Pain Management With The Carnivore Diet | Dr. Gurpreet Padda

the original origin of Physicians because in the United States I mean Physicians were really they were the class of people that were either doing butchering or they were doing hair cutting it didn't get corporatized it didn't become like medical school with corporatization until people decided that they wanted to sell drugs and they needed high- pric salesmen for these drugs there was a way to indoctrinate a sales crew into it and keep a separation between you and the sales crew and the sales crew makes their money but they sell your product they just don't realize it almost everything that we do in medicine is driven by these large agencies that are trying to figure out how to sell more drug welcome to the plant-free MD podcast with Dr Anthony chaffy where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hello everyone thank you for joining me for another episode of the plant-free MD podcast uh I'm your host Dr Anthony chaffy and today I have a very special Des guest Dr gpri P who I met in San Diego at the uh Symposium for metabolic Health he is a pain specialist and he has very interesting uh views and Revelations on that so uh Dr po thank you so much for coming on I appreciate it thank you so um for people who haven't come across you before can you tell us a bit about yourself and what' you do so yeah I'm a uh Interventional pain physician I started my world in uh surgery at Cook County in Chicago but then converted over to anesthesia and then Interventional pain um I've been in the field for over 20 years I practice in the urban core of St Louis which happens to be the number one capital for um gunshot wounds and Trauma uh and also for uh for murders in the United States so it rival Somalia um so I'm I'm in the urban core and I deal with a lot of the urban core issues and i' I've been treating in this area and trying to figure out how to help patients and over over the last 20 years I've come to some conclusions that are a little bit opposite of of of where where we thought we were with pain management okay so that was something that we that we were talking about is that you have a very different approach to pain management you know there's a lot of different different you know tools in the in the in the in the shed for pain management there medications there's injections there um you know spinal stimulators things like that all sorts of different different things but you take a slightly different approach don't you yeah so historically we initially thought historically that that pain is a symptom and in about 252 27 28 years ago um the pharmaceutical industry got involved and they said oh no no no no no pain is not a symptom pain is a disease and they said we have a medication that treats this disease it's called a narcotic and we have a variety of these narcotics and they're moderately expensive but you as the physician should use these narcotics and they pushed those narcotics out to initially pain management doctors and then to everybody say hey these things are totally safe anybody can use them and so that's began the oxycoton issue um and everybody thought well it's a disease just like hypothyroidism is a disease so I just give the patient the pain medication it's going to fix the disease but that's not the reality pain is the symptom so the ISP which is the International Association for the study of pain has like six criteria and it's a bioc psychosocial model of pain that's that's not my definition um my definition is one which is pain is the final pathway it's the body screaming that something terrible has gone wrong and you got to fix it it's your alert system and everything else feeds to it so I don't care if you have multiple sclerosis I don't care if you have diabetic neuropathy I don't care if your limb got cut off I don't care if somebody poked you in the belly with their thumb it hurts and it's an alert system that says quit poking me in my belly with your thumb because there's something wrong now if you use the if you use the original way that the pharmaceutical industry was pushing it you have a pain symptom take this narcotic it'll cover up the pain symptom and then once your body habituates to that narcotic then we're going to give you more narcotic and then we're going to give you more narcotic now there's something interesting that happens the body has a natural endorphin system it produces chemical compounds that stop the pain on their own and if I give you outside narcotics the body stops producing those endorphins and so the more narcotic I give you the less endorphin you produce the more dependent you become on the narcotic and then eventually you start to do honic substitution because that's the nature of creatures that's the nature of human beings and practically all animals is they start to self-stimulate and they figure hey this makes me feel good so I'm going to start taking more of this and and thus begs the beginning of addiction um you're you're stimulating and it's honic substitution and you've got an addiction issue now and so my model goes against that and says look let's restore the Endorphin production let's use pain medication judiciously as needed but the least amount possible so you can maintain endorphin production and then try to figure out the root cause of your symptom and unwind it um and so I'm an interventionalist I do all kinds of procedures and stuff but my goal is to minimize my procedures and minimize my narcotic and restore health and and that's typically through a lifestyle mediated approach globally okay and so what is your your sort of Lifestyle approach that you would enact for your your patients yeah so it it's a combination of things but the the fundamental thing um is all of the things that are associated with healthy living and so people talk about a Mediterranean diet as being healthy I don't view the Mediterranean diet as a Mediterranean diet I view it as a Mediterranean lifestyle so ideal amounts of light ideal amounts of activity ideal amounts of interaction with other human beings and eating in a way that's consistent with our biology and our biology is that we are we're apex predators we have a pH in our stomach of two uh we're not herbivores we don't have a ruminant stomach um and certainly we can consume vegetable matter but that's not what we're designed for we're designed primarily to eat rotted flesh we're designed to eat rotted meat we were the tiny creatures on on on this on the serengetti we were the tiny creatures that live next to the ocean that would break things apart and eat the saturated fat fat and we were obligate heterotrophs we could absorb the nutrients of other creatures and that's what built our brains we were not the creatures that can consume pounds and pounds and pounds of fibrous material and turn it from fibrous material into um short chain fatty acids in our ruminant stomach we don't have that and so when we eat a bunch of vegetable matter we start to get bloating and we don't feel good um and we need we need a lot of saturated fat we need a lot of protein we don't need a lot of fibrous material that we can't metabolize or do anything with now that doesn't mean that there's no value in Plants there is I mean there there's definitely some value in plants and to and to use them and certainly plant medicine's been around for a long time but it's not the predominant aspect of a pH 2.0 stomach that's not what we're supposed to do yeah no I agree and um so so how do you how do you approach that with your patients then you know when you have you have someone coming in with you know extremely bad back pain you know the surgeons can't do anything with them and there's just you know a big mess you know what what do you first how do you first approach that so the first thing is harm reduction and stabilization um and and that is the value of these potent medications and potent techniques but that's not that's not where you can live that's not a bridge you can live on first you want to help the patient get out of symptoms so that you can start working them up and figuring out what's going on but the fundamental thing is figure out what their drivers of inflammation are um I can tell you that in studies that we've done in our clinic in the United States 93% of the population has severe metabolic inflammation moderate to severe um in the pain population it's 99% plus the only people that don't have severe metabolic inflammation in the pain population are those that are athletes that got hit by a car and they're coming in and they might have a neuropathic pain because they've got a stump or they've got you know some issue that has not been able to spontaneously resolve um but the the ones that I see all have chronic inflammation almost all of them whether they're obese or not obese they have severe insulin resistance um and the typical methods that we use to figure out insulin resistance are inaccurate in this population in general popul populations in fact um because the hemoglobin A1c which is a measure of of diabetes is wrong 75% of the time it really is a function of where you are with your insulin against your glucose and the reactivity of insulin against the insulin receptor um and the vast majority of our patients are insulin resistant or they're pre-diabetic um so the first thing is to get an adequate history and in that history educate the patient and that's where we start we we start with a serious education of where are you what's your dietary intake we go through all the the usual stuff but then we pull forward their social determinance of Health you know what are the things that are impacting their ability to function what's their financial status what's their neighborhood look like I can tell you that in St Louis I know these neighborhoods and I know where the crime heat map are and I ask patients oh where do you live oh I live here I'm like so do you live in a safe neighborhood oh yeah I live in a safe neighborhood I'm like how many gunshots do you hear in a week well yeah every night and so people get desensitized to what's a safe neighborhood they we very quickly um when you live in a when you live in a potential war zone we forget that that's not a safe neighborhood um and so understanding that gives you a little bit better information because you know that that person is being awoken multiple times at night you know that they can't go to a grocery store they don't have transportation and they're going down to their local Bodega and getting fried food and it's enriched in vegetable oil and they haven't changed that vegetable oil in six weeks nine weeks 12 weeks so it's all oxidized and and that's the beginnings of their neuroinflammation so you you take these histories you also look at Aces scores which is their childhood experiences and about 40 to 60% of the patients that we deal with have significant underlying PTSD um they just don't may not recognize it so you put all that information together you do your exam and then you come up with a plan that jives with where where they're going to go and once patients have information they're able to see a bigger picture and so it literally takes us 35 45 minutes to get through the initial history which is rather unusual because most people go to their doctor and they're like I got in and out in 15 minutes well you come to us we see a lot of patients but that initial intake is going to take us 45 minutes to an hour and we're going to spend our time and we're not this isn't a concierge clinic this is a we see a lot of Medicaid which is public aid and we see a lot of Medicare and we see a lot of regular insurance and but if we don't set those parameters up front the patient's not going to do well and and so want to spend we want to frontload the education and we give them specific dietary advice right up front we do all of our biomarkers and that way we can feed the information back to the patient on what to do later but we draw all that upfront and then we get a radiologic exam and then we start on the plan and we're not just oh do lifestyle only it's it's a combination of medication lifestyle behavioral coaching Interventional technique and then slowly unwinding the issues yeah and so how is that that approach I me well how long have you been doing that for starters almost 20 years plus um I started in so I I started in the adult world with anesthesia went into pediatric anesthesia heart liver lung transplant then went into pediatric ank anesthesia and dealing with all the kids and that's how I really got into pain and then came out of that did adult pain as well and so it was a circuitous route and the reason I ended up here was not because I had some Epiphany and and saw a burning bush next to a rock one day that wasn't it what it was was I was doing procedures and there was no durability like I could get to the pain generator but then things came back a few months later and I would use the pain medication and I realized hold on we're we're we're we're not really getting to the source of the problem we're creating addiction and and so I had to reformat and I and I kept wondering you know these people are so poor how come they're so fat I mean what's going on here why are my poor people the fattest people and historically the fattest people have been the richest people because there was a show of wealth but I'm dealing with populations where people can barely move and they're morbidly obese and they're insulin resistant and they have been diagnosed and so I had to unwind it and that's why I got into first I tried to understand obesity and got boarded in obesity and then boarded an addiction and just trying to like unwind the whole thing and and then I ended up concluding hold on the whole thing is is collected together it's called metabolic inflammation that's the that's the that's the core nexus of what we're dealing with it's 2third of Healthcare in the United States it's a 1.3 to$ 1.7 trillion problem it's the prim AR problem if we fix that then we can unwind and and and that's that's how I ended up here okay and so have you been using these uh you know metabolic Health approaches and and and lifestyle sort of interventions from the beginning or did you transition that uh it's it's incrementally built up um I I it didn't didn't happen like immediately it it took me a long time to to discard what I had been taught because you know we don't get much education in nutrition or lifestyle and you have to be very careful that the advice that you're giving people doesn't run contrary and then everything that the patient's exposed to and everything as a physician we're exposed to um is really nutritional guidelines that promote carbohydrate consumption and they dissuade you from meat consumption those are the fundamental nutritional guidelines in the United States um and so you really have to unwind and you have to rethink and you you have to spend a lot of time being able to read literature and then be able to defend what you're saying because if you can't defend it and somebody turns you into the board then you're in trouble and so you better know your stuff and that's why it took me so long I understood it but I had to come up with position papers that would say okay I can defend this and I can defend this and I can defend this and these are the holes in the science over here so I had to build a dossier for myself um and then be able to stand up in front of my peers and say look this is what I need to do so I'm the president of the Missouri Society of Interventional pain um I've spoken at National ASAP meetings I've spoken at the Ada I've spoken at a whole host of conferences and it always amazes me how far from patient reality some of the some of the guidelines are and and those guidelines are basically industry based not not saying that there's you know not saying that there aren't utilizations for those but a lot of it is so so deviated from from biology that it doesn't make a lot of sense to me and so I had to be able to defend it for myself and to to protect my license because if you're not if you're not careful you you will lose your license yeah definitely even if you're even if you're getting good results results which is scary yeah exactly yeah um that's something that David Unwin is doing um you know Dr unwin's a a GP Family Practice physician over in the UK and he um was getting thoroughly attacked for his uh carbohydrate restriction in diabetics um uh that he was doing and and so he started publishing his own case reports and his case series and now he's got you know 150 Plus confirmed reversals of diabetes and come completely come off medication and and that was that was again just to defend himself so that he could say hey look this is what I'm getting this is what these are the results I'm getting and I'm saving the NHS you know all this tens of thousands of dollars a year just on these diabetes medications that we're not having to to give to these people and now all of a sudden you know everybody everybody wants to know him where before everyone was um yelling at him and saying he was killing people and just terrible and Quack and all these sorts of things but yeah it's a it's um you have to be able to protect yourself because there will be anytime you deviate from the norm someone's going to come after you even if you know there's that that saying that you know if if you have a whole crowd of people running towards a cliff the one guy running away from the cliff is is the is the crazy person right so like what the hell exactly so yeah so that's very good um so how how do your colleagues colleagues in the pain management Specialties um view your position on this hey guys just want to take a second to thank our sponsor at carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnivore bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to thrive as well and the more we support meat only products the more meat only product that will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys it's slowly changing so when I first presented this eight years ago you could have like when when I stood up in front of ASAP and you know 500 physicians in the room and I'm presenting this they're looking at me like you're bad crazy just put a s Ator in the patient and be done or just put pump in and be done I'm like but the pump is the wrong idea the stimulator is the wrong idea there's High infection rates that you're not getting to the fundamental problem you got to you gota I I don't care how good your your feedback loops are why don't we fix the metabolism and then if you still need it then then you've got this other technology but the but we know that if you're metabolically healthy and you have you're severely traumatized your body will heal and it'll turn it off by itself so maybe if we fix that we don't need this um and it's not to say that there isn't a good indication for technology I mean because people are seriously damaged and you have to you have to be able to repair that damage but that doesn't mean that you have to go overboard on medications that suppress the brain and and turn off the brain and turn off all of the all of the the path ways and so it's it's a comprehensive approach and when I first started it was you could have like people were they just they couldn't even understand or fathom why it would go that way because one it's it's not financially lucrative to do that in fact you lose money because you can't do the one thing that you know generates a ton of Revenue um and you look kind of foolish because you're spending a lot of time trying to get it better but then the patients do better and that makes a huge difference I mean I can tell you that we see a lot of patients and there's and by a lot I mean like hundreds a week um you know 60 a day to 100 a day so it's it's a lot of patients and I I've got colleagues that have trained into this and we're all kind of pulling in the same direction um we have really embraced artificial intelligence and we've embra embraced all kinds of ways to increase our reach with our patients so that we can really do feedback in an appropriate way and we do a lot of Lifestyle coaching and Behavioral Health coaching and so we're able to able to get that done and and brought in a psychologist and brought in people that are all swimming in the same direction so we created a team of people that think the same way and that's really helped us and then as I more recently presented in the last six months I I just presented um to asip again in the last two months in Ohio and I had a room about 150 people and they were enthralled and they loved the idea so it's it's changing there there's been a massive change I think because I keep dripping the water on the rock over time and people are seeing that what they were doing wasn't working and they also they they understood what happened during Co they understood that it was a metabolic Health phenomenon and a lot of Physicians have recognized hey hold on the people that didn't do well in covid were the metabolically ill patients and maybe if we fixed that that would help and because we you know the us we we lost a lot of people and and it it was it was the dry Tinder that we we lost um and those are the people that were metabolically the sickest and it it made it a very Stark example of what was going on yeah so I it's it's it's much better received now now I don't feel like the parah when I start talking yeah and people get it yeah you that you like like you described there doing everything you can diant lifestyle going about these approaches which do take longer you don't get to build for them uh you know as you would procedures which is what um you know a lot of doctors you know make you know pay the rent with um but it but it works and you get better results and then if you have if you have a case where it's it's just not enough you know or they're not able to quite do it or or a combination of the two then you have these interventions and then there there's something like you've done everything that you can in your power to fix this it's just not quite there then you intervene I mean that that's real medicine that's what we used to do they so we had you know these medical interventions that allowed us to achieve things that were unachievable you have a you have a burst appendix you know you're a septic you know now you can go in there and you can clean that up um take out the damaged tissue sew it back together and and someone can heal that's something that the body may not be able to do so that's real medicine whereas these metabolic issues that manifest as pain that manifest as other sorts of symptoms that's you know a lifestyle issue and that's the largely and so um at least the things that you can address through the lifestyle I mean we really should we shouldn't just be papering over these these underlying issues with symptom control alone and then just and leave the fire burning underneath you know just blow away the smoke and forget about the fire you know um but that but then when you when you address as much as that you can um I think that's that's the really exciting medicine that's the real you know interesting stuff that hey I can do this for you and and you're not able to your body's not going to be able to do this and we can we can fix you I think that's really the exciting Stu um it's it would it would be really interesting to see if we could ever work with the insurance companies to try to incentivize that sort of intervention because it would save them a hell of a lot of money that they're not paying you know millions of dollars a year in you know spinal cord stimulators and all this sort of stuff and I think I'm sure they'd be thrilled to not have to pay all that you know they incentivize like hey if you do these sorts of interventions or if maybe you publish a series or you know a study showing that hey we get better outcomes in these patients and then take that to the insurance companies and say hey why don't you pay me to do this so that I'm not charging you to put in these these simulators and do these expensive interventions and see what happens I think they probably would go for it if it's viable because there's already um well I went to a a conference in Switzerland and there was the CEO of was it one of these Swiss um reinsurance companies they insured the insurance companies and they were actually really interested in this because they they saw this saving them billions in payouts and life insurance and things like that yeah they they reinsure they they insured the life insurance companies things like that so you know if you could have people you know live longer do better be healthier then you know they save a lot of money so I wonder if that might be the way to do it because there there has to be some if we can incentivize this for the Physicians out there to spend an hour instead of like look I got 15 minutes and I've got to go on to my next patient and I can do an I can do an intervention and do a procedure and uh and make a lot of money versus sit there for an hour and talk to somebody and only build for one consultation you know it's not as desirable for people I I saw at one conference that really bothered me um someone was telling a story he was an Interventional cardiologist and he was really interested in preventative medicine preventing heart disease and atherosclerosis and heart attacks and all these sorts of things he was talking to a colleague of his about his interest in this and his his colleague was an Interventional cardiologist as well in the UK and he said I don't want to prevent heart disease that's what pays my bills I I don't I don't want there to be less heart attacks I want there to be more heart attacks so I can do more stent so I can take more people to the cath lab all these sorts of things I mean that guy should be locked up that guy should you know be you probably you giv a blindfold in a cigarette and put in front of a wall I mean that that's like those are the type of things we we we we hung people for nurg trials I mean you don't do that you want more heart disease you want more suffering you know just so you can make money like that's wild but if if you can change the incentives so you know you're not making 15 grand putting in stance in somebody you know you're making not that much but you're making a decent amount of money educating people so they never have to have stance in the first place you know I think that might be the way well I think that would that would help help uh people anyway have get better outcomes yeah no I agree the the it it harks back to hearkens back to the the origin of Physicians and and the original origin of Physicians because in the United States I mean Physicians were really they were the class of people that were either doing butchering or they were doing um hair cutting and that's the origin of Physicians and surgeons that's that's the the fundamental basis and then there was a a large group of people that were um mostly women that were saucer saucer or witches and so that's the origin of medicine but it didn't get corporatized it didn't become like medical school with corporatization until people decided that they wanted toell sell drugs and they needed high price salesmen for these drugs and so that's the origin of of why we have medical school because it was a way to indoctrinate a sales crew into it and keep a separation between you and the sales crew and the sales crew makes their money but they sell your product and they just don't realize it that they're selling your product and so it's the the origin of pharmaceutical sales is a problem and and almost everything that we do in medicine is driven by these large agencies that are trying to figure out how to sell more drug because it when you make a drug it doesn't you do some research you make the drug and at that point like for example AIC probably cost $5 to make a dose of a zic but they sell it for 800 to $1,200 a month um but it costs five bucks um insulin it costs almost nothing to make um but they sell it for $1,000 a month that Delta is the incentive for those companies to do that but they can't do it on their own so they have the Physicians do it by manipulating the Physicians into saying oh this is what you need patient so here take this medication so we end up we end up in bed with the pharmaceutical industry if we're not careful and and that's pretty classic that that that's a that's a that's a that's that's how it works almost all new devices you end up in bed with the device manufacturer and the margin is really on the side of the manufacturer of the medication or whatever in the United States we have these things called pbms uh which are wholesalers for medications and they make a ton of money the hospitals make money because there's programs where they can buy Pharmaceuticals at wholesale and then they can sell them at retail and they get to keep the difference but they got a subsidy to buy them at wholesale so a lot of the medical system in the United States is driven by medication and it's the sale of that medication it just so happens that Physicians are you know one of the derivatives is that they they were high price salespeople and and I know that's very pejorative and I know that people take take that as offensive but that's the origin um and so you to separate yourself from that you have to step away you cannot accept funding from drug companies is you you you really have to once you get away from that then it clears your thoughts and you ask yourself okay what what's the best thing for my patient not what's the best thing that this drug company told me to give them but what's the best thing for the patient because I mean medications are life-saving and we we need them but just because you reformulated it slightly and changed the milligram dosage slightly and then put it under a new patent doesn't mean that you should charge an extra couple thousand dollar for it um and the the reality is is that if you're trying to do health and as opposed to unhealth unhealth thrives on misery and it's like it's like the creature that just lives on the misery of human beings and we can get away from that if we make human beings healthy but then that means that a big chunk of our Healthcare expenditures will disappear and it'll radically shift the power in in in the structure in in in our governmental influence and things of that nature so it's it's it's a tough tough thing it's a tough it's a tough road to hoe but at the end of the day if you want to really help your fellow human being that's where we should be as Physicians we should be trying to make that radical departure difference that says hey my patients don't need this or I can I can I figure this out without this not to say that there isn't like amazing stuff that we can do with medication techniques and procedures and we need to do those things but there's other things we can do as well and then we wouldn't have you know we if we incorporated lifestyle coaching and health coaching it would take more resources in terms of people and and and and other things but it would it would potentially stop a lot of the complications because these devices and medications also have complication risks and those complications build up at least 5% of people are Mis diagnosed completely and the probably one of the number one causes of of death in the United States is iatrogenic we caused it our own selves we caused the problem that killed the patient and we didn't do it on purpose but it's it's a side effect and so those are the things that we need to kind of be aware of yeah um yeah I'd say both my grandparents were sort of L down by the medical establishment probably would have Fallen under iatrogenic cause of death unfortunately um they were you know they were in their 90s but they you know they didn't need to it didn't need to happen the way it did you know and and there are a lot of very well-meaning people that um are just in a in a system that funnels things in a very specific way unfortunately and um and the the patient doesn't always get the get the the right end of it um yeah it's interesting you know uh how expensive in is that I was you looking at um you know Gary tals who um wrote a book called um well on the the origins of diabetes and treatment and everything like that and uh and he spoke about how um when they discovered insulin and um and and it use obviously in diabetes and type 1 diabetics in particular um they thought it was I mean these guys pretty sure they won the Nobel Prize uh for this and they um they thought it was such an important thing for the world that they uh didn't even keep the patent they they sold the patent to the public for a dollar just he's like no this has to be everywhere no one should be you know capitalizing on this it's it's probably unfortunate they did that they probably should have kept the patent and then s sold it for a reasonable price because then people got their hands on it and then they they manufactured and sold it for for exorbitant amounts of of money and you know obviously it's hundred years down the line now I mean that was 19 21 um when they they came up with insulin and now it's you know they're coming up with all the new different kinds of insulins and things like that so they can just keep charging more and more and more um and then there's other sorts of issues too I mean there was all that that weird um problems with the epipens where they sort of boxed out their competition then all of a sudden EpiPen was the only one on the market and then all of a sudden boom it was $400 a pen and I like what are you doing you're talking about like kids with a peut allergy they're going to die and it's just like 400 let's go um it's pretty pretty uh ghoulish to do something like that when you're talking about saving someone's life um I remember see a friend of mine he was um uh he was from Ireland and he was playing um you know a game in the US somewhere don't remember where East Coast somewhere and he had travel insurance but then he like broke his arms sort of distal radius and so it's was real simple with was in there uh for a day casee just to um you know just to do an you know open reduction and fixation and just put a little plate in it and so it was really easy it's just a day case didn't even stay overnight and he got the bill and it was like 50 Grand you know and and he's looking through this he's like what in God's name is this or maybe he's even more than that um and this was you know 1520 years ago and he looked at the itemized breakdown of it and he found uh he was he said that he was in pain in recovery and they gave him two Tylenol and they charged him $600 for those two Tylenol it was just wild just wild that they that they can do that as well and um I gu when you have travel insurance will sort of hey whatever but I mean it was just um you know taking advantage of that was just shocking to me well if you look at the so I'll give you an example it's akin to this um and I looked at you know I work with my orthoped colleagues all the time in the United States if you get a total hip or total knee replacement what do you ballpark is the surgical fee for a total hip or total knee in the US oh I would say $800 to ,200 so yeah the surgical fee for a total hip is 1375 for a total need is 1430 that's a surgery fee yeah in a hospital yeah but what's the fee to the what's the fee that they're charge Medicare it's between 65,000 and $95,000 the bulk of that money goes to the facility yeah um about $20,000 of it between between eight to 20,000 would go for the implant um but the surgeon is making 1375 to 1470 whatever it is and they take care of the patient for the next 90 days and and so if the patient has a complication in the next 90 days it's ass with a total hip or total knee the the surgeon's going to have to take care of it grus and that and that tells you where the incentive is because the incentive the surgeon barely making it because it takes him 40 minutes to do that procedure and they've got to still pay their office they got to pay everything and the surgeon's not making much money who's making the money is the hospital it's the facilities and and and it's the pharmaceutical industry it's not so the average the average house the average income inflation adjusted for PHS has gone down in the United States by 50% over the last 10 years wow inflation adjusted income is down 50% whereas the cost of Health Care in in the United States has gone up by 80% inflation adjusted in the last 10 years so where's what's going on here why is the physician income down 50% inflation adjusted but the cost has gone up 80% in inflation adjusted the difference is that per phys we now have 10 administrators in the United States who can't practice medicine but work in healthcare so each physician is is pulling the donkey cart for 10 administrators and they need that physician to work a lot harder so that they can maintain their salaries there's been a 3,800 per growth in administrators in the United States that's ridiculous and so we've gotten so far away from practicing medicine that we're basically just the we've become the slave class almost and I hate to say it that way but that's that's what it is we if if we stopped doing what we're doing there'd be a lot of Administrators that would be really pissed off because they need us but at the same point you know we need to we need to help our patients and we need to be able to spend the time to do it um and and and to do it correctly and so you know and we've just migrated from one one catastrophe into another for example we have this amazing drug AIC and Muro these are uh glps and we use them to a small degree but within the context of their what they're used for so they certainly will help you lose weight because they'll give you gastro pris they stop your stomach from emptying but there's something more important um and that is that they cause your brain brain to be anhedonic they cause you to no longer seek that pleasure of the food which reverses that hedonic cycling and when you do that it it has a side effect too which is if you're an alcoholic you stop drinking and so if you're a serious alcoholic and I put you in a glp you might end up seizing because you acutely stopped drinking because you no longer have a desire and that's happened to me a couple times that's issue one issue two though is because you get gastroparesis you can't empty your stomach so you're not likely to eat and you can't break down protein and when you can't do that you start to get sarcopenic wasting first and the sarcopenic wasting precedes the weight loss and that sarcopenic wasting never comes back so even when you get off the glp once you've gotten to your weight that you think that you should be at you've gotten there in a way that you've lost your muscle mass and that muscle mass doesn't come back you get off the glp all of a sudden you regain the weight but it's it's not muscle and you're you're at a higher risk of having problems because you're not able to produce the myocin that you need which are actually anti-inflammatory and you end up with more white adapost tissue producing more leptin which has all of the cyto problems and all the inflammatory issues so you're not getting the benefit that we'd want and and what we did was we traded insulin for a zic and they both cost $1,200 a month so the companies didn't lose any money but we made the patients sicker over time and I think that's going to be our next big thing is we're going to see patients that we've put on to zic they've gotten a lot sicker and now they're skinny fat um and they're going to be even worse than they were and they're going to be a higher risk a fall and a higher risk of sarcopenic cloths yeah definitely um yeah I I actually um I I've heard this for years I'm sure you have as well that you know the reason that healthc care is is out of control and the cost of Health care is out of control is because doctors just get paid too much and you know they're just all rolling it and things like that and um and that always pissed me off because I actually read an economic report that showed that if you didn't pay doctors a single scent that it would not appreciably lower the cost of Health Care to the to the people it would not change anything um we're basic like you said you know people go you know there come telling to see the doctorine you're you're supporting the entire establishment um it's a big establishment it's big hospital these things are like little cities you know and you're going to see the doctors those are the minority of um of the people that work there and they they get paid a minority of the fees and have sort of turned doctors into sort of hourly workers or just a you know wheel in a machine you know Cog in a machine and and they're just there to churn out office visits and procedures just to you know generate revenue for the hospital um but they don't they don't see much of that they're just a sort of an hourly employee or a you know bill for you know procedure sort of employee whereas it used to be the doctors you know would would own the practice would own the hospital and now you have these big hmos and and uh massive corporations that own everything just hire doctors and then they just feed off them um a friend of mine as a lawyer sort of equated this to indentured servitude you know they've got they've sort of you and and um school loans as well you know get these massive school loans hundreds of thousands of dollars and you you're paying those off for 20 25 years now and um you're paying back far more than you gain you borrowed and the interest rates you know what 88.5% or something like that I think is on my student loans anyway and um and so it's it's a massive Roi for these people and I think I graduated when I graduated in medical school I had already racked up another $100,000 in interest it was like okay it's like already at the point of absurdity at this point and um that uh you know then they have you working for them sort of for the rest of your life and then you're in this institution that you're basically just turning out money and like you said you sort of uh yeah you're in this indentured servitude you know know we brought you here we let you be a doctor but now you work for us for the rest of your life and it's sort of this deal with the devil that um you they sort of snuck in on us because that didn't used to be the way you know doctors used to do very well and because they had you know they had um you know a slice of the pie of the profits you know they would would have own art ownership in the practice or the hospital or something like that and uh like my great-grandfather he was um uh he went went to Columbia he was the still to date the youngest graduate from Columbia Medical School he was like 20 years old couldn't even practice until he was 21 so we had to just go home and hang out like you know the 18 you know Doogie Hower 1800s and um and just you know and then go back to um residency after that at bellw hospital but he went ended up in Southern California and he was like the 13th medical license that California ever gave out and he helped found Redlands Hospital and so you know he was he you know was part owner in that and that's that was a pretty common thing that doctors would would actually be the ones building the facilities and and and running them um and now that's definitely not the case we've just sort of been suckered into this position where we're just sort of yeah just cogs in a machine and just turning out for other people and like you say the only way out of that is to step out of it you know just not not uh be involved in the first place and you also get to practice better you actually get to practice real medicine you actually get to do the things that you see helping your patients instead of just doing what you're told because that's what the hospital says you need to do you know Dr Shawn Baker he got drummed out of his practice um he was head of Orthopedics at um at his group in I believe New Mexico at the time and um because he started coming to these metabolic therapies for people and and getting them better so they didn't need joint Replacements and he was really happy with that because his patient was doing better um but it was really pissing off the hospital because they weren't able to Bill $70,000 you know per per joint replacement and um and they made some trumped up charges and tried to get his license taken away to get him out of there and you know it didn't stick know they didn't take his license away they just investigated him for a couple years and then said yeah there's nothing wrong and um you know but it it's uh it's very it's very you know disenchanting with the whole system that uh that because you know you're doing real real work for your patients and real benefit for your patients that your hospital tries to destroy you and destroy your career and your medical license it's absolutely wild hey everyone really happy to announce a new sponsor for the show and for everybody down in a Australia Stockman steaks who are delivering highquality grass-fed and finished pasture raised beef and other meats flash frozen and vacuum sealed to Door something I've been enjoying a lot of myself recently as well they also have a great range of specialty items such as high fat keto mints and carnivore beef and organs mints with liver kidneys and beef heart as well so use code chaffy today for free order of beef mints or another specialty gift along with your order at Stockman steaks.com DOA and I'll see you over there thanks guys yeah I mean but from the from their incentive standpoint they don't want you doing that you're taking money out of their mouths and they need you to do those procedures they they have to live on the misery of that patient um and it's they're not practicing health care they're practicing sick care yeah and they they need that patient to be sick they need the patient to be severely diabetic so they get an amputation if the if if we eliminated type 2 diabetes 2third of our hospitals would have to close I mean it wouldd be done and and yeah it would be a better world but two-thirds of the hospitals would have to close because those are the inpatient centers that we don't any longer need um and so it's it's a challenging situation there's always going to be a need for healthc care there's always going to be a need for acute care there's always going to be a need for certain things but a lot of the stuff is iatrogenic we've self-created it as a society and it's 2third of our Healthcare expenditure in the US and we need to fix it we need to unwind it um and it's it's it's doable and and and patients want to do better that's the other thing you know so like for example I get a patient in and and and as I said hemoglobin ainy underrepresents diabetes but if their LP is high and they're starting to rise their hemoglobin agency and they're getting into beta cell fatigue um then my first step is that educational component but then putting a CGM on them because once patients have a gamification process and they can see that what they're eating impacts the glucose in a real time that they're not checking their finger stick but they're actually seeing that interstitial glucose change in real time within 40 minutes of eating they can see it they go oh that's what's making my sugar go up and I gu so what's interesting to me is when we've done this in our in our own Clinic um we did a very brief short study about 50 patients every one of them almost except for two dropped their sugars and we never had to go forward the that lifestyle change with a hemoglobin A1c between 5.7 and 6.4 with with a CGM they immediately changed their lifestyle and they never went forward those patients never had to go forward now the thing is it is glucose it is the carbohydrate but there's other factors and it's it's that it's the lipid raft and the the Omega 6 to3 fatty acid ratio it's all of those other factors that we have to fix as well and then as we unwind it their whole body gets better you know the vitamin D gets better their sun exposure gets better um there's all kinds of tricks that we've got to really make these people metabolically healthy um and and yeah we we certainly will use medication but judiciously um and it's silly stuff like vitamin K2 you know we want to reverse cardiovascular disease so we use vitamin K2 K2 um we want to reduce the calcification in the US you can't buy a calcium artery Cal you can't do a CA score on a patient under their insurance so they have to pay for it and CX score once it's high it's really hard to reverse because it the calcium stays but if you give them vitamin K2 it helps natoy helps so there's all kinds of Lifestyle tools that we can use to improve them and as you use those tools you get them off their Mets you get them out out of their chronic pain um and you bridge them the whole way so that they're not suffering um one of the biggest things that I find is the patients come to me they've already been treated by somebody typically and they're coming in on benzos they're coming in on benzo me like Al pre Lam or xanax they're coming in on highdose narcotics our average incoming patient is on about 140 to 160 milligram morphine equivalent and within a month they're on less than 40 our average patient's coming in and they're on two milligrams two and a half milligrams of Xanax and within six months they're off um but you have to do it judiciously you have to you have to tweak them and and recognize what those things are like we have a we have an epidemic of everything we've got an epidemic of impotence we've got an epidemic of anxiety we've got an epidemic of pain we've got an epidemic of obesity we've got an epidemic of diabetes all these epidemics are all the same thing it's metabolic inflammation it's it's it's it's it's your health system it's it's all of those things are interrelated and so you have to you have to spend the time to figure out what it is does the patient need a gut microbiome reset does the patient need a sympathetic reset do they can I use Gaba aminoter acid to calm them down at night can I change do they have a PTSD and should I have them get a dog who's GNA help protect them at night and get them to turn their TV off um it's a whole host of factors and it it's it's it's pretty complicated if you if you don't categorize it and that's what we've gotten good at over the last 20 years is categorizing the problem and then trying to pick the technology that meets that social environment necessity and everybody's in a different demographic class everybody's in a different economic class so a tool for one person is unaffordable for another but you have to figure out another way yeah I have you um published those results on how you can your patient coming in and being able to reduce them off their their payment uh we've done some publication on it and we've presented uh an abstract and we I've got a more comprehensive um group of Publications that'll probably come out next year that'll that'll be more widely distributed I've done some U publication stuff but there's to give you an example we did a very simple study and and the reason I did this was because I kept wondering what what am I missing here I would have patients that you know because we use BMI as a calculation body mass index even though we know it's not terribly accurate we use BMI to figure out somebody's weight and I would look at somebody and go that BMI can't be 30 that BMI has got to be higher I'm looking at their height looking at their weight and then I realized there was a discordance my staff were accepting the words of the patient so then I said okay look we don't accept the words of the patient anymore yes we I know that we routinely weigh them but I want you to routinely measure their height I found out that the average patient was 1.7 uh inches off on their height which completely destroys their BMI when they come in I always ask them what do you weigh and what's your height and until you measure and weigh them they give you bad numbers they're usually 20 pounds fatter than they are and they're you know and they typically think they're about almost two inches taller than they are and I don't care who it is and that really changes those numbers and if if that's the basis of what most primary cares are doing if that's the basis of our health care System where we accept the word of our patient for height that that really changes a lot of information from a BMI standpoint which then changes your renal function calculations which changes practically everything um and so understanding that that that patients have this ego that they want to be taller and they want to be skinnier which that that's the nature of human beings um as soon as you figure that out and you correct for it and then you're able to protect project give them exact information and say okay this is where you're actually at this is and this is where we need to go then it allows you to reset and there are other biologic tools that change in real time um like I said CAC Corner rity calman score is not something that you and I can get to easily on a routine basis and it doesn't change over time but plethysmography does so which measures nitric oxide production it's an ankle brachial index it's cheap it can be done in your office and you get a score that tells you an ABI score and it tells you nitric oxide production and their vessel elasticity and you can get it in real time and as the patient changes behavior that ABI changes and it gives the patient a gamification technique to to self-manage and so we have a whole host of like tools that are direct and give real data to the patient so that they can self-manage and the the whole goal here is to put the power of healthc care back in the hands of the patient because I mean we should really be the Sherpas that guide our patients but it's really the patient journey and my goal is to put that that power back into the hands of the patient and then give them the information they need just in time so they can make a decision they don't need to go to medical school but they need to get the right information at the right time and it needs to be true information not some information that's been manipulated so that we can sell more drug yeah and and and that's that's that's the purpose of a physician we're we're actually supposed to be guides we're supposed to be sherp and and we we take our take our patients and we protect them and we have to protect them from the trolls and we have to get them along this journey and those trolls unfortunately happen to be the system the the the Health Care System itself we're supposed to guide them through it if we get to that our patients will really trust us and they'll they'll they'll follow what we want them to do and they'll be healthier for it yeah that's um the getting them the true information is so important and and even even you know Physicians understanding what the true information is because like you said we're we're sort of set up as these drug dealers without even realizing it we're just pushing a product and we think we're the decision makers we think oh I have all these tools at my disposal I'm the one making the decision but really we've just been sort of manipulated and put us in place to you know uh you know shell their Wares but that true information is very important animportant and I was listening to an interview with um a professor at MIT and um she's a you know you know PhD researcher and professor at MIT it's been there for years and and she has been doing a lot of research on glyphosate and how how seriously harmful it is destroys the mitochondria it's a endocrine disruptor and actually has an inverted inverse relationship um a inverted dose relationship with as endocrine disrupting ability like the lower the exposure to glyphosate the worse the endocrine disruption and so and there have been you know experiments you know showing these sorts of things and how longterm like the um there's a guy who recreated the um the animal studies that GL that Monsanto did for glyphosate uh saying that this was safe and could be used was animal studies rats you know three months and they said look there's no problem there's no harm and um so he did the same thing body let it go out for the entire lifespan of of the of the rats and it turns out they were horribly sick they had all sorts of you know tumors and illnesses and and other just massive amounts of problems kidney failure all these other sorts of things because it's a slow poison it takes time and so um you know Monsanto sort of gamed the um the research and and stopped the research before it showed any sort of symptoms and said oh look it's safe and then didn't talk about how how horrible got after the fact and she said that that the game's pretty rigged and so she's been she says it's very difficult to publish anything on the adverse effects of glyphosate and um she said that you know she's had some things published and then the people that this would have hurt to have this published came after the journals and uh and they sponsor the journals and they pay a lot of money for these journals and I think that that is exactly uh why they do it is is to buy them and so they and they do this with um there're some of the major these big drug Food and Drug companies are the major sponsors for media Outlets you know uh all all the newspapers and and uh news organizations you know they're the major sponsors and a major reason for that is that they're not going to be dumb enough to bite the hand that feeds them and put out a story that goes against them and and shows them up for what they are um and they might go out and defend them you know when when something comes out against them and uh but she was saying that these big companies would actually go after the journal and just put a lot of pressure on them saying okay you can't publish this you have to retract it and they ended up retracting a lot of her papers on glycate and um and and a lot of them don't even get published in the first place and I you know I can't imagine that that doesn't happen with big drug companies as well I mean they have they have a huge influence Financial influence uence on these major uh papers as well these ma major journals as well and so you know the the the papers and studies that are coming out against them are going to be very hard pressed to actually get published in any of these journals which skews the literature and makes it so you can't really trust the literature anymore the vast majority of um nutritional research is is paid for by the food the processed food industry they spend 11 times the amount of money on nutritional research than the NIH so there putting out all this money putting out quote unquote research uh that's really just marketing for their product and then they attack any any paper that might be coming out against them and um and can prevent them from even being published in the first place and and this you know MIT I mean you don't have any more bonafides than being professor and at MIT I you should be able to publish sort of anywhere and she used to be able to now she can't right because now she's publishing on something that the powers that you don't want her to publish on and that that really skews the message as well even for for doctors that are really trying to do the right thing it you have to dig and you have to search and a lot of the really good research is going to tell us what's actually going on and what we should be doing as Physicians and people um is is not even being publish in the first place it's it's actually quite concerning yeah I mean like for example there's another component to this too it's not just the publication it's also the regulation and it's the governmental regulation because there's a continuous exchange of of people at the top of Industry who are paid for by the industry who then become regulatory they go into the regulatory system in the government and then they come out of the regulatory system and go back into industry and they Circle continuously so that put that that creates a moral hazard and one of the classic moral hazards associated with that is is Alzheimer's so we've got Alzheimer's and Alzheimer's is very interesting because we've gone down the the we've gone down the the pathway that Alzheimer's is a tow protein issue and and Tow protein certainly is a accumulation of fibers in the brain but is to protein the problem or is it the accumulation of it it's similar to the heart uh the cholesterol hypothesis for the heart is the cholesterol the problem or is it that the cholesterol accumulates in the area of the damage and that's what we're seeing and and slowly we've migrated finally people are starting to recognize that cholesterol is is the Band-Aid that the body is applying to the injury area and that's where the foam cells are the tow protein is very similar but it's there is probably an issue of the tow protein representing the inflammatory State and when you're hyperinsulinemic um the the compound that breaks down to protein is called IDE insulin degrading enzyme so when you're hyperinsulinemic there's a pleotropic effect that either it breaks down the insulin or it breaks down the tow protein and if you got too much insulin it can't break down the tow protein so it accumulates that's why we call Alzheimer's type 3 diabetes of the brain because you get cognitive impairment now what's interesting is if you are at risk of dementia your Apple E4 homozygous with a 95% at risk rate of dementia I can put you on a med that's between at the low end 35,000 at the highend $888,000 a year and the benefit to you is 1% maybe and if instead I put you in a lifestyle coaching program the benefit to you is 40% m now that means that I probably saved at least 32,000 to 85,000 a year that means that didn't money didn't go to the pharmaceutical company but you probably got better almost 50% of the time as opposed to 1% of the time but we approved this drug by the Food and Drug Administration even though the some of the researchers said hey this is not a good drug it doesn't make any sense this is this is not a good drug and so but the but they were overruled and in fact researchers quit the panel saying hey we can't approve this drug it it doesn't work it doesn't do anything but they still approved it and once a drug gets approved by FDA in the United States that means that our Medicare system will go on to pay for it and that means that that company will make a lot of money and so it's in their best interest to to slightly manipulate the system to maximize their revenue um which may not be in the best interest of the patient and so as a good phys I you have to guide your patient hey there is this drug but it doesn't work that well and this is what it actually does and if you did this lifestyle change you might get more benefit what would you like to do what would your family like to do and and then you can make a decision but you have to have integrity and you have to be able to see both sides of that coin um unfortunately if all you're doing is looking at doximity and Medscape as your as your source of information those are sponsored and if you're looking at journals those are sponsored and so you really have to look beyond the journals and and to have a conversation and and to look at the statistics and a lot of those stats are present in the literature but but people ignore them and and we we look at the Highlights Highlights and we look at that abstract and go oh okay that's what this says and then we don't dig into the stats and it's hard to navigate that um and that that's one of our biggest problems but it's that it's that continuous feedback with regulation it's the overarching um control of the literature um it it's kind of like it's what what YouTube and and and and Facebook have done to social media and changing people's political perspective um it's very similar it's akin to what's happening to Physicians or has happened to Physicians over the last 10 or 15 years um we've had our opinions changed based upon what we're being told and the yeah the revolving door policy where you just sort of yeah going in and out with government and then going straight into some sort of uh you know board executive um on on the drug companies and things like that we were just regulating and you know could be like a have to wonder if that's a quid proquo sort of situation that you did some you know approved a lot of drugs that made them a lot of money and now they're happy with you and you get some some cushy um cushy job afterwards that's certainly the accusation anyway and it's probably founded in most cases um I know you have um patients coming on in in a second I just wanted to sort of be remiss if I didn't ask because I we have I see a lot of patients with with things like um fibromyalgia and just generalized you know pain and um uh a lot of doctors have no idea what to do sort of half of them don't even believe it exists it's just in their head they're just drug seeking or something like that um but you know I see this really affecting people's lives and I've seen them recover from it as well and and people coming off their um their opiates and things like that do you do you treat fibromyalgia as well and what did your experience been with that yeah we treat it all the time so fibromyalgia is a description of multiple trigger points above and below your waist so of upper and lower extremity um and it's a multitude of trigger points with a defined set of characteristics um and it's a diagnosis but it's not it's not a it's not a disease process in it of itself it's a diagnosis and it's associated with other things um I don't know if you realize it but there's good published studies that show that metformin works on fibromyalgia and there's actually several studies on this and the treatment of fibromyalgia is to treat their insulin resistance and if you can get to that it'll help and then sleep restoration um and typically it's it's a gut microbiome issue and so we get sleep restoration and we make sure their insulin resistance is improved the trigger points are of no benefit acutely they can help you to get you out of the mess so that you can sleep and be more comfortable right now but doing repetitive trigger points is of no value and a lot of the neurals that we use have limited utility so a lot of the anti-depressants really don't have much benefit and I don't even know where they got the studies to say that they did benefit because if you look at the outcomes they don't work and narcotics really don't have a place in fibromyalgia um there really is no indication other than to create a dependence on them so we we really get away from narcotics we do stretching we do everything that we can biomechanically and then we get their restoration done as in terms of their insulin resistance and the studies are published already these are peer-reviewed Placebo control studies that show that metformin works and so why not use the drug that works um and and go down that road now sometimes though what's been diagnosed as fibromyalgia is not fibromyalgia because you'll find out that some of these patients at least a third to half have a radiculopathy either cervical or Lumbar and it's been missed somebody has completely missed the radiculopathy and and you got to get to that and figure out that diagnosis um or somebody's missed the osteoarthritic change and and the Perry joint um muscle stabilization that's occurring the reason why you get muscle pain around a joint that's inflamed is the body naturally tries to immobilize The Joint till it heals and that's what happens in your lower back if you injure your lower back you get paraspinous muscles that become really taught to keep you from over utilizing it and to protect your spine temporarily uh and then if you if psychologically you feed into it and you you become overly sedentary for too long of a period of time you actually get sarcopenic loss and then the immobilized joint becomes arthritic and you start to get bony spicules in the joint and then it creates this terrible Loop of of symptom so you have to unwind that Loop yeah okay um I I spoke to one um researcher on the subject that you know they don't treat this but this is something that they sort of came across um was that um they found some evidence that it could be also to do with like a toine deficiency and um and interestingly you know we make torine but we make it in the liver it gets Express in the bile and then we eat a whole bunch of fiber which binds the bile and eliminates out the bile and the torine and so people are being torine deficient deficient even though we make torine and then you know they're eating less meat that has toine and eating more plants and fiber because we're told that's good for us and we're pulling out our own torine and then that can be contributory as well have you come across that yourself yeah yeah it's it's part of the stack that we look at for for patients I mean we're what we're doing is we're analyzing what they're doing and I mean our our stack of of supplementation can be extensive um it's everything from does the patient not have enough Lucine and they not don't they have muscle mass torine is a routine that we're using um between four to six grams a day um do they need an Omega three supplementation um we prefer krill oil because it has acanthine in it which is a tarpine and it's an an inflammatory and it's also a a slight analgesic um and so there's a whole host of of different supplements that are relatively inexpensive um that you can get to that that do make difference um some of the things that we've been playing with more recently and and trying to help our patients um especially the ones that are a little bit more sophisticated that that kind of can see their body changing over time um is things like C15 uh Carbon 15 uh the the fatty acid um looking at that using urolithin uh for patients with defective mitochondria especially covid um we there's a whole host of techniques that that are supplementation and a lot of Bio feedback too a ton of Bio feedback heart rate variability um that's one of the simplest biof feedback systems that we've got and box breathing is amazing to calm people's central nervous system down but use an Apple Watch because you can you can get a heart rate variability right on that on on their breathe app um as soon as you teach people how to calm themselves down their cortisol drops and they're able to focus a little bit better so there's a whole host of tools that are lifestyle that that are easily accessible um touring is certainly like you know it's one of I think it's one of the Crux bases of of of of dietary intake and it's one of the early things that we talk about with our patients great well that's great Dr Pa thank you so much for that I know you have uh patients showing up in a couple minutes I won't keep you uh but I could definitely keep keep talking to you for a while it was absolutely a pleasure um how do people find you follow your work and come see you if they need your help um probably the easiest way is um well I'm on LinkedIn that's the easiest way to reach me if somebody has a question or something um pay md. TV is our um diabetes site and we've got a fitness site and all that other stuff but shoot me a question through Linkedin that's probably the easiest way um I find that I can respond in real time um but if somebody wants information on pain md. TV we've got tons and tons of like lifestyle and pain based um articles and it kind of weeds through the the junk and says hey this study didn't make any sense because of this consider this instead um and so my my goal so I grew up in India and I I left India when I was very little uh when I was very young I was like nine and you know in India we didn't have a lot of resources and and so you're always trying to figure out bang for buck you're always trying to figure out how do I get the maximum value for the least amount of resource and and that's one of the fundamental drivers of of how I approach this how do I how do I make patients better without doing too much just doing what they need and then giving them the opportunity to get as best as we can and then and then going forward um and and so a lot of the articles that we've got on painmd talk about those techniques like you know improving your vitamin D through walking in Green Space even if even if if you can't tolerate the sun getting getting up early having a routinized um schedule and having appropriate sleep hygiene and the impact that that makes on outcome you know how do you deal with PTSD and how do you deal with other Alpha Predators um like I have a lot of veterans that have been blown up by IEDs and so one of the things we we discovered was that once we took these veterans with their ptsds and we introduced them into the Wolf Sanctuary which we have one that's pretty close the one wolf recognizes the other wolf and they both calm down and so you know we have an arrangement with one of the local animal shelters where always like okay so and so is coming in and see if you can introduce them to a dog that that they can walk around and be friendly with I can't tell you how many adoptions we probably facilitated through the animal shelters just because we we think that those connections are well well worthwhile um you get a tremendous oxytocin release from being next to one of those animals and they also get that oxytocin released and and there's a bonding that occurs and and loneliness is a big problem in the US so we're always trying to figure out that lifestyle thing that's going to make a difference um and trying to come up with as many different tools as possible to make a difference so that's that's the easy way to reach me pay md. TV or LinkedIn perfect we'll put those in the in the description and uh if people want to reach out they can go there uh Dr po thank you so much uh for coming on it's been an absolute pleasure it's great to see you again all right thank you I appreciate it everybody thank you for watching hopefully you enjoyed it if you did please hit the like and leave a comment let us know what you um let you thought know what you thought of the episode and if you are someone who suffers with chronic pain and you've addressed it with these lifestyle means please do leave a comment to let other people know uh what your experiences has been because a lot of people are really inspired by those comments to try it themselves and that's something that helps a lot of people so please do consider that thank you everyone we'll see you next time hey guys thank you very much for taking the time out to listen to what I had to say if you like it then please like And subscribe to my YouTube channel and podcast and if you're on YouTube then please hit that little bell and subscribe and that'll let you know anytime I have a new video out which should be every week if not more and if you could share this with your friends that would help me get the word out and let me know that you like what I'm doing thanks again guys