← Feel Better, Live More with Dr Rangan Chatterjee
Feel Better, Live More with Dr Rangan Chatterjee
The Most Important Daily Habits That Could Add Decades to Your Life & Keep Your Brain Young with Dr Darshan Shah #573
02:00:36
Did you know that your daily habits directly affect the speed at which your brain is ageing and your risk of getting Alzheimer’s disease in the future?
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- [00:01]
Darshan Shah
I really believe that even if you are genetically susceptible to Alzheimer's, the chance of you being able to prevent it completely is very, very high. So I think we need to move on from My mother had it, my family members had it, so I'm destined to have it. That is absolutely not the case.
- [00:21]
Dr. Rangan Chatterjee
Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better Live More this will be the last episode in the current series of my podcast. If you are a longtime listener of my show, you will know that every summer we stop releasing weekly episodes for around six weeks. Now, there are many reasons for this, but the main one is because the summer is the time of year where as a family we try to prioritize undistracted time together. My wife is the producer of this podcast and so very involved, like me, with the weekly production of each episode. So for us, it's really important to have some time each year when we stop. Now, I'm well aware that many of you really look forward to each week's episode and that this podcast has earned a place in your weekly schedule. And honestly, I am so, so grateful for that. Do not forget that There are over 500 episodes now in the back catalog and pretty much all of them are just as relevant today as they were when they were first released. So perhaps this summer you can take our little break as an excuse to delve into the back catalog and listen to some episodes that you may have missed first time round. Or perhaps revisit some of your favorites. Honestly, I think so many of these conversations are worth a second listen. If you do go back and listen to a conversation you have already heard, I pretty much guarantee that you will hear different things and that the ideas within the episode will land with you in a different way. Because of course, what we hear and pay attention to will depend on what else is going on in our life. After all, we don't see the world as it is. We see the world as we are. Our plan, as always, is to relaunch the next season at the start of September. So, onto the topic of this week's episode, our brains did you know that your daily habits and behaviors are directly affecting not only the health of your brain, but but the age of your brain as well? Did you also know that they directly influence your chances of getting Alzheimer's disease in the future? Well, this week's guest is the wonderful Darshan Shah. Darshan is a medical doctor, a board certified surgeon, an Expert in preventive health and the founder of Next Health, the first health optimization and longevity center to offer life extending and enhancing technology and treatments in a beautiful welcoming environment. Whilst working as a surgeon, Darshan became seriously ill with type 2 diabetes, hypertension and an autoimmune condition. And he was told he had a 50% chance of dying in the next 25 years. This wake up call came just as his first son was born and rather than accepting a life dependent on medications, he immersed himself in functional medicine and completely reversed his conditions in just eight months. During our conversation, you will discover the five things you could start doing today that would actually increase your chances of getting Alzheimer's. The 8020 principle for health. Basically how focusing on just 20% of your behaviors can deliver 80% of your results. Why sitting for more than four hours in a row increases your risk of death by 15%. How inflammation in your mouth and guts can directly impact your brain health. Darshan's top supplement recommendations for longevity and why eliminating ultra processed foods might be more important than simply adding in more superfoods. Darshan is someone who has become a really good friend of mine. He is kind, knowledgeable and has a real passion to help people take control of their health. This conversation challenges the notion that we can simply live intuitively in today's environment and expect to stay healthy. Darshan argues that in our current toxic world, taking an active role in monitoring and optimizing our health is not just beneficial, it's essential. I wanted to start off with a question I imagine you don't get commonly in your practice. Okay. Most people are asking you how they can prevent getting sick in the future. But I wanted to start by asking you what would I need to do if I want to get Alzheimer's or shorten my life as quickly as possible to get Alzheimer's?
- [05:49]
Darshan Shah
Okay, you're right. No one's ever asked me that question. But I can give you a five step program to getting Alzheimer's. Why don't we do that?
- [05:58]
Dr. Rangan Chatterjee
Let's do it. Yeah.
- [05:58]
Darshan Shah
And you'll be surprised to hear that your genetics actually not in my five steps, believe it or not. Okay. Because I really believe that even if you are genetically susceptible to Alzheimer's, the chance of you being able to prevent it completely is very, very high. So I think we need to move on from My mother had it, my family members had it. So I'm destined to have it. That is absolutely not the case. Okay. So the five steps to getting Alzheimer's starts in childhood, believe it or not. Play football American football or rugby, a sport that you're hitting your head over and over again at high velocities. Right. That constant trauma and not necessarily getting concussions, the trauma of hitting your head over and over again as a child and then into high school and beyond definitely sets you up for a situation where your chance of having dementia later on in life is greatly increased. Okay. Many people take that even into adulthood, playing professional sports, even riding a motorcycle and falling off, riding mountain biking and falling off and hitting your head. The amount of trauma that builds up over multiple episodes of hitting your head sets your brain up to have not just Alzheimer's, but also Parkinson's later on in life. The longer you extend that and the more you play these sports that your head is unprotected, the more damage builds up over time in your brain. Okay, then step two, moving on to, like, adolescence and early early adulthood. Eat a ton of ultra processed food, lots of sugar. Don't start your meals with vegetables. Instead, you have a very carby diet and throw your metabolism off. And so step two is having poor metabolic health. Right. We know in the Western world, 80% of adults have poor metabol, and that sets you up in a situation where you have a much higher risk of getting dementia in the future. And what's beautiful about this conversation, Rangan, is like, we don't need to just talk about dementia. Same for heart disease, cancer, all sorts of longevity.
- [08:13]
Dr. Rangan Chatterjee
Longevity in general, exactly at the minute. And of course, I know we're already two parts into the five step plan, and of course, it's a slightly ridiculous question in many ways, but the reason I was asking it was to really just showcase how many of these things so many of us are doing. So we don't directly ask ourselves the question, how can we speed up getting a brain disease? But it turns out that many of us are living lives which are actually doing that. Right?
- [08:43]
Darshan Shah
Exactly, exactly. And the damage builds up over time. And what's incredible about our human body is it's so incredibly resilient, especially up to the age of about 30 or so. Right. And this resiliency tricks us into believing that we're incredibly healthy, that we can live through anything, that nothing bad is gonna happen to us. But the damage builds up in childhood and adolescence as well, just as much it can build up later. Now, what happens as we age? So step three of the program then, is to create a massive amount of inflammation, and that is through having poor gut health, even poor oral health, being sedentary. So this all happens when we get A job, right. We become more sedentary, we continue have a poor diet, we're eating more ultra processed food, and our gut health suffers. And 90% of our immune system lives in our gut. Right? And so when our gut is not healthy, it's being attacked by thousands of toxins that are basically in our food. And our immune system is on overdrive, which creates a situation that we all know is another root cause of disease called inflammation. Right. Then the next thing that you can do is just don't care about your level of exposure to toxins. Right? And so, you know, we know that we live in a society now where we have 150,000 man made toxins in our environment. And these have only been here for the last 60, 70 years. These were never here before. And we are constantly and consistently exposed to toxins in our air, our water, our food and the skin products that we use. And you just don't even think about it. Right. And so we live in this state of just ignorance of toxins. But they do build up. They're almost the fourth leg of the stool of health. You know, you have nutrition, you have exercise, you have sleep. I really believe that toxin buildup and detoxifying your lifestyle is incredibly important. Right. And then lastly, you hit your 30s and your 40s and many people are living a very stressed life. You have children, you have a job, you're trying to make it financially, and the amount of stress builds up, cortisol builds up, your hormones levels start going down. Right. As we age. And all of that situation where you have hormonal dysfunction or dysregulation combined with high levels of stress also, then start predisposing you to Alzheimer's disease and all the other diseases. Right. And so I think those are the five steps you can take to try to get Alzheimer's early.
- [11:21]
Dr. Rangan Chatterjee
Yeah. Okay, so that's, that's super, super clear. Okay. So head trauma, poor diet, inflammation, toxin exposure and chronic stress. Okay?
- [11:31]
Darshan Shah
Exactly.
- [11:31]
Dr. Rangan Chatterjee
If we supercharge those five things, we're going to start increasing our risk of getting sick in the future. We're going to start increasing the rate at which we age. And I guess it's interesting that as I think about those five things, all of them are amenable to change.
- [11:50]
Darshan Shah
Absolutely.
- [11:50]
Dr. Rangan Chatterjee
Okay. And I think that's the key thing that we're both very passionate about. Now, I want to go through some of those things in detail, okay. Because I want this to be a really practical episode for people so they truly understand what kind of things they can start Doing immediately, of course, we're living in a world now where there's more and more information out there. People are getting very, very confused. And I know, Darshan, that you're very passionate about the 8020 rule, aren't you? So can you explain what the 8020 rule is? And then I think it'll be fun to start going through various things like sedentary behavior, food, et cetera, et cetera, and figure out how can we apply that rule to all of these different pillars of health.
- [12:34]
Darshan Shah
I love that. And you know, you. And I see patients all the time. I see patients almost every single day. And I find a lot of people have paralysis by over analysis of their Instagram feed. Right. One, you scroll your Instagram feed and one person is shouting from the rooftops. You must focus on your VO2 max. Another person says, no, it's all about strength training. Another person says, eat the carnivore diet, Eat the vegan diet. And it gets so confusing. And in reality, there's really 20% of the information out there that we know moves the needle. 80%. And if you don't get those right, it doesn't matter how much you go down the rabbit hole of supplements and biohacking, you're not gonna get the that you need. And so we need to absolutely focus on the Pareto principle, which is the 2080 principle.
- [13:19]
Dr. Rangan Chatterjee
I heard an interview you did a few weeks ago, and in that conversation, I think you shared someone who came to see you in your clinic in LA asking about the best sauna and cold plunge protocol yet. When you looked under the hoods, he was eating a lot of junk food, not moving his body and not doing the basics, basically, but trying to see if sauna and cold plunge could hack his way to health.
- [13:45]
Darshan Shah
Right, Exactly. I told him you could live in the sauna 24 hours a day if you want. It's not gonna negate the negative effects of the junk that you're putting inside of your body.
- [13:54]
Dr. Rangan Chatterjee
Okay, so this 20:80 rule, maybe that can be a kind of underlying theme throughout this conversation today, so that in this world of increasing information, people can go, okay, well, there's a bit of debate on this, bit of debate on that, but these things are. Are going to move the needle. Okay, so you know when you went through your five step getting Alzheimer's plan, one of the things you mentioned was the inflammation caused by sedentary behavior.
- [14:24]
Darshan Shah
Right.
- [14:24]
Dr. Rangan Chatterjee
Okay, so talk to me about physical inactivity. Where do the real problems come and what can we start to do to start Changing things.
- [14:34]
Darshan Shah
Yeah, it's a great question. First of all, it's very important to define what is sedentary behavior, right? I think we have this intuition, like, you know, we wake up, we sit down for breakfast, and we sit in our car, drive to work, and then we sit at work for four hours, and then we sit at lunch, and we're just sitting all day long. But in science, you can actually define where that stretch of sedentary behavior actually goes wrong. And what we see is that for every hour you spend being sedentary, after four hours, there's a 15% increased risk of all cause mortality. Okay? So really the magic number is anything more than four hours is gonna be detrimental to your. And what I tell people is this is more important than exercising. A lot of people think that they can work 8 hours in front of a computer, go to the gym for an hour afterwards, and then that's fine. They've done everything they need to do to combat this negative aspect of being sedentary. And that's not true. The gym workout does not negate the sedentary behavior during the day. Right? So what I tell people is we've also had a lot of research into how do we counteract sedentary behavior. And the Pareto principle here is it's just one easy thing. It's so easy, it's mind blowing to people every 45 minutes, getting up and moving around. And that's it. It's called an exercise snack. We have lots of research out there on exercise snacks. Completely negating the effect of being sedentary. And it could be as simple as just like getting up and having a conversation with somebody or walking around the office for three to five minutes. What I tell people to do is once you start getting to that routine and habit, why not do some air squats? Why not have a pair of weights and just lift some weights for a few minutes, right? There's other things that you can do that actually can then build up into even not just negating sedentary behavior, but reversing the negative effects of it as well. And so 45 minutes is the key. Take an exercise snack. I actually buy some of my patients a little manual egg timer. You know, those little timers you can twist and it's for cooking eggs, but you put it on your desk and you set it to 45 and it gives off a really annoying buzz that just kind of stops everything. You're like, oh, okay. It gets you out of your state of just being in massive focus and you get up and move around. And that combats a sedentary behavior. I will say one more thing on this too. I think it's so important to walk. You know, humans were meant to walk. That's why, you know, we started off in a small area in Africa and we went all over the world is because we were walking. Our biology is meant to to be constantly in motion. And so the more steps you can add to your day, the research is around 8,000 right now. Is the number of steps the better. And just find little moments in the day where you can get up and move around. Maybe do your meetings while you're walking instead of sitting there on the phone. Maybe you walk after every meal. Walking after every meal has massive effects at reducing blood glucose level as well. So getting those steps in is also important.
- [17:35]
Dr. Rangan Chatterjee
Yeah, it's really interesting as you talk about movement through the lens of this 8020 principle. The two things that you brought up there are actually quite easy, cheap, if not free to do right now. Yes, we can acknowledge that some people may feel that they don't have time to walk because of their job or the pressures in their life. Let's just park that to the side just for the moment. But there is a feeling, isn't there, when people think about moving their body, that it has to be intense and severe and I've got to push myself to the max. The two things you just mentioned there don't require any of that. You're talking about walking. Yes, walking is a uniquely human movement. But this idea of getting up regularly, of course the modern world makes it hard for people to do that. So you give them an egg timer or some of your patience. I think you also once said that you've got an app on your computer that automatically shuts it down. Tell us about that.
- [18:34]
Darshan Shah
Yeah, there's quite a few apps now out there. The one I use is called Flow app and it just makes your screen green every 45 minutes and it puts a five minute timer on there so you can't do anything. The other hack there too is do you zoom a lot?
- [18:49]
Dr. Rangan Chatterjee
Quite a lot, yeah.
- [18:50]
Darshan Shah
So if you don't pay for your Zoom account, guess what? They kick you off in 45 minutes. So that's a great excuse to just tell the people on the other side of the meeting, I'm so sorry, like Zoom is kicking me off and that gets you off the zoom and then you go, you go do your exercise snack.
- [19:05]
Dr. Rangan Chatterjee
Yeah, that's super interesting. And this Flow up is that flo.
- [19:09]
Darshan Shah
F L O W Flow.
- [19:10]
Dr. Rangan Chatterjee
Flow Yep. What I really like about that is that it's, you know, ultimately we can talk about the negatives of technology or the negatives of having to sit down and work in an office and on emails, whatever it might be, but that is the reality for huge amounts of people. So having some form of technology that just gives you that prompt every 45 minutes just to go, hey, the screen's gone green again. This is my prompt to walk around the block or go to the toilet or do 10 squats, whatever it might be, is super helpful. And, you know, the research on exercise snacks just keeps on coming. Even 10 years ago, there was a really good trial showing that people who moved regularly throughout the day actually had better blood sugar control than people who went to the gym after work.
- [20:00]
Darshan Shah
Exactly.
- [20:00]
Dr. Rangan Chatterjee
Right. I. E. What you're saying you can't undo the negatives of 8 hours continuous sitting by working out in the evening. Yes, you're gonna get benefits from that working out for sure. But there are still negatives from that sedentary behavior, aren't there?
- [20:14]
Darshan Shah
Right. Exactly. And it brings up a really good point because a lot of times I'll sit down with patients and the first thing they want me to do is program out a gym routine and they go into the nitty gritty of how many sets do I do, how many reps should I do? Then I ask them, before we talk about your gym routine, let's talk about what happens during your day. And I find they're spending 8, 10, 12 hours sedentary during the day. So I said, let's put the gym routine to the side. Obviously it's important. Right? But predo principle, let's focus on this one behavior that's gonna improve your health 80%. And then we add the gym in after that, right?
- [20:47]
Dr. Rangan Chatterjee
Yeah. And what's really interesting about that, what I've seen so many times with patients over the years, is that if you go to the gym, which again, we're not saying is not a good thing, we're saying, great, if you like the gym and you can go regular, this is brilliant. But sometimes if we focus on that first, there's a belief, isn't there, that, oh, I'm doing my, you know, I don't need to worry about anything else. I went to the gym and did my 40 minute strength workout, which is good, but often people will go, yeah, so, you know, I don't need to worry about anything else. You know, I can just sit all day every day because I know I go to the gym. So it's it's kind of trying to just reframe movements. I mean, I don't know where you're at in life with this darshan. I'm 47 at the moment. Okay. And I've got to say that it is becoming so clear to me that I now if I want to stay well, which I do, and look after my well being and age well, I've just got to move my body every single day. So I'm, you know, I was sharing with you just before we started recording. I'm. I've just come off a pretty crazy six to eight months with tour and launching an international book. And I'm really dialing down. I'm sort of focusing in on my movement. I'm currently trying to see if I can walk 90 minutes a day.
- [22:11]
Darshan Shah
Amazing.
- [22:12]
Dr. Rangan Chatterjee
And I've done it for the last 10 days and it's sometimes it's three 30 minute walks. It'll be, you know, sometimes I'm getting half five, I'm going for a 30 minute walk before the children get up, then maybe at lunchtime, then maybe after dinner. But it's, I feel incredible. And you know what's really interesting is that I can start to see elements of my physique changing. People don't think it's gonna do that. Right. But I honestly believe that walking's, it's having a profound effect on my physique as well.
- [22:41]
Darshan Shah
Walking is so profound in so many ways. I think not only does it help with like you're mentioning your physique, but also as we know it helps you to balance your sympathetic and parasympathetic nervous system as well. And so you'll see your HRV start improving over time.
- [22:56]
Dr. Rangan Chatterjee
It is. And it is.
- [22:57]
Darshan Shah
Right. And then also walking obviously gets you out in nature a lot of the times. Right. If you're able to walk outside. And that's also very helpful in decreasing stress and cortisol levels. There's so many stacked benefits to walking. It's just mind blowing.
- [23:12]
Dr. Rangan Chatterjee
Yeah. And we have very much undervalued walking I think. And it's, it's free, it's accessible. Certainly for most people, as you say, there's all these benefits as creativity, problem solving, even things like constipation. Right. A lot of people don't realize that actually one of the reasons that so many people struggle with constipation, of course there's many reasons for it and there's all kinds of things that can help. But if you're not moving your body regularly and there's something about walking, there's a contralateral motion between upper and lower body as you walk, which does compress the organs and it does, you know, have a compression effect on your bowel.
- [23:51]
Darshan Shah
Yeah.
- [23:52]
Dr. Rangan Chatterjee
Right. So again, talking about one thing that can have multiple benefits, walking is right up there.
- [23:58]
Darshan Shah
Yeah. And to your point on constipation, I can tell you I see patients all the time with constipation and once we get them walking, it's a miracle. Like many of them don't have constipation anymore.
- [24:09]
Dr. Rangan Chatterjee
They just have movement deficiency or walking deficiency.
- [24:11]
Darshan Shah
Exactly.
- [24:12]
Dr. Rangan Chatterjee
Right.
- [24:13]
Darshan Shah
Yeah. Another way to uplevel walking, I'll tell you, I was trying to talked to you about this a little bit earlier, is getting a rucksack or a weighted vest. And let me talk to you a little bit about that science too. So as we age, we know that we tend to lose balance and strength, particularly in our lower extremities. Right. And what I love about the rucksack, which is basically a weighted backpack, is it adds 20, 30 pounds to your walk. And as you're hiking and you're managing this weight and you're, especially if you're hiking through trails with the weight, it can really help preserve your balance and your ability to move and not fall as we get older. Because as you, you know, you and I both know one of the main reasons people demise as they get older is they lose their balance and they fall, they break a bone and then that's their, you know, sometimes the last thing that ever happens to them. Right. And so I really like adding that I'm 52 now. I added that into my routine when I was 50 and I really believe that's what's going to help me stay mobile number one. And also help me maintain balance, help me to be able to navigate terrain because I love to travel. Right. I love traveling with my family. And as you know, when you travel, you walk a lot and there's a lot of terrain. This is my attempt to maintain that well into my older years.
- [25:30]
Dr. Rangan Chatterjee
Yeah, amazing. Okay, so that's the 80, 20 applied through the lens of movement.
- [25:36]
Darshan Shah
Right.
- [25:37]
Dr. Rangan Chatterjee
Let's talk about food. Now food, of course, is a very important pillar of health. In your five step plan, point two was directly about food, but I guess point three, inflammation is also related to foods. Point four, you could even argue. And this sort of toxin exposure depending on what you're eating can also apply. So food is one of those key pillars. And I don't know what you're going to say here, but I think we share, I think again, quite a similar viewpoint on foods, which I don't think enough people talk about. Let's come to that. Let's start off by going, what is your 8020 approach when it comes to food?
- [26:19]
Darshan Shah
Yeah, it's very similar to movement. So I'll see a patient, they'll sit in front of me. Doctor, tell me what diet is perfect for me. Right? That's always the first question. Program out my diet for me. I'm eating vegetarian. Should I be adding more protein? How many grams of protein? Protein. And I always take it back to look, I really almost don't care what diet you eat. You can have any diet that makes you feel good as long as you eliminate ultra processed food from your diet. So we know also through research, massive studies, that for every 10% increase that you have over your daily caloric requirement in ultra processed food, you also add 15% to your all cause mortality rate. It's massive. Ultra processed food is everything that comes in the center of the supermarket. You know, in the United States, 90% of the supermarket real estate is ultra processed food, the entire center, Packaging food, dyes, preservatives, things that were never really meant to be food in the first place, has a tremendous amount of salt, tremendous amount of chemicals, and a tremendous amount of inflammatory fractures in it as well. So just eliminating ultra processed food can completely change your health. Not even talking about what type of diet to eat. Right. Because what's gonna happen is you're naturally, once you eliminate ultra processed food, you're gonna eat more produce, you're gonna have more protein in your diet. It just happens naturally. And I think that's the one thing that I think makes the 80% difference. That's it.
- [27:53]
Dr. Rangan Chatterjee
I completely agree with you. Okay. I, I don't know when maybe a year ago I said in one of these podcasts that I think contrary to, I think popular opinion, it's more important in the modern food environment to focus on what you're not eating as opposed to what you are. Okay. And people push back and no, it's about, you know, just small changes bring the right foods in. And I get that thinking, but I've got to be honest and go, in my entire clinical career, if you add a punnett of blueberries to your diet once a week, Right. And you change nothing else, I haven't seen much of a change.
- [28:35]
Darshan Shah
Right.
- [28:35]
Dr. Rangan Chatterjee
You can look at the study about blueberries and cognitive health.
- [28:38]
Darshan Shah
Exactly.
- [28:38]
Dr. Rangan Chatterjee
There are great studies on that. Okay. I don't dispute that. But what I've seen, I'VE seen move the needle is when people start eliminating the modern ultra processed stuff. And of course, as you mentioned, when you eliminate that stuff, you've got to eat something. Right. So you tend to eat that good stuff.
- [28:56]
Darshan Shah
Exactly.
- [28:56]
Dr. Rangan Chatterjee
But I think through that 80, 20 lens, I think if you just focus on cutting out the ultra processed foods or reducing them compared to where they are now, you're gonna start to feel better. And that feeling of more energy, more vitality, that's the motivation you then need to continue with it. Whereas if you just add in a bit of blueberries or some strawberries or some broccoli, luckily, sure, they've got benefits, but I'm not sure the benefits are enough to outweigh the negatives from the ultra processed foods. Do you see it like that as well?
- [29:29]
Darshan Shah
1,000%. A lot of people, when I ask them, let's use blueberries as an example, how do you get your fruits? I get blueberries every morning in my little container of oats that I add hot water to. And that's my blueberry. And I'm like, that's not even real blueberries. It's like blueberry flavored junk in there. That's not a blueberry. And I think what's happened is in our modern day society is it's become very difficult to avoid ultra processed food.
- [30:01]
Dr. Rangan Chatterjee
It really has.
- [30:01]
Darshan Shah
Right. Because a lot of the marketing is made to trick you into thinking that the foods are healthy, that they're providing us. Right. No one's marketing broccoli to you on the tv. Right. They're marketing to you. All these foods that are trying to convince you are healthy, but they're not. A lot of people consume these snack bars, for example. Right. And these snack bars, even though they might fill you up, they're just candy bars. They're not really healthy for you. Some of them could be healthy, but most of them I find are not. And so just getting to the point again where we are more in touch with nature, we're eating foods that were grown, they're organic. Hopefully. If you can get organic foods and just selecting foods and bringing it home and cooking it, I think that's a, a game changer for people, you know, and it's hard to do that nowadays.
- [30:50]
Dr. Rangan Chatterjee
If a patient comes up to you and says, hey, listen, Dr. Shah, I've heard about the negatives of having too many ultra processed foods, but they're everywhere. Right. I don't know where to start. What kind of practical guidance do you have for people? This episode is brought to you by Whoop Now I've been wearing a WHOOP band for about a year now. Honestly, it has had a transformative effect on my health and well being. I've gained so many insights how different types of exercise and life stress affect my recovery, how different evening routines affect my sleep quality, and overall I would say that wearing it has helped me to understand my body better. WHOOP is the only wearable that turns your health and fitness data into personalized guidance. And I'm pleased to announce that the all new latest Whoop is now available 7% smaller and with 14 plus days of battery life. Now the new Whoop includes so many exciting features including hormonal insights and on demand ECG readings. But I think my current favorite is healthspan, a new feature that demystifies the aging process and shows how your daily habits impact your pace of aging. And for me, seeing this regularly really helps to motivate me and keep me on track with my desired behaviors. Now look, I've been a doctor for over 20 years and honestly I don't think that health wearables are necessarily for everyone, but for many people like me they can be absolutely game changing. I think it's really important to use your WHOOP data as a tool to help guide you, not something to dictate your life. And I think it's also important to to correlate what the data says with your own subjective feeling and what else is going on in your life. So if you want to take a look at the Ornu Whoop and use it as a tool to help you improve your performance, health and longevity, get the ornu whoop@join.whoop.com livemore that's join.wh o p this episode is brought to you by BonCharge, a wellness brand who have a fantastic range of products to help you sleep better, feel better and live better. From blue light glasses to red light therapy and beyond, Bon Charge makes it easy to prioritize wellness at home and I myself have been using many of their products for well over five years now. Now, without question, one of my favorite products from them is their Demi Red Light therapy device. I closely follow the research on red light therapy and I'm really interested in potential benefits including enhanced recovery, improved skin, better eye health and improved sleep. And ever since I got this panel I spend about 10 minutes in front of it each morning whilst reading and about 10 minutes in front of it every night. It helps me wind down, feel more relaxed and I'm finding I fall asleep a lot easier. I'M also a big fan of their infrared PEMF grounding mat. PEMF stands for pulsed electromagnetic field, which sends magnetic energy into the body, which can help enhance sleep, improve focus and increase energy. Bond Charge Ship worldwide in rapid time. They offer easy returns and exchanges. And as an exclusive offer for my podcast audience, they are giving you 20% off everything on their website. All you have to do is go to bondcharge.com livemore and use coupon codes live more to save 20%.
- [35:05]
Darshan Shah
Yeah, that's a great question. So I tell people, let's make it as simple as possible. To start, pick three meals that you can easily make that have no more than two or three or four ingredients. And let's plan out a breakfast, a lunch and a dinner for you that has those ingredients. So, for example, breakfast can be three scrambled eggs and a piece of rye toast and some steamed vegetables. For example, pick your vegetable for lunch. It can be a salad with a piece of salmon on it or a piece of chicken. And then for dinner, it could be a vegetable, one piece of protein, and maybe some good carbs or slow carbs. Right? And so just pick that and eat that consistently. As many meals as possible. Right? And then let's start stair stepping you into a healthier diet. Then let's add another easy, simple meal and another one and another one to your menu of options. And so my patients actually have on their fridge, like, here are my options, here's my list of things I need to buy from the supermarket on a weekly basis. And we add to it. You're an expert in habit formation yourself. You gotta start simple and then add and stack on top of it. And that's how we kind of shifts people's diets completely. And look, it's not not fun, it's kind of boring. The foods that you're eating are boring. They're very simple. But the amount of change I see in people's health in just two weeks, it's so massive. People get addicted to this new way of eating.
- [36:38]
Dr. Rangan Chatterjee
Yeah, it's really helpful that you say boring. And I think if people are used to having their taste buds constantly stimulated and tantalize with lots of different flavors, well, relative to that, yeah, it can seem boring, at least initially. But you do this for long enough and it's not that long, then suddenly your taste buds do start to change.
- [37:04]
Darshan Shah
Exactly.
- [37:05]
Dr. Rangan Chatterjee
And again, look, we're all on our own journey. We've all got different levels of means. We all have different capacity to make choices in our life. I'm at the point now Darshan, where I generally don't want to eat out anymore.
- [37:17]
Darshan Shah
Right.
- [37:18]
Dr. Rangan Chatterjee
Like if I can help it, I just want to eat at home. A I can control what I'm eating. Don't get me wrong. It's still fun to go out sometimes with your friends. And there's a social aspect. I don't dispute that. But again, as I get older I realize that. Hey Rangan, you know, if you are not being really proactive about your health, the modern world is going to drag you down a certain path. Right. It's not easy anymore for most people to be well and healthy. You have to actively make choices often that are in conflict with the world around you. I mean that's a harsh reality, isn't it? For people to accept. Because I think if you look at these mythical so called blue zones and I know there's some sort of debate as to all kinds of things that go on in these blue zones. Right. I appreciate that. At the same time, what's really interesting to me is that these long living populations are not trying to live for a long time.
- [38:13]
Darshan Shah
Right?
- [38:14]
Dr. Rangan Chatterjee
Right. Their environment is just naturally set up in a way where good health is the easy option. Whereas where you live in America, where I live in the uk, that's certainly not the case, is it? So again, going back to what you said before, once your taste buds re acclimatize to what whole natural food tastes like, after a while you will choose that over the ultra processed foods. Is that what you found yourself?
- [38:42]
Darshan Shah
1,000%. You know what people need to understand is the ultra processed food is made by giant corporations that have a lot of money and they found the right chemical mixture. I mean they have scientists paid hundreds of thousand dollars a year to make that food hyper palatable, to make it addicting to your taste buds and your mouth. And you have to untrain that in your biology, in your brain. Right. And. And it's that way on purpose. Right. That's why it doesn't seem as enticing to eat a salad as it does maybe a TV dinner. Right. But at the end of the day your brain does want to rewire itself into choosing natural food. For sure.
- [39:27]
Dr. Rangan Chatterjee
You know, one thing, I haven't seen any research of this and this is purely an n equals 1 or certainly within my own family, I'm very happy having the same meal.
- [39:38]
Darshan Shah
Yeah.
- [39:39]
Dr. Rangan Chatterjee
Day after day.
- [39:40]
Darshan Shah
Right.
- [39:41]
Dr. Rangan Chatterjee
I actually don't mind that. I feel it eliminates choice I have to make in terms of what are we going to eat And I wonder. It's not only the ultra processed food and what's problematic in it for our health and well being. I wonder if one of the hidden consequences of UPFs Ultra processed foods is also that it's conditioned us to believe that but we can have something new, delicious and tasty three times a day, seven days a week.
- [40:11]
Darshan Shah
Exactly. Right. I mean, what ends up happening is you get decision fatigue as your day goes on. Right. And especially when you're hungry, you're at your weakest point and you make the worst possible decision. You find what's easy and tasty and that's what you go for. Right. And so I think the elimination of choice is actually one of the methodologies I use to get my patient's diet to shift. Because we go, like I said, super simple. Only three menu items for the day. Right. And some people even eat the same menu item twice a day. They'll eat their eggs and vegetables for lunch too, which is fine. You know, we just keep it super simple.
- [40:48]
Dr. Rangan Chatterjee
Yeah. And for some patients, I've got people, you know, friends who do this, they have a meal plan for seven days. And that seven days just rotates 52 weeks a year. Right. So you're gaining variety. But you know, on a Monday, this is what we have for dinner. This is what we have on a Tuesday, this is what we have on a Wednesday. And although in the modern world we think, oh, that's a bit restricting. Right. It's taken away my choice. I actually think that kind of discipline leads to the freedom. It's like, oh, I don't need to think, you know, we're gonna have a variety. Seven different evening meals and we just repeat. So everyone knows on Monday what we're having, everyone knows on Wednesday what we're having.
- [41:26]
Darshan Shah
That's what we do in our house.
- [41:26]
Dr. Rangan Chatterjee
Is it really? Is it?
- [41:27]
Darshan Shah
That's exactly what we do in our house.
- [41:28]
Dr. Rangan Chatterjee
What's Friday in your house?
- [41:30]
Darshan Shah
Friday is usually the only day of the week that my wife and I, we go out and have dinner together. Okay. But you know, even the choices that we make when you go out, you really have to be able to choose the right foods when you go out to restaurants. Because, you know, restaurants hide a lot of ultra processed foods in the foods that they cook. So in general, Friday is usually protein and salad, whether we're at home or we're out in the restaurants. Yep.
- [41:59]
Dr. Rangan Chatterjee
In your five step Alzheimer's plan, in number three, where you mentioned inflammation.
- [42:05]
Darshan Shah
Yes.
- [42:06]
Dr. Rangan Chatterjee
I think you also mentioned inflammation from the gut and inflammation from the mouth.
- [42:11]
Darshan Shah
Yes.
- [42:11]
Dr. Rangan Chatterjee
Okay. So could you just briefly explain to people what inflammation is.
- [42:16]
Darshan Shah
Absolutely.
- [42:17]
Dr. Rangan Chatterjee
And then sort of talk to us about gut inflammation and oral inflammation and what we can actually do to improve those things.
- [42:23]
Darshan Shah
Yeah. So inflammation is a state where your immune system, which is there to help us fight off bacteria, viruses, toxins, is there to eliminate cancer cells from inside of our body. Our immune system is incredibly important, and unfortunately, as we age, it does become weaker. It's a process called immunosenescence that happens as we age. But the healthier you are, the longer your immune system will stay healthy. And why is that important? Because obviously we need it to fight off infections and cancer, et cetera. Now, what happens when you get inflammation is that your immune system is active all the time, and it's not active fighting off cancer, it's not active fighting off infections, it's fighting off all the toxins that are being accumulated in our body. Most of those toxins come in through our gut, and our gut starts in our mouth, and it goes all the way down to the other side. Right. And so, once again, ultra processed food has a lot of toxins in it, a lot of inflammatory factors in it, and if you constantly assault your gut with ultra processed food, it's gonna all be absorbed and keep your immune system overactive. And when you have a lot of inflammation, what's happening is your body is just in a state where it's fighting off these toxins, but it's also destroying normal cells, and it's also creating havoc throughout areas of your body that aren't necessarily injured. And so this is why we always check for inflammation in our patients. And then when we see high inflammatory markers, the first place we look is in the gut.
- [43:54]
Dr. Rangan Chatterjee
Wow.
- [43:54]
Darshan Shah
Yeah.
- [43:55]
Dr. Rangan Chatterjee
How do you check for inflammation in your patients?
- [43:57]
Darshan Shah
So we use a marker called hscrp, highly sensitive C reactive protein, as one of the first markers we look for. This is a super simple blood test that anyone should be able to ask their doctor for. And I'm a huge believer in checking this marker once a quarter or once every six months.
- [44:15]
Dr. Rangan Chatterjee
Wow.
- [44:15]
Darshan Shah
Just to make sure what's happening in your lifestyle over the last few months is not causing inflammation. Right. One area where people get a lot of inflammation from is from their oral cavity. What happens is they haven't seen a dentist in a while, they forget to floss, and they get inflammation in their gums. And people live with inflammation in their gums in their oral cavity, sometimes for years and years and years. And you and I both know there's an association between poor oral health and Alzheimer's disease and cancer and also heart disease. And so we know keeping your oral cavity healthy is critical, so go to see your dentist every six months at least.
- [44:55]
Dr. Rangan Chatterjee
Yeah. It's interesting hearing you talk, Darshan. It's interesting. We started talking off about the brain, right. And the various things that many of us are doing without realizing that are assaulting our brain and increasing the risk that our brain is gonna age prematurely and then potentially get things like age related cognitive decline. Okay. But as we sort of unpick those five areas, it's very clear, as we both know very well, that everything's connected.
- [45:27]
Darshan Shah
Right.
- [45:28]
Dr. Rangan Chatterjee
It's not as if you need one lifestyle approach for your brain and one lifestyle approach for your heart and one lifestyle approach for your inflammation. Right. It's the basic foundations of what it means to create health in the body. You just mentioned the oral cavity. Right. Again, people may think, oh, I'm, I've, you know, I focus on my physical health. You know, what, what the hell's my tooth or my teeth got to do with my physical health? But of course, there's ample research on the relationship between oral health and brain health and gut health and mood, you know, all kinds of different things. And I guess what's always interesting for me is to kind of figure out the journey medical doctors take to get to this point. Because we're not trained like this, are we now? Because a lot of my audience may not have come across you before, I think it would be really insightful for them to understand how you got to this point. Because you wouldn't say this about yourself. I'm gonna say it for you. I think you were a bit of a child prodigy.
- [46:36]
Darshan Shah
Thank you.
- [46:37]
Dr. Rangan Chatterjee
Is that true?
- [46:38]
Darshan Shah
Well, you know, I did graduate from medical school very young. I was 21 years old when I graduated from medical school.
- [46:44]
Dr. Rangan Chatterjee
And can I just pause you there? Right. That would be massive in the uk but in the US I think it's even more impressive because we don't have to do a degree before we go to medical school here. So I went to medical school when I was 18. Right. So we finish like 23. You can walk out of medical school in this country as a doctor in the U.S. i think it's normally 26, 27. Right. Because you do a degree first.
- [47:10]
Darshan Shah
Right.
- [47:11]
Dr. Rangan Chatterjee
You qualified as a medical doctor at the age of 21. When did you start training?
- [47:17]
Darshan Shah
I actually went. I left my parents home at the age of 15 to go to school. Yeah. And so I was very lucky. I was trained in a system that was emulated. From the UK system in Kansas City, Missouri University of Missouri, Kansas City. And they took the UK system as one of five schools in the United States that had a six year medical degree program. However, you still had to go through college. So they compressed all of college into two years, plus they put you right into the hospital. I remember the first day of college, I was in the hospital following a doctor around.
- [47:53]
Dr. Rangan Chatterjee
How old were you?
- [47:54]
Darshan Shah
I was 15 years old.
- [47:56]
Dr. Rangan Chatterjee
Wow.
- [47:56]
Darshan Shah
Yeah. With a lab coat on. Following a doctor in the hospital and. Yeah. So, you know, I'm so lucky that I got to do this because it's afforded me multiple times in my life that I've had multiple careers in medicine now.
- [48:10]
Dr. Rangan Chatterjee
Yeah, I've heard you say you're in your third career at the moment within medicine.
- [48:13]
Darshan Shah
Third career in medicine. Right.
- [48:14]
Dr. Rangan Chatterjee
So what were they? What was the first one?
- [48:16]
Darshan Shah
Yeah, so the first one, as soon as I graduated from medical school, I decided I wanted to do surgery. It was just enthralling to me how you could go to the operating room and literally open someone up and fix something or save their life or change their life. And so I was a surgeon for 10 years. I did trauma surgery, general surgery. After doing that for 10 years, I got another challenge. So I went to the Mayo Clinic and I trained in reconstructive surgery. So this is doing incredibly complicated procedures, sometimes under a microscope, where you're reconstructing people after cancer. And so I did that for another 10, 15 years. But then I got sick because I was a stressed out surgeon. I was operating 14 to 16 hours a day. I was not sleeping, I was eating a lot of junk, just whatever was in the hospital because I basically lived.
- [49:04]
Dr. Rangan Chatterjee
You were on the Alzheimer's plan?
- [49:05]
Darshan Shah
Yeah, I was on the Alzheimer's plan. Exactly, exactly, yeah. And I decided on the birth of my first son. I remember this very vividly. My wife was in the hospital. She had just birthed our son. And I went to the doctor's lounge because we birthed our son in the same hospital where I'd normally operate. Right. So I go down there and at this point, I'm 50 pounds overweight. I have diabetes, full blown diabetes, hypertensive. I'm on three different medications for my blood pressure. It's still out of control. It can't get under control. And I develop an autoimmune disease. And I happened to be in the doctor's lounge. There's a journal about the specific autoimmune disease that I had developed and the medications used to treat it. And it said, I had a 50% chance of dying, a mortality rate of 50% because of my constellation of diseases in the next 25 years. And remember, my newborn son was just upstairs. So this was a very stark reality for me.
- [50:03]
Dr. Rangan Chatterjee
How old were you at the time?
- [50:04]
Darshan Shah
I was 42 years old.
- [50:06]
Dr. Rangan Chatterjee
42 years old. You're pretty sick. You've just read that you have a 50% chance of dying in the next two, two and a half decades. And your first child has just been born, so quite a pivotal moment for you.
- [50:21]
Darshan Shah
Yeah, yeah, it was very. It was almost as though, you know, God was giving me a sign, because this is a medical journal that I would normally never read. And it was right there on the counter after the birth of my son. And so I decided I need to make a change. But as you know, in Western medicine, we are not taught the science of disease reversal. We are not taught the science of health. Really, what we're taught is to seek out a specialist that can help solve the various problems that you have. Right. So I'm seeing a cardiologist for my high blood pressure. I'm seeing an endocrinologist for my diabetes. I'm seeing a rheumatologist for my autoimmune disease. And no one's talking to each other. Right. And so even myself, being in Western medicine, I was conditioned to. This is how we think about our body. It's just multiple different silos. And I went down a rabbit hole of trying to fix these things, and all I got was more medications. I went from eight pills to 12 pills, you know, And I said, there has to be a better way. And right about then is when. When Jeffrey Bland and Mark Hyman started teaching functional or root cause medicine in the United States. And I was lucky enough to be one of their first students, because I went out there and said, I have to go learn how to get myself healthy. And I applied the principles of root cause or functional medicine to my own health, and I got healthy in eight months, completely off most of my medications. In eight months?
- [51:45]
Dr. Rangan Chatterjee
In eight months. Okay. This is really interesting, isn't it? This idea that. That Western medicine is phenomenal at certain things, but it's not great at everything. Okay, and you were a trauma surgeon for years, right? Of course. Trauma surgery is phenomenal. What we. I say we, the collective, we can now do, right? Yet all of that training, the fact that you were this child prodigy who went to medical school so early, none of that allowed you to fix yourself, because that model, which you were taught is good for some things. But not good for disease reversal or chronic disease management, is it?
- [52:24]
Darshan Shah
Right, exactly.
- [52:25]
Dr. Rangan Chatterjee
So if you're open to sharing, what was the autoimmune condition that you had, and then what was it that you did in those eight months that caused your health to improve so much?
- [52:38]
Darshan Shah
Yes. Absolutely. Can share. So I had this really rare condition, actually, called coupes de sabre. And this is a condition where your immune system basically starts eating away at the subcutaneous tissues of your. And so you can kind of still see the remnants of this. I have no muscle underneath half of my forehead. And if you look at my skull at a CAT scan, my skull is extremely thin because this autoimmune condition was eating away at the bone of my skull. And the treatment for this is methotrexate. Right. Which is a very powerful immune suppressant. So now what I've done is my body is frantically trying to fight off all the toxins that are building up in my system, and now I've suppressed the immune system. Right.
- [53:22]
Dr. Rangan Chatterjee
With methotrexate.
- [53:23]
Darshan Shah
With methotrexate, Right. Exactly. And so, you know, it was. And methotrexate, as you know, has a lot of side effects. Right. And I started experiencing all those side effects, too. So I got even sicker because of these medications, and. That's. Right. Isn't that the problem with Western medicine is for every problem, you don't try to reverse it. You cover up the symptoms with a pill or with a surgery. The other thing that was recommended for me for my weight was a gastric bypass procedure, which we know is one of the most risky procedures that you can do to bypass your stomach to help you lose weight. Right. A lot of people end up very sick after a gastric bypass surgery. And no one talked to me about the food I was eating, the status of my gut health, the status of my hormones, none of it. Until I went to learn functional medicine.
- [54:09]
Dr. Rangan Chatterjee
So what were the key things that you did over eight months that led you to believe, oh, wow, this is working? And actually, this may be the approach that I take for myself and the approach I want to start teaching my patients about.
- [54:25]
Darshan Shah
Yeah, yeah. Because once I did this, I was like, this is the kind of medicine I want to practice. You know, this is so inspiring to me to be able to turn my own health around and turn the health around in my patients and get them off the medication. Right. I think that should be the goal of most physicians, is let's use the medications to help for the moment, but the goal is to eventually get off of them. Right. And I think that's a helpful construct. So some of the things that I did was the 8020 principle. I went from not moving at all to moving my body constantly getting 10,000 steps. And back then there weren't any wearables. So I bought a pedometer actually, and I got my 10,000 steps in. I stopped eating the ultra processed food. I started really focusing on my sleep. I was brought up in this generation where sleep was considered a waste of time. And instead I started just making sure I slept eight hours a night. And then I did some of the principles of functional medicine. I looked at my gut health, which was a disaster, right? I was eating ultra processed food. I had a lot of pain from my autoimmune as well. So I was taking Advil and Motrin, which is like a nuclear bomb to your gut bacteria, right? And then I stopped the immune suppressant and I checked my hormone levels. It turned out my testosterone level was in the toilet. It was so bad it was even. You know, we look at the testosterone levels now and the numbers have been brought down because over the last 50 years, normal levels have become lower and lower. Mine was even lower than what is considered normal now. And so, so, you know, I just started then seeing a functional medicine practitioner that could really help me improve my hormone levels, get my gut fixed. And that made all the difference.
- [56:08]
Dr. Rangan Chatterjee
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- [59:33]
Darshan Shah
Maybe I'll answer another question and taking it back to Alzheimer's disease, right?
- [59:37]
Dr. Rangan Chatterjee
Sure.
- [59:38]
Darshan Shah
One of the main causes of a subtype of Alzheimer's is lack of trophic factors. Trophic factors are the hormones that our body secretes to keep us in a state of growth and health. Right. And testosterone for men is the most important trophic factor for women. They have estrogen, progesterone, and testosterone as well. Very, very important. And unfortunately, we're genetically programmed to have these levels start going down after the age of about 40 or so. You know, women go through menopause, men go through menopause or andropause. That happens genetically. But what happens now in modern society is that comes sooner and sooner and sooner. Sometimes even I see patients now in their 20s with hormone levels that are in the toilet. Right. And so, and that's because of our lifestyle, our sedentary lifestyle, our lack of good nutritious food and micronutrients in our food has caused this to happen.
- [60:39]
Dr. Rangan Chatterjee
Chronic stress.
- [60:40]
Darshan Shah
Chronic stress, yes, exactly.
- [60:42]
Dr. Rangan Chatterjee
Big one for hormones, isn't it big one.
- [60:43]
Darshan Shah
Right.
- [60:44]
Dr. Rangan Chatterjee
I mean, it was the fifth one of your five step plan, I think. Yes, we were talking about chronic stress through the lens of brain health, but you can also look at our hormonal levels and the kind of hormonal havoc that many people are living through these days, men and women. I would say chronic stress is one of the key drivers.
- [61:06]
Darshan Shah
Absolutely, absolutely. And so, you know, a lot of times patients will come to me and I'll show them their hormone levels are a problem. And the immediate question is, what hormones are you going to put me on? Before we put you on hormones, what we do is we manage their stress levels primarily and then also look at all the other things that we talked about. And I would say five times out of 10, we can make significant improvements just by doing those things.
- [61:31]
Dr. Rangan Chatterjee
Yeah. It's interesting. You know, if you talk about a man and testosterone, a lot of people's mind will jump to libido or sex drive. Okay, but what you just said there is again, not that libido and sex drive is not important, but. But you're talking about this on a completely different level. You're talking about these hormones and testosterone has been a trophic factor to signal growth to the brain. Right, right. It's really expanding that, I think, very narrow view that many people have in society of hormones like testosterone.
- [62:05]
Darshan Shah
Exactly. Yeah. It's a biological signal that works on almost every organ of your body. And we could argue the most important organ of your body is your brain. Right. And so testosterone, your thyroid hormones for women, estrogen, progesterone, extremely important.
- [62:23]
Dr. Rangan Chatterjee
Yeah. It's really inspiring hearing your journey and hearing, A, just how sick you got, but B, how quickly and successfully you were able to reverse a lot of these disease processes in your body.
- [62:40]
Darshan Shah
Yeah.
- [62:42]
Dr. Rangan Chatterjee
I'm also interested, though, Darshan, as I think about your medical career and the fact that you're now on your third stage of your medical career, you're a surgeon for those first two stages. Okay. Trauma surgeon, then a reconstructive surgeon. Even though you no longer operate. That's true. Right? Isn't it?
- [63:01]
Darshan Shah
Correct. Yeah.
- [63:02]
Dr. Rangan Chatterjee
Yeah. Even though you no longer operate and your focus now is on reversing disease, improving longevity, creating health in your patients, I'm interested as to what did surgery teach you? Okay. Because being a surgeon, it's quite incredible really, to be able to open up a human body, see what's under the skin, and do things that have a massive outcome for your patients. Right. So I'm interested. What did you learn from surgery? About the human experience, about the human body that you now apply with your patients, even though you're no longer operating.
- [63:47]
Darshan Shah
This is a fantastic question. So I would say surgery teaches you or taught me a tremendous respect for this, for a human biology. It is incredible what evolution, or God, whatever your views are, has built. It's absolutely incredible how resilient it is. The people that we brought back from death, basically using surgery. It's mind blowing, right? The resilience of our human body is more than anyone could ever really imagine. Until you've actually done some of these trauma surgeries or cancer surgeries, and see how we can resect massive portions of a cancerous esophagus, for example, and replace it with intestine. And it just blew my mind. But then the flip side is also true. The human body is also extremely fragile and susceptible to constant micro traumas. Okay. And micro traumas is the exposure to toxins in our food, ultra processed food, sugar, sedentary behavior, because what you're doing at a cellular level cannot be turned around with surgery. Right. And so it just gave me a tremendous respect that we have to take care of every cell in our body from a very, very young age. And moving forward by having all these good habits. And look, thank God we have surgery, right? Thank God we have the entire western medical system. If you get hit by a truck or if you get diagnosed with cancer or you have a heart attack, that system is incredibly advanced to take care of those disaster situations. But hopefully, if anything, you learn to take care of that system in the first place. So you don't need advanced medical therapies.
- [65:41]
Dr. Rangan Chatterjee
Yeah, it's fascinating hearing that, hearing your reflections, that, I guess heightened appreciation for the miracle that is the human body. You had a look under the hood in a way that most of us never get to see. Right. And yeah, it's quite interesting to reflect on that. I guess, for me, it also ties into one of the things you're passionate about today. You talk a lot about that. We should all be the CEO of our own health, right? So we need to be in charge of our health and empowered by measuring things, tracking things, seeing our biomarkers. We'll talk about all of those things in just a moment. But it's interesting me to sort of tie that back to, you know, your days as a surgeon where you look under the hood, you see the fragility and the magic of the human body, yet most of us can't see that. And it's not dissimilar with our biomarkers. Right.
- [66:45]
Darshan Shah
Right.
- [66:45]
Dr. Rangan Chatterjee
We can't see that. We can't see what our blood sugar is doing. We can't see what our liver enzymes are doing. Right. We can't see what our VO2 max is. Right. So. So do you think that also plays into why you're so passionate about measuring things and tracking them?
- [67:06]
Darshan Shah
Yes. I mean, exactly. It's like now we have the science. We've had the science for decades, but now it's actually allowed to be distributed to where people can actually see their own biomarker results. And now everyone has the ability to look under the hood. Everyone can see what's going on in their biology by just learning a few simple numbers and taking control of those. I talk about becoming the CEO of your own health or the boss of our own biology, because what does a CEO do? He or she runs a company, and they look at numbers every single day, sometimes every hour. They look at quarterly reports, they look at yearly filings, and they're managing their business based on what do those numbers show? Everyone now has ability to do that. And so once you gain the understanding of how to do that, how to get these numbers and what they mean, and there's not a lot of them, there's probably like 10 numbers that I have my patients follow. It's massively empowering because, remember I talked about the resilience of the human body. Your numbers change 20 to 30 years before you start feeling symptoms of disease. Right. By the time you feel symptoms, usually there's a lot of damage done. Right. And what's also magical about these numbers is they're not just on off numbers, not just 0 and 1. We have levels, so you can aim for optimal levels. You can follow and track your progress. Just like a CEO would look at their profitability number over time, and they continue to try to optimize and optimize to get it to a good number. We can do that.
- [68:37]
Dr. Rangan Chatterjee
Now, what would you say to someone who's listening and says to you, hey, Darshan, listen, I get what you're saying. At the same time, I don't think that's what being a human is about. Being a human is about experiencing life, not obsessing over what's under the hood, not giving myself health anxiety when I see numbers going up or numbers going down. I don't want to live like that. What would you say to that individual?
- [69:07]
Darshan Shah
Yeah, I would say that might have been a good model 60 years ago, but unfortunately, it's not a model that you can realistically live under right now. And so Look, I totally realize health anxiety is a real thing and I have patients with health anxiety and so we don't throw a lot at them. But this is the era of medicine that needs you to participate in it. Because if you're not participating in your own health and you're outsourcing your health to your primary care doctor who has 15 minutes with you once a year and maybe checks two or three things, if you're lucky, you will head down a path of early disease. Alzheimer's, potentially cancer, heart disease. The incidence of all of these is increasing rapidly. You know, in the Western world, 33% of people over the age 85 have dementia. One out of every three. Who wants to lift 85? If you have a one in three chance of having dementia and not recognizing your friends and family, and that's a long, drawn out course that eventually leads to death. Right. No one wants to do that. You don't have to be in that category at all if you can take some personal responsibility of your health. And it's not that hard. Almost everyone has a car and you're constantly looking at your dashboard of your car, making sure that the check engine light is not on. A lot of people do their own oil changes, they're doing maintenance all the time. We spend more time and energy on our, our motor vehicles than we do on our own biology. Right. So I think it's necessary now because unfortunately, the medical system is not built to handle the volume of chronic disease right now. And your only chance is to be able to detect it early and reverse the trend before it becomes a problem.
- [70:58]
Dr. Rangan Chatterjee
Yeah, it's a really interesting point. You just made this idea that, hey, that more intuitive way of living, not looking under the hood, just experiencing and enjoying life, that approach may well have worked for the bulk of human evolution. But as you started off this conversation with that five step Alzheimer's plan, that was a question that I asked slightly tongue in cheek. But what was interesting as you went through that five step plan, I was thinking, wow, this is a plan that many people are unintentionally following.
- [71:34]
Darshan Shah
Exactly right.
- [71:36]
Dr. Rangan Chatterjee
And so it was interesting to say, or to think and reflect and go, so in this modern world where it's hard to make the healthy choice if you're not tracking or taking ownership or. I like what you said. Being the boss of your own biology, who's going to do it for you?
- [71:57]
Darshan Shah
Exactly.
- [71:58]
Dr. Rangan Chatterjee
Like no one is. And that's, you know, people don't really get that these, the US healthcare system, the UK healthcare system, these things are Built and structured around disease management. Once you've got sick or something's wrong, these things come in to help, Right. Their whole DNA is not about health creation, prevention. Do you know what I mean? It just isn't. And so if you don't take ownership of your health and there's so much info out there today to help people do that, I think you're sort of rolling the dice.
- [72:32]
Darshan Shah
Exactly.
- [72:32]
Dr. Rangan Chatterjee
You may get away with it. You might be one of the lucky ones who can be healthy in this environment, but you may not.
- [72:38]
Darshan Shah
Right, Exactly. You know, I always give this example to my patients in the United States about health insurance. Right. I always say, do you have house insurance, like fire insurance for your house? And they say, yeah, for sure. And do you expect your fire insurance to pay for cleaning your house, vacuuming your carpets? Of course not. Insurance and even the health system was never built to maintain your house or your body. It was there to handle disaster scenarios. Right? Now chronic disease has become a disaster scenario. People have massive amounts of chronic disease and end stages of chronic disease. Right. But that's because we've let it get there by not maintaining our house. It's like having a home for 30 years and not putting a coat of paint on it, not doing anything to it to keep it viable. Right. It's the same. Same analogy.
- [73:31]
Dr. Rangan Chatterjee
Yeah. I keep thinking back to you as a surgeon and I don't know, looking under the skin and seeing someone's liver or seeing someone's bowel and seeing the health, you know, does it look healthy and rosy? Possibly not if you're operating on them, or does it look necrotic or so the blood flow is lacking, whatever it might be. Okay. And it just makes me think how many of us don't take action, Right. Or they want to take action and they don't. And there's many reasons for that. One of the reasons, I believe, is because we don't have a direct relationship or we think we don't have a direct way of seeing what we're doing and how it's impacting us. Right. So just as a thought experiment, Right. If you were drinking alcohol. Alcohol. And you could also look at your liver like a surgeon, and you could see when I have three glasses of wine with my meal or half a bottle of wine with my meal because I'm celebrating something, and if you could see that your liver suddenly started to change shape or contracted, it might actually change your behavior. Right. But obviously we can't do that, but we can do that with some things, can't we.
- [74:49]
Darshan Shah
Yes, we can.
- [74:50]
Dr. Rangan Chatterjee
Do you know what I mean? It's quite interesting, isn't it?
- [74:52]
Darshan Shah
Absolutely, yeah. It's such a great example, the liver, by the way, because I've seen the liver over a thousand times, maybe over 10,000 times, doing surgery. And it's incredible how many people you look at their liver and it's infiltrated with fat. It has a million fatty cysts in it from alcohol, from eating lots of sugar and having metabolic disease. And the liver, as we both know, is an extremely resilient organ. You're not gonna feel this until you need a liver transplant. Right? Yeah. And so the liver is a perfect example of how your body can mask the damage that you're doing to it for decades. Right. But I will tell you now that we have blood tests, as you and I both know. Ast, alt, these are some of the basic blood tests that I think everyone should follow. They're your liver enzymes, and they go up years and years and years before you start developing severe liver damage. And if you were following your AST and ALT and say you were a half a bottle of wine with dinner drinker and you started seeing it tick up to 60, 70, 80, that's an indicator in your brain, like, wait a minute, my drinking is really doing something to my liver. I need to do something. Right?
- [76:08]
Dr. Rangan Chatterjee
Yeah, yeah. It's interesting on so many different levels. Okay. Before, you said there are no normal ranges of hormones like testosterone have changed, not because what human biology needs to function has changed, because the modern world and modern humans are so unhealthy relative to how we were that in adverse compass, normal range has had to change to reflect normality. Normality, though, is probably not what we're looking for. When you say 80 to 90% of the west of the world, depending on which country you're in, has some degree of metabolic dysfunction. But a lot of people don't realize that our liver tests like AST and ALT have also shifted their normal ranges to reflect an unhealthy population.
- [76:52]
Darshan Shah
Exactly.
- [76:53]
Dr. Rangan Chatterjee
And there's another point I wanted to just bring up there because a lot of the kind of modern fancy therapies that hopefully we'll talk about later on are not available to everyone. Okay. There is a cost element to them. And I know you recommend that people track various biomarkers. There's actually a really good free PDF on your website for people. I downloaded it last night when I was preparing for this conversation. And it's great that you provide that resource for free. Just tell people how they get that Because I think it will be super useful for people.
- [77:28]
Darshan Shah
Yeah, just go to my website, drshaw.com biomarker and I have have a PDF that I created of all the biomarkers that everyone should follow. There's not a lot of them.
- [77:37]
Dr. Rangan Chatterjee
I think it was 10 and normal ranges and one normal ranges.
- [77:40]
Darshan Shah
Right.
- [77:40]
Dr. Rangan Chatterjee
I did it last night, but it's really good. So maybe we won't get time to go through all of them, but let's just break it down into super accessible and cheap ones that are readily available to people all over the world. And then we could talk about the more fancier, newer ones that maybe not everyone has access to. Alt and astronomy. These liver enzyme tests are basic, cheap, bog standard tests that you can probably get in any country around the world.
- [78:08]
Darshan Shah
Absolutely. All the biomarkers that I have my patients follow are in that category.
- [78:13]
Dr. Rangan Chatterjee
Really?
- [78:13]
Darshan Shah
Every single doctor in every country, I don't care what country you are, can check these.
- [78:18]
Dr. Rangan Chatterjee
So what are some of that? Okay, so the liver function test we've just mentioned, what else?
- [78:21]
Darshan Shah
Okay, let me divide it up into a few categories, if you don't mind. Okay, so metabolic health we talked about. Right. So metabolic health has to do with how your body's handling sugar. We know that if your blood sugar level is too high for too long, your insulin levels go high and then you get insulin resistance, but then becomes diabetes. So in the metabolic health bucket, I'm always looking at hemoglobin A1C and AST, ALT and triglyceride levels. Those are the four markers there. Hemoglobin A1C is a really good example of one of these biomarkers that everyone like. If I see you walking down the street, I should be able to say, Dr. Chatterjee, what's your hemoglobin A1C? And you should be able to tell me what it is. You should know this number.
- [79:01]
Dr. Rangan Chatterjee
I agree. I, I probably try mine every three months.
- [79:04]
Darshan Shah
Yeah, so do I. Yeah. Because it changes.
- [79:07]
Dr. Rangan Chatterjee
Yeah.
- [79:07]
Darshan Shah
As, you know, like as you travel a lot, it can shoot up because you lost certain control of your diet. Right.
- [79:14]
Dr. Rangan Chatterjee
Well, it's, it's that motivating tool. Right. It's that idea that. Oh. Because it's a range and it changes in real time. Right. So it's an, it's a two to three month average of your blood sugar. One of the most, arguably one of the most important metrics to look at. If you see it creeping up, you can take action. Instead of waiting a year or two years, you can see it after three and go oh, wow. What was I doing over the last three months? Oh, maybe I'll make some changes and recheck it in three months. So I find it very empowering. Okay, so HbA1C cheap test, available to everyone in most countries. Okay.
- [79:52]
Darshan Shah
Also, triglycerides are available to everybody ast, alt, super cheap, easily available on the inflammation side, really, there's two markers, but the one I focus everyone is HSCRP that we talked about earlier, C reactive protein. This is a marker that should be as close to zero as possible because that means that your inflammation is under control in your body once it starts going over one or two. The problem is, is your immune system is becoming overactive. And we talked about the negative consequences of that. The other group of biomarkers I look at are cardiac biomarkers. Okay. And so these are heart disease markers that we know are tied to your risk of potentially developing a heart attack, which is the number one killer of men and women throughout the world. The marker I like to look at there is apob. Apob. You know, everyone so used to talk about LDL and VLDL and hdl, but the reality of the situation is APOB now is the newer biomarker that is also available everywhere now. And it's a collection of all of the bad forms of cholesterol that could potentially cause heart disease. And so we look at that marker as well. Now, I wanna be very clear, having a high cholesterol number, a high APOB number doesn't automatically mean you're gonna get heart disease. Heart disease is a combination of multiple factors, including inflammation, poor metabolic health, health, cholesterol, and damage to your blood vessel wall, which happens with high levels of stress and high blood pressure. So this is something that everyone should also track. And then lastly, after the age of about 35, start tracking your hormone levels. Men and women should look at their hormone levels and they can drop very quickly in people without even knowing it. And so this is something that ulcers should be looking.
- [81:41]
Dr. Rangan Chatterjee
Yeah. Going back to a 1C for a minute. HBA 1C, this average blood sugar marker, what level do you like to see in your patients?
- [81:49]
Darshan Shah
We aim for 5.2 or lower. 5.7 in the United States diagnoses you with pre diabetes, 6.5 with diabetes.
- [81:57]
Dr. Rangan Chatterjee
And I don't know if you know this or not, but in the UK the levels are slightly different.
- [82:00]
Darshan Shah
It's.
- [82:01]
Dr. Rangan Chatterjee
You have to hit six in the UK to be diagnosed with pre diabetes. And so you have the crazy situation where people still today there will be people in the UK today who come back with an A1C of 5.9 and it's been reported as normal.
- [82:18]
Darshan Shah
Yeah. This is the fallacy of the whole system, right?
- [82:21]
Dr. Rangan Chatterjee
Yeah.
- [82:22]
Darshan Shah
Because you can't unlock the medical therapies until you cross that threshold. Right. But the reality is you need to be doing so much. If you're at 5.9, fine, it's a problem.
- [82:33]
Dr. Rangan Chatterjee
And how did you decide on 5.2?
- [82:37]
Darshan Shah
I decided on 5.2 because what I saw in my patients is that's when they felt the best, they were at their healthiest. There's also a lot of research showing that if you look at people that have the best metabolic health, it's at 5.2. Another marker, serum insulin level. That's the first thing that changes if you're developing diabetes. Most people with a 5.2 hemoglobin is A1C will have a serum a fasting serum insulin under 10, which is extremely good as well. So it just correlates well with good metabolic health.
- [83:07]
Dr. Rangan Chatterjee
Yeah. A lot of the tests that you mentioned there are readily available to most people, I will say, in the uk, depending on where you live. Hscrp, unfortunately, is still not a standard test for many people, unfortunately. Nor is apob, although I hope that's starting to change. In terms of newer, more fancier blood tests, should we say that maybe people don't have access to. You've got a pretty phenomenal clinic called Next Health, which I had the privilege of attending when I was in LA in November. You show me rounds and I'll tell you, if I'm completely honest, one of the things that I reflected on after going to your clinic was, wow, this is what the future of healthcare looks like to me. Okay, yes, the testing and the therapies that were available, but it wasn't just that, actually. It was also the fact that it was a really desirable space to be in. It's a beautiful building, smiling reception staff, a bit like, I don't know, a bit like an Apple Store in some ways. Now, was that intentional? Did you think about when you were creating Next Health, the whole experience of health, or were you just thinking about the therapies?
- [84:35]
Darshan Shah
You know, when I wanted to practice this type of medicine, I sat down, I wrote down everything wrong with the current healthcare system, and one of them was exactly that. No one wants to go to the doctor. You wait forever, they don't have enough time for you. It's in the 10th floor of some building with furniture from the 70s and a glass wall between you and the receptionist who's mad that you're even there. It's like a horrible experience, you know? And so, yes, absolutely. I wanted to create something where people were inspired to take control of their health. Right. And so the other thing that was wrong with medicine, too, in my view, is. Is I think patients are kept totally in the dark about what's being checked, what their diagnosis is, all of it.
- [85:20]
Dr. Rangan Chatterjee
It's like, we're the doctors. We'll give you the information that we think you're allowed to have. It's ridiculous.
- [85:26]
Darshan Shah
It's ridiculous. It's the same ridiculous philosophy that doesn't allow patients to even check their own blood tests. Right. I mean, now this is changing in the United States, where you can go to any lab and get your own blood test so you finally have your own data. Data. But it's crazy.
- [85:40]
Dr. Rangan Chatterjee
And so one of the arguments there, and I'm just going to put it to you to see your perspective, one of the arguments that some doctors would. Would make is that, well, patients aren't qualified to interpret that data. Right? So if patients start ordering their own tests, they're going to create unnecessary anxiety and they're going to start doing things that perhaps aren't gonna help them. Right. So do you recognize that as a valid case, or do you totally rebut that?
- [86:15]
Darshan Shah
I mean, to be honest, I totally rebut it. I think we need to know that we live in a very different society now where people have incredible access to information. Right. And people are able to take their blood tests and now even upload them to ChatGPT and get really good information. You know, I mean, obviously don't do things that are medical that ChatGPT recommends without consulting with a doctor just to make sure. But no one had that access to information. And podcasts, like our podcasts and the Internet, people are smart enough to figure out what's going on. It's almost like saying, don't give people information about what's going on in their home because they won't understand. They won't understand it. So obviously, if something's broken in your house, you can look up a YouTube video on how to fix it now. And then you decide, are you able to do these things or not? Or should you call a plumber or get a consultation?
- [87:14]
Dr. Rangan Chatterjee
Yeah. And of course, look, can there be some downsides? Of course. But that's the same with most things in life. There are upsides and downsides. Right. We can't withhold information from people in this era of information to try and Keep things the way that they were in the past. I mean, and things have moved on. And, you know, I run training courses for doctors with my colleague Ayin Panja. We have a course called Prescribing Lifestyle Medicine. We've trained thousands of healthcare professionals around the world now. And one of the things I say in that course is, guys, you've got to recognize that we're living in an era now where your patient may come in knowing more about their condition than you do.
- [87:59]
Darshan Shah
Do.
- [88:00]
Dr. Rangan Chatterjee
Right? Instead of pretending that's not the case, you've got to embrace that. Go. Actually, you know what? If you're suffering with something and you're not getting access from your doctor, you are incentivized to spend hours and hours reading, researching, listening to podcasts. So it is entirely plausible that sometimes a patient's gonna go in knowing more than their doctor. And when I'm training doctors, I say, guys, it's okay to say I don't know. Right? If you don't know something your patients read about, be honest. Say, hey, you know what? I've not come across that, but let me look into that. Why don't I give you an appointment in two weeks, I'll do some research, and we can have a conversation about it rather than going, oh, that's a load of rubbish, which is often what happens. So I agree. I think whilst I recognize there could be some downsides, in some cases, I think people are gonna do it, right? It's like doctors saying, oh, you shouldn't Google your symptoms. How realistic is that? Right? We google everything in our lives. Right. Why would you not Google your symptoms? Sure, it can cause problems, but people are gonna do it, right? And this whole point about testing and empowerment, I think is really interesting. Okay, so when I went to your clinic in November in la, one of the things we checked for was my BPA levels.
- [89:26]
Darshan Shah
Yes.
- [89:26]
Dr. Rangan Chatterjee
Okay. So I appreciate this is probably for most people, not a test that they commonly get, but on a personal level, Darshan and I think I shared this with you a few months ago. I know about the research on microplastics. Okay? I'm familiar with it, cognitively gay, and I do my bit. But you guys drew my BPA level, and when you sent me the result, it was in the red. Right? So I know the science. I know the research in my rational mind, but it wasn't enough to force me to take drastic action. I'm telling you, since I saw my BPA levels in the reds, I have not had a single hot drink from a takeaway cup. I've rarely drunk out a plastic bottle. I think I did it once on a flight and it was a small bottle. Right. Even on the train this morning down to London, I was thirsty and I thought, no, no, I'm waiting. I'm not having it. Right. So the point I'm trying to make is that testing and understanding, not what's happening in general science, but what's happening in your own body is one of the most powerful motivators for change.
- [90:42]
Darshan Shah
Yeah. Because now it ties back to you. It's not just like a concept in the strat. Actually, I think a lot of people have heard about microplastics now, and it can be overwhelming for people.
- [90:54]
Dr. Rangan Chatterjee
I get that.
- [90:55]
Darshan Shah
But at the same time, until you. You're not going to feel the effects of microplastics. Right. So until you do a blood test and you see it's in the red now, you know it's causing a problem. And just five days ago, a paper was published showing microplastic accumulation inside of arteries that go to the brain and the heart as well. And so these microplastics are actually making their way into our circulation and into the walls of our arteries, causing a higher risk of strokes and heart attacks. So we have to do something about it. Yeah.
- [91:26]
Dr. Rangan Chatterjee
There's some researchers who are saying, you know, because you mentioned, look, cholesterol is one marker that we tend to look at as a risk factor for heart disease. But. And while there's a bit of controversy on cholesterol, it's not the only thing. There are other things. Inflammation, how much damage there's been to your blood vessels, how much plastic is going. Is being accumulated inside your body. So can you just, I mean, explain a little bit about microplastics and BPA and what these things are and why people might want to consider reducing their exposure to them.
- [92:01]
Darshan Shah
Right. So microplastics is the amount of plastics that our body is actually absorbing into our bloodstream. Okay. And so these are plastics that either come in a micro or a nano scale, which means that they can actually be absorbed through our gut, through our skin, et cetera. In the plastics industry, they also add chemicals to these plastics to make them more stiff or to make them more pliable. And these chemicals, like BPA is one of them. They leach out from the plastic into whatever it is that you're consuming, especially when it's being heated. Heat is the. That is a major culprit. Okay. So unfortunately, we live in a plastic society now. There's plastic all around us. The trick Here is to. Number one, try not to consume your food through plastic. So Tupperware should go away, like you said, you know, plastic water bottles, all of this stuff needs to be replaced with glass or some other type of container, like a ceramic containers. But the number one thing that you should really not do is paper cups are lined with plastics. Having hot coffee in a paper cup is a massive problem. And so a lot of people do this. Right.
- [93:17]
Dr. Rangan Chatterjee
Okay. So we're talking about these microplastics, but again, without going into a deep dive on them, what are some of the health consequences of people potentially from having high levels of BPA in their blood or having high levels of microplastics in their body? Why should people get. You know, cause someone's probably thinking this. Someone's probably listening to this right now whilst drinking a coffee from a takeaway cup. They've got it, they're in the sun, they're walking to work, and they're enjoying the podcast so far. And now they're like, wait a minute, what are they talking about? So just at least some top line of why people might want to reconsider that.
- [93:54]
Darshan Shah
Absolutely. So, number one is that we don't really know all the effects yet, but I will say that it's fairly convincing when you see studies showing microplastic accumulation in blood vessels. Right. Because we know that one of the other root causes of all disease is our blood vessels not being able to work very well or to get clogged. Right. And so just in a macro level and also a microvascular level, which we. Going all the way back to Alzheimer's, they did a study on brains of people who had expired. Right. So people with Alzheimer's and strokes, people that were at risk for Alzheimer's and strokes, and then people just completely normal. The people that had strokes and Alzheimer's disease, they had 50 times the amount of plastic as the ones that had no risk. Okay. And so there's definitely a lot of correlation between this plastic accumulation in our brains and also in every organ in our body and disease. The other chemicals also have. We have studies showing hormone disruption, more inflammation, et cetera. So I think it's important that we. The Pareto principle applies here. Really, really well. There's 20% of the actions that you can do to detoxify 80% of your life. And if you just do a few simple actions, like you did, you can stay healthier a lot longer by avoiding these toxins.
- [95:20]
Dr. Rangan Chatterjee
Yeah. It's interesting you said there's a lot of correlation, and some people Will then go, oh, there's no proof, so why would I change? But you could flip it and go, well, wait a minute, where's the proof that this stuff is safe? We don't have that yet, so why not adopt the precautionary principle whilst the research has been done? And when you start looking at this, we know that there's microplastics now in amniotic fluids. So new fetuses are literally bathing in microplastics. In men's testicles we're seeing microplastic accumulation. I mean, it's pretty stark. And on, you know, on one level it's like, I don't think this is a good thing. Right. There's some sort of links with insulin resistance as well that I've seen. And so for me, on a personal level, all I needed to see was my level in the reds. And when I'm next at your clinic later on this year, I will be planning to do a recheck because then if I recheck and it's gone out of the red, through the yellow and into the green, which touch what I'm hoping it is, that is then added motivation.
- [96:28]
Darshan Shah
Right?
- [96:28]
Dr. Rangan Chatterjee
Right. Because of course it's tempting. You don't have your metal cup with you and you bit tired, you fancy a coffee in a nice coffee shop and do you know what I mean? You're constantly being tempted. But that is one thing I haven't done yet. I'd rather not have coffee than drink it in a plastic cup. Me too, because of that blood test. Right. So that's super interesting thing.
- [96:47]
Darshan Shah
Yeah.
- [96:48]
Dr. Rangan Chatterjee
What's your take on wearables? I see you. I think you have an aura ring on.
- [96:52]
Darshan Shah
Yes, I do.
- [96:53]
Dr. Rangan Chatterjee
I've been wearing a whoop band now since I think July last year. So yeah, maybe nine months now. I'll share my experiences with it in just a moment. But what is your take on wearables? Are you a fan or are you against them?
- [97:08]
Darshan Shah
So part of my, my talk track with patients about becoming the CEO of their own health or the boss of their own biology is not just blood tests. There's a few other simple things, things that you can empower yourself with on a day to day basis that can completely change the course of your health. And those are. Number one is a wearable. Right. Number two is a special kind of scale called a bioimpotence scale. You can buy these for US$25 and it sends a little electrical signal to your body every time you step on the scale and gives you your skeletal Muscle mass and your fat mass. I always tell people I don't care what your weight is, but I want to know what your skeletal muscle mass week after week after week. And lastly is the blood pressure cuff, because you and I both know that blood pressure elevation is usually ignored for sometimes up to a decade before anything is done about it. Right. So I know I gave you a longer answer to your question about wearables, but let me tell you why I love wearables. You can get them for less and less money now. In fact, you can start. There are some Fitbits now that are less than $50 that people can buy. And this gives you a few really important numbers. One of them is your amount of movement you've had throughout the day. So we had a lot of discussion about number of steps. Another one is the hrv, which I think is a biomarker that, you know, in medicine we don't even look at that. Right. But it's such an important biomarker of health. Right. And lastly is a sleep score. Okay. And so another marker we rarely talk about in medicine and in Western medicine, but something that people can really improve on. And what I love about all of these markers is there's something that you can do almost every single day that can make it a tiny bit better. And, you know, just doing a 1% improvement day after day adds up to a 3,800% change over the course of a year. It's massive. So just getting a few more steps in just, you know, trying to optimize your sleep so you get better, deep sleep, doing some breath work once a day for even just two minutes can help improve your hrv. This is all data that you can now get on yourself that, once again, no one's going to care about this more than you do. Right. And so I think it's important.
- [99:18]
Dr. Rangan Chatterjee
Let's just talk about blood pressure for a moment. In terms of home monitoring, of course, there's been blood pressure cuffs that we've been able to buy from pharmacies for decades now. Are there any more modern, less intrusive ways to measure our blood pressure that you're using with your patients?
- [99:39]
Darshan Shah
I mean, I wish I could use this because it's available in the UK and is not available yet in the us. I'm hoping it will be soon. But there's a company called Actea that now has a continuous blood pressure monitoring device. Just a little wristband, little light, and it gives you your blood pressure monitor every. I think it's 15 minutes throughout the day. And that is an incredible device. And I have personal experience because it's what finally allowed me to get my blood pressure under control. So I'm a big fan of that.
- [100:09]
Dr. Rangan Chatterjee
Yeah, I'm looking into that. Actually, I haven't got one yet, but I'd love to try that. I have been looking at that for a while. Okay, so that's blood pressure.
- [100:16]
Darshan Shah
One thing on the blood pressure, I will say too, that I think is really important for people to know. Younger and younger ages now are having high blood pressure. I'm seeing people in my clinic even, even in adolescents have high blood pressure. So I think that even after the age of 30, it's important for people to get a blood pressure cuff and measure it at home on themselves, once every one to three months. If you're doing it once a month and it's coming out normal, normal, normal, you can kind of expand that. But in Western medicine, especially in the United States, this happens all the time. People only get their blood pressure measured once a year at their doctor's office. And we know the research has shown in massive trials that for every year that you spend that your blood pressure is over 130 over 80, you're adding 1 to 2% mortality to the end of your life. And so you gotta keep your blood pressure under 130 over 80 for as long of your life as you can. And if you ignore it for 10, 15, 20 years, you don't have the opportunity to do that. And blood pressure is also another way that you can cause yourself. Alzheimer's disease, as we know it's a massive contributor to Alzheimer's disease.
- [101:31]
Dr. Rangan Chatterjee
What's really interesting is that what we're looking for is trends, right?
- [101:37]
Darshan Shah
Yes.
- [101:37]
Dr. Rangan Chatterjee
So our blood pressure is variable throughout the day, isn't it? So a patient could check once every three months, but it could, of course, be that they're really anxious and their last measurement was up, and they're scared of getting a heart attack or a stroke. So that fear is playing in when they're checking it. Right. Which, of course, can artificially elevate your blood pressure. A lot of people are familiar with the term white coat hypertension. The idea that when you go and see your doctor for your blood pressure check, it is artificially higher because of the rush in getting there, the stress, the waiting, the, oh, my God, he's gonna measure it. Maybe he put me on Medicare. Whatever it might be, this is where these more modern wearables potentially play an important role. So you're not really thinking about it. You're Just going on about your daily life and it's just in the background checking what your real blood pressure actually is.
- [102:35]
Darshan Shah
Exactly. You know, having access to this continuous blood pressure measurement has completely changed the way I think about blood pressure. Because now it's not just a static measurement. It's looking at the area under the curve of how high was the blood pressure, when was it high, and how much of the day was actually spent in that blood pressure range.
- [102:53]
Dr. Rangan Chatterjee
But presumably then we're gonna need new guidelines, right? Because the guidelines at the moment are based upon, I guess, one off readings, right? If we're measuring it every 15 minutes, we're gonna have to have new guidelines set. On average, what we want to see is 80% of the time we want under. Do you know what I mean? So again, our guidelines are going to have to evolve to reflect the newer technology, Right?
- [103:18]
Darshan Shah
But here's the beauty of this too, though. Just like I see you're wearing continuous glucose monitor, another one of my favorite devices on the planet, you're going to be able to see your own blood pressure just like you're seeing your own glucose and make, make behavior change, right? And so you'll know what are the moments throughout the day that your blood pressure is high. Why did that happen? Was it when you forgot to take your exercise, snack while working? Right. And then it'll be further reinforcement for you to make those behavior changes. Just like the continuous glucose monitor helps you make behavior change on your eating.
- [103:51]
Dr. Rangan Chatterjee
It's interesting. When I went on your podcast, I think last November, Darshan, one of the things I said to you, one of the things I wrote about in my, my latest book is this idea of reliances and through the lens of health, wearables. What I said and what I still stand by is that I believe wearables are a fantastic tool. At the same time, I acknowledge that for some people, they seem to really stress them out and we mention health anxiety. So I've got people within my family who get really stressed out with the thought of any reading, right? And so one of the things I've said many times is that if you are overly reliant on that device, if you can't live without it, if the data starts to really stress you out so you're not getting empowered, it perhaps isn't the right tool for you at this moment in time. But I'm thinking more and more about that and through the lens of root causes, right? Because we're all about getting to the root cause of a patient's problems. I would also Encourage people to think about the root cause of their health anxiety. Right. Why is it that a reading of your blood sugar is causing you anxiety? I would encourage people to go, there is an opportunity for growth there. Do you know what I mean?
- [105:13]
Darshan Shah
Absolutely. Yeah.
- [105:14]
Dr. Rangan Chatterjee
Because there's a reason why it's causing anxiety. Did your dad die of a heart attack and you. Do you know what I mean? But there's something to explore there.
- [105:21]
Darshan Shah
Yeah, definitely. Definitely. And sometimes it takes a mindset shift and I think net net giving it a try and trying to make that mindset shift. If you are one of these people that have health anxiety, I think net net is a positive. At least you gave it a shot. Right. And no one's saying you have to wear this all the time. I, I take mine off when I'm traveling sometimes because I just don't want to know. Like, I know I'm not gonna say.
- [105:44]
Dr. Rangan Chatterjee
So I personally, you know what I used to do with my CGM for a while is I just wear it because they last for two weeks, this continuous glucose monitor. And I probably wear it four times a year, once a season. Right. As I said before, I'm on the back of quite a busy time. And so for me, I wore it for the last two weeks. I just put this one on the last night. I'm at the moment really focusing on my health and wellbeing. And I personally find that this really helps me make really dialed in choices. I'm now getting back on track, nailing my routines, my rhythms, my structures. So again, it's about knowing yourself, isn't it?
- [106:27]
Darshan Shah
Yes.
- [106:28]
Dr. Rangan Chatterjee
Why are you such a fan of these continuous glucose monitors?
- [106:32]
Darshan Shah
I've seen them completely change people's health. Because metabolic health is an extremely important root cause of a lot of other things that are going wrong in people's symptomatology. And I'll say, you know, we already talked about as a root cause of disease, but way before that, I've seen people have brain fog, inability to lose weight, joint pains, inability to sleep, all of it due to having metabolic health disturbances. And once they put that continuous glucose monitor on and they use it as a catalyst to make some behavior changes and a catalyst for learning. They perform the actions that not just make the numbers in the continuous glucose monitor better, but their symptoms go away and now they're able to lose weight, they're able to think clearer, they're able to sleep better. It's just been such a miraculous device. I think in the modern world that we now have access to that people can Once again, take personal agency over their own health and their choices.
- [107:32]
Dr. Rangan Chatterjee
How often do you wear yours?
- [107:34]
Darshan Shah
Same exact as you. So I like the two week time period. A lot of times when I get back from travel, like after this trip to London, I'll put it on for a couple weeks just to kind of dial myself back in because I've been gone for a week.
- [107:46]
Dr. Rangan Chatterjee
Have you ever worn one on a flight?
- [107:48]
Darshan Shah
Yes. Oh yes.
- [107:49]
Dr. Rangan Chatterjee
It's not, I mean that's not good. Well, in terms of invisible stressors, I don't think people realize how much of a stressor travel and plane travel can be on their bodies.
- [108:03]
Darshan Shah
Right.
- [108:04]
Dr. Rangan Chatterjee
And I think it was on that trip when I, when I went to LA last November when I first met you, I had a CGM on of the flights and I was shocked by how high my sugars went. I was actually eating really well. But I think, you know, again, I need to test this again. But I think the flights, from what I understand, and there's all kinds of fluid changes in your body, I think it's pro inflammatory, it's a stressor on the body. And of course stress increases cortisol, which increases blood glucose. And so for me it was like, wow, this is quite interesting. Okay. Even the flight alone is a stressor on my physiology that I'm picking up with my cgm. So I found it really, really interesting.
- [108:48]
Darshan Shah
Right. I've had the same experience when I travel, travel, and what I changed because of that is I noticed that if I eat the meal that they gave me in the flight, not only my glucose shoot up, but it would stay up for hours. And I was like, I just got, I'm gonna fast on every plane trip now. It's just not worth eating.
- [109:07]
Dr. Rangan Chatterjee
But I do, I mostly do that. Or I'll take some stuff myself. But I will, in fact, on that flight, you know, I'm a very chatty person. So I was getting out when I was chatting to the cabin service director and he basically said the stuff that needs to be added to plane food so that you find it tasty at altitudes, if you knew, you wouldn't touch anything on him. And he doesn't, he brings his own food. He's been flying for like 25 years.
- [109:37]
Darshan Shah
Wow.
- [109:38]
Dr. Rangan Chatterjee
He also doesn't drink sparkling water or any fizzy drinks. Cause he said we all know as air hosts and air hostesses that that bloats you. He said, you know what happens to those crisp packets where they all puff out? That's what's happening inside our guts as well. It was Quite interesting, that conversation. I already wasn't eating plain food anyway, but that made me even more convinced.
- [109:58]
Darshan Shah
Ah, that makes total sense because it just feels like the food has a tremendous amount of additives to it and that makes complete sense.
- [110:07]
Dr. Rangan Chatterjee
Yeah. Okay. We've covered quite a lot in terms of this 2080 principle, and we could dive a lot deeper into wearables for sure. But I would encourage people to check out that biomarker PDF on your website. I think it's very helpful. Free, accessible, people can empower themselves and be the CEO of their own health. Supplements is a topic that many people are interested in, and a lot of people will say it should always be lifestyle first and supplement are exactly that. They're a supplement. At the same time, I just want to. And again, I want your perspective on this. I think that is one way to look at it. And I'm very much a nutrition and lifestyle first guy, but I've also had many patients over the years who really didn't feel good. Low energy, brain fog. And actually certain supplements allowed them in the short term to feel good so that they could then engage with the nutrition and lifestyle changes. So, like all these things, I think we love the black and whites. You know, you can never use supplements until you've dialed in your nutrition and lifestyle. I'm like, look, I get the principle behind that. I just don't think it works in every case. What's your take on supplements? And do you have a few favorites?
- [111:24]
Darshan Shah
Yes. So one of the things I always am very empathetic about is that even myself, I can't maintain the same level of diet every single day, day after day after day after day. Right. And so there are some days that I take in probably very little nutrients. Maybe I'm fasting on a plane and, you know, I get off the plane and it's late at night and I just eat something quickly, maybe a quick salad. And obviously I didn't get my nutrition for the day. Right. And so that's where supplements come in helpful. And the nice thing is too, is now we can have actually measure in blood tests whether you're low on vitamin D3, B12, et cetera. What I find is most people are low, they are nutrient deficient, and like you said, they're not feeling good because they have nutrient deficiencies. And one of the things that worked really well for me, and it's so powerful, was seeing my vitamin D level BE20, which is extremely low. And I just started taking a vitamin D3K2 supplement. And we know 60, 70% of people are deficient in vitamin D. That really helped me turn around my health as well. And so I'm a believer in supplementation. I think there's some core supplements that most people should consider. And if they're one of these people that are skeptical of supplements, you can get blood tests to see if you really need it or not. Then I think there are some more advanced supplements that I like. And then there's other people that are biohackers. Right. They wanna take, take every supplement that they hear three biohackers are taking and they have little baggies that they carry around all day. And I think sometimes that can also be detrimental. I think sometimes we have to take people off of supplements they don't necessarily need or probably have very little benefit. So I see all sorts of people and I try to just meet people where they are and try to get them to a place where they're supplementing. Smart.
- [113:17]
Dr. Rangan Chatterjee
Yeah. It's interesting, this idea that many doctors are skeptical of supplements. If you have used supplements with patients in a targeted way, you will know that they can be extremely powerful for the right person.
- [113:32]
Darshan Shah
Right, Exactly.
- [113:33]
Dr. Rangan Chatterjee
Okay. Again, it's obvious. If your D3 is low and you're getting symptoms related to that, sure. Correcting it could have a benefit. If your B12 is low, which it is for many, many people. And here's the other point. With supplements, when people like to say, well, it's all about good nutrition. Well, hold on a minute. To absorb certain things like B12, okay, you need adequate amounts of stomach acid. Right. We're living these chronically stressed out lives. What does chronic stress do? It changes how much stomach acid you've got. So even people who eat meat can often be low in B12. They're putting it into their mouth, they're not absorbing it.
- [114:10]
Darshan Shah
Exactly.
- [114:11]
Dr. Rangan Chatterjee
Do you know what I mean? So this kind of nuance, I just think it's not good or bad, it's for who? On a personal level, you're someone who's very proactive about your health. I don't know if you'd put yourself in the biohacker category or not. Are there any kind of newer fancy type supplements that you think. Actually, there's pretty good evidence for this and I'm going to take it so that I can live and age well.
- [114:36]
Darshan Shah
Yes. Yeah, there's three or four of them that I really like. So my core supplement supplements are vitamin D3K2. We talked about that one, a good Omega 3 supplement as well. And then creatine and creatine is one of the most researched supplements in history right now. And we know that taking 10 grams of creatine a day can also help prevent cognitive decline. So very safe, very, in my view, very effective, massive research around. Those are my core. Then my kind of new darlings that I like, if you want to call it that, is two supplements that I really believe, and I've seen the research on them help improve mitochondrial health. Those are urolithin A, which helps. It's a really interesting supplement. It's made from gut bacteria, actually, that helps increase the number of mitochondria that you have in your cell. A company called Timeline makes that one. And then there's another one, one that I really like, which is called nicotinamide riboside. So I think a lot of people have heard of nad, nmn. Nicotinamide riboside is a very well absorbed form of nad, and a company called Tru Niagen makes that one. So mitochondrial health, we are now seeing massive correlation with all disease as well. So there's a lot of things you can do naturally to improve your mitochondrial health. But these two supplements, supplements have good research showing that they can also improve your mitochondrial health.
- [116:03]
Dr. Rangan Chatterjee
Yeah, I love that. I've been following the research on timeline nutrition for a little while now. I've started taking it about three weeks ago. I think it does look good.
- [116:12]
Darshan Shah
Like you said, though, I always start with the things that are gonna move the needle the most for your health are the things that are actually free. It's just behavior change that really makes most of the difference. But then say you've done all those things. Like a lot of people go through a health journey, journey for a year. Like I did eight months, I did all those things, I felt better and I want more. I want to know what else is there that I can do. And so now I'm doing things like taking some additional supplements. I'm looking, you know, doing sauna therapy, these added little things. I think that can even boost your health even more.
- [116:44]
Dr. Rangan Chatterjee
Yeah, I love that. Dashit. I was hoping to go into a lot of these newer treatments that exist in your clinic and that are proven game changing for many people, like plasmapheresis, hyperbaric, oxygen, all that kind of stuff. I think we'll save that for a part two. If you'll come back on for a part two. I think today was just full of practical advice for people that's gonna massively help them. For someone who feels inspired, who's like, right, you know what? I was happy Living in the dark. But Darshan, you've convinced me. I now wanna be the CEO of my own health. I wanna be the boss of my biology. But I don't know where to start. What do you say to them?
- [117:29]
Darshan Shah
Number one, like you said, go to my website, download the biomarker sheet and just read through it. You don't have to do it. Just read through it and understand kind of the philosophy behind it. And just start with one thing, right? Just maybe one biomarker. Maybe it's your blood pressure. Get into the habit of checking these things on yourself. Secondly, I would say is, you know your podcast, my podcast, extend. I really am committed to getting this information to people in an easily understandable, digestible format like you do. And I also do these solo sodas to just be like little mini courses in things like blood pressure or Alzheimer's, et cetera, et cetera. And they're just 15 minute solo sodes. I think a lot of people are pressed for time and I really want to give them little bits of digestible information that they can take, can have something actionable to do, and then just understand it takes time, right? And so give yourself a year to go through a health journey, perhaps, but keep doing something on a day to day basis, week to week basis, whether it's tracking a biomarker or getting one of those egg timers. Do something, one thing a week, and it will add up over time. I think that's the model. I use that model with all my patients and it seems to work. Works really, really well.
- [118:47]
Dr. Rangan Chatterjee
Yeah, I love that. Thank you for sharing so much. Darshan, for people who don't know you, which will be most of the people listening, what they won't know is that you're probably one of the kindest and most generous people that I've had the privilege of meeting.
- [119:00]
Darshan Shah
Thank you.
- [119:01]
Dr. Rangan Chatterjee
You really are a wonderful human being. Your patients are very, very lucky to have you, I'm sure. And I really appreciate you making time to come on the show.
- [119:10]
Darshan Shah
Feeling is very, very mutual. Thank you for. You know, I feel like you're my brother from another mother. Like we're sitting across talking the same language. And I think both of us have this incredible commitment just on a personal level to see people succeed with their health. And I love that about you. So thank you for coming on my podcast too.
- [119:32]
Dr. Rangan Chatterjee
Really hope you enjoyed that conversation, as always. Do have a think about one thing that you can take away and apply into your own life. But also have a think about one thing that you can teach to somebody else. This will not only help them, it also helps you learn and retain the information. Now, as this is the last episode of the season, I want to say a heartfelt thank you to all of you who listen, even each week. And if I may ask you two quick favors. If you have ever received value from this podcast and have never got round to leaving a review for the show on Apple Podcasts or Spotify, I would really appreciate it if you could take a moment right now to do so. It will only take you about one minute and it makes a massive difference for the show. Secondly, if there is anyone in your life who you feel would benefit from listening to this episode or this podcast in general, please do spread the words. My team and I work really hard each week to make this show in order to help people improve their lives. And of course the more people who listen, the more people who can experience the benefits. So my request is this over the summer, can you would you share this show with five people in your life who do not currently listen if all of you were to do this? I honestly feel we can create a powerful positive ripple effect where we help more people feel happier and healthier. No pressure. Of course. If you don't want to share for whatever reason, that is completely fine as well. Now, before I sign off, if you have not yet picked up my latest book, the number one Sunday Times bestseller Make Change that 9 Simple Ways to Break Free from the Habits that hold you back, might I suggest that you pick it up as a summer read? I do believe it to be the most important book of my career and if you take a look at the reviews on Amazon, it is clear that many, many readers also feel the same way and have found the book to be life changing. And I think that because of its reflective nature, the summer is a perfect time to read it. It is available as a paperback ebook, but also as an audiobook that I am narrating. Thank you so much for listening each week. I hope you manage to have a relaxing and nourishing summer and I will see you back here in September for the new season. And as a little teaser, I have some phenomenal guests lined up already. Always remember, you are the architect of your own health. Making lifestyle change is always worth it because when you feel better, you live more.
- [122:34]
Darshan Shah
RA.