#814 - Doctor Mike - Reacting To The Rise Of Anxiety, Microplastics & Antidepressants 01:40:02

Hello everybody, welcome back to the show. My guest today is Dr. Mike. He's a family medicine physician and a YouTuber. There is a lot of information in the health space. With so much data out there, the huge challenge then becomes how to discern actual, real health advice from fake bro science claims. Thank you so much for joining us.

Thankfully, Mike has a very illustrious career as a doctor and also 12 million subscribers on YouTube. So if anyone knows, it should be him. Expect to learn whether there is really an uptick in adult ADHD diagnoses, whether SSRIs are still being overprescribed, the worst beauty trends Dr. Mike is seeing at the moment, the problem with microplastics in men's testicles, which health trends we will look back on in 50 years with horror, how big of a change Ozempic will make in the health space.

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Head to drinklmnt.com slash modernwisdom to get a free sample pack of all eight flavors with any purchase. That's drinklmnt.com slash modernwisdom. But now, ladies and gentlemen, please welcome Dr. Mike. Dr. Mike, welcome to the show.

Excited to be here. Let's chat evidence-based medicine, my favorite. It's having a resurgence at the moment. What's it like being on that side of the fence? Well, you know, I feel like I was one of the early adopters doing this on social media because when I was coming about during my residency training, it was mostly people doing it on television.

And doing it quite poorly, might I add, in terms of confusing people or selling some miracle cures. So that's why I started social media medical conversations. And now it's just exploded into every different possible niche. Whatever you want to find online, there's a confirmation bias waiting for you.

Well, that's the problem. This multiplicity and the democratization of access to health information sounds great in principle, but in practice, what it feels like to a muggle like me or everybody that's listening is just confusion and an abundance of conflicting messages. Yeah.

Yeah, I think it's encouraged all of us to develop healthier skepticism, which I feel like before the age of social media, we might have been lacking. But now with the rise of AI, people don't right away see a video and assume it's real. In fact, they're more likely to say, is this real? Where is this from? Can I see the original video? Can I see the sources and the description of where the evidence is coming from? That stuff gets me excited.

One of the problems with that is when skepticism runs too far and when even credentialed experts know they're part of big insert your favorite evil organization of choice, big ag, big pharma, big food, big earbuds, big whatever. Yep.

I think in that regard, there's negativity if you want to find it everywhere. It's about understanding where that negativity lies and how it impacts people's messaging. So I think just broad stroking or broad brushing certain subjects in healthcare will always be an incorrect message.

So you can't say anything is all good or all bad. You can't say humans are all good or all bad. In fact, that's the first thing we really teach when we institute cognitive behavioral therapy with patients that are struggling with anxiety and depression, because it's very easy to get into this cognitive distortion of labeling things as all good or all bad, or this is a terrible catastrophe and it's going to end everything for me. Just because I got this C in my class, it means I'm a failure and labeling ourselves.

When in reality, if we just have a little bit of a pause, go back and think a little bit rationally with less of our emotional mind, we can go a lot further. And that's a lot easier said than done. That's why we need the help of some mental health specialists from time to time. Are you trained in CBT?

Not professionally or not officially, I would say, but I was trained by a family medicine institution that put a huge emphasis on

on mental health. We have a behavioral specialist in our faculty that consistently trained us, that brought in different psychologists and psychiatrists to conferences that would actually interview patients at these conferences to teach us how to be better in our interviewing techniques. They would watch our patient interactions, our encounters, and give us feedback on how to be better. So because of that, I have a much greater interest and understanding of how

I guess, primary care CBT works. And for me, what that means is a general introduction to CBT, a general introduction of why anxiety happens, how we can fight back against it from an evidence-based perspective. And unfortunately, many of my colleagues don't go that far and have to rely on specialists. And these days with our American healthcare system, the disaster that it is, it's near impossible to find someone in a reasonable amount of time.

Give me the overview of what you've learned about anxiety, treating it through CBT, what the evidence says, what it doesn't say. Yeah, recently we've seen the evidence show that the best quality treatments that exist for anxiety and depression, when we say anxiety and depression, we're really quoting from DSM-5. This is generalized anxiety disorder, a major depressive disorder. The highest level of evidence goes for a combination of

Mental health therapy, which means usually cognitive behavioral therapy or some other avenues, plus medications, which are usually SSRIs, but there is a whole range of medications that can work for individuals. Now, if you have a mild case of these conditions, which we use validated scoring systems and conversations with our patients to figure out,

We don't have to institute both simultaneously. It really needs to be tailored to the specific patient you're working with. So there's some patients that their case is so mild that we can just institute bibliotherapy and talking with me as a primary care physician. Bibliotherapy being reading some information, a book on the subject, doing some handouts from that book that is written by a psychologist on the topic.

And then the next level of that would be working directly with a therapist, getting someone on board to see them week in and week out. And then medications as another option as well, if their case is that significant. What's the book that you prescribe?

The most common book that I give to my patients is called Feeling Good by Dr. David Burns, who I'm actually scheduled to have a conversation with the next month, kind of on the forefront of the development of CBT and talking about how our cognitive distortions, which are

natural emotional reasoning part of our brain that we're all susceptible to can sometimes go too far and drive these symptoms of anxiety and depression in us and how that therapy can actually help an individual. And what I like about cognitive behavioral therapy and why I've been on board for

on recommending it for such a long time is that not only is the evidence for it great that it works, but it's also really rational. It's very reasonable. A lot of people think when we say therapy, there's some kind of woo-woo involved in it. And I say woo-woo in quotes because it's not really woo-woo. It's just a very practical way of thinking. And it doesn't mean that therapy is not going to make you

feel. It's not going to remove all anxiety or all depressive symptoms. The goal of it is to recapture some control so that when you do feel anxiety, it doesn't take you to that really dark place. That when you do feel depressed, you don't go to that dark place. And it's really a way of giving you back that layer of control. Are there some CBT strategies or techniques that you find yourself relying on the most? I'm sure that

there's times when a video goes up and the comments begin to light up and, oh God, here we go again. There has to be something that you rely on for yourself.

Yeah, this is, I guess, less of a CBT principle, but something that I force myself to do when I get into dark times is our brains are wired for negativity. There's great books on the subject called literally The Power of Bad or The Power of Negativity. And that's assumed to be the reason why we've survived so long, because we were constantly worried about the risks and threats around us. And now we're worried about the risks and threats around us.

Now we live in a safer place in comparison to a thousand years ago and therefore those anxieties are still present but a lot of times they're overblown and when you have a mind that's not moving meaning that you're not doing much you're not surrounded by stimulus you will experience more anxiety than the person who is busy doing something or that is facing a true threat and

And what I have to remind myself quite often is the positive things that happen. I'm not great at celebrating my wins, and that's something I've been striving to change for a long time. And it's not easy to change, but it's important to have some techniques ready if those symptoms or, I guess, situations arise where you do feel down. It feels like there's an adult ADHD diagnosis happening every day on celebrity Instagram posts.

Have you noticed an uptick among your patients too, or is this just famous people?

I think that there is a pretty fair uptick in it, whether that's recognition of the condition and more people being aware of it, whether that's patients coming in requesting treatment specifically for said condition and doctor goes along with it without truly doing a diagnosis, whether that's a doctor giving someone ADHD medication in order to help them from a performance enhancement standpoint, which does happen.

Hard to say what percentages those things fall under, but there's definitely been an increase in the diagnosis, at least, of ADHD. And the treatment for those who struggle with ADHD is amazing because if you're truly struggling with hyperactivity, with attention deficit, you can't maintain good social relationships. You can't focus while you drive.

You can't do well on tests. You can't get a good education. These are things that actually contribute to not just a shorter life, but a life that is less quality, meaning that you have true mental health issues that arise as a result of the undertreatment of ADHD. So the fact that we're treating people who are truly suffering with it is amazing and we need more of that.

What does a person on the absolute extreme end of ADHD look like? I think most of the people I've, my business partner in my productivity drink, James had an adult ADHD diagnosis, but you know, it's, I'm going to guess that it'll be mild. It'll be enough to be classified, but I'm going to guess it's mild. What does someone at the absolute extreme end of that look like?

Someone who can't sit and concentrate for more than seconds at a time, constantly having to shift their attention because they're unable to control it. And really, it's that lack of control that we'll probably come back to throughout this conversation where people struggle with ADHD who have a severe case of it.

And what's interesting about ADHD, it's not going to be just noticeable to the person. It'll be noticeable to their coworkers. If they're a student, it'll be noticeable to their teachers. They'll get in trouble more. They'd be labeled as a troublemaker in their class. Their parents would know about it. So a lot of times when we're doing these investigations, especially in adolescence, we give people

papers that allow us to do a scoring system for the patient, but also for those around them to get a better view of how they're interacting with their outside world. What's going on in the brain that causes that to happen?

overactivity. The exact specifics, we'd probably have to get a neuroscientist on board and give you those details. The difference between myself as what I like to call an expert of family medicine is that the advice that I give and my understanding of conditions is on a practical basis. How it impacts my patients, how we can help not just the individual patient in my room, but also the population of all my patients, of all people who are undergoing treatments or preventions.

So the specifics, I tend to not memorize exact molecules and names of chemicals unless they're specifically important to the treatment of my patient.

I've never heard family medicine before I came to America. What do you mean when you talk about that? It's your GP. It's your equivalent of your GP in the UK. The only difference is I believe that we also do obstetric care and I'm not sure that in the UK that is something that is done under GP's guidance. Obstetric care for pregnancy. Oh, okay. Gynecology as well.

I don't know if that's done by your GP. Yeah, maybe that is a specialist. There's pregnant women screaming into their AirPods at the moment. Okay, just going back to the ADHD, have you got any idea what's driving this? Because it seems there's always kind of a nod toward, well, you know, increasing smartphone use and, you know, technology and TikTok and shortening attention spans. But I

I don't know whether overusing your smartphone can induce ADHD. That seems like a very specific diagnosis, or whether it creates symptoms that are similar. Have you thought about how you sort of split all of this apart? It's very difficult to tease apart. One of the major questions that I ask my patients that are concerned about the diagnosis is whether or not their symptoms are present during all aspects.

of their day. So if they have trouble concentrating while in class, but then when they're hanging out with friends or even hanging out at a library or hanging out with their parents, they don't have those symptoms.

That signals to me that maybe this is something else going on, that they might not enjoy their time in the classroom, that they might be craving the dopamine rush that they get from their cell phones, especially in the way those things are programmed. There probably is something to be said about the epigenetics of it all. So epigenetics is how our interactions with our environment and how we treat our bodies, how it actually impacts our genes, right?

And there's probably something to be said with an individual who is constantly bombarded with this stimulus from our phones of constantly giving that feedback, dopamine rush when you get a like, dopamine rush when you get a comment. And that constant flickering, it definitely has some effect on our neurophysiology, the

The consequences of it, I think, remain to be seen. I think we need to study more of it because we on the front lines don't have perfect answers to all these questions. And that's why I get frustrated a lot of times on health podcasts because I frequently see guests come on and talk about things that they claim to have all the answers to. And boy, I wish that was the case because I could be helping a lot more patients if that were true.

Yeah, very interesting. What's the current state of prescription for SSRIs? Because I saw a study that came out, I think last year, talking about SSRIs kind of got thrown out of the window a little bit, that it seemed like the impact was only negligible. Then that got pushed back against it. What's sort of the world of SSRIs at the moment?

The world of SSRIs is that they're still very much prescribed. They're still very much first line indicated for major depressive disorder. In some cases, generalized anxiety disorder. I use them quite frequently. Do I use them on every patient? Absolutely not. I think they've been villainized. There's stigma attached to them. There's also misinformation about them constantly on the web.

I mean, there's even a popular, I guess you could call him a health influencer, Gary Brekka, who I've made reaction videos to where he talked about how these SSRIs work. And it just was like flat out wrong. What did he say? Scientifically about how they work. Hard to remember exactly the details, but it was about the mechanism of action of how SSRIs work. And the unique thing about SSRIs is...

It was a medication that we quite didn't understand the physiology of how they work. And yet we saw the positive outcomes. Initially, back in the day when these medications were coming about, we thought that depression was an issue with low serotonin in the brain. So then we put out these medications in trial form where they would increase the amount of serotonin in the area where they work.

And what we found is an improvement of symptoms over several weeks. And we assumed it was because of the increase in serotonin. Well, that's been disproven. And yet some people are still repeating that and talking about that.

There's now new theories about the fact that when your body sees more serotonin as a result of the medicine, it downregulates its response to the serotonin, which are the receptors that serotonin binds to. And the body actually, over a period of weeks, decreases the amount of reactivity to serotonin. And it's been theorized that that's a possible mechanism by which these medicines work. But we have to be honest here.

and transparent about our knowledge of what we know, what we don't know. When we claim to say like, this is how they work, we're 100% confident. We have to be really careful. And this is, I don't want to single out Gary Brekker here. A lot of people do this. In fact, we as medical institutions, the broader we, did this throughout COVID and it was a disaster for mass communication where a

Initially, I remember on my YouTube channel, we talked about how masking wasn't recommended because of reasons A, B, and C. That we were short on masks. We didn't think it would spread through the air. We thought it was droplet only driven. And then as time went on, we learned more and we changed that guidance. Luckily, and I guess fortunately for our channel, we were very clear about that early on and said this may change.

But there were some people in the major agencies, like the Surgeon General at the time, who was making fun of people for wearing masks on planes. And boy, did that end up hurting the public message because then people took that information early on and then used it to discredit his message later.

And that's problematic twofold. One, because I wish the messaging was different early on on his part. But on the bad actors front, they're acting as if science doesn't change, as if we don't learn new things every day and adapt our recommendations. In fact, if we didn't adapt our recommendations to new quality guidance, we'd be failing as scientists.

So I think it's a twofold problem that we need to discuss on both ends rather than just nitpicking or cherry picking one person. How difficult is practicing medicine in the wake of what happened through 2020? Government agencies and the CDC and all of these very famous, well-known medical professionals showering themselves in something that wasn't glory.

It's never easy practicing medicine, period. Because...

Medicine is science, but it's also an art. So you have to, at the same time, understand what's happening in a disease process, in the treatment process, but also understand how your patient is experiencing it, how they're understanding the words that you're giving to them, the options that you're giving to them, their financial situation of whether or not they can access those treatments. And that's hard at the outset.

but then throw on top of it a trash healthcare system that favors profits and private equity over patients. The mess that we had with COVID and the errors of mass communication, the rise of misinformation through algorithms and social media trends. Now our jobs have become exponentially harder and

I ultimately want my patients to have the best experience and to get the best treatment for them. But that starts with a good line of communication. And I feel like on our YouTube channel, that's what I've strived to do from day one, to make sure that anything that I'm saying comes from a sound financial perspective.

And then from there, if we make a mistake or if knowledge changes, we admit it openly and honestly so that people know that they're getting the real deal. And unfortunately, that's not always the case on social media. So that's why we're kind of out there debunking and doing what we do on our programs.

When you said that it's a trash healthcare system that prioritizes profits over patients, as someone who still, I've only been in the US for two years, many people might not understand how the US healthcare system works and goes wrong. What is there to know about that? We have a hybrid system, meaning that

There are some people who get government-funded insurance if they're over a certain age, if they fall below a certain poverty level, they get covered. And if they have certain disease states, they get covered. Then there's people who get insurance through their employer. Then there's people who buy individual plans and just get coverage for themselves. And this hybrid system is incredibly messy.

And I don't yet know if there exists a country that is as big and diverse as the United States that has gotten health care right. Because I hear complaints from Canada. I hear complaints from the UK, all the issues with the NHS that's going on. So I don't yet know who has it all figured out. But definitely the direction that we're going now.

Towards is more problematic, and I'll explain why. You're a sharp individual. You're a business person. You understand how companies work. Their sole goal, especially if they're on the stock exchange, is to not just have a profit, but to grow said profit.

And the way that this works these days, especially when starting a business, we frequently hear, oh, this person made an exit of 10 mil, 100 mil, one bill. And we all envy those individuals. Well, what we're not seeing is the back end of that problem where an exit means that they're exiting to a larger company that is buying that information, that data, that process of however they generate income.

And then they're trying to streamline it as much as possible by maximizing profits and getting rid of waste. In some instances, amazing. I love getting my product shipped to me faster. I love being able to access certain things quicker. There are some avenues where this is great, like the on-demand car sharing option is amazing. Then there's some instances like health care where it becomes a disaster.

Because, for example, in the United States, we get outraged when we find out police officers have a quota of how many tickets they have to write. We go on the news and we say, oh, it's not right. They're just giving tickets just to give tickets because of quotas. No, no, no. The real problem is doctors have quotas of how many patients they have to see in order to get paid.

What? What if I have? How many times have I had a patient that was scheduled for 15 minutes that comes in with a stomach ache? And then I find out their loved one just died, that they got a recent diagnosis of brain cancer. I'm not walking out of that room in 15 minutes. You have to be a human as much as a doctor.

And when you see how often those things happen in an exam room, you understand that putting a quota on health care is just flawed from the start. And the sad part is private equity doesn't care. It's whoever is going to drive those growth and profits. That's who they're going to pick.

And that's why the things that private equity has jumped into the most when it comes to health care are things that are scalable. Telemedicine, urgent cares. There's one popping up on every corner. And young people think, oh, urgent care, it's awesome. I can go get treated quickly because it's quicker than seeing my primary care doctor where there's a wait. In some instances, true.

In some instances, relying on urgent care as your form of primary care is not good long term. You're not establishing a relationship. The doctor doesn't know you well to help give them the best advice for what works for your body, for your mind, the best way to explain a treatment to you.

to calm your nerves when you're going through a stressful time. Long-term continuity of care is better than just band-aid, band-aid, band-aid, band-aid. And unfortunately, the young people of our country, the millennials, the Gen Zers, have largely relied on urgent care to get their treatments, to get their primary care. And that's

That's no bueno, Chris. It's led to a lot of disruption in our healthcare system. And I can't even blame them because if you call a good primary care doctor and you ask to be seen same day, that's like you get laughed at by a receptionist. And when you're sick, that hurts even more. So-

I'm going to guess that young people in particular, this is impacted because medical insurance is expensive. If you have to pay for it yourself, maybe you don't have a job that is offering healthcare cover. But also you're so young that you think you're made of rubber and magic and I'm not going to get sick in any case. And it happens so infrequently that it doesn't really matter. So it's kind of playing a reverse lottery that I'm not going to bother putting the money in. Once every...

500 days when something goes awry, off to urgent care I go. Yeah. And what's interesting about healthcare is we much prefer to do things on a proactive or elective basis rather than a respondent emergent basis. So for example, if I have a patient that I can schedule for a hernia surgery,

ahead of time so I can do a surgical clearance for them. I can make sure that they're medically optimized to make sure their blood pressure is under good control, their sugars are under good control. They're going to have better outcomes during that surgery. As the opposite end of that example, waiting for that hernia to become incarcerated where the intestines are literally being choked out and you have to go for emergent surgery, the risks exponentially go up.

So we want to plan for things as opposed to react to things happening. And there are certain things that we can do from a primary care standpoint to get ahead of issues and prevent them.

to a degree, and institute those things for our patients. And I specifically say to a degree because there's a lot of even physicians and experts online who think that we can prevent every problem and that we should be doing more for prevention. But that's only thinking from one side of the problem as opposed to viewing it holistically.

It's interesting that you brought up the UK. I have a number of friends that were doctors that I was friends with as they went through med school, as they went through F1, F2, as they finally got there, finally got themselves signed off. And I mean, God, if the US is a mess, the UK is something else. They're still using Windows XP. That's the operating system of choice. I mean, we still have pagers. My residents still have pagers, like literally beepers. Why? Just because they've been grandfathered in from the old system?

Yes, and there was some talk about that maybe in the basement of the hospital there's bad reception, but the pagers work on a different thing, so the signal would be better. I don't know. It's just this wonderful cocktail of cutting-edge medical technology.

ancient assessments with ancient technology and trying to get these two things to fuse together. Some of the horror stories that I've heard, man, about a doctor needs to prescribe something or get something cleared for a particular patient. And one floor below them is where they need to go in order to get this done. But they go down to that floor below them physically. They go there and ask for it. And they say, no, sorry, you need to fax us.

a piece of paper i can't email it i can't call you i can't ask you while i'm here i can't even fill it out physically on a piece of paper and hand it to you it needs to be faxed through here so that we've got the record of the facts and then the facts needs to be filed in a particular place but it needs to be signed off and the guy that signs it off he's not actually back in until the morning so they're gonna have to wait and you just think here's another one actually so a good friend of mine uh has a um

fitness business online. And he wrote programs many, many years ago that were just evergreen and they're still selling away in the background, but they were super cheap PDFs for 12 pounds, something like that. I think that while he was doing

F1, his first year out of med school in the UK, I think he was on about £11.50 an hour. So I think that was around about the wage that he was getting. So one ebook was more than that. A particular patient had been struggling passing solids for a while and needed to be, I think, is it called decompacted?

Disimpacted. Disimpacted. Sorry, decompacted. Close enough. Disimpacted, which is put a gauntlet on, get in there and pull out what hasn't come out of the back passage of the patient. So sure enough, at three in the morning, Yusuf rang the specialist. He said, look, is this something that can...

Do you need to come in? He says, I'm not coming in for that. You can do it yourself. So on goes the gauntlet, a couple of pairs of gloves. Yusuf spends the next 30 minutes. This woman's in discomfort. Her family are there. There's an issue with them. They want her to be right. She wants him and he's just doing his thing. And after he, maybe 45 minutes later, peeled off all of the layers of gloves,

and checked his phone to see that he'd sold a ebook that he wrote nine years ago for 50 pence more money than he'd just earned from doing that one thing. And the attraction for working in that kind of an environment, it doesn't surprise me that the NHS is struggling with talent and that they're losing people and that nurses and doctors are going on strike. And then I don't also completely understand why patients are thinking, hang on,

The people that look after our health are striking. That feels like they're playing roulette with our well-being. That doesn't seem fair either. And yeah, it's not good. It's not good. I think you're right in saying that nowhere's got it right yet.

It's between a rock and a hard place where healthcare providers find themselves in because they want to do the right thing by their patients. And I understand your example because it's so clear of the patient needing that disimpaction and yet your buddy was earning more money by selling the book. That's not even the biggest concern for doctors or nurses. That is actually the part we have a problem with least.

Like it sounds to the average person like, oh, this impacting someone that's below us or it's not. We want to help patients. Do you know what is the most destructive thing when we actually want to help the patient for 11 pounds an hour? And we can't because we're forced to see so many patients. So certain institutions make more money.

or we want to give the patient a medicine, but it's not covered by their insurance, so we can't help them. Or after working a full day where we stay late in order to be able to disimpact and help all our patients and get paid not the greatest salary, we still have paperwork to do to prove that we did all of these things on ancient systems that require dozens of clicks to get even the simplest thing done and

That is disheartening way more than it is about not being properly reimbursed for this impact. Because that strikes at the soul of why we're doing what we do. Disimpacting a patient is what we signed up for.

sitting and writing charts for hours at a time after actually helping our patients and then getting one administrator to make sure that the billing is done and that the billing, like all the facts stuff that you talked about, that is the prime example of why doctors are burning out and nurses are burning out at historic rates because it's like,

Doctors used to run hospitals and be in charge on the leadership C-suite teams. And now doctors have become laborers. And the people that are in charge are these financial folks who are thinking about the profits more than anything. And I think that's ultimately a bad thing for patients more than anybody. Talk to me about the rise of estheticians and cosmetic procedures.

I mean, I see it happening. I've seen that happening all the time. That's not a new phenomenon. I just think that probably social media, Zoom, has fueled people's self-criticism of what they look like. And there's probably been a spike as a result of seeing themselves on camera more often. These days, I saw some surveys where half of Gen Z feel like they're creators or influencers and

And when that happens, people want to look a certain way. They want to have more control over the way they look. And it's not necessarily a bad thing. The issue comes up when it's people who are not licensed to do it, who are not well-trained to do it, who are not adequately giving people information about side effects of certain treatments. Like, who am I to tell someone what's right for them? Nobody. It's not my job. I should never act paternalistic.

paternalistic to a patient unless they have some cognitive issue or someone's hurting them like a child and they can't speak up for themselves or elder abuse, some rare situation. But in general, my job as a physician is to give the best quality of information that I have in a given moment about a treatment, about a topic so that the patient can decide for themselves.

And what happens when someone who's unlicensed or untrained does a procedure, that person may not realize what they're signing up for. And that happens quite often. I see issues with medical tourism where people to save some money go to other countries to get treatment where there's less supervision and things are cheaper sometimes because of less bureaucracy, like all that paperwork you discussed. And that could be good, but it also could be bad because there's less oversight in what's going on.

And I've seen some pretty horrible infections and complications that happen as a result of that. What are the most dangerous esthetician cosmetic procedures that you're seeing people have more of at the moment?

I think BBL is a procedure that people have gotten excited about. I don't necessarily see a lot of the consequences of it, but I've covered it enough from a research standpoint for content online where I've seen that a risk of a fatty embolism where you actually get a piece of fat lodged in an artery that then travels to a different part of your body and it creates a blockage happens like one in 3,000 cases.

And that's one in 3,000 healthy people. You know, if you're going for an emergent surgery because you're having a life-threatening condition, one in 3,000 to save your life is good odds. But when you're healthy and you could potentially get this life-threatening condition and lose your life, that's absolutely terrible. So I just hope people understand the risks of what they're signing up for and not just getting excited about what they see on social media. Where are you practicing?

Family medicine clinic at a community health center in New Jersey. New Jersey, right. Okay. I was going to say, you may see more of them if you were in Miami. Miami seems to be the hotbed for BBLs. What is it about that procedure? You know, people have had boob jobs for the rest of time. I thought a BBL was just a boob job for your ass. What is it about the- It's not implants. Okay. Okay.

Uh, unlike, uh, with breast augmentation, uh, a BBL requires liposuction. So removal of fat from one part of your body and then inserting that fat in another part of the body. Usually people will get their waist slimmer and then insert it into their butts. Uh, and when you do that, if you accidentally position that fat into an artery, uh,

That's where that complication happens. Whereas with breast augmentation, it's, um, an opening and insertion of a breast implant, which has risks of its own. But, you know, with this specific condition, I feel like the fatty embolism isn't discussed as often as it should be. Is that in order to get the, I know that you don't do BBLs on the side, or at least I don't, I don't think that you do BBL, you know, night, night, night flying to Miami to go and do BBLs. Um,

I'm going to guess that they have to sort of put the needle in at multiple locations or else you would just have one huge deposit of fat, which wouldn't make for a particularly round shaped ass. Now, again, walking through the streets of Miami, I've seen what can only be described as

a bag of cats inside of a set of leggings. You know, that's sort of, it's like this, it sort of looks like paws being pushed out. So my point being, there are gradations to the quality of a BBL that you can get in any case, but in order to try and create that round shape, you're going in and I'm going to guess that that's what you're getting at. There is blood flow through

the glutes and then as you're going in if you strike an artery and then you put fat into it very not good yeah the exact pathophysiology of how it happens

I'm not super familiar with, but the fact that it does happen. And again, a lot of people, especially in Miami, I'm familiar with anecdotal cases of people traveling to South America to get these things done. And I've actually seen some pretty ridiculous things, people getting injected with certain solutions and, um,

I believe that there was a case, if I'm not mistaken, in the news of someone getting almost like concrete injected. And it's unfortunate that people are taken advantage of because sometimes they just don't know. And usually it's people who struggle financially that get taken advantage of the most. So.

Yeah. I mean, the cosmetics thing is not my expertise, but it's just unfortunate where it's another area on social media where people get misguided and they have wishes and expectations. So I hope to enlighten them about the risks of what they're going for. Have you looked at this leg lengthening surgery trend that's happening at the moment? Yeah, absolutely. I have. I've seen it a

And I'm surprised that people are willing to go through that level of recovery and physical therapy and immobility for a period of time. I know immobility on its own has pretty significant risks of having blood clots and such. So yeah, pretty surprising the lengths that people will go to. No pun intended lengths. Have you seen any of these patients in real life? Have you ever seen anyone that's had this done? No.

Yeah, me neither. I've never met anybody that's had it done. It's crazy though to think, yeah, what guys are prepared to go through in order to gain a few inches in height. Yeah, again, as long as they're of sound mind and they're making the decision based on knowing all the risks involved.

That's their choice. You know, like some people will look at me and say, you're a doctor and you box professionally. What's wrong with you? Don't you know about head injuries? I do know. And I've signed up for it and I understand the risks. I look at someone like, what's his name? Alex, who solo climbs. And I'm like, oh my God, you're doing that without safety equipment. Cool. He knows the risks way better than I do. That's not up to me. So.

What should we know about posture? That's something else I've seen talked about an awful lot on the internet recently. Posture has become a buzzword for certain people online where they say, you need to keep this specific posture. You need to do this specific exercise. And it's rarely ever that cut and dry in healthcare, let alone when it comes to posture. The probably most correct statement is that there is no such thing as a perfect posture.

Because, Chris, if I was sitting here and I was sitting with what people refer to as perfect posture, you know, chest out, shoulders back down, like neck back. If I hold that position locked in for the entirety of our interview, that's going to cause me pain.

So really perfect posture is about having a healthy balance of being able to sit up straight like this without overly fatiguing your body, taking some time to lean back, to maneuver my legs below the camera in certain ways, and actually not holding a specific posture for too long.

Because whether you keep this posture while you're gaming or chatting or whatever for a long period of time, or you're keeping this posture, you're going to run into trouble either way. So it's about keeping mobility, keeping circulation going. That's really the correct way to talk about posture. Look, do people have certain deficiencies in posture, meaning they have a significant scoliosis to a severe degree where it can impact their functioning? Yes, absolutely.

But a lot of times people have a very mild scoliosis where they have a abnormal curve of their spine and they want to blame every issue on that. When in reality, not every case of back pain is necessarily related to their mild scoliosis curve. I spent quite a bit of time researching lower back pain. I had two bulging discs and flew to Gravenhurst in, uh,

just two hours north of Toronto to see Dr. Stu McGill, who is regarded as one of the number one back pain specialists on the planet, specifically for lower back pain. Very conservative with his management, so he's quite anti-surgery, which I think is probably a pretty good position to hold and has been proven as we've seen Ronnie Coleman or, you know, pick your favorite athlete of choice work their way through some insane amount of pain. Just as a side point, I

From what I know, the reason that surgery is so dangerous is the potential for scar tissue to form around nerves. And you can already have certain areas of the back which are impinging on nerves. But if you've got scar tissue which is formed around it, that causes pain.

the most sort of intense chronic pain. And really interestingly, Matthew Hussey, he's a dating coach guy. He had, um, chronic pain, uh, in a headache. And he explained it to me that chronic pain is one of the few types of, um,

physical maladies that you don't adapt to. So everyone's heard the same story of you win the lottery or you lose a leg in a car crash within the space of about two years, your happiness set point has come back to something approximating where you were before. Hooray, we're very robust. Or boo, we're robust against winning the lottery. That sucks. But chronic pain is a permanent reminder

of the fact that you have this thing which is wrong with you. It is always taking away. It's always going. It's always firing. And the sufferers of chronic pain seem to be... The outcomes for them in terms of mental health, increase in suicidality risk, all of that stuff, not good. So yeah, went to go and see Stu McGill and he said something very similar when it comes to posture. That...

Sure, a neutral spine, a tall-ish neutral spine is optimal. But the most important thing is to allow yourself to vary that posture as much as you can, which is why, you know, whichever the biggest company in the world for standing desks is has probably absolutely exploded over the last five years because everybody...

wants to go from sitting to standing. I'm going to have one of those sexy rocking tools I'll go back and forth on. I'll be a Bosu ball like a pregnant woman. You know, all of these different ways that people can do things to try and vary their posture. And for me as someone, you know, I'm patient zero, two bulging discs, L3, L4 and L5 S1. And I have managed to get myself to a place now where I can sit for

a 10 hour plane journey and be absolutely fine. I can go on a tour where I'm stood upright still for a while, listening to some tour guide talk. And most of that was

not putting myself into positions that irritated my spine, not going unnecessarily into flexion or extension, shearing forces. So that kind of position you get into when you're in a good morning or you're doing a bent over row where your spine is perpendicular to the ground and the force is going through it like that, for me was very, very painful. So finding out what hurts for you, not doing it and giving your back enough time to recover. And then just thinking about building a relatively good posture for the most part and varying it.

I went from a lot of back pain five or six years ago to now, I don't notice it. I have zero back pain day to day. Yeah, that's an amazing result. And I'm glad you were able to avoid surgery because

A lot of my patients, unfortunately, either get talked into it or think that they absolutely need it for their pain. And as you said, those who struggle with chronic pain, it's a devastating condition for them mental health wise. And the unique thing about pain is that there's a lot of things that impact pain that we don't realize. So there actually is this like pain cycle that we go through of where we

we can actually condition ourselves to feel pain more often. And sometimes, you know, back in the day, we would talk about it as someone maligering, so pretending to have pain in order to get some kind of outcome. But there's actually much more evidence now talking about it from a mental health standpoint, where you turn up your sensitivity to pain because you expect it. And when you expect it and guard against it,

You're actually like almost, you know, when you're trying to hear something a little better, you concentrate just a little bit more. The volume of that sound doesn't change, but you perceive it a little better. So we can actually train ourselves out of expecting pain, therefore decreasing the volume of that stimulus. And on top of it, our emotional state greatly contributes to the volume of how we experience pain.

So a lot of times I get into this situation with my patients where they come in for a physical malady, back pain, neck pain, elbow pain, and we might do a workup. We might not. We might just get enough information off the history and physical exam where we end up talking about how their mental health is impacting their perception of the pain. And some people get understandably angry and say, are you just saying this is in my head?

And that's absolutely not what I'm saying. The answer is that if you're having true pain, it will feel worse if you're in unhealthy mental state. Because if you have a torn hamstring, whether or not you're at work or at a party, it will still be a torn hamstring.

But if you have a mild injury there that hurts only when you're at work, but you forget about it when you're hanging out with friends and you're able to do whatever you want when you're relaxed, that signals to me that it's not an anatomical issue per se that's the problem. It's the perception problem of it. And there's many instances where

Mental health therapy, focusing on how they're feeling, what's going on in their social relationships is a treatment for physical pain. And that's a very unique field of evidence that I've kind of had a lukewarm reception to on social media.

I can understand why. Again, speaking as someone who has had a pretty serious injury that absolutely was contributed to, is that psychosomatic? Is that where that word works? Yeah, that could be a form of psychosomatic, yeah. Okay. Well, my mindset definitely contributed to how much pain I was in, whatever that means. And I began to identify with the label of being someone who had a bad back.

Oh, I have a bad back. I have back pain. And then you begin to avoid doing movements that put yourself in pain. That's guarding. Yes, that's probably not too bad, especially if it's close to the actual incident, especially for a lower back. Yeah, exactly. But after a while, you actually realize that this has become part of your identity.

And, you know, you go into do CrossFit class and you look on the whiteboard and you realize it's got hip hinging in it. And you say, oh, no, I can't. That's not that's I have back pain as if, you know, this is your family name or something or the country that you're from. I have back pain. She's fine. You can say, look, I'm going to adapt this thing, but trying not to identify with it. And I understand completely why people would feel attacked.

and upset if their doctor was to say to them, you and your mindset are making the thing that you're feeling worse because they're going to say, hey, fuck you. I didn't choose to have this. This pain is real. You can't tell that it's real. You're disregarding the fact that it's, and I go through this all the time and I did, and you spiral out and I can see why that would be the case. But I also know that as I gave myself more proof in the real world, i.e.

allowing back pain to dissipate, allowing myself to not be in so much discomfort and then realizing, well, maybe it's not quite as bad as I first thought. And just one tiny little micro step away from. And now if someone says, Hey, what's your back like? Works pretty well. I try not to squat because that's probably a bit of a high risk movement for me, but I don't, I don't identify myself as someone who has back pain or is a bad back. And, um, yeah, I,

That's difficult. That must be a hard thing to try and deliver delicately to a person who's in pain. Yeah, it's tough. You have to be very present and very focused on the visit, and you're not getting it done in that 15-minute time frame that we're often allotted.

What you did for yourself is essentially exposure therapy. And there are certain conditions where exposure therapy works quite well, where we gradually work you up into reducing, let's say, social anxiety or phobias, etc.

And we gradually expose you to a level of stimulus where you're comfortable and we continually challenge you a little bit. But we don't challenge you so far. It has to be an acceptable level of challenge. So much in the same way, you know, it's fun to shoot three pointers. You miss sometimes, you make it sometimes.

But no one's standing on the other court, full court away, lobbing shots the whole time. That's not fun because the level of challenge is just way too high. So you want to have a level of success or a chance at success. And once we could find the right level for the individual, we can help them have some exposure therapy. There's a great doctor who unfortunately passed by the name of Dr. John Sarno.

who is actually a physical medicine and rehabilitation doctor from NYU that really pioneered the knowledge of how back pain and pain in general is related to our mental health. And while not everything in the book is 100% accurate because there were some theories in there as to why it happens or how it happens, maybe they're not perfect. But the general thought behind this

The idea of our mental health impacting how we feel physically is so strong. And I really recommend folks to read his book. One is called The Divided Mind. Another one is called Healing Back Pain. Really great reads. I recommend them to patients so often. And the number one thing that patients say when they come in for their follow-up visit is, I read the first chapter and that was me.

And I started thinking about how that could be happening. And right away, my pain went down a certain level of threshold. That's amazing. If I could do that without medications, that's such a win. And some people might say, oh, well, that's placebo. Oh, man, if I'm getting placebo off reading a few pages of a book,

I'll take that placebo all day. Yeah. Well, what do you, what are you, when we're talking about pain, which is enhanced by your mindset, what is that? That's, that's the exact inverse of what you've just said. Okay. So if we've accepted that some people's pain can be made worse by their mindset and, but you're not going to accept that someone's pain could be made better. That's somehow less valid. No. Yeah.

Exactly. So like when someone you mentioned that patient that would feel discounted or unheard or like they're making it up in their mind, how we go about talking to them, it's actually in an optimistic way, not antagonistic, where we'd say, hey, what I'm saying is your mindset is contributing to it and your current mental health state could be contributing to it.

If it is, this is under a level of control in some ways where you can make this better. So there is a bright light here. I'm not saying I have no idea what this is and throwing my hands up and saying, you have to figure this out. I'm saying that there is a way actually out of this.

And usually when you give patients actionable steps, especially if they're not trying to sell them some miracle formula or do anything ridiculous, they get really excited about it. So one of the main things that I tell my patients is avoid guarding if the condition is mild. Like if I have a patient who I'm not worried about hurting their back by standing up off a chair, I tell them don't stand up gingerly.

Like we oftentimes get into this habit of if we hurt our backs, let's say two weeks ago, we get up like this. Like we're waiting for the pain to hit us. And when you're going to get up like that, the same thing happens as if when you're walking into a dark room and you're a little bit scared and someone whispers near you, you jump.

Because you're on edge. You're already primed to be in that mindset. If anyone whispers to you on the street of New York City, you wouldn't even hear them. You wouldn't even care. But when your mind is in that primed state that any sound is going to make you jump,

you're priming yourself every time you're guarding your back. And look, there are times where I tell my patients, you have to take it easy and we need to do some serious activity modification. But a lot of times with back pain, it's about restarting movement safely, getting them working with a therapist, a physical therapist who knows what's going on. And if there is a mental health component, which is very common, I recommend talking about that as well.

Are there actually microplastics in everyone's testicles? I saw that article. I saw it. I was worried. Have I got microplastics in me? Probably. I mean, it's not... In the testicles? I don't know specifically the testicles. I didn't read the study fully to know exact details of it, but it's not unusual to...

for that to happen in the day and age where we live in, where people pollute, companies pollute. There's these chemicals that we've used for waterproofing that last forever.

way beyond what normal chemicals last in the environment, very similar in our own bodies. So I think that absolutely is a real scenario. And just like how we talked about, um, I feel like I'm villainizing capitalism here and I'm not anti-capitalism by any means, but a lot of these private equity companies, they find a product that works as waterproof, uh,

water bottle or jacket or whatever article of clothing, they're going to mass produce it without thinking about the effects on society as a whole. Because again, their main focus is on the profits and I'm not anti people making profits, but you have to think about what's happening with these chemicals and

And, you know, with public pressure right now, I think a lot of companies are waking up to make some changes and it's not full, but it's a step in the right direction for sure. I saw you do a video about Lululemon leggings and whether or not they're dangerous. What's the conclusion from that? Are Lululemon leggings killing everyone? That would be funny. Yeah.

No, there was a pretty common claim that I saw that there's this chemical PFAS that exists in Lululemon leggings as well as other athletic wear companies and whether or not that's harmful for us.

And then as I researched that video, I realized how pervasive the use of PFAs are in our lives. That the reality is, even if you're a minimalist, you still have exposure because of food containers, because of the trash that people get rid of and how it transfers to wastewater and how it's present in our oceans. So...

Hiding it from it is not easy. There are some consumer things you can do to check if your products do contain these chemicals. But now, luckily, Lululemon, we reached out to them for comment. They said they're no longer using those chemicals in their products, probably from social pressure. People are up in arms about it.

How interesting. I had Dr. Shanna Swan on the show. She wrote the book Countdown, which was about sperm rate decline over the last few decades. Really interesting, a bunch of interesting things from her. First one being that I would have thought that we would have had tons more data about testosterone levels than about sperm levels. Not true. Apparently sperm counts have been tracked for a much longer, which kind of makes sense, I guess, when

The sperm count level is much more important to the continuation of the species than the testosterone level. It's only recently that bros like me and you have maybe been concerned about whether we're in the high 800s or the low 500s. So that was the first thing. Second thing being,

To your point about avoiding and the difficulty in avoiding microplastics, that you can get farmer's market, raw milk, glass bottle from the farmer. Farmer's going to hand it to you and you think, oh, fuck you, plastics. You can't get me. My testicles are sweet and pure. What you don't realize is that what they used to pump the cow raw.

was a tube attached to the udder, warm milk, and it's heat plus these plastics that are really, really not good because they seem to be able to sort of liberate some of these molecules from the binding going through these plastic tubings. What's in the plastic tubings?

all of the materials and all of the compounds that you're worried about in any case. So yeah, it is so difficult. What's it packed in? What was it collected in? What's it been transported in? What's the heat that it's been in throughout all of this time? What's the lid on the top of that bottle made of? And what's the heat? It is...

It is unbelievable. My friend George, who I'm traveling with, this is not for the people listening at home. I didn't realize we're an hour and a bit in. This is not my normal studio. I'm currently in Lake Norman in North Carolina. George, the guy that I'm traveling with, has a question he asks, which is, what is currently being ignored by the media but will be studied by historians? And I think that microplastics and the ubiquity of those are definitely going to count as one. It's big.

beginning to catch a little bit of steam now, but it's still very much in the sort of micro niche influencer fringe. And I, I'm not seeing it really break out into the mainstream just yet. Yeah. We have so many things that pose risk to us on a given day. It's hard to know where our attention should fall.

So I very much hope more scientists are focusing on this. It's difficult for me. Like, think about it this way. I think it was a Lay Norton that actually said this on my podcast in a different way, but same example. If I'm looking to pick up the biggest weight as possible and there's different size boulders around me.

And those boulders represent risks I can reduce for my patients, like basically beneficial things I can do for them. Most of the boulders are focused on really the fundamental things of health care, which means making sure that you're not carrying excess weight. You're consuming at least a varied plant based diet with good sources of protein, fish, chicken, meat, all that good stuff. Exercising, sleeping correct, eating

mental health check-ins, social relationships. Those are the big boulders. And then the plastic, while it could be a big threat down the line, I don't know if I have the capacity to tackle microplastics right now, unless we get more information in the next... Think about how many testicles you'd need to be around if you were going to tackle the microplastics. Well, I don't remember how much that study is actually present. Swimming in testicles...

But that's also why I approach medicine the way that I do in saying that there's so much we don't know. Like there's so much we don't understand. Our grasp of subjects is so novice level that.

And while we are advanced as a society because we compare ourselves to puppies and kittens, we say, look how advanced we are as a species. There's so much we don't know so that when someone comes on and acts very confident that they have the key to everything, I think that's great for their work. I don't think that's necessarily great for the average person. Speaking of that, you mentioned before some of the independent influences in the health space.

What is your perspective on the ascendancy of health podcasts and health influences? It's kind of been a mixed bag. There's some people who are bringing really great information to the forefront, who are discussing nuanced, complex topics. There's individuals who fall and

have this little middle ground of talking about that, but then also straying into weird non-science evidence-based areas. And then you have people full on that are just in it for viewership, maximization of profits and look like more power to you. But my job is to give people accurate info. And if you're going to be one misleading them, I'm going to be out there trying my best to correct it.

Who are the people that you like the best? Who do you think, or who do you follow? Who do you recommend to your patients? You know, he's doing less content these days, but I really liked Zubin Damania, known as ZDogg. He was doing some really great content, especially surrounding moral injury, as he called it, of like burnout when it comes to being fed up with our current healthcare system and it needing to change. I thought that was fantastic.

I also really like people who make content on social media that not necessarily is a podcast focused, but long form content like Mama Dr. Jones. She does some great obstetric and gynecology content. I actually have a series where I try include evidence based doctors of answering like one specific question or talking about their experiences in health care from different specialties.

And I think it's cool to have a variety of that. So I applaud those who stay true to the evidence and don't sell out, as people often say. Where did Zubin go? He was on fire during...

COVID. I mean, I, he was doing social media before I was, I remember meeting him when I had my little viral moment of popularity 10 years ago in a hotel room. And we did like a live stream that went out on Facebook. That's how long ago it was. And, um, yeah, I don't know. I check in with him every now and then. I need to. Yeah. He did really, really good stuff. I was just thinking then when you spoke about the obstetrics and gynecology that, um,

There is an entire world of healthcare that guys are just absolutely blind to. Like the entire sort of perimenopause. Yeah, guys, healthcare is blind too. How so?

When we did our preliminary research for a lot of the conditions that are common in society, we studied males. We excluded women from our research. So like when we say the classic signs of a heart attack is an elephant sitting on your chest, pressure, et cetera, that's a white male's definition of what it feels like to have a heart attack. Is it different if you're a black male?

It's totally different if you're a woman. And what ends up happening as a result is women come into the emergency room with slightly different symptoms. They describe it differently. They do it more in a narrative style description of what happened. And because older doctors especially weren't trained in that,

Heart attacks are missed. People lose their lives. And we need to do more of that when it comes to health care. Even you mentioned for a black person, the fact that our dermatology books are

Like the older dermatology books have only skin conditions on light colored skin, which is a problem because not all my patients have light colored skin and conditions present differently in those individuals. And as a result, I'm not as good as a doctor if I'm not trained in that environment. We need to do a better job in researching these subjects because what ends up happening is we

without proper education won't be as good in treating our patients. That's the bottom line. What about scented candles? How dangerous are they? Fire risk, if left unattended, for sure. Burning many of them in an enclosed environment, also not a great idea. But interestingly enough, as I was researching that, what I found is burning the candle itself

does not release as much harmful chemicals as the initial lighting of the candle and the put out of the candle. Have you got any idea why? It's because of the combustion or something. Someone's going to fact check me and say that I'm doing it wrong, but it's basically if you don't have complete combustion, you create more soot.

Oh, interesting. As a result, it's an incomplete combustion that causes this unique chemical reaction. Dude. So people can go back and look at this. My first ever studio, which was my old bedroom in Newcastle upon Tyne, I'd got into a Yankee candle, a little bit of a Yankee candle phase. I liked the smell of them. I thought they were nice. I had a good rotation going. One of the things I hadn't encountered-

I think, shamefully, I think I loved this sort of spiced apple thing that was only a Christmas release. And I kind of lived Christmas all year round. They had a cotton, something cotton one, which was quite nice. But anyway, the soot that collected on the ceiling made my low ceiling bedroom look like it was covered in mold. And I...

I got absolutely flamed appropriately on the internet for months and months and months so badly that I had to pay for decorators to come around to repaint the ceiling just because of how badly I was having the piss taken out of me so much that I couldn't bear to do it anymore. And so I had my entire bedroom ceiling repainted in an attempt to get away from that, which was good. But no, people can go back and look at that. So that's real. I see that. And there is a bit of me that thought as I looked at the ceiling

If that's what it's doing to the paint, it's got to be doing something to my precious boy lungs. And yeah, yeah, I don't know. Austin, my current home base, is kind of one of the ground zeros for a lot of forward thinking concerns about health and microplastics and...

fluoride in your tap water and whatever you've got that's coming out of your shower head. And we can dechlorinate the water by using. And one of the things that's been next on the chopping block was, uh, candles. So it was inevitable. I think that they were going to come for Yankee candles eventually, but I was, I was out ahead of it. I'd already quit my, my addiction a while ago. Yeah. I mean, I, I think it falls into that, uh, Boulder rock situation. I think it's still a pebble in the grand scheme of things.

And I also think that if you're chasing perfection when it comes to health, you're actually doing your health a disservice because chasing perfection and health is not just an illusion that's impossible. It's a toxic illusion because it comes along with anxiety, stress, constant worry that you're not doing enough. And as a result, you end up harming your health more than helping.

Yeah. Speaking of the big rocks, the debate around obesity is surprisingly contested for something that seemed to be a bit of a slam dunk for what it does to people's health. What are your, what do you think is going to be the future of obesity given that we're maybe just about to turn a corner with GLP-1s and the ability for most people to choose to be the weight that they want to be?

It's very interesting. I'm not sure how this will play out because these medications are not just beneficial from a health standpoint. They're also beneficial to our healthcare system.

Because if we can prevent heart attacks and all of the strokes and the situations that can arise as a result of carrying excess weight, we would be also improving the burden on our healthcare system. So that's one. Two, we're going to be definitely harming the profits of some food companies. I think they're going to be pretty angry. I've seen them do some unique things, actually. There's one that just launched a GOP1-focused meal plan.

where like they're in the supermarket and saying, if you're on one of these medicines, Regovio, Zempik, Manjaro, eat our food because it's made specifically for you. And I guess it's more protein rich so that you're still consuming enough protein. But it's funny watching them try and adapt. But at the same time, I'm also wondering how society will react when there is always on hand an option that

May take some of the required willpower out of the equation. I think it's fair to say that there's a lot of it around it. Surprisingly, so I think I've had a number of conversations. Johan Hari's new book, Magic Pill. He came on. Scott Galloway came on. He spoke about it. Dr. Mike Isra tell who you just had on your show. He came on. He spoke about it.

the internet really, especially maybe my corner of the internet, the personal development, bro, high agency, sovereign individual thing. Very concerned about it. And I'm

cautiously optimistic, but it seems to me based on all of the smart people that I know who would not typically fall for, he says as he recommends something that's about to destroy the entire world, would not typically fall for something that wasn't robust and that they hadn't done the research on.

they are basically saying that this is going to be as big of a revolution as the smartphone was. But for healthcare, that we've been promised... And I understand why Fen-Phen and all of these previous iterations of drugs that had wild, crazy side effects, super toxic or dangerous, or had long-term risks. I understand why people are not too confident about this one, but it does seem like a difference in kind, not just a difference in degree. And yeah,

The flight companies, the airlines predicting lower fuel costs because of a lighter populace to transport around. Confectionery companies trying to drill their margins because they're expecting to do less sales volume. The hip and knee replacement companies expecting to do lower sales volume. And the most interesting one, jewelers.

Because they've had to spend money. People's fingers have got fatter, so they've had to spend money to get their wedding rings changed and increased in size. So there's going to be an initial increased boon to get the jewelry changed again. And then after that, a little bit of a nosedive because there will be less gold that will be needed to fit ever thinner fingers.

I have a question for you. I had a world-renowned food expert on. It's not a published interview yet. Marion Nessel, she's a PhD professor. She asked me a question that I want to pass on to you and see what you think. Is there any industry that will make money on us as a society losing weight? And I couldn't think of one. So if you do, I'm going to be impressed.

Certainly some niches within the food and drink industry will, because you now have a new...

gastrointestinal environment. So high density, low volume. I think if you can make protein... But if those companies are making those foods, they're not going to be selling as much of the foods, period. So... Agreed. Agreed. If you have... I'm thinking more disruptive, you know, a single small startup or a number of small startups that get to come in and disrupt Mars...

or whatever and they make something which is which is let's make it more industry focused as opposed to company yeah uh it's really going to be hard the only thing the only other thing i could think of would maybe be companies that make sportswear stuff because sportswear is a kind of clothing i'm aware that i'm like niching down again so i'm breaking a rule but um sportswear is a kind of clothing that people who are more in shape tend to wear um and yeah they're going to make

Did they do that thing? Is it more expensive to buy bigger people clothes? They probably flattened the price, right? That would be a huge social campaign if the 3XL was twice the price of the small. That's definitely going to be like fat tax accusations thrown around. I don't know. I think it's really hard to think of one. Sports stuff, like is there a world where people go to gyms less because they're lower weight and they're not worried about their weight? What are they doing? Here's a question. What are people doing with their time?

Where does their time go if they lose weight? If they lose more weight, what is it that they're doing, which is different? Yeah, I don't know. And I'd love to see something better than my anecdotal answer on it because, you know, I have patients on the medication, but that's not representative of the entire population. What have you seen? What have the results been and the responses, good and bad?

Largely people lose weight. Their numbers improve from a cholesterol standpoint. Their sugar control improves. They're happier, less musculoskeletal issues. A large percentage of those people either have had issues with side effects like nausea being the most common. Some, the nausea is mild, persistent, but manageable to them and a valid enough trade-off.

I haven't had anyone personally as a physician where a patient had such a bad side effect that they had to stop it. But I am aware, obviously, that does happen. Fascinating. This is the most, I think, interesting development that we're going to see.

Over the next few years. I agree. And I think it's largely representative of how society has been reacting as of late. And a lot of people who are smarter than me come on my show and

Yeah.

It becomes so weird in that, look, like we created hyper palatable foods that were junk foods, processed foods that were very tasty, non-satiating. So we're always hungry. We want more of them. They're addicting. That was largely driven by private equity. Then we created a medicine to solve the obesity epidemic.

Is there a world where these private equity companies are creating apps that are making us hyper addicted and shortening our attention spans where now more people are requiring to take ADHD medicine? Maybe. So,

Are we now seeing private equity in telling people, well, look, if you really want to take care of your health, you really got to get your testosterone up. And if you want your testosterone up, you got to look like this person, look at the muscle, you can maintain their erections, whatever. And you need to have this level. So let me give you some testosterone. Now they're selling you testosterone. So like how many times is private equity going to create a problem and then sell you the solution? That is a very good point. Yeah, I am.

It's like starting a fire in someone's house and then offering to put it out for a fee. Yeah. Yeah, yeah, yeah. And charging them for the water. Yeah. I don't know, man. I'll be very interested to see what happens over the next few months with GLP-1s. I think that it's going to make a very interesting moral challenge. It's going to create a moral challenge for a lot of the people who have been a part of the body positivity movement. And I think that that's one of the most interesting sort of social elements to this, that when...

uh maintaining a heavier weight becomes a choice uh i.e you have more control more direct control over whether or not you maintain that heavier weight i think that it's going to uh put many people into a catch-22 situation uh that a lot of people who have been very pro body positivity and um

promoting bigger lifestyles, I think that they're going to be faced with a very difficult decision because so many of the members of that community that were their compatriots are going to elect to not do that. And I wonder how many people that were a part of that movement were doing it because they

They tried dieting. It really hadn't worked. So I'm going to be a part of a group of people that accepts me as opposed to one that villainizes me or says that I'm wrong or undisciplined or whatever. You don't know. Fuck you. I tried to diet. A huge percentage of diets don't work for people, and I get that. But when you can just take the shot twice a week and you can dial in your weight to the poundage that you want by just increasing the dose or decreasing the dose...

I also want to point out that's not exactly realistic. Most people still don't have access to the medications. Can you explain what that means about the access? I'm not familiar with that. The medication's very expensive. Insurance is...

largely aren't covering it for weight alone. I've had plenty of patients struggle to get coverage for it where they have to pay for it out of pocket or pay a company out of pocket to try and get access to the medicine. So access is a huge issue. And why it's like kind of an exponentially problematic issue is that the people who struggle with access to that medication are also the same people that food industry targets the most with junk food.

So they're getting doubly harmed.

And it creates this cruel irony where if you take a king from the 1400s who was overweight because they had access to unlimited food while their populace was starving, they come in now and they must think everyone is rich when in reality it's the people who are struggling with finances that are being targeted with crap foods that live in food deserts where they don't have access to good quality fruits and vegetables. Our government is disastrous because

in that they put out, let's say, an accurate recommendation of like, hey, you should eat mostly fruits, vegetables, plant-focused foods with some lean sources of protein. And they'll say the percentages correctly as per science, but then on the other side of their mouth, issue subsidies to the corn industry or to these other industries that make the necessary components for either animal feed or for junk food and processed food. So,

These people who are struggling with finances are getting hit on so many angles in ways that is visible and invisible. It's very, very problematic. And then the second thing is the idea of dialing in weight with these medications. OK, the medicines are good. They're not that good.

Like I have patients that have taken the medicines, have lost significant weight, but to say that I can get them to their goal weight so easily to the exact weight number, that's, we're not there yet. I'd spoken to some of the smart friends that were evangelists for this new category of drugs. One of them's on Tazepatide. And I can't remember what the next generation one is after that. This is the first one, Tazepatide.

uh, semi-glutides to Zepatide, which has fixed the glucose problem. I think there was a glucose issue with one of them, um, glucose regulation, and then there's another one. Uh, and that was the terminology that he'd used. So I may be speaking out of turn. Maybe it's something that the future generations of these drugs will allow you to do more carefully. Yeah, they probably will. Yeah, they probably will. I just want to point out that the reality where people live these days where, because what happens is that's how stigma forms, right?

People hear on the news that these medicines are largely available. People can choose their own weight. And that becomes commonly said over and over and repeated. And then as a result, the people that can't afford the medicine that are being targeted by food industry are

don't lose weight, and then are ostracized or shamed because it's like, oh, why didn't you do that? It's like, wait, it's not that easy. It's even more of a choice now. Yeah, exactly. So we just need to be careful of how people are treated these days. Understood. Will there be a...

dialing down of this, all things near accessible levels of cost over time, right? Yes, it's more expensive now. Do you predict that in future this will be pretty much available to everybody on pretty much every insurance plan? I hope so. I react to medical memes, man. I don't know.

I wish I knew these answers. Logically, I think that as more people take them, it should come down. If it's up to the pharmaceutical companies, no. But hopefully we have some regulation put in place where...

we can fight back against that. And there's all sorts of, not necessarily clear corruption, but just like gray zones where due to a lack of transparency, companies can get away with some really problematic things behind the scenes. Speaking of medical memes, how was your conversation with Stephen Gundry? Great, great intro to that. It was bittersweet. I was excited to talk to him.

because he has these best-selling books that are influencing millions of people. He goes on a lot of podcasts, and he says things, and people ooh and ah, not challenged as often as he should be. And I did, and I had a great cardiologist, Dr. Danielle Bilardo, on who challenged him on a lot of his notions. And largely what I found is he's a person who's excited about innovation, but lets...

The lack of experience in mass communication lead him to make statements that land with the audience in ways that he probably doesn't understand that they do. Like when you say to a parent that grapes are so problematic, might as well give them a Hershey's.

You're making a statement that's encouraging mothers to feed their children processed sugar as opposed to a fruit. And that's a problem. And he might be talking about how fruit is now raised in the nutrient content has changed and the intricacies and all. Great. Talk about that. But the way that the message is delivered, I think ultimately misleads people in their understanding of what science and health care is.

The problem of short videos, I wonder whether this is a bigger problem on TikTok and Reels and YouTube Shorts than it is on the slightly more long form stuff. Just that when you do pull a Gary Brekker clip of a protein shake stays in your body for 75 years, this is how long it takes for your body to process it or whatever.

Uh, maybe I don't tend to watch those podcasts in full. Maybe there is more context in there. Maybe he does explain that it's to do with the way that grapes are now farmed and they've been changed from their original grape form. And what are we putting on them in terms of their fertilizer? Uh, but certainly when you see it on TikTok, which is obviously affecting

like disproportionately affecting a much younger generation. But then you also see the same thing happening. I, you know, how long has it been these crazy adverts on Facebook that are impacting our parents' generation? And, you know, they're seeing like just wild boomer misinformation get deployed through Facebook. So yeah, it's a medical misinformation at the moment is, it feels like it's picking up. It feels like you've got a big harvest to get stuck into. Yeah.

Yeah. And look, you're saying that maybe you're doing actually a very psychologically healthy thing right now where you're exhibiting charitable thinking. And I like to do that as well, where you're saying that, well, you know, maybe Dr. Gundry in the long form of the information gives the context to that statement. Now, that's partially true. He does give context and explain some things. But then when presented with the fact that people are misunderstanding it,

He will not walk the statement back and correct himself and say, oh, I can see how one have misinterpreted that. I should give more context. Folks, if you're taking it that way, don't. But he does it. And that's where I really, really need to push back heavily. Yeah, that's not cool.

Come on, Steven, play the game. He's not alone in that. Again, this isn't a single person problem. It's more of a problem of our day and age of social media. And it's not just short form. There's a ton of misinformation on long form podcasts all day long. Yeah, I think, you know, certainly for me, someone that's been in and around the health and fitness and wellness space for a very long time, I quite liked the corner that we seem to have turned maybe about three years ago, just out the back end of COVID, where we

I think especially Andrew Huberman is sort of a spearhead of that. I'm aware some studies have got dodgy p-values and they've got low end numbers and so on and so forth.

But what you had to me was someone who made the biohacking community, kind of the old school biohacking community, look quite silly, look very experimental, look very kind of un-evidence based. And you had someone who was coming in and the first whatever two seasons or so, two years that Andrew did his show, it was like basics, sleep, nutrition, training, caffeine, nicotine, concerns for menstrual health and fertility and stuff like that. All right, yeah, these are big boulders, right?

And then I wonder how much of the sort of wake behind that popularity of content has opened the door for people who are just prepared to kind of say whatever sounds sexy, something that seems to be really cool. This is like the demonization of individual foods. And, you know, the answer is boring to this, which is.

Most things don't have a sexy answer. Most of the solutions that you're looking for require a moderate amount of willpower and discipline. Your environment design counts for an awful lot. You have a genetic predisposition, which people don't really want to talk about all that much. But the people that do want to talk about it too much, also they're kind of overselling you on something too, which is victimhood narrative as opposed to the kind of self-made man narrative. But who's listening to that? That's not a good 60 second reel. Go fuck yourself. Hold on, Chris.

A lot of people listen to my podcast and that's exactly what we do. I think over the last like 20 episodes, we averaged almost a million views just on YouTube alone. Good man. That is true. I want to, I want to prove to people and why I started the YouTube channel is that you can make science nuance sexy without overselling it. Yeah. With that hairstyle. Damn right you can. With that jawline and that beard. Damn right. Yeah.

Look, everyone uses their own gifts to certain ways. And I make my silly, corny humor. I actually, I remember like Men's Health did a top 10 medical influencer list. I think actually Huberman was number one on that list. And they gave like some people a page and then some people they gave a byline to. And to us, they gave us a byline and they said, you know, the OG medical influencer, Dr. Mike can get corny at times.

I love it because instead of taking medical information and corrupting it, I get corny. That's how I get views. The spectrum goes from corruption to corniness. Yeah. Well, you know, it's like a Batman, like how long do you live as the hero before you become seen as the villain or whatnot? So I, you know, I see an individual like Huberman and

controversy and all that aside with personal life, I don't think that's up to me to talk about. I haven't fully dug in to see the research, but on one hand, I'm very excited that he's gotten this whole swath of people excited to talk about health, to learn about health, to learn about research, talking about sources and pathology. And then on the other hand, I see irresponsible statements made on a decent amount of times on the show. And I'm like,

why why does that happen and i don't have the answer to it and i i wish that wasn't happening as often as it was well i'm sure that you guys will cross paths at some point and that'll be one hell of a conversation yeah absolutely the invitation is open and uh i'm very excited to have that conversation because i think people will benefit from it i i don't think this is an ego thing at least it's not for me i never planned to be popular on social media um i

I didn't want to do it by giving up anything. I still practice medicine and I don't say it often, but I practice for free three days a week, two to three days a week in my hospital because I love what I do. I work at a community health center. Could I go quit and not work and just make a great living on social media? Yes. Could I get a concierge practice where I charge six figures a year for me to be some celebrity doctor? Yes.

But that's not why I started this. The reason I started this is to help people who...

struggle with their health, who have real problems, like how I grew up as an immigrant, the things that I was facing as problems. That's what I ultimately set out to do. And even when I had my viral moment of popularity, there was times where selling out was so easy. I was in debt as a med student. I was in debt as a resident, making the $10 an hour, as you mentioned earlier, working 80 to 90 hours a week. It was tempting to take some deals where I would

talk about a powder and how it's going to give you all the nutrients that you need. It's tempting to take those deals. I understand why people do. But for me, the reason of why I started this doesn't let me do that. And I hope more people can look at what I've done and do it better and say, oh my God, I don't need to sell out and do all these things to be financially well off. There is a responsible way to do this.

And, um, I just wish more health influencers looked at it that way because otherwise folks get into a lot of trouble. How do you find being the personal doctor whilst being the public doctor now? How many complications are you encountering as your online fame grows? Are people requesting that they want this Dr. Mike because they know that he's over there and he's the person I watch on YouTube? The patients that I saw, um,

During my residency, they're my patients and I built them up sort of as my portfolio of patients. I've seen them, I'm treating them. There's some babies that I've delivered that I'm still treating. And now six, seven years old, it's pretty amazing.

Um, but I also work in an urgent care capacity. I also see patients of the other doctors that work in my practice that may not be available same day. So we work together as a team in that regard where we can plug holes, plug scheduling issues. And because of that, I'm very grateful to where I work and the ability to help those individuals. It's just, it's, it's such a different world.

Like the things that are discussed on social media versus the problems my patients have in their everyday lives are just,

completely different, completely different. And that's why I think I've had a lot of success taking what my patients tell me in the office and then bringing it to YouTube because it's so relatable. It's so honest to what people want to know, what they want to see debunked, what they're being misled by. And I hope to continue doing that as long as possible on social media. Does it feel like the human social equivalent of touching grass?

It's definitely a humbling experience. You're constantly challenged. You're constantly taught that there's so much you don't know.

Um, my staff that I've been working with for over 10 years now, I can't believe I've been in the hospital for 10 years. Um, they humble me all the time. They make fun of me all the time. It's a big family. You know, I even had one of my nurses that I work with for 10 years on my channel the other day to talk about how I helped her with back pain, much in the same way that you had with your specialist. Um,

And it was great to be able to show that side because people see what's on camera, but social media is not always real. And when you are able to have a long form conversation with someone that's known you for that long, that's special. I treasure those moments. And anytime social media gets dark or I get down, the biggest value in boost, in mood boost and happiness is when I do mundane things as a practicing doctor at a community health center.

Oh, cool. Dr. Mike, ladies and gentlemen, I did. I really appreciate you. I really appreciate the effort that you're going through. The fact that you're doing three days a week, uh, pro bono is a really good credit to you. I'm very, very glad that we've got people like you giving us health advice on the internet. I'm really lucky with social media, so don't give me too much credit, but it's, uh, it's still, it's still.

I probably gain way more value from doing and practicing medicine on like a spiritual personal side than any kind of financial benefit I could get. Damn right. Where should people go? They want to keep up to date with all of the things that you do.

I've somehow been able to corner the market on Dr. Mike, Dr. spelled out because D.R. Mike is the great Dr. Mike, the diesel Dr. Mike. Dr. Mike is the... He's your dark side. Oh, I just had on my podcast. Yeah. And you did as well. Yeah, he's great. Dude, I really appreciate you. Thank you for today. Thank you so much, Chris. Get on the fence.