that might not know
5:26 who you're referring to when you cite that doct doctor that is you you reach a lot of people every month you have 12 million subscribers on YouTube now you have other channels with you millions of people following you across the board and that's happened in quite a short space of time what is it about you that you think has been so resonant with so many people as it relates to sort of medical information and spotting disinformation I think it's not one thing much like in healthcare this would be a multifactorial situation I think when I first started the reason why I got popularity was because I was an early adopter of Instagram and I would share my medical Journey uh of being a med student mostly because I wanted to show people that you can have a life a
6:12 social life a family life a sports life and still go through medical school because I felt like there existed this stigma you have to give up everything to study medicine and while I was doing that I got some followers on Instagram and at that point having 10,000 followers was a huge win because it was so new and being a broke medical student to go to a club and say oh my God I have 10,000 followers let me in without paying the admission that was a win then fast forward just a couple years later I'm in my residency program BuzzFeed writes an article and they didn't write an article about me being the youngest doctor in my hospital they didn't write an article about the fact that I did some medical research they didn't write about the fact that I was passionate about putting out accurate info they the title of the article was
6:59 you got check out this sexy doctor and his awesome dog and I'm like oh that's silly no one's going to read this I thought it was cute I'd send it to some friends and then boom that was the moment everyone was going viral and it seemed like every Outlet in the world was reaching out and when I say in the world I'm not exaggerating like Outlets from the UK from Budapest from Asia from the every possible Outlet here in the United States was calling for an interview and I very vividly remember all the talk show hosts were reaching out and I had no idea about this world that there existed so much competition where I remember the Ellen degenerous show folks reached out and they said if you do our show you can't do the Steve Harvey Show and Steve Harvey reached out and said
7:45 you know if you do our show you can't do their show I talked to some friends I'm like all right I'll do the own degenerous show I think that'll be a cool opportunity and they do the pre-interviews I meet with the producers I tell them about what I'm passionate about and the day before filming they call and they say hey we have some news Hillary Clinton is announcing her bid for the presidency of the United States and she's doing our daytime talk show as the first talk show and like the other guests were like pink and Jimmy Kimmel so you're the one getting kicked off and I said no biggie I'll go on Steve Harvey so I called Steve Harvey's people back and they said oh no that was two weeks ago we're not interested anymore and it was such a wakeup call where the 15 minutes of fame statement was true you were hot for a second people were
8:31 interested about this unique story and then they move on but I said no way I I still have to push this because I viewed it as an opportunity to get people to care about the information but drawing their attention to something else first if you look at who's successful in media 20 years ago uh in the healthcare space it would be unfortunately people who corrupted the health information for the viewership and it feels like you often times have to corrupt something to get views and I felt that if I could corrupt and have people come for the scandal of sexy doctor but when they come for that I instead give them some accurate information or maybe have them come for some comedy and give them some health
9:17 information that was a way to get people interested because if we're being honest Healthcare information textbooks science it can be boring if you're not passionate about it but if you can present it in a way like some of the amazing teachers that I've had over the years in a way where it's fun it's engaging they make it um almost like a journey that you're going on suddenly you pay attention you have a few takeaways and then from those takeaways you're better equipped to handle some of the things that could come up with it during life and I really took that to heart in the beginning and over the last five years I've really studied what marketers have done so well in the commercial space or what those snake oils salesmen have done so well in pitching their misinformation and take
10:03 those same principles but bring them to evidence-based medicine allow people to have fun while they're learning there's a lot of information out there as it relates to health what is your sort of framework for deciding what you share and how you share it when there's so many a lot of these studies as well the the methodology of the studies is often hard to trust because of the way that that you know certain studies where they look at kind of they don't isolate one variable so you look you look at the study and it could be anything they say you know they you hear these studies about like veganism for example where they say veganism is is healthier but that doesn't remove out all the other factors in that person's lifestyle maybe okay maybe they're they're eating less meat but it's processed meat that they're having with fries and hamburgers Etc so how do you
10:48 what's your framework for deciding if something is true in a SP in a sea of information every time I look at some new research I treat it differently than most people would in the media space and I also treat it differently than an individual would treat it so if you're a news outlet and a breakthrough study comes out they treat it like it's the answer to people's problems like it's the new and best I take that research and I apply it to the existing data and knowledge that I've gotten over the years through my medical education and position it in where it belongs so some research comes out it might make me lean
11:36 in saying we need to move closer to a plant focused diet it doesn't mean that everyone needs to be on it doesn't mean we need to eliminate everything because in medicine extremes are rarely right even when we're talking about optimization you'll hear oftentimes people say oh you can boost your immune system you could hyper optimize this no no no hyper optimization is Extreme whenever you're going to those extremes you start creating problems because that's how the human body works it works in homeostasis it wants to be balanced and the enemy of balance is bad but also perfect so what do you make of this optimization longevity anti-aging live forever culture that's emerged in the last couple years I understand where it's coming from uh We've made a lot of
12:21 scientific progress we believe that we should have the answers to the one problem that is facing all of us and that's that life is not forever but I feel like the field has been corrupted and it's actually the way that healthc care has been corrupted across the board so when we talk about health insurance the Pharma industry anti-aging industry a lot of it has been corrupted with capitalism and I take and I say that as someone who's actually Pro capitalism but I believe Healthcare is a commodity that cannot be lift I love the idea of being able to call something on demand doesn't quite work for healthcare you demanding what you want for your body when you're not
13:08 the expert doesn't always yield the best results we've seen that time and time again I see it with my patients when they come in and it's very clear that they have a viral Illness but they demand antibiotics or they demand uh a medication that's going to help them live longer doesn't exist we don't have yet the evidence to sell these things to people to explain them to people but there will always be a person who will take some new information some preliminary data data from an animal model from a petri dish and sell it as the next great thing this happened with the Fountain of Youth this happened with literally snake oil hundreds of years ago and now it's happening but with the power of social media and the fact that this misinformation a lot of times is
13:55 Insidious you don't realize that it's so bad and so problematic because what it's doing is it's actually tricking people into not understanding how science Works how when we put out a hypothesis an idea of what we think could happen we actually strive to disprove our hypothesis so if I say this glass of water here will help you live longer I will actually as a scientist want to set out to prove that it doesn't and I will think of every way and I would bring on people to disagree with me and find ways that we could test that this doesn't work but right now on social media what you see is a lot of people just supporting what agrees with them what are some of those ideas that have proliferated across social media that irritate you the most and you think are
14:41 most harmful I think the ones that create certainty in an uncertain world and I think that could apply to pretty much any field I talked about the gray Zone earlier and I think the gray Zone has changed 30 years ago the gray Zone was weight loss yeah and if you put on any TV channel especially late at night there would be a fat burner there'd be some grapefruit diet or some next great thing that someone came up with but everyone forgets about all that people used to sell you nonsense to try and help you lose weight and all of it didn't work it was not healthy even if it made you lose weight it was in an unhealthy way it ended up creating and fueling this almost eating disorder like cycle for most folks and then came out
15:28 some medic s like OIC and people started actually losing weight with an FDA approved medicine that had Real Results now you see less of those fat burner ads but you see more of a new Gray Zone anti-aging science doesn't have an answer to stop us from aging we don't have the answers perfectly to our genetic code but boy there will be a genetic test for sale that will tell you exactly what you need to avoid but the reality is we just don't know and it's not sexy to say I don't know but I've been passionate about encouraging folks to celebrate those experts who come in and say here's what we don't know but here's how we're working to get to those
16:13 answers because that's what gets me excited there's so many breakthroughs being made in medicine and we don't talk about those honest breakthroughs because they're not always exciting but if we could pair it with something cultural if we could pair it with some comedy with some fun I think we can get in front of a lot of eyes one of the first things you said there was was about weight loss in a zmek and it's a incredibly relevant and um widely discussed subject at the moment as zmek I I listen to the research on a zek and I am someone that typically has a bias towards not taking medications if I can and pursuing a natural route and and that is what we do too yeah which is understated in most uh circles
16:59 as doctors yeah yeah so our training for example if you look at our we have a reference called let's say up toate it's a medical platform where we could go and get guidance on any medical condition and it could tell us what the epidemiology is who gets sick with it uh what is the diagnosis that we should do to try and make it like what Laboratory Testing what Imaging we should do uh What treatments work first line Second Line third line Etc if we look at pretty much any crime disease treatment whether it's high blood pressure um sugar management from like diabetes all of the first steps is lifestyle modifications that's what we're taught is that because of the type of training you had doctor you became or is that all
17:45 medical doctors that is all medical doctors but what ends up happening is twofold one patients love a shortcut they love having a medication potentially do the work that they may not be able to or don't want to you know it's difficult to generalize here because some patients truly have difficult lives they have three jobs they're a single parent they're uh having a mental health crisis so they may not be able to do those lifestyle changes but then there's a portion of us who could do it but prefer to take the shortcut and that's pretty human of us we we would like to get the shortcut we would like to take the edge is there such a thing as a shortcut in healthcare
18:31 no and I heard you actually say it on your last podcast uh covering OIC that there is no shortcut there are side effects and trade-offs to everything and you're absolutely right in that there is no such thing as just something that is all good hydration you can't live without it over drink you'll throw off your electrolytes you could damage your brain you could lose your life carrots healthy food I would say eat enough you'll turn orange same thing goes for medications and that's why when people go and villainize treatments medications supplements it just depends and there needs to be Nuance it's too hard to paint medicine with a broad brush but social media makes that really
19:17 tempting that that non aemp path if I'm not going to take the the new sort of fat burning magic pills or the appetite I guess I guess they suppress appetite um magic pills that becomes another a bit of still is a bit of a gray area in many respects because we on the drug side of things people now have an option that's FDA approved but if they don't want to pursue that path there's still all of this other information around okay I want to lose weight and there's lots of opportunity for a lot of people to present them with Solutions there's a there's a roaring debate around calories which seems to just be never ending and um I wanted to get your take on that if if someone was you know in your training when you've been advised to suggest Lifestyle Changes first and foremost if I'm trying to lose a bit of weight I'm
20:02 you know at risk of being diabetic or something what would you say to me as your patient it would be hard to generalize it because it really depends on what pre-existing conditions exist what have you tried thus far what works what do you have time for what do you have budget for on that point of tried thus far why is that why does that matter so much if I have a patient who's tried dieting and failed and I don't ask that question and I recommend dieting they may not take the advice they may nod because they want to be a quote unquote good patient and leave and say not doing it but if I ask that question they can say they tried and failed then that gives me an opportunity
20:49 to ask what exactly did they try did they try some really restrictive diet that's out there carnivore keto what have you and that set them up for fail something that wasn't able to be sustainable whereas now I can explain that hey the thing you tried actually set you up for failure and here's a more reasonable recommendation that we can try and now I can actually be a doctor that recommends a dietary modification that could help them what's the key to finding a diet that is successful from your experience what are the like the foundational factors of that diet that's going to typically make it stick there's two real things that you need to think about when it comes to dieting one is its impact on your weight because
21:35 calories in and calories out as non-sexy as it sounds as clinical and cold and heartless as it sounds is true second you also need to think about the nutrients in your food because if we just take one of those parts and ignore the other we can get into a really bad place I can uh even see those grapefruit diets that people say like eat three grap fruits a day and you'll lose weight yeah you will because you're underc consuming calories but is that healthy from a nutrition side absolutely not on the other side is you can get enough protein enough nutrients but if you're overeating calories you can get into a metabolic problem where now you're carrying excess weight and increasing your risks of all sorts of conditions so the goal is to get you in a place where it's balanced in both a caloric weight
22:23 management standpoint but also an ideally a healthy nutritional balance as well well and what that means personto person is going to vary it's going to vary based on the medical condition they have some patients who are anemic may need certain nutrients that someone who's not anemic doesn't need someone who's prone to kidney stones may need a slightly different diet than someone who is IBS prone so we need to always take into account that generalized advice isn't great when it comes to Health Care especially when it's very easy to create Buzzy statements from truth in healthare like I said on a podcast not too long ago that exercise for weight loss Almost Doesn't Matter and that's a buzzy statement because on one
23:10 hand it's true but you also need to pair it with some nuance and say exercise has so many benefits outside of weight loss of why it's important to participate in exercise and the idea of weight loss needs to come from nutrition that's where the majority of the change will come from Super interesting cuz I've sat here with so many people that have said that to me um they've said that when you look at a lot of the studies exercise as a if you if you give prescribe someone exercise to lose weight they probably won't lose weight um but I would definitely say that in culture people see exercise as the many would see I reckon the primary way you lose weight they think you have to go for a run to lose weight and and
23:57 again you've Express the Nuance there but I've even I've struggled with understanding that because over here people say exercise isn't super useful for weight loss in the studies but then the the prevailing narrative in society is that if you want to lose weight you got to get on a running machine that's because they're equating in their minds Health with a magazine cover and health is not a magazine cover they think that you need to have big muscles to be considered healthy and while you can have big muscles and be healthy you could have big muscles and be tremendously unhealthy so just looking at someone's appearance doesn't give you the full picture just like looking at someone's weight doesn't give you the full picture you need to know more and when it comes to exercise and
24:45 weight loss let's just take for a very simple example I used to go to the movies when I was a kid I loved it I did it all the time it is not unusual to eat a tub of popcorn a little candy bar and a soda well over over 1,000 calories do you know how hard it is through exercise to burn off a th000 extra calories most of us are not physically even equipped to burn a th000 calories during an exercise session so it's just about the science of not being able to out exercise a bad diet what if I just eat loads of salads I think I've been in that mindset before where I thought well I it's just really I could have well I've been in periods of my life where I've just just eaten more and more and more good stuff quotequote good
25:31 stuff things that I thought were good um but I also didn't lose weight you are you're a really smart person you're a person that wants to be as effective as you can in your podcast in your communication style and you're amazing at it you want to do the same thing with your diet and the hacks and tricks that you use in your business mind in your communication mind don't work for healthcare you cannot find the shortcut of the salad that's going to fix everything that bothers you of the probiotic Miracle supplement it's not going to be there that's why some of the minds that actually end up falling for the most simplest forms of misinformation are those who are really good at
26:17 business because the things that work very well in the business world and the communication space don't work in healthcare because Healthcare is not a commodity healthare does not work well with extremes you cannot do something so good all the time without it having negative repercussions you want to be good not perfect when it comes to healthare and the more you try and Chase perfect number one you're going to get the negative response but also number two you're going to create anxieties worries that are also toxic to your body you have to be very careful so perfect is not only Just an Illusion it's a toxic illusion I saw someone talking recently
27:02 about the calories in calories out thing and the first comment was a lady who I think had a pre-existing condition basically saying because my because of my pre-existing condition the calories in calories out thing does not work for me I've tried it and then the health influencer responded and said it works for everybody both statements are true okay dialectics are common in healthcare we're two opposing ideas can both be true someone can try and do calories in calories out which through science works but the application of it can fail well I'm thinking not about the application and like the science of it is it regardless of whether I have a pre-existing condition not
27:49 regardless pre-existing conditions is part of the application okay the individual is part of the application I think she was making the case that because of that existing condition that the maths of it don't apply to her like it doesn't actually work on her body it shifts versus the applic okay it absolutely shifts and that's the truth for most medicine like when I try and get my patients into a healthy blood pressure range because we know that uh having a resting blood pressure above a certain number predisposes you to having risks of heart attack stroke all these cardiovascular conditions when I treat them with a medication after lifestyle changes either didn't work or they weren't able to go down that route
28:34 we have this really unique knowledge public healthwise we know that controlling the blood pressure on a large scale will lower deaths significantly we'll lower heart attacks significantly but by me medicating this one patient I have no idea if it's going to help this individual exactly but that's because all we're doing in medicine is doing our best with the limited information that we have on hand closing off on that point about exercise so if if we shouldn't be thinking about exercise as a way to lose weight what what is the sort of Medical Advantage the physiological Advantage for me if I go to the gym every day and I'm I'm active literally everything else if I could bottle the effects of uh
29:21 exercise and sell it richest person on Earth happiness mood social connections strength ability to decrease cancer risk decrease uh increase ability to fight off cancer increase longevity literally everything else is the benefit of exercise and I say that as someone who's been very exercise focused but over the last few months I've kind of fallen off I've gained some weight I haven't been exercising as much as I want because sometimes life gets hard life gets in the way things become problematic mental health sometimes takes a struggle and we need to be aware that that can happen the idea that we need to make every person perfect or if they're not perfect
30:08 they failure that's such a dangerous Rabbit Hole to go into how much exercise going to vary person to person General guidelines say 150 minutes of moderate intensity exercise per week which isn't a lot two and a half hours um moderate intensity meaning that you shouldn't be able to speak full sentences maybe one sentence at a time until you're out of breath is a simple way to put it when you you um have such a broad view on medicine well I noticed that in your content I was like this guy really knows he really has a real much more Broad View than the neuroscientist I spoke to yesterday who's really focused on you know maybe one part of the body with that broad view what are you concerned about in terms of macro social trends the direction of travel
30:55 that we're going in with our health we talked about misinformation and disinformation but but actual realities of the Western Health Care condition first of all I think it's important that we have both individuals participating and having a seat at the table the broad view primary care physician and the single point expert neuroscientist like you had on your podcast before me we need both in fact where I'm able to gather my information from is from all those researchers that are putting in those hours at the bench making sure that they're checking their biases showing the flaws of their own research without them I am nothing right like where did I get my knowledge from from them so we absolutely need to do this in a teamwork approach I think the
31:42 big problem that we face today is two things one the loss of trust in our health care world that's huge people don't trust healthc care advice they don't trust our agencies frankly the loss of trust of doctors has been rather shocking over the last decade and then second is it's more of a philosophical issue that I raise because I don't know where it's going to go where we've created this world of processed foods unhealthy Foods foods that it caus us to eat more and more and more and feel not satiated and then we've come up with a medication to solve that we've created apps that pull our attention spans that
32:28 allow us to focus 10 15 seconds at a time before we swipe to the next thing now a lot of people are requesting prescriptions for ADHD medications there's people who want to stay out all night and party and still maintain their physical gains they get on testosterone early when they don't need to how hyperm medicated are we going to get as a society to a point of actually harming us and I don't know the answer to it I'm not smart enough to know the answer to that but I think it's a good philosophical question to ask ourselves are you scared about what would happen if we had a pandemic that is 10 times more deadly than the previous pandemic break out now are you
33:14 scared because of that loss of trust the more deadly the pandemic a lot of times the less problematic it is isn't that weird oh okay so initial SARS virus was significantly moread than SARS Cove 2 which is the virus that causes covid-19 so initially when the reports came out about The lethality rate of SARS Cove 2 covid-19 we said oh well it's not as bad as SARS we'll be okay because most people with SARS got really sick they lost their lives but because asymptomatic spread was a thing with covid meaning that you could feel fine or maybe just have a sniffles and spread it it killed Millions more people and that's what that brings me back to that point of when I said
33:59 Insidious misinformation can be more problematic than true disinformation because when something doesn't seem so bad that can we can allow it to go much further and cause much more harm complacency can complacency and feelings of safety like oh well this one's not as Hill we're good I I feel fine we're good but when you look at it and you zoom out macro oh my God it's Wrecking Havoc across the world and I've actually equated this to vaping vaping is not as harmful as cigarettes on paper but because the odor is not as offensive it's easier to hide you could
34:46 do it much quicker and get a bigger dose because it feels like it's not as harmful many more people can get hooked on it is vaping dangerous yes why and how so many of my friends VIP I think three three out of my six best friends they're just like they're like they're just absolutely addicted they never smoked interestingly that's the issue of it that it gets people who maybe would have been turned off by smoking to try and the chemicals found inside are really rewarding to the brain nicotine being prime example of it and the more dangerous part of it is with kids who have a developing frontal lobe meaning that the part of their brain that is responsible for complex decision- making is not yet fully formed
35:33 so they're incredibly susceptible to anything that can build a tolerance a dependence uh an addiction to and it can change the chemistry of their brain moving forward so we don't want to make it easier for them to start smoking vaping should be used as a tool as a way of getting you off of cigarettes not as a way of introducing you to cigarettes or nicotine at all is it dangerous for adults as well if you're coming off cigarettes no it's a good choice but if you never all my friends that Vape never smoked yep it's not it's not something that carries value healthwise and can only potentially harm have they have they done any I guess it's super difficult to do studies on these kinds of things but have is there any studies that have been done around vaping yeah there's been vaping related lung injury where that's
36:18 its own diagnosis code now um there's been children that have been hospitalized with it um there's been even technical problems of the devices blowing up in people's faces so it's not the fact that I'm trying to fearmonger here and say vaping is the devil I'm here trying to explain that vaping can be problematic because on the surface it may not look as harmful by comparison Everything is trade-offs Everything is trade so interesting it's like when I see all my friends vaping they're all in we're all in Dubai a couple of about a year ago and I thought Poss me because they will have these little like disposable Vape things now so let me try I tried it and it was really nice and I thought oh God I could get into this and if it's not unhealthy CU like we all know that smoking is
37:03 unhealthy I thought you know your head you think oh what's the harm I could have so easily gotten to it luckily I just I'm always skeptical when I don't know the side effect I I would rather accept the side effects yeah and it be super clear than to someone say say to me there's no side effects when someone says there's no side effects I always well that's like the whole nature fallacy when someone's like oh but this is natural natural first of all what does that mean because like they say vitamins are natural but they're made in a lab I don't know how that's considered natural and also just because something natural doesn't mean it's safe arsenic cyanide natural but deadly the ADHD point you mentioned Y what are you seeing as a doctor you know over the last couple of years the the
37:49 term ADHD neurodiversity has seems to have become more and more prevalent everywhere I look it feels like I'm hearing a conversation around ADHD is that because there's been a social sort of heightened awareness to the subject and now people are getting diagnosed more are we creating more ADHD somehow or is it somewhere in between yeah I I assume it's something in between I don't have a clear answer to it uh I do know that neuro Divergence needs to be talked about more and that's not just from the ADHD perspective it's also from um autism spectrum disorder uh situation as well where it's folks are going to be different and some people want treatment for a condition others don't and we have to respect people's autonomy even when we talk about something like vaping if
38:34 an adult wants to vape as long as I can convey to them as their doctor the risks everyone's free to make their own decisions no one lives a life where they say I'm going to take no risks everyone has a different risk tolerance level everyone is comfortable with a different level of care in life some people want more care some people want less care even at the end of life I have discussions with my patients for end of Life Care often and a lot of times they're shocked by it they're like wait do you think something's wrong with me I'm 30 years old why are you talk this is the time to talk about it when you're healthy when you you aren't facing a decision that you have to make right now that's when you're going to be able to spend some time and think about what kind of medical care you want you know I'm a doctor here that became a
39:20 professional boxer A couple of years ago that is not healthy I do not recommend it it increases all sorts of risks for head and injury chronic traumatic incopy all of that is true it's a risk that I was willing to accept because I studied the risks I accepted the risks I don't doubt the risks but it's something that I'm passionate about and uh I wanted to go down that route enjoying it very much so it's a great outlet for me why did you choose boxing despite the risks yeah I would say that boxing probably chose me instead of uh me choosing boxing I uh I did Taekwondo growing up so I was in martial arts for8 years and then um when I was in medical school I unfortunately lost my mom to cancer and that was a a
40:06 really strong wakeup call for me being in the medical field knowing what it's like to be in the room to ask the doctors to stop doing chest compressions on your mom I mean that is not something that I wish on anyone that's that's the worst thing you can experience especially when my father was there also a doctor who was saying no keep going but I knew was futile I knew we were causing more harm and in going through that journey I got into a very unhealthy mental state I didn't leave my house except to go to class I came home I was socially isolated and after a period of 3 four months where that was going on I said I need to get out of this I need to take the my own advice that I give to people and take the advice that you need
40:52 to have action before you get motivation and the action that I took was to go on guilt City do you remember that app it's like a group ones app where you can get a coupon to a a class and I got a coupon for a boxing class and I went and did this boxing session and then I ended up boxing for 10 years after that session fell in love with the sport and then a couple years ago I ended up fighting on Showtime pay-per-view in front of an audience of 15,000 people wow and uh it's it's been a unique Journey so while it's easier to vilify boxing and say that it's problematic for some people if the trade-off is right it
41:39 might be something that uh they could participate in and it could be very healthy for them losing your mother for anybody I think is just something that is unimaginably unimaginably painful but in the circumstances that you lost your mother where from what I understood she was given the all clear at one point with her yeah so um she had this unique form of cancer called CLL and this is usually a cancer of old age where you get diagnosed with it and you end up dying of something else other than that cancer but she had a unique more aggressive form of CLL where they needed to really ramp up treatment and her
42:25 treatment took a toll on her body like she did not look the same post treatment she did not feel the same but it was all in the hopes of curing this cancer and I remember very vividly I was I was going to Memorial Sloan ketering hospital to pick her up one day and she actually fell waiting for me at the waiting area so the doctor came down and talked to me and said maybe we should keep her observation for a day or so um but overall she's doing great she's just very weak from the treatment and he shook my hand in that moment and said she's cured there's no more cancer in her body now we just got to get her to recover from all these treatments and that's the greatest news anyone can hear your hopes 10 out of
43:10 10 and just a few short days later her weakness got so severe that she got uh a very unique type of bacteria called gram negative in her blood causing gram negative sepsis spread throughout her body she required the use of Presser medication to artificially raise her blood pressure to prevent her organs from dying and it didn't work and unfortunately she lost her life and one of the hardest moments there was watching my father go through this who with my mom sacrificed their lives to bring us to the United States as immigrants gave up their lives he went to medical school for a second time in his life she went to University after having a PhD in Russia to learn English and be able to teach students math here
43:55 in the states it it was um it was painful to watch my dad go through it so I think for the first few months my focus was more on him than it was even on myself did that experience change your perspective of medicine and the medical industry in any way because in that moment a doctor a doctor turned to you and said your mother is cured and it wasn't the it sounds like it wasn't the cancer itself that did the harm it was the treatment for the cancer that did the harm I never was mad at the doctor for saying that it would have been easy to in a situation like that where you thought you were good but then it wasn't it taught me a lesson about how life can be cruel and take things away from you very quickly after just receiving good news I
44:42 remember sharing a a meme on my Instagram that it had like you colon I'm actually happy right now and then life colon hang on a second and that's kind of kind of how life is so it taught me to be able to bounce back from adversity and realize that you have to put one foot in front of the other while still being able to feel because repressing emotions in the short term is a valuable tool you know if you're unable to function in terms of high stress in the moment you could lose your life you could make a really bad decision you could harm others you might not be able to successfully
45:29 hold down a job but if you do that for a really long period of time even that as a aute coping strategy can become toxic and I was getting into that point where it was becoming chronic and I was blocking my feelings of not mourning my mom not having the proper process and for everyone that process will be different you moved in with your father after that yep if I was a if I was a fly on the wall in that in that household at that time what would observed two gentlemen trying to raise a dog very poorly that's probably not what you expected but I um in trying to always find some kind of way to help um I
46:15 thought by helping my dad redirect his feelings towards something else um I got a Siberian Husky for him in that moment which we always wanted a dog even my mom wanted the dog and uh he took some time to travel to more in my mother's passing and while he was doing that I raised a dog a little bit for a few weeks got her at least potty trained and then when he came home she was there he was typical Soviet father yelling at me and telling me why this is a bad idea crying which I never saw in my father before obviously until the loss of my mom and um then he started being happy he started saying what should we call her his Focus shifted his Focus shifted
47:03 to going for walks with her which allowed him to think about my mom to not be locked into the house as so many people are when they're going through a rough time so while I think it was chaotic of us trying to raise this puppy together it gave us something to bond around in a moment of tough times there will be a lot of people listening right now that are maybe in the throws of that grief or the throws of Their Own sadness or depression for whatever reason right and it's um when you're in the midst of the storm when it's it's hard to see any way out and you said something super interesting which is you said you realize that like action comes before motivation yep if I if I'm someone that's in that situation right now and I'm listening what would you say to that person put on your
47:50 shoes they'll you'll go somewhere doesn't matter where you'll go Chim not Jim walk dog park you can go to a dog park without a dog it's therapy the biggest therapy that I think I've ever had and I've gone through traditional therapy was going to a dog park with my dog after my mom passed away it's such a weird thing but animal therapy is real and you know who actually gave me that advice speaking of Dragons Den um Barbara corkran oh really she said that the way that she gets herself to exercise cuz she doesn't like to she hates it she's very vocal about it but she says next to her bed are her shoes her athletic shoes that if she puts them on she's like all right well since I have them on I may as well go exercise
48:37 and that one little step creates that Cascade look will it work for everybody is this the Miracle Solution no but it's one step and even if you just do that one step and nothing else the next time it'll be easier to put on the shoes and maybe try for the second one putting on the shoes is hot as well when you're in that in showering is hard grooming is hard the basics of all Basics is hard that's why when I hear advice like go make some friends online when you're feeling down oh boy that's tough advice that's not easy so the putting on the shoes thing is simple in the sense of doesn't require others to be around you to judge you doesn't have any steps
49:25 after that just to put on the the shoes and if you're at that point seeking help from a medical professional is of utmost importance because we've put this stigma where if you go for mental health treatment you're somehow weak but if you go for treatment for a broken bone you're not weak that stigma doesn't exist for it and that's strange because both things can have problems arise with it especially from a mental health standpoint especially with the society we find ourselves in currently Society is the most unnatural that's ever been for humans how would you describe the journey you've been on with your own mental health I don't know how I would describe the journey I I would say just like most
50:14 people it's had ups and downs I would say the the thing that's really thrown me for a loop is the social media world of it all because of how unnatural that that is but I feel like a lot of people are working through that without even having a social media platform because at the end of the day these days everyone's a content creator right like when you make a video and it gets millions of views you kind of know what to expect being a content creator you have experience but Johnny Rebecca someone else putting out a video on their social media at 16 years old that too can get a million views and they're not ready for what comes with a million views in fact so many people
50:59 even in the medical community reach out and say how do I go viral I'm like do you want to go viral that's thrown your your mental heal through a bit of a loop yeah I was obsessed with it checking it all the time and I wasn't obsessed for it for the reason most people think I was obsessed with it from a place of growth I was like even if they're 99% BS there's some kind of truth there's a kernel of Truth there that I could take away and make myself better and you know there is truth to that I did learn a lot of things I did prevent some mistakes I've improved my content as a result of listening to negative feedback and criticism but I've had to in working with my therapist carve out moments where I'm not in a place where that's
51:46 acceptable for me right now where you just have to say this I'm not in a healthy mindset to look what was the symptom of the impact it was having on you um tremendous anxiety where you're just worried at all times and you're almost addicted to checking it because you want to be ahead of it you want to be safe you want to be able to think of a response and when you get to that point you're never letting your mind rest you're always in fight or flight and when you're in fight or flight you're not resting you're not repairing you're not getting good quality sleep even so I know how important that is I talk about it all the time but as I said you know we're all not perfect doctors are
52:32 probably the biggest Hypocrites when it comes to their own health I guarantee you some of the people that have come on your podcast that talk about sleep or talk about this they struggle with sleep they don't do those things just like how some advice that I give I don't follow to the tea my job is just to present the evidence so I know certain things that I should be doing better but just because I know doesn't mean that I'm going to be 100% following it all the time this is interesting thing that I I was just thinking about as you're saying that that um at like a philosophical level I think we're all kind of just passing our anxiety on to someone else like it's like energy cannot be destroyed and must be transferred I I noticed this because on my podcast I have multiple guests that often disagree with each other and if I was to do a map of how those people are feeling they're all suffering well
53:19 that's just Humanity as a whole they're all like really suffering and sometimes those people are suffering because of someone else who suffered and then because of someone else's it's almost like this this chain of suffering because of misunderstanding a variety of different reasons but I think as you say Humanity as a whole the person that's leaving those messages or you know attacking you is probably also suffering in their own way of course it's a real shame but I can't see any way out it's it's a like the circle of anxiety is an artistic way to put it for sure um but I think there's there's some truth to it you know uh even from trauma the odds are that if you've experienced a traumatic childhood that you will also potentially cause trauma to others goes up that risk does go up and that's also
54:05 pretty Common Sense even if you're not looking at the medical research you could just say that if you've been hurt ozar you can hurt people what do they say hurt people hurt people too right um I think that that's like uh that Common Sense logic that does get it right what's the um did your therapist give you any advice that's proven to be useful well the advice that you put perfectly in in place of logging off not looking at certain things at certain times of the day like literally I had to completely shut off my phone at certain times of the day because otherwise what happens is I would get into the cycle of okay I just finished in the hospital I just filmed my video for the day now it's sleep time and just before going into bed let's check my phone one last time and search the social media sites
54:51 what people are saying and it's like why that's ultim Ely what I think probably got me healthier like not looking at it was very good in moments of Despair because during those moments I was just so fragile and it would not be a good time to look but really where it got me is what got me is don't look unless there's something valuable you're getting from looking at it so now if I'm in a healthy place and I feel like I'm looking and I'm doing some kind of preventive task I'm learning from it I'm like okay I'm looking at it but I'm looking at it with some kind of intention and that's actually true for all of social media I think um he was on your show as well Dr Robert waldinger who ran the largest uh the longest
55:37 running study at Harvard of Happiness talked about the different usages of social media how if you use social media passively and you just look and consume it can be rather disheartening and make you unhappy but if you use it to form a community to learn from it to better yourself suddenly the social media may not have as bad of a health impact and can actually have a positive mental health impact so if I'm looking at the negative comments I'd have to do that check-in with myself of am I doing this because I'm actually benefiting from it or is it destructive in nature have you ever wondered if there's something about you that makes you more likely to look at that stuff or to care about that stuff I've often wondered about that myself yeah I I I
56:23 feel like I have I think it's a it's a pretty natural thing I think most people look um I think for me I derive so much value in the work that I do on social media because this was never meant to be a financial Venture this was not some Grand ideology that I had to make myself successful this was solely because of my frustration as a practicing doctor which the first question ever anyone ever asked me when I got into social media is like now that you're doing so well you must want to quit medicine right like you're probably out earning it yeah but that's not why I do medicine I work at a community health center most doctors that do really well on social media either leave medicine or maybe do concierge practice or you know
57:11 celebrity practice or something I work at a community health center where 50% of people don't have insurance so that's been my goal and social media is just a tool to help me with that goal and when I see negative comments I view it as a threat to that goal have you ever considered quitting social media seriously I pondered what life would be like um but I just viewed it as a negative all around not just for me I just VI view as social media such an opportunity to help people it's like me saying quitting medicine I don't want to quit medicine I I want to be there for people I want to be valuable and useful I in fact I think about myself as like a more practical useful person and every
57:56 strength that everyone has can also be their weakness so sometimes I'm too practical and that impacts you as a friend as a partner as a family member so sometimes being too practical is problematic but because of my practical nature I want to be useful to my patients so let's continue with this um this health related stuff supplements and vitamins I wanted to get your take on that there's a lot of you've mentioned supplements and a few times in this conversation is that part of the gray area is that snake oil what's your POV on supplements I want to say like one sentence that is all-encompassing and answers all those questions but it's really hard because there's just so much Nuance with it um
58:41 vitamins we can't live without them we need them supplements supplemental vitamins are not necessary the huge majority of the time and are often sold by people who are praying on Securities promising shortcuts and honestly people trying to get wealthy the evidence for almost all supplements unless you have a very specific reason for needing to take them is missing and what I've learned at through my 10 years of being a physician and the hundreds of years of practice of medicine unless we're certain of some benefit introducing new things
59:29 distracting people from things that work is not a good solution is the harm of supplements that they don't actually work again with supplements is a broad word so probably have to be is it the harm that they don't work or is are you saying that we should be getting all of the things that we're supplementing from our natural diet anyway or are you saying both yes and you can get all of your nutrients again unless you have a specific medical condition from foods to they will make you skip out on doing things that are healthy for you because you think you can take a shortcut three you're spending your limited health care budget that many people have a very limited health care Budget on things that are very expensive making a lot of
1:00:14 promises and the thing that I'm most worried about is when we enter the space of people saying you need supplements and not true Medical Treatments for conditions that bother them or that affect them if I'm someone that maybe I'm not talking about myself here but if I'm someone that has a very very limited diet just because of my lifestyle choices whatever would you recommend that individual to take a multivitamin supplement I probably wouldn't but if they did I wouldn't discourage them do they work that's what I'm trying to figure out oh and then the other point that I didn't mention is that there's harm like you said everything has trade-offs there's no such thing as no side effects so supplements have side effects they have interactions with medications they can create health conditions uh the term
1:00:59 antioxidants antioxidants are generally healthy uh you know B vitamins are traditionally labeled as healthy you have too many of them we notice that they become pro-inflammatory but no one talks about that because you can't really sell that so what instead gets talked about is the promise of what they could do but there's harms that come from taking supplements especially in our world where you know consumer labs and Consumer Reports goes and pulls supplements off the shelves to find out that they don't have the ingredients that are listed in them because they're not regulated by the Food and Drug Administration they have some ingredients at 5 to 10x what's on the label like vitamin A which is a fat soluble vitamin and can actually be
1:01:45 really harmful so they're not regulated they can cause potential harm their benefit unless very clearly indicated is in the air and not proven why recommend them why sell them and I say this as someone who can make a fortune I mean you said to yourself 12 million subscribers you know I take a little boxing selfie fit and say the reason I'm this fit is because I take whatever thing I bottled up in my house put into those pills whatever powder I want no one checks it and I could sell it and become a multi-millionaire is that sure that no one checks it no one checks it no one checks this no one checks it these supplements
1:02:30 no like right now we could bottle up on the table our Miracle formula we can call it a miracle formula yeah as long as we don't make a claim that it treats a specific medical condition that requires the treatment of a medical doctor okay and I just put buzzwords on it so instead of saying this helps your depression I just say depression immunity support just buzzwords feel good feel good happy happy natural simple from the earth we could sell it how much we don't have to get anything we don't have to get anything cleared by anybody how much you think we'd make too much money and that's why it's like man I understand why people do it and there is the notion that they could potentially work there's always like a
1:03:16 little bit of evidence coming out that're just going to cut break for miracle M which is on it's so tempting I get it and I get there's also I don't want to label everyone with a broad brush and say they're evil and just trying to make money some people do believe that they work they they want the belief that this is what alss us as a society and I wish that was true I wish it was as simple as giving people some supplements or that eating eight almonds a day will extend your life by 10 years I wish that was the case um the subject around gut microbiome is something that I've talked about a lot on this podcast because I've just had a lot of experts talking to me about subject and something that I didn't even know existed three years ago I didn't realize there was loads of bugs in my belly
1:04:01 um there are prebiotics probiotics all of these things coming out now for to enhance the what do they call it it's not gut Flora is it microbiota encompasses all of it is there truth that prebiotics and probiotics are useful for well there's truth in the fact that we have all of these living organisms inside of us there's a very strong interconnectedness between how we feel disease conditions and and what species of those bugs exists in us the counts by which they exist that people who generally eat specific foods that are rich in them may have better health outcomes than those who don't but manipulating those bugs has not been proven or clear in the majority of ways that people promise they do like we know
1:04:49 consuming fiber correlates With Better Health less negative health outcomes do we know that taking a Prebiotic supplement does the same we don't know do we know that having specific bacteria in the gut gets destroyed if you have a health condition we do know that but does that mean reestablishing it by taking it in a pill will fix that condition we don't know that but people will make that jump and say no big deal we're trying to help but to me it's a big deal because we're promising something that we're uncertain of without even some good evidence for it there's very few conditions that probiotics can actually help with well what advice would you give someone that
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