Metropolis Founder on Fake Labs, Disease Prevention & Future of Healthcare | FO330 Raj Shamani

0:00Amira Shah, welcome to figuring out. What do you think? What's the most wrong thing in your profession? We're going to Metropolis, which is the second leading diagnostic chain in the country. No one is checking behind. The lab is testing properly or not. Anybody can enter the business. Whatever you do, you can do that. Do you know how to do that? Who are you fake or who are you right? Look, I think... What's the scariest thing you have seen? You don't have to eat a lot. In your gut lining, it has caused disruptions. And there's bacteria flowing from your gut to your brain, Which is therefore then leading to mental health issues.

0:33Before marriage, you say, you get a Kundalini or not, you get a blood test profile, because that's very important. When your bloods mix, your child can have a significant problem in life. If you know their bank balance and you know which car they drive, you should know what's happening in their body also. Why is diabetes in India's capital capital? Only 6 % of India has ever been diagnosed. So, 94 % never tested any test? No test. You're talking about that many things from blood samples. . .

1:27हमारी आज कि guest is Amira Shah, promoter and executive chairperson of Metropolis Healthcare Limited which is a pioneer in diagnostic field and in this episode we have discussed top 5 tests which should all people do their health. Cancer, diabetes and PCOS like health issues in early stages identify how can we our family better prepare and what can we take precautions which is why

2:19So, Ameera Shah, welcome to figuring out. Thank you. What do you think? What is the wrong thing in your profession? Now, in the healthcare industry, our work is to keep up with people's knowledge. Right? And in healthcare, our work is to be diagnostics. So, we're going to Metropolis, which is the second leading diagnostic chain in the country and in Africa. so the test we do is simple blood sugar and cholesterol but the most complicated cancer genomics can be very complicated tests which you can see critical illness we have 4 ,000 varieties of tests here we have patients who are sick but they can be healthy let's say we know that I have diabetes I have to test something so that can be straight to us but when something is complicated So he needs guidance from a doctor.

3:12So in our business, we have to go to doctors and educate us, understand what is the test, what is the patient's test, why is it helpful, etc. And then we also have to go to consumers and make life easy for them. We have to start a collection center, then we will come to technology, we will give them reports, quality, experience, all of these things. The hardest part of the business is that our government is that in today's day, in healthcare and in diagnostics especially, there is no minimum standard. Now you will say, what are you saying? What is it? What is it? It means that when you go to the test, there is no check behind that the lab is doing it properly.

3:59Everyone assumes that what are you saying? That the government is not checking. The answer is no, the government is not checking. So, you mean you take blood and you will tell any test and you will give any answer to that? Today, there is no governance in this sector. When you start a new path lab, you don't need to register. So, anybody can enter the business, anybody can start and whatever you have to do malpractices, you can do that. And no one will do check, no one will stop, nothing will happen. But how big of a problem this is? Because 70 % of the market is an unorganized place. In fact, in Delhi, 85 % I mean, only 15 % are organized, authentic brands I don't say that 85 % is bad, I don't say that I don't say that with the lack of governance, I don't know anyone today That's the problem, you don't know which is good and which is bad Because there is no rating, there is no accreditation, no check-in Right, so as a patient, how do you know how to tell?

4:57So, like there was this research, I think Times of India I had 65 ,000 tests in Delhi and blood tests in Mohalaya clinics and they were all fake like 65 ,000 blood tests in the doctorate clinics and they were fake and their results were fake and their diagnostics didn't have any value. Doctors don't agree but they are bad. So how do you know that which is fake and which is right? I think patient has come interest. Patient's interest is that I'm ill, I'm going to the lab and finally the result I'm getting, can I do something about it and it's right or wrong? So what do the patient have to do? First, he has to check if he is accredited or not.

5:34Now, there are 3 ,000 ,000 labs in India. There are 2 ,000 labs that have accredited accreditation. And they are optional. So usually the labs who are accredited, are already doing good things and they should be able to get good things. So usually the best labs are already accredited. So what do accreditation do you need? For example, an accreditation is NABL, National Accreditation Board of Laboratories. This accreditation is not only India, it's an international accreditation. Many countries are part of it. In that, the people who have a body from the government, NABL, they basically check your processes, systems, check your people qualified or not, etc.

6:20So at least you know that there is a minimum standard. is on that. There is another accreditation of College of American Pathologists CAP which is the gold standard in pathology. Now see in India we will have maybe 50 or 100 labs that are CAP accredited. Right? They check more from there. Right? Are you really excellent at what you do? So you see we are CAP accredited for 20 years. And we are sending our samples every month to them in the US. And they are comparing us to labs in the whole world. And we are in the whole world in the top 1 % labs. Right? Now this is what you have to look as a patient to see.

7:04Look where I'm going, that's right. Accreditation or not. But if there is no governance, no body is not watching, I have opened a lab. I have also written a cap. You can write, but there is no cap you will come and say, you cannot write without the accreditation. You have a certificate. that you can fake it, that is in India, it is possible. But nobody can do anything. If you do fraud, then who can do something? Exactly. And then because it is not Indian body, do you think Indian government will take action even if it is? No. But if tomorrow cap US finds that someone is making fake certificate then that person can obviously go to court and sue you.

7:45That is possible. But another problem that is I heard this from Dr. Velu Mani and he told me this and he said if Metropolis, Thyrocare or whatever Dr. Lal Paths like 20 other brands and they take blood and they take different time so there are variations in that test they can come but the variations that come will not be very big see because today whether it's a Metropolis or a Lal or an Agilis we are all using standardized systems. Means we are using Roche, Abad, Siemens very good quality high quality systems. Right? Now you have to take a home and then how you maintained how you maintained it then you kept it or not it's in your hand.

8:34So we may all get the same best systems. Now how we use them how we use the teams how we use all that is up to each person. So there will be some differences but that difference will not change your life. So I gave you 210 and someone gave you 220 but both are abnormal. right unlikely but if you look at unorganized sector and organized sector there's a difference that's big normal abnormal abnormal abnormal something happens so there's a risk where your treatment gets changed that is the risk and cancer it is critical to your life it is cancerous or not cancerous it's binary right in that you have to take a chance in that not at all not at all No, no.

9:20No, no. No, no. No, no. No, no. No, no. No, no. I don't think any other thing is so much I mean, rarely few there are things that it won't be but it won't be a difference in maximum So you are saying that if all those good heavy quality accredited companies will do almost the same test it will not be You will find if same day same patient goes and gives blood see blood is different blood is also not standardized you will give blood you will give someone else and you will change in that everybody has their own way of doing testing. There will be a little marginal difference but I don't think it will be very large.

9:54And then those who collect blood Yes. They are also a big problem for training. They are not like a lot of people who come and collect your blood they don't train rightly. They don't train professionals. If they don't train professionals then you don't have to take it from the lab. Simple. No but you wouldn't know. But that goes back to the accreditation. See that's exactly what I'm saying. It goes back to the accreditation. if you think that someone is coming who is not trained right you know how it will be when you think but you know who you are going to the lab so all the people are heavily trained in your company what is the process they go through so for example if someone let's say a new phlebotomist joins us before the induction kit will get a thorough training you will test their skills there are testing mechanisms for example different people at different levels will have different things but for example in a phlebotomist case at least it will be 3 weeks to a month you'll test their level.

10:49If their level is good, suppose he's a 20-year phlebotomist, his level is good, then they don't need four weeks training with us. They will only require maybe five days training, six days training, which is what is our style. Okay. Like our practices. Blood collection practices. Our specific practices. Right. But if somebody is a fresher, then obviously you're not going to put them on the job without giving them proper training. So, our company is rigorous. Skill enhancement rigorous. NPS score, which we call consumers is very strong we have an 86 NPS strong score which is very very high which means that every patient we get every feedback if they don't for some reason we call them we talk to them we understand what is the problem we fix it if it's our fault but largely we find obviously people are happy so it's not so this collection of blood is not a big problem no for us For us, it's not a problem we find actually because our systems process is very clear.

11:51And technology also helps us. Our culture is that this is honestly not a hard part. And then you're talking about that a lot of things from blood samples. Let's talk about that. What can we know? What can we detect from blood? What are the major things that can be detected? There can be a lot of things. Because when we have full body profile, what I have heard, that more than the things are no work. Do you agree with that? No. So, every one who has 15 pages of reports or 10 pages of reports You can have a package. Like some packages have. Some people do it. All metals do it. It's all nonsense.

12:28It's not necessary. For example, you may need to do some but not all. So, what has happened in the bundling of the things that labs or hospitals are just adding tests that are not necessary. So, if you choose to choose that I have a package that is necessary. But like for example, your liver function test, important is. Kidney function test, important is. So what is important? Liver function, kidney function, cardiac markers, your blood counts, like your complete blood counts. Your urine routine, stool routine, important vitamins, thyroid. You know, these are all important and then it depends on your family history.

13:04For example, suppose your family has a lot of allergies. So you have to test allergy. But if your family has no problem in allergy, why will you do it? But it's reliable all tests. Reliable, are you saying they're 100 % correct? Yeah. There is nothing in science 100 % correct. Like you go to the doctor, a doctor gives you a treatment. Is it 100 % correct? It cannot be. You take a drug, is it 100 % going to cure you? It cannot be. So, in science, 100 % doesn't exist. But 99.9 % exists. So, 99.9 % you can detect allergy? Yes, you can. Really? Yes. I mean we have right now artificial intelligence powered allergy testing panel we do 250 allergens all prescribed for Indian population because India where you have allergies in America it will be a problem so Indians can be useful and you can do it with us and based on your history the panels will be done for you you can know from that data you can see who is an allergy you have milk allergy you have wheat allergy you have lemon, orange I mean there are so many different items, pollen, dust and you'll find that allergy when you know what you can do with them you can avoid it you can't do dust unless you move to Kerala or Goa or something but things for example food items, there are certain things you can avoid you know, so allergy actually something we live with we don't need to live with we actually have a solution for it but many GPs who are general doctors they say no, if someone doesn't know but the allergy test kara do and allergy test se zada chizai pata nahi chalti so it's not like a short short way of your being able to be cured by an allergy see cure is different from diagnosis I agree you cannot be cured by allergy because allergy is an autoimmune response so aysa nahi hai ke apne humne apko test result de diya apne ek shot le le hai ap cure ga aysa to nahi but you can then with knowledge you can avoid certain things at least you will avoid the problems in your life but the diagnostic is possible the treatment may not be possible But if I got to know that Okay, dust allergy, what am I going to do now?

15:09You can't do much more, but you can do two or three things. For example, you can add air in your house. Right? You can clean your pillows. You can clean them properly. You can regularly wash and clean them. You can make sure your curtains are cleaned regularly. There are hot spots for dust in the house. So you can make sure your deep cleaning is good in your house. Right? So there are certain actions you can take. Now, you can wear a mask and go if you're going in a very polluted area. So there are actions you can take to protect yourself. But not completely. But not completely. But food items you can.

15:38For example, if it's a food item and you're let's say allergic to coconut, you can choose not to eat coconut. That is a good idea. But in India, people say, we're eating from childhood. That is usually a... Recently, one of my friends, he got tomato allergy. And he didn't believe in it. Why did he eat tomato in childhood? That's not possible. But that's why you have to check out your allergy. That's why I checked out. but Indians don't like they don't have I mean it's a lot of cognitive bias right that the thing if we don't have to think in family tradition we can't believe in that we can't believe in that for example wheat because gluten or milk lactose intolerance like I got lactose intolerance in my report and then for like 2 weeks I wasn't ready for thinking I was also like this is not but by the way allergies are not lifelong allergies can come and go right so for example it's not that if you have not had an allergy since the time you were young you will not have it later in life or if you had it early it will stay for life right it can come and go okay tell me diagnostics say kawun kawun si cheez hai ya kawun kawun si diseases are like you can diagnose or you can know which people don't know like blood test usually people know people can understand liver markers know how many kidney markers can you know how many kidney markers can you get all of your normal things you can get very interesting things are coming for example genetics and genomics are the fast growing area now you can see here we have a panel that is very interesting it's called a hereditary cancer panel if anyone has cancer in a family then people say that my family didn't have cancer so how can I get it firstly when you had grandparents or great grandparents that time there was no diagnostic possibly So if someone died 50 years, 50-60 years old or 80 years old and they had undiagnosed cancer, you would have never known.

17:37So to first start with this assumption that my family was not in high because they didn't die of cancer is wrong. Number one. It may have been undiagnosed. Second, if somebody in your family has got cancer, there is a high chance that it is a genetic risk factor. It's not 100 % but it's a high chance. Now question is what do you do with that information? what you can do with that information is test other family members you can find out which is the mutation in your gene which is causing it what is the genetic name and number which is causing it now if you know it is a2 whatever whatever can other family members look for that gene in their blood right and come to know in advance okay i also have this risk factor but then isn't it scary It's very scary.

18:22But you know why that fear is important. See, fear is not a bad thing. Fear is a human response to help us to be careful and protect ourselves. Right? So if let's say you find out that okay, what can you do with my family with this information? You can regularly do screening. for example my cousin had colon cancer right at the age of 30 35 he had colon cancer he found it they went through surgery recuperated went into remission is fine right then his brother was told look you may have a genetic risk factor so you need to watch it so what the brother used to do the younger brother every year he would go and do a colonoscopy and because every year he did a colonoscopy he also at the age of 30 caught colon cancer now both of them are thriving with families with kids with everything life is fine but why because they did the test early they caught it early and they were able to treat it early so testing is about if there is a problem in the body then it is scary but it's better to know than not to know because you can do something about it hopefully first question are you 99 % sure that cancer is getting started?

19:3499 % sure that cancer is getting started I'm saying that the results that you know, 99.9 % can be accurate. Right? Now, just because you go for testing, are you always 99 % of the time going to be diagnosed? Answer is no. Science, for example, even COVID PCR you take, which is the latest issue we had. Right? For example, there were three types of tests, if you remember. There was a rapid at-home test. There was a COVID PCR. Antigen. Antigen and there was a COVID PCR test. Right? now you see the home test the accuracy was not more than 50-60 % right you check in the house but half the time you are wrong right a COVID PCR test has 75 % accuracy but 75 not 100 right because it depends on many factors so a test can be very accurate right 75, 80, 90 % but is it 99 % sure that every time you go for a test it will catch it the answer is no but that's where the more precise labs the ones who are better quality is where you can make a difference because you're increasing your chances of catching the right thing at the right time so if you're 100 people 100 people test 100 times cancer so it's not that they'll know that they'll know whether it's or not black and white answer will not come out but if 50-70 people know and if you go to a better quality lab then the chances are probably 85 will come So you can, today the technology has reached a point where you can know that there is no gene in your family or not.

21:07And there is no chance in your cancer in the future. Yes, but you are looking for something specific. It's not that you have said that I am healthy, I don't have anything in my family. Now I will go and do a full body panel. Now there is a lab that is promoting. You have to do a whole lab panel. We will tell you you are cancer free or you have anything. This is not true. It's a shame. It's a shame. right so these things that I will tell you the whole genomics body and I will tell you your predictive disease and that's nonsense right the science has not come there yet but if in your family someone has cancer and you have found somebody has cancer you can find the gene and then you can look for that gene in other people that you can do here's a question so my nani okay she had cancer and then her death was because of cancer so, there's a risk, right, because of mom and everyone else, so, if I'm texting today just to check that I don't know or something happened or not, now I did it and I realized that there's a particular thing then, even though, like you said, we can do something about it, I had a lot of tension that I realized that shit, there's a particular gene or a particular thing that can be cancer in life.

22:25It can be, is the right word. Because just because gene doesn't mean necessarily it will happen. Right? The gene just means that it's chance. Right? And it gives you fear, but it also gives you great opportunity. Because then you will be more careful. You will change your life habits. You will say, if I have a chance of getting cancer, let me make my body as a hospitable place that cancer doesn't come. Because what does cancer thrive in? Cancer thrives in acidity. Right? Cancer thrives in a certain environment. Right, so for example, the more you drink, the more spicy food you eat, the more you smoke, the more drugs you do, whatever you do in your life and if you're putting harmful substances in your body, you're creating a nicer place for cancer to thrive.

23:12Okay, double click on this. Cancer thrives on acidity. One of the things, yes. So if there's acidity and cancer has chances, or cancer has, it increases? I'm not saying there's a direct causation. What I'm saying is that usually one of the factors is also a very highly acidic environment. Right. So all I'm saying is it's like, for example, when you want to become pregnant, like when I want to become pregnant. Right. What do you do? The smart thing to do is say, look, make my body as hospitable a place for a baby to come in and to grow. Which means what will I do? I'll try to ease my mind. I'll try to get rid of, you know, bad bacteria and toxins in my body.

23:54Am I going to fill my body with alcohol and shots every night? or am I going to keep it cleaner? Am I going to eat more nutritious food? Am I going to put junk in my body? Right? So you're trying to do something positive and create life. You'll make it a hospital environment. You don't want something to invade your body. Make it a hospitable environment. If you make it in a hospital, it'll be worse for you. So it's just simple common sense actually. We don't have to be greatly medical about these things. We just actually have to use simple knowledge. We have information. Let's do something with it.

24:22And now that scares us. You know why it scares us? It scares us because we don't want to change our lifestyle. Actually what scares us is, hey shit, I know this got problem. Now I have to stop this or two things. That's what scares us. Stop attacking me. Coming back to the test, if you said you know it and after that, you have to better it. Why not? The bigger question is, if you don't know it, then if I better my body without it, then why do I need diagnosis? Because sometimes there are things which are not in your control. For example, most things are in our control. Good exercise, good eating habits, good environment in our body, less stress, etc, etc.

25:03These are all things in our control, right? But genetic traits which we have inherited. We have seen patients, for example, who have lived amazing lives. They've done everything right. But they had a genetic trait, right? Now that you're not going to know. You have to test because your body and your blood reveals things to you that you don't know otherwise. So I think it's not this or that, it's both. Okay. Right? you have to take care of yourself and you have to find out what's happening in your body and then if I catch it early what can I treat maximum things maximum things can be treated you may not be able to cure everything but you can certainly manage it much better before it gets to a point of suffering or death so you said allergies can be found heart, liver, body markers blood markers can be found cancer can be found what can you know diagnostic where the technology is There's 4000 varieties of tests.

25:58But where are the technology? What people don't usually know?

26:03You know, I'll give you another example of gene mutation. You know, there used to be a time when a woman would have a miscarriage. And we didn't know why this miscarriage happened. Today, genetically, you can know that this gene mutation, if it was a genetic issue, then, you know, because of this particular issue would happen. And there are things you can actually do about it. The other very interesting thing is drugs. For example, today you find out, let's say theoretically, you have HIV or you have hepatitis. Right. Now, what do you do with the problem? HIV is possibly a lifelong infection. Not much a virus.

26:41You can't do much about it, but you can treat it. You're taking drugs. Now, some drugs work better on your body because of the way your body is made up. And other drugs don't work so well. So, we have a drug resistance testing to tell you which drugs will work better on your body and which doesn't work so well. so you do the same thing for TB so what happens is it helps the doctor treat you better otherwise what happens is you start the drug A after 3 months you will test again and you have not improved then doctor will say now move to drug B then 6 months not improved drug C meantime your body is getting worse and worse so if you know upfront which drugs work better on you and which don't you actually have a better faster way to treat give me top 5 tests which every person should know because now that every time you talk about a new test I'm like shit, I didn't do this, I should do it.

27:26I should do it. I should do it. I should know who the drug is a worker. Because the more and more you talk and I'm getting to know new things. I'm sure what you can see, it will be like this. But you can't do all the things. 4 ,000 things. But it's simple. Look, our company has packaged it for you. So it's very simple. I'll tell you today you go into a metropolis center and for 2 ,500 rupees you can do everything that is required for you. But that won't involve your cancer for gene testing that won't involve allergy that won't involve drug AB testing so I'm asking you but allergy everybody may not need to do because if you don't have history of allergies you don't need to do it why don't you do it don't do it cancer also for example do a sonography once a year I would say and that will keep you relatively clear you are anyway going to be doing all the other blood tests because see cancer honestly in blood tests we have panels etc but the the i think the higher chance of picking them up is actually through sonography okay so sonography so give me five tests which should be done and then give me two three more which can be much health conscious afforded okay so look everybody must do these packages like i said which are you know annually or six months annually more than enough okay you know you don't need to do six months but you know you have packages ranging from 2 ,000 rupees to 5 ,000 rupees pick whatever's in your price point and do it 2500 3000 is perfectly fine right it'll give you a coverage of all the basic things that you need to do and cover your heart your lung i mean your liver your kidney uh urine stool all of that it'll cover it'll tell you what's going on in your gut it'll tell you if there's any infection all of that now additionally if you if you are affording right uh get your vitamins checked something as simple as your vitamin d why is it important to do right vitaminosis which is over having too much of vitamins which is unlikely most people have a deficiency actually there's a statistic that says i think some 60 percent of indians have a deficiency of vitamin d and a vitamin d impacts your daily energy so all of those of us who feel very tired very fatigued very this very maybe it's as simple as a vitamin d deficiency and that can play out in many parts of your life so something is simpler that too to a test okay right if you're a thyroid for example you need to know whether you are a hyperthyroid hypothyroid because it's very easily solvable you can take one medicine every day and you can normalize your thyroid your thyroid balances your temperature in your body right so that's an important one for you to do besides that if you have a family history of allergy must do if you have a family history of cancer you know definitely screen once a year people who've had a family history of cardiac problems you know heart disease must do a ct angio what is it once in three four years it's radiology test we don't do it but a ct angio is available at good hospitals good centers once in few years like above the age of 40 45 especially men because men are at not so unless you have a history see if you have a history then yes but if you are not having a history then frankly if you are more than 40 45 you're pretty okay you can do once every couple of years right but that's necessary so it's really about curating it to you and that's that starts with empowering yourself with knowledge on self-care.

30:43Right? The good thing is the data is available. You go to our site, you go to other sites, you go to Mayo Clinic, you'll get the data. Now it's about saying I care enough about my body to dedicate 20 minutes of my time away from fabulous housewives to my care. And I'm actually going to make sure that every year I just take out a couple of hours to take care of myself. See, you get a lot of data. Yeah. And you must be seeing a lot of new patterns. in India how does hereditary play an important role in having a disease in a kid or like in anyone it's quite significant it's quite significant but not everything gets transferred right so it's not that just because my mother was diabetic I'll be diabetic it's not the necessary that all the gene pool gets transferred every generation sometimes it skips generations goes to somebody else etc so but I mean it's the nature versus nurture conversation which has been there for donkey's years and we know for sure that nature plays a very important role.

31:42Now, you yourself have many things in your control. Even if you have a genetic trait for something, all the other things you do will determine whether that genetic trait becomes a defining moment in your life or it remains a less defining moment in your life. That is an argument. And work as a definer. By lifestyle. Lifestyle. But if we are careless, we are negligent, we say, I'm too busy, I'm working, what do I do here? My job is, I have to travel every time, I'm very stressed. I am this or that. That is actually negligence. But the bigger negligence is that nothing happens. Yeah, the bigger negligence and that is the same part of it.

32:19Which is I don't want to know because I don't want to do anything. So I'll be in denial. That's problematic. And what if you have to put weightage in percentage form. If a disease has to be given, let's say diabetes or cancer or anything. How much of a hereditary role is the percentage of hereditary? And how much of a lifestyle is the percentage? Very difficult to tell. I don't have that data. I'll be just making up some number which I don't want to do. Okay so it's like but both are equally important or Yeah I mean look diabetes for example I mean it appears like everybody has diabetes so what's going on?

32:50But actually diabetes is a very complex disease and you know if you actually see when people finally get hospitalized at the ages of 75, 80 whatever they may have had a hip replacement surgery because they may have fallen in the bathroom and gone therefore nothing to do with diabetes but when the hospital starts treating the patient it is usually the diabetes that complicates the working of all the other organs and even if you solve the hip issue something else may go wrong so these chronic diseases right heart blood pressure diabetes which are actually very manageable because we have hundreds of years of data on them there are drugs there are all kinds of things available to help you manage it you just have to keep it in control you keep it in control your life doesn't get complicated and hopefully you survive and you don't die right so you know to me I mean the knowledge we have should be empowering to us you talk about diabetes India what's going on like have you seen any pattern is there any region where diabetes is there is there India I don't know like geographically we are at a place where diabetes is more our lifestyle lse like what is the reason india so there are definitely different communities and different illnesses that affect different communities right for example like you asked the question on diabetes we've seen patterns where tamil nadu is a big diabetes hub we've seen gujarat big diabetes hub now i don't know direct links but there are a lot of research and theses that say that you know your diabetes gets caused by a bunch of reasons part of it is genetic part of it is your lifestyle and what you eat and how you behave will determine finally you know how strong or how bad your diabetes is there is a theory on saying that the amount of for example saturated fats that you eat right like you have this ghee for example which a certain kind of ghee which is uh you know it's really sort of coating uh you know your arteries and it's really making it not so healthy for you or for example if you're eating carbohydrates at multiple spikes in a day so you ate idli in the morning you ate lunch in the morning you ate samosa in the morning you ate this in the evening like you know poha is supposedly a very healthy breakfast in India I have never understood this it's all rice flakes how does poha become a healthy you know it's pure rice rice is pure carbohydrate carbohydrate when it breaks down in your body is pure sugar right so actually when we are eating you eat poha for breakfast you eat rice dal you know for lunch you eat you know in the evening I don't know whatever like a samosa or a vada pao or whatever it is and then at night again you eat rice or pasta or whatever I mean it's carbs all day right and it's spiking your blood sugar constantly and those are the things that actually potentially you know cause you more harm so I think this information on nutrition how it's impacting our bodies all out there we just have to go read we just have to understand and then we just have to start balancing our our food and our daily lives and habits in a little bit more balanced way but isn't it healthy carbs versus non-healthy carbs of course of course and then ideally you want a balanced meal every meal you want little protein little fat little carbs little uh you know different different things right fiber so are you saying jo states zada carb-based diet right there you have seen higher like higher number of diabetic patients more carbs more frequently in the day it's about the spikes of sugar right so it's not about if you're eating like two meals a day and you're eating carbs it's not that's not the problem the problem is how many times a day you're eating carbs snacking culture gujarat is a very snacking culture yeah but also what what the snacks are right like it's deep fried it's uh made of maida just carbs yeah any kind of carbs carbs and maida carbs and meata that's gujarat and tamil nadu i've heard that they have a good diet in what way in like they have like a better diet than compared to the other states because they there is no more junk food streets on the streets.

36:54No, but for example it's very rice heavy. What's the scariest thing you have seen based on all the data that you have seen? No, Sajj. I wouldn't say the really the scariest thing I have seen. Somewhere the shocking data you found out was like, oh, this pattern I could have never been able to understand if I was not the head of metropolis. I mean, for example we've seen polycystic ovaries at a crazy number in India. Right? PCOS. is very very high as a percentage of women in india right now that is something i would have been it's just like why such an abnormal percentage right so it's very very high in india but we're also seeing obviously you know a fair amount of infertility in india now right and and again what you know people may be may not be correlating is it's combination of many things right i mean we have far more radiation from electronics in our lives uh you know we are keeping our phone on all parts of our bodies we are using it next to our ears all the time you know from bluetooth there's constant some sort of radiation coming out all of that is is is causing some of the damage right also there's much more smoking there's more drinking again the same thing you're not keeping your body that healthy so therefore you are you are also bound to see other effects of that so as people decide to parent older in life and i'm a late parent right so i have no biased there but as you decide to parent later in life you still have to make sure that your body is healthy enough to absorb that choice right like I had my first child when I was 40 and I had my second child at 44 right or my two children at 44 I had twins just seven months ago but you know something which I did which is very interesting and I want to share that it's been very private I haven't shared it generally but I think good for people to know that you know the age for women when the fertility starts going down has traditionally been known to be 35 yeah globally and what happens is that till 35 you're reasonably okay I mean it's dropping dropping dropping but at the 35 it's a very grave fall yeah where fertility goes down now those numbers of 35 are also known to be decreasing now because your lifestyle has changed from a younger age you're drinking younger age you're smoking younger age you're doing mulch of things you're harming your body more right so your fertility levels cannot stay stagnant so you're also using you know like i said phones electronics etc so that number is falling we don't have a number yet but at the same time so in my case at 32 i said okay let me do a fertility test and at the age of 32 i realized my fertility is very low so what do i do now i was not ready to have a kid then i wasn't married i I wasn't ready to have a child.

39:40So I said, what should I do? So first I was, you know, quite suffocated by the idea of it. And I never grew up thinking, I'm dying to have kids. I was not that person. I was not like a 22 dreaming of children. I wasn't. But I still wanted the option in life. I wanted to say that, look, if tomorrow I meet somebody who I want to be with, I want to have the option to have children. Whether I choose to or not is a different story. So I actually went about my research and I found out that there is an ability to egg freeze. There is an ability to freeze embryos, right? Embryo is when you take the sperm and the egg and fuse them together.

40:16And egg is just when you're doing your own eggs, right? So you won't believe it. I was dating my boyfriend then, who's now my husband, for six months. Just six months. And I told him this story and I said, look, you know, this is the case. And I'm thinking of doing egg freezing. And he said, okay, great. You should do it. Fully support you. What do you need from me? then after a month I told him you know actually my mom is telling me I should do embryo freezing because at that time egg freezing was not so stable which is much better now science has progressed a lot so she's suggesting why don't we think about freezing our embryos so he was quiet for a minute and then he immediately said he said yeah let's do it right just six months into dating right it was a big plunge a big leap conversation just escalated pretty quickly right and you won't believe it we went through three IVF cycles together we froze embryos and that decision was the single decision why I have three children now because if at the age of 40 I went to decide to get pregnant I can tell you 100 % I would not have because my fertility was not so great even at 32 and look there's nothing like you would take this time out of your life just for you to know the first time I I did my first IVF cycle, you know, in 2012 and 13.