#814 - Doctor Mike - Reacting To The Rise Of Anxiety, Microplastics & Antidepressants

28:06He's not actually back in until the morning, so they're going to have to wait. And he just think, here's another one actually. So a good friend of mine has a fitness business online and he wrote programs many, many years ago that were just evergreen and they're still selling away in the background but they were super cheap, PDFs for 12 pounds, something like that. I think that while he was doing F1, his first year out of Med School in the UK, I think he was on about 11 pounds 50 an hour. So I think that was around about the the way to he was getting so one ebook was was more than that I'm a particular patient had been struggling Passing solids for a while and needed to be I think is it called decompacted Yeah, so I needed to disimpact it sorry decompacted close enough disimpacted which is Put a gauntlet on get in there and and pull pull out what hasn't come out of the back passage of the patient So sure enough at three in the morning, used to trying the specialist, he said, look, is this something that can, do you need to come in?

29:12He says, I'm not coming in for that. You can do it yourself. So on goes the gauntlet, a couple of pairs of gloves, used to spend the next 30 minutes. This woman's in discomfort, her family are there. There's an issue with them. They want her to be right. She wants him and he's just doing his thing. And after he, maybe 45 minutes later, peeled off all of the layers of gloves and checked his phone to see that he'd sold a e -book that he wrote nine years ago for 50 pens more money than he'd just earned from doing that one thing. And the attraction for working in that kind of an environment, it doesn't surprise me that the NHS is struggling with talent and that they're losing people and that nurses and doctors are going on strike.

29:51And then I don't also completely understand why patients are thinking, hang on, the people that look after our health are striking. That feels like they're playing roulette with our Well, well -being, that doesn't seem fair either. And yeah, it's not good. It's not good. I think you're right in saying that nowhere's got it right, yeah. It's between a rock and a hard place where healthcare providers find themselves in because they wanna do the right thing by their patients. And I understand your example because it's so clear of the patient needing that disimpaction and yet your buddy was earning more money by selling the book.

30:30That's not even the biggest concern for doctors. or nurses. That is actually the part we have a problem with least. Like it sounds to the average person like, oh, disimpacting someone that's below us or it's not. We want to help patients. Do you know what is the most destructive thing when we actually want to help the patient for 11 pounds an hour? And we can't because we're forced to see so many patients, so certain institutions make more money. Or we want to give the patient a medicine, but it's not covered by their insurance, so we can't help them. Or after working a full day where we stay late in order to be able to disinfect and help all our patients and get paid not the greatest salary, we still have paperwork to do to prove that we did all of these things on ancient systems that require dozens of clicks to get even the simplest thing done.

31:27And that is disheartening way more than it is about not being properly reimbursed for this impact. Because that strikes at the soul of why we're doing what we do. This impacting a patient is what we signed up for. Sitting and writing charts for hours at a time after actually helping our patients and then getting what administrator to make sure that the billing is done and that the billing like all the facts stuff that you talked about. That is the prime example of why doctors are burning out and nurses are burning out at historic rates because it's like doctors used to run hospitals and being charged on the leadership C -suite teams.

32:07And now doctors have become laborers and the people that are in charge are these financial folks who are thinking about the profits more than anything. And I think that's ultimately a bad thing for patients more than anybody. Talk to me about the rise of estheticians and cosmetic procedures. I mean, I see it happening. I've seen that happening all the time. That's not a new phenomenon. I just think that probably social media Zoom has fueled people's self -criticism of what they look like. And there's probably been a spike as a result of seeing themselves on camera more often. These days, I saw some surveys where like half of Gen Z feel like they're creators or influencers.

32:55And when that happens, people want to look a certain way. They want to have more control over the way they look. And it's not necessarily a bad thing. The issue comes up when it's people who are not licensed to do it, who are not well trained to do it, who are not adequately giving people information about side effects of certain treatments. Like, who am I to tell someone what's right for them? Nobody, it's not my job. It should, I should never act paternalistic to a patient unless they have some cognitive issue or someone's hurting them like a child and they can't speak up for themselves or elder abuse some rare situation.

33:31But in general, my job as a physician is to give the best quality of information that I have in a given moment about a treatment, about a topic so that the patient can decide for themselves. And what happens when someone who's unlicensed or untrained does a procedure, that person may not realize what they're signing up for. And that happens quite often. I see issues with medical tourism where people to save some money go to other countries to get treatment where there's less supervision and things are cheaper sometimes because of less bureaucracy like all that paperwork you discussed and that could be good, but it also could be bad because there's less oversight in what's going on.

34:09And I've seen some pretty horrible infections and complications that happen as a result of that. What are the most dangerous esthetician cosmetic procedures that you're seeing people have more over the moment? I think BBL is a procedure that people have gotten excited about. I don't necessarily see a lot of the consequences of it, but I've covered it enough from a research standpoint for content online, where I've seen that a risk of a fatty embolism, where you actually get a piece of fat lodged in an artery that then travels to a different part of your body and it creates a blockage, happens like one in 3 ,000 cases.

34:53And that's one in 3 ,000 healthy people. You know, if you're going for an emergent surgery because you're having a life threatening in conditioning condition, one in 3 ,000 to save your life is good odds. But when you're healthy and you could potentially get this life -threatening condition and lose your life, that's absolutely terrible. So I just hope people understand the risks of what they're signing up for and not just getting excited, but what they see on social media. Where are you practicing? Family medicine clinic at a community health center in New Jersey. New Jersey, right? Okay. I was going to say you may see more of them if you were in Miami.

35:27Miami. Miami seems to be the the the the hotbed for for BBL's. What is it about that procedure? You know, people have had boob jobs for the rest of time. I thought a BBL was just a boob job for your ass. What is it about the plants? Okay. Unlike with breast augmentation, a BBL requires liposuction, so removal of fat from one part of your body and then inserting that fat in another part of the body. Usually people will get their waist slimmer and then inserted into their butts. And when you do that, if you accidentally position that fat into an artery, that's where that complication happens. Whereas with breast augmentation, it's an opening and insertion of a breast implant, which has risks of its own.

36:18But with this specific condition, I feel like the fatty embolism isn't discussed as often as it should be. is that in order to get the, I know that you don't do BBLs on the side, or at least I don't think that you do BBLs. Night flying to Miami to go and do BBLs. I'm gonna guess that they have to sort of put the needle in at multiple locations, or else you would just have one huge deposit of fat, which wouldn't make for a particularly round shaped ass. Now, again, walking through the streets of Miami, I've seen what can only be described as a bag of cats, inside of a set of leggings. You know that sort of, it's like this.

36:58It sort of looks like paws being pushed out. So my point being there are gradations to the quality of a BBL that you can get in any case. But in order to try and create that round shape, you're going in. And I'm going to guess that that's what you're getting at. There is blood flow through the glutes and then as you're going in, if you strike an artery and then you put fat into it, very not good. Yeah, the exact pathophysiology of how it happens. I'm not super familiar with, but the fact that it does happen. And again, a lot of people, especially in Miami, I'm familiar with anecdotal cases of people traveling to South America to get these things done.

37:38And I've actually seen some pretty ridiculous things, people getting injected with certain solutions and I believe that there was a case if I'm not mistaken in the news of someone getting almost like concrete injected. And it's unfortunate that people are taking advantage of because sometimes they just don't know. And usually it's people who struggle financially that get taken advantage of the most. So yeah, I mean, the cosmetics thing is not my expertise, but it's just unfortunate it where it's another area on social media where people get misguided and they have wishes and expectations. So I hope to enlighten them about the risks of what they're going for.

38:19Have you looked at this leg lengthening surgery trend that's happening at the moment? Yeah, absolutely. I've seen it. And I'm surprised that people are willing to go through that level of recovery and physical therapy and immobility for a period of time. I know immobility on its own has pretty significant risks of having blood clots and such. So yeah, pretty surprising. The lengths that people will go to, not an open intended length. Have you seen any of these patients in real life? Have you ever seen anyone that had this done? Yeah. Me neither. I've never met anybody that's had it done. It's crazy though, to think, yeah, what guys are prepared to go through in order to gain a few inches in height.

39:01Yeah, again, as long as they're of sound mind and they're making the decision based on knowing all the risks, that's their choice. You know, like some people will look at me and say, you're a doctor and you box professionally. What's wrong with you? Don't you know about head injuries? I do know and I've signed up for it and I understand the risks. I look at someone like what's his name, Alex, who solo climbs. And I'm like, oh my god, you're doing that without safety equipment. Cool. He knows the risks way better than I do. That's that's not up to me. So what should we know about posture? That's something else I've seen talked about north a lot on the internet recently.

39:41Um, posture has become a buzz word for certain people online where they say you need to keep this specific posture. You need to do this specific exercise and it's rarely ever that cut and dry in healthcare let alone when it comes to posture. The probably most correct statement is that there is no such thing as a perfect posture because because if I was sitting here and I was sitting with what people referred to as perfect posture, you know, chest out, shoulders back, down, like neck back. If I hold that position locked in for the entirety of our interview, that's going to cause me pain. So really perfect posture is about having a healthy balance of being able to sit up straight like this without overly fatiguing your body, taking some time to lean back to maneuver my legs below the camera in certain ways, and actually not holding a specific posture for too long.

40:36Because whether you keep this posture while you're gaming or chatting or whatever for a long period of time or you're keeping this posture, you're going to run into trouble either way. So it's about keeping mobility, keeping circulation going. That's really the correct way to talk about posture. Look, do people have certain deficiencies in posture, meaning they have a significant scoliosis to a severe degree where it can impact their functioning? Yes. But a lot of times people have a very mild scoliosis where they have abnormal curve of their spine and they want to blame every issue on that when in reality, not every case of back pain is necessarily related to their mild scoliosis curve.

41:22I spent quite a bit of time researching lower back pain. I had two bulging discs and flew to Gravenhurst in just two hours north of Toronto to see Dr. to Stu McGill, who is regarded as one of the number one back pain specialists on the planet, specifically for lower back pain, very conservative with his management. So he's quite anti -surgery, which I think is probably a pretty good position to hold in. It's been proven as we've seen Ronnie Coleman or pick your favorite athlete of choice, work their way through some insane amount of pain. Just as a side point, from what I know, the reason that surgery is so dangerous is the potential for scar tissue to form around nerves.

42:08And you can already have certain areas of the back which are impinging on nerves, but if you've got scar tissue which is formed around it, that causes the most intense chronic pain. And really interestingly, Matthew Hussey, he's a dating coach guy. He had a chronic pain in a headache, and he explained it to me that chronic pain is one of the few types of physical maladies that you don't adapt to. So everyone's heard the same story of, when the lottery or you lose a leg in a car crash within the space of about two years, your happiness set point has come back to something approximating where you were before.

42:46Hooray, where very robust or boo, were robust against winning the lottery, that sucks. But chronic pain is a permanent reminder of the fact that you have this thing, which is wrong with you. It is always taking away, it's always going, it's always firing. and the sufferers of chronic pain seem to be the outcomes for them in terms of mental health, increase in suicidality risk, all of that stuff. Not good. So yeah, went to go and see Stu McGill and he said something very similar when it comes to posture that sure a neutral spine, a tall -ish neutral spine is optimal. But the most important thing is to allow yourself to vary that posture as much as you can, which is why whichever the biggest company in the world for standing desks is has probably absolutely exploded over the last five years because everybody wants to go from sitting to standing I'm gonna have one of those sexy rocking tools.

43:37I'll go back and forth on I'll be a bosu ball like a pregnant woman, you know all of these different ways that people can do things to try and vary That posture and for me as someone you know, I'm patient zero two bulging discs L three L4 and L5 S1 and I have managed to get myself to a place now where I can sit for a 10 hour plane journey and be absolutely fine. I can go on a tour where I'm stood upright still for a while listening to some tour guide talk. And most of that was not putting myself into positions that irritated my spine, not going unnecessarily into a flexion or extension, shearing forces.

44:13So that kind of position you get into when you're in a good morning, or you're doing a bent over row, where your spine is perpendicular to the ground and the forces going through it like that. For me, was very, very painful. So finding out what hurts for you, not doing it and giving you back enough time to recover and then just thinking about building a relatively good posture for the most part and varying it. I went from a lot of back pain five or six years ago to now, I don't know, is it, I have zero back pain day today. Yeah, that's an amazing result and I'm glad you're able to avoid surgery because a lot of my patients unfortunately either get talked into it or think that they absolutely need it for their pain.

44:51And as you said, those who struggle with chronic pain, it's a devastating condition for them, mental health wise. And the unique thing about pain is that there's a lot of things that impact pain that we don't realize. So there actually is this like pain cycle that we go through of where we can actually condition ourselves to feel pain more often. and sometimes, you know, back in the day we would talk about it as someone maliguring, so pretending to have pain in order to get some kind of outcome. But there is actually much more evidence now talking about it from a mental health standpoint, where you turn up your sensitivity to pain because you expect it, and when you expect it and guard against it, you're actually like almost, you know, when you're trying to hear something a little better, you concentrate just a little bit more.

45:44or the volume of that sound doesn't change, but you perceive it a little better. So we can actually train ourselves out of expecting pain, therefore decreasing the volume of that stimulus. And on top of it, our emotional state greatly contributes to the volume of how we experience pain. So a lot of times I get into this situation with my patients where they come in for a physical malady, back pain, neck pain, elbow pain. And we might do a workup, we might not, we might just get enough information off the history and physical exam where we end up talking about how their mental health is impacting their perception of the pain.

46:26And some people get understandably angry and say, are you just saying this is in my head? And that's absolutely not what I'm saying. The answer is that if you're having true pain, it will feel worse if you're on healthy mental state. Because if you have a torn hamstring, whether or not you're at work or at a party, it will still be a torn hamstring. But if you have a mild injury there, that hurts only when you're at work, but you forget about it when you're hanging out with friends and you're able to do whatever you want when you're relaxed, that signals to me that it's not an anatomical issue per se that's the problem.

47:06It's the perception problem of it. And There's many instances where mental health therapy focusing on how they're feeling, what's going on in their social relationships is a treatment for physical pain. And that's a very unique field of evidence that I've kind of had a lukewarm reception to on social media. Yeah. I can understand why. Again, speaking as someone who has had a pretty serious injury that absolutely was contributed to, is that psychosomatic? Is that what that word works? That could be a form of psychosomatic here. Okay. Well, my mindset definitely contributed to how much pain I was in, whatever that means.

47:48And I began to identify with the label of being someone who had a bad back. Oh, I have a bad back. I have back pain and then you begin to avoid doing movements that put yourself in pain. That's guarding. Yes, that's probably not too bad, especially if it's close to the actual incident, especially for a lower back. Yeah, exactly. But after a while, you actually realize that this has become part of your identity. And you know, you go into do CrossFit class and you look on the whiteboard and you realize it's got hip -inching in it and you say, oh, no, I can't. That's not... I have back pain. As if, you know, this is your family name or something or the country that you're from, I have back pain.

48:31She's fine. You can say, like, I'm gonna adapt this thing, but trying not to identify with it and I understand completely why people would feel attacked and upset if their doctor was to say to them, you and your mindset are making the thing that you're feeling worse, because they're gonna say, hey, fuck you, I didn't choose to have this. This pain is real. You can't tell that it's real. You're disregarding the fact that it's, and I go through this all the time and I did and you spiral out and I can see why that would be the case. But I also know that as I gave myself more proof in the real world, I allowing back pain to dissipate, allowing myself to not be in so much discomfort and then realizing, well, maybe it's not quite as bad as I first thought and just one tiny little micro step away from.

49:20And now if someone says, hey, what's your back like? Works pretty well. I try not to squat because that's probably a bit of a high risk movement for me, but I don't identify myself as someone who has back pain or is a bad back. And yeah, that's difficult. That must be a hard thing to try and deliver delicately to a person who's in pain. Yeah, it's tough. You have to be very present and very focused on the visit. And you're not getting it done in that 15 -minute time frame that we're often allotted. What you did for yourself is essentially exposure therapy, and there's certain conditions where exposure therapy works quite well, where we gradually work you up into reducing, let's say, social anxiety or phobias.

50:04And we gradually expose you to a level of stimulus where you're comfortable, and we continually challenge you a little bit. But we don't challenge you so far. It has to be an acceptable level of challenge. So much in the same way, you know, it's fun to shoot three pointers. You miss sometimes, you make it sometimes, but no one's standing on the other court, full court away, lobbying shots the whole time. That's not fun because the level of challenge is just way too high. So you want to have a level of success or a chance at success. And once we could find the right level for the individual, we can help them have some exposure therapy.

50:38There's a great doctor who unfortunately passed by the name of Dr. John Sarno who is actually a physical medicine and rehabilitation doctor from NYU that really pioneered the knowledge of how back pain and pain in general is related to our mental health. And while not everything in the book is 100 % accurate because there were some theories in there as to why it happens or how it happens, maybe they're not perfect, but the general thought behind the idea of our mental health impacting how we feel physically is so strong and I really recommend folks to read his book. One is called the divided mind.

51:21Another one is called healing back pain. Really great reads. I recommend them to patients so often. And the number one thing that patients say when they come in for their follow -up visit is I read the first chapter and that was me. And I started thinking about how that could be happening and right away my pain went down a certain level of threshold. That's amazing. If I could do that without medication, that's such a win. And some people might say, oh, well, that's placebo. Oh, man, if I'm getting placebo off reading a few pages of a book, I'll take that placebo all day. Yeah. Well, what are you, what we're talking about, pain, which is enhanced by your mindset?

52:00What is that? That's the exact inverse of what you've just said. Okay. So if we've accepted that some people's pain can be made worse by their mindset, but you're not going to accept that someone's pain could be made, but that's somehow less valid. No. Exactly. So like when someone, you mentioned that patient that would feel discounted or unheard or like they're making it up in their mind, how we go about talking to them, it's actually in an optimistic way, not antagonistic, where we'd say, hey, what I'm saying is, your mindset is contributing to it and your current mental health state could be contributing to it.

52:38If it is, this is under a level of control in some ways where you can make this better. So there is a bright light here. I'm not saying I have no idea what this is and throwing my hands up and saying, you have to figure this out. I'm saying that there is a way actually out of this. And usually when you give patients actionable steps, especially if they're not trying to sell them some miracle formula or do anything ridiculous, they get really excited about it. So one of the main things that I tell my patients is avoid guarding if the condition is mild. Like if I have a patient who I'm not worried about hurting their back by standing up off a chair, I tell them don't stand up gingerly.

53:22Like we oftentimes get into this habit of, if we heard our backs, let's say two weeks ago, we get up like this. Like we're waiting for the pain to hit us. And when you're gonna get up like that, But this same thing happens as if when you're walking into a dark room and you're a little bit scared and someone whispers near you, you jump because you're on edge. You're already primed to be in that mindset. If anyone whispers to you on the street of New York City, you wouldn't even hear them. You wouldn't even care. But when your mind is in that prime state that any sound is going to make you jump, you're priming yourself every time you're guarding your back.

53:57And look, there are times where I tell my patients you have to take it easy and we need to do some serious activity modification. But a lot of times with back pain, it's about restarting movement safely, getting them working with a therapist, a physical therapist, who knows what's going on. And if there is a mental health component, which is very common, I recommend talking about that as well. Are there actually microplastics in everyone's testicles? I saw that article, I saw it, I was worried. Have I got microplastics in me? Um, probably, I mean, it's not in the testicles. Um, I don't know specifically the testicles.

54:35I didn't read the study fully to know exactly details of it, but it's not unusual for that to happen in the day and age where we live in where people pollute companies pollute. There's these chemicals that we've used for water proofing that last way beyond what normal chemicals last in the environment, very similar in our own bodies. So I think that absolutely is a real scenario. And just like how we talked about, I feel like I'm villainizing capitalism here. And I'm not anti -capitalism by any means. But a lot of these private equity companies, they find a product that works as waterproof, water bottle or jacket or whatever article of clothing, they're going to mass produce it without thinking about the effects on society as a whole because again their main focus is on the profits and I'm not anti people making profits but you have to think about what's happening with these chemicals and you know with public pressure right now I think a lot of companies are waking up to make some changes and it's not full but it's a step in the right direction for sure.

55:44I saw you do a video about Lulu Lemon leggings and whether or not they're dangerous. What's the what's the conclusion from that? It'll be 11 leggings killing everyone. That would be funny. No, there was a pretty common claim that I saw that there's this chemical PFAS that exists in Lulu lemon leggings as well as other athletic wear companies and whether or not that's harmful for us. And then as I researched that video, I realized how pervasive the use of PFA's are in our lives That the reality is even if you're a minimalist you still have exposure because of food containers because of the trash that people get rid of and how it transfers to waste water and how it's present in our oceans so hiding it from it is not easy There are some consumer things you can do to check if your products do contain these chemicals but now luckily, Lou Lemon, we reach out to them for comment.

56:49They said they're no longer using those chemicals in their products. Probably from social pressure. People are up in arms about it. How interesting. I had Dr. Shana Swann on the show. She wrote the book Countdown, which was about sperm -rate decline over the last few decades. Really interesting, a bunch of interesting things from her. The first one being that I would have thought that we would have had tons more data about testosterone levels than about sperm levels. Not true. Apparently sperm counts have been tracked for a much like which kind of makes sense, I guess. The sperm count level is much more important to the continuation of the species than the testosterone level.

57:30It's only recently that bros like me and you have maybe been concerned about whether we're in the high 800s or the low 500s. So that was the first thing. Second thing being, to your point about avoiding in the difficulty in avoiding microplastics that you can get farmer's market, raw milk, glass bottle from the farmer, farmer's gonna hand it to you and you think, oh, fuck you plastics, you can't get me, my testicle is a sweet and pure. What you don't realize is that what they used to pump the cow was a tube attached to the other warm milk and it's heat plus these plastics that are really, really not good because they seem to be able to sort of liberate some of these molecules from the binding Going through these plastic tubings what's in the plastic tubings all of the Materials and all of the compounds that you're worried about in any case so yeah, it is so Difficult as it what it packed in what was it collected in what's it been transported in what's the heat that it's been in throughout throughout all of this time What's the lid on the top of that bottle made of?

58:37And what's the heat? It is unbelievable. So my friend George, who I'm traveling with, this is not for the people listening at home and it really is for an hour and a bit. And this is not my normal studio. I'm currently in Lake Norman in North Carolina. George, the guy that I'm traveling with has a question he asks, which is what is currently being ignored by the media but will be studied by historians? And I think that microplastics and the ubiquity of those are definitely going to count as one. It's beginning to catch a little bit of steam now, but it's still very much in the sort of micro niche influencer fringe.

59:14And I'm not seeing it really break out into the mainstream just yet. Yeah, we have so many things that pose risk to us on a given day. It's hard to know where our attention should fall. So I very much hope more scientists are focusing on this. It's difficult for me. Like, think about it this way. I think it was Lay Norton that actually said this on my podcast in a different way, but same example. If I'm looking to pick up the biggest weight as possible and there's different size boulders around me and those boulders represent risks I can reduce for my patients, like basically beneficial things I can do for them.

1:00:00Most of the boulders are focused on really the fundamental things of healthcare, which means making sure that you're not carrying excess weight, you're consuming at least a varied plant -based diet with good sources of protein, fish, chicken, meat, all that good stuff. Exercising, sleeping, correct, mental health check -ins, social relationships, those are the big boulders. And then the plastic, while it could be a big threat down the line, I, I, I, I, I don't know if I have the capacity to tackle micro plastics right now, unless we get more information in the next thing. Think about how many testicles you'd need to be around, if you were going to tackle the micro plastic.

1:00:42I don't remember how much that study swimming in swimming in testicles. But no, that's why I approach medicine the way that I do in saying that there's so much we don't know. Like there's so much we don't understand. Our grasp of subject is so novice level. And while we are advanced as a society, because we compare ourselves to puppies and kittens, we say, look how advanced we are as a species, there's so much we don't know. So that when someone comes on and acts very confident that they have the key to everything, I think that's great for their work. I don't think that's necessarily great for the average person.

1:01:20Speaking of that, you mentioned before some of the independent influences in the health space, what is your perspective on the ascendancy of health podcasts and health influences? It's kind of been a mixed bag. There's some people who are bringing really great information to the forefront, who are discussing nuanced, complex topics. There's individuals who fall and I have this little middle ground of talking about that, but then also straying into weird non -science evidence -based areas. And then you have people full on that are just in it for viewership, maximization of profits. And look, like more power to you, but my job is to give people accurate info.

1:02:05And if you're going to be one misleading them, I'm going to be out there trying my best to correct it. Who are the people that you like the best? Who do you think or who do you follow? Who do you recommend to your patients? You know, he's doing less content these days, but I really like Zubin Dimaña, known as Zedog. He was doing some really great content, especially surrounding moral injury, as he called it, of like burnout when it comes to being fed up with our current healthcare system and it needing to change. I thought that was fantastic. I also really like people who make content on social media that not necessarily is a podcast focused but long -form content like Mama Dr.

1:02:49Jones. She does some great obstetric and gynecology content. I actually have a series where I try include evidence -based doctors of answering like one specific question or talking about their experiences in healthcare from different specialties and I think it's cool to have a variety of that. So I I applaud those who stay true to the evidence and don't sell out as people often say. Where did Zuban go? He was on fire during COVID. I mean, I... Before COVID, he was doing social media before I was. I remember meeting him when I had my little viral moment of popularity 10 years ago in a hotel room in a live stream that went out on Facebook that's how long ago it was.

1:03:32And yeah, I don't know. I check in with him every moment. I should need to. Yeah. He did really, really good stuff. I was just thinking then when you spoke about the obstetrics and gynecology, that there is an entire world of healthcare that guys are just absolutely blind to, like the entire sort of peri - Yeah, health care is blind to. How so? When we did our preliminary research for a lot of the conditions that are common in society. We studied males. We excluded women from our research. So like when we say the classic signs of a heart attack is an elephant sitting on your chest, pressure, et cetera, that's a white male's definition of what it feels like to have a heart attack.

1:04:23Is it different if you were a black male? It's totally different if you're a woman. And what ends up happening as a result is women come into their emergency room with slightly different symptoms, they describe it differently, they do it more in a narrative -style description of what happened. And because older doctors, especially, weren't trained in that, heart attacks are missed, people lose their lives, and we need to do more of that when it comes to healthcare. Even you mentioned for a black person, the fact that our dermatology books, like the older dermatology books have only skin conditions on light colored skin, which is a problem because not all my patients have light colored skin.

1:05:11And conditions present differently in those individuals. And as a result, I'm not as good as a doctor if I'm not trained in that environment. We need to do a better job in researching these subjects because what ends the happening is we without proper education won't be as good in treating our patients. That's the bottom line. What about scented candles? How dangerous a day? Fire risk, if left unattended for sure. Burning many of them in an enclosed environment, also not a great idea. But interestingly enough, as I was researching that, what I found is burning the candle itself does not release as much harmful chemicals as the initial lighting of the candle and the put out of the candle.

1:06:07Why? Have you got any idea why? It's because of the combustion or something someone's going to fact check me and say that I'm doing it wrong but it's basically if you don't have complete combustion, you create more soot. Oh, interesting. And as a result, it's an incomplete combustion that causes this unique chemical reaction. Dude, so people can go back and look at this. My first ever studio, which was my old bedroom in Newcastle upon time, I'd got into a Yankee candle, a little bit of a Yankee candle phase. I liked the smell of them. I thought they were nice. I had a good rotation going. One of the things I hadn't counted.

1:06:50I think, I, shamefully, I think I loved this sort of spy -staple thing that was only a Christmas release. And I'd kind of lived Christmas all year round. They had a cotton, something cotton one, which was quite nice. But anyway, the set that collected on the ceiling made my low ceiling bedroom look like it was covered in mold. and I got absolutely flamed appropriately on the internet for months, a month, a month, so badly that I had to pay for decorators to come round to repaint the ceiling just because of how badly I was having the piss taken out of me so much that I couldn't bear to do it anymore.

1:07:30And so I had my entire bedroom ceiling repainted in an attempt to get away from that, which was, which is good, but no people can go back and look at that, so that's real. I see that, and there is a bit of me that thought as I looked at the ceiling, If that's what it's doing to the paint, it's going to be doing something to my precious boy lungs. And yeah, I don't know. Austin, my current home base, is kind of one of the ground zeroes for a lot of forward thinking concerns about health and microplastics and fluoride in your tap water and whatever you've got that's coming out of your shower head and we can declarinate the water by using and one of the things that's been next on the chopping block was candles.

1:08:19So it was inevitable I think that they were going to come for Yankee candles eventually but I was out ahead of it. I'd already quit my addiction a while ago. Yeah, I mean, I think it falls into that boulder rock situation. I think it's still a pebble in the grand scheme of things. And I also think that if you're chasing perfection when it comes to health, you're actually doing your health into service because chasing perfection and health is not just an illusion that's impossible. It's a toxic illusion because it comes along with anxiety, stress, constant worry that you're not doing enough. And as a result, you end up harming your health more than helping.

1:09:01Yeah. Speaking of the big rocks, the debate around obesity is surprisingly contested for something that seemed to be a bit of a slam dunk for what it does to people's health. What are your... What do you think is going to be the future of obesity given that we're maybe just about to turn a corner with GLP ones and the ability for most people to choose to be the weight that they want to be? It's very interesting. I'm not sure how this will play out because these medications are not just beneficial from a health standpoint. They're also beneficial to our healthcare system because if we can prevent heart attacks and all of the strokes and the situations that can arise as a result of carrying excess weight, we would be also improving the burden on our healthcare system.

1:09:56So that's one. Two, we're gonna be definitely harming the profits of some food companies. I think they're gonna be pretty angry. I've seen them do some unique things, actually. There's one that just launched a GOP -1 focused meal plan, where like they're in the supermarket and saying, if you're on one of these medicines, with Gobi ozempic, Mnjaro, eat our food because it's made specifically for you. And I guess it's more protein rich So that you're still consuming enough protein. But it's funny watching them try and adapt. But at the same time, I'm also wondering how society will react when there is always on hand an option that may take some of the required willpower out of the equation.

1:10:46I think it's fair to say that. There's a lot of it around it, surprisingly so. I think I've had a number of conversations. Johann Hari's new book, Magic Pill, he came on, Scott Galloway came on, he spoke about it, Dr. Mike Isritel, who you just had on your show, he came on, he spoke about it. The internet really, especially maybe my corner of the internet, the personal development, bro, high agency, sovereign individual thing. Very concerned about it. And I'm cautiously optimistic, but it seems to me, based on all of the smart people that I know who would not typically fall for, he says as he recommends something that's about to destroy the entire world, would not typically fall for something that wasn't robust and that they hadn't done the research on.

1:11:35They are basically saying that this is going to be as big of a revolution as the smartphone was, but for healthcare that we've been promised. And I understand why FENFEN and all of these previous iterations of drugs that had wild, crazy side effects, super toxic or dangerous or had long -term risks. I understand why people are not too confident about this one, but it does seem like a difference in kind, not just a difference in degree. And yeah, flight companies, the airlines predicting lower fuel costs because of a lighter populist to transport around confectionery companies trying to drill their margins because they're expecting to do less sales volume.

1:12:17The hip and knee replacement companies expecting to do lower sales volume and the most interesting one, jewelers because they've had to spend money people's fingers have got fattest, they've had to spend money to get their wedding rings changed and increased in size. So there's going to be an initial increase boom to get the jewelry changed again. And then after that, a little bit of a nose dive because there will be less gold that will be need to fit ever thinner fingers. I have a question for you. I had a world -renowned food expert on. It's not a published interview yet. Mary and Nestle, she's a PhD professor.

1:12:58She asks me a question that I want to pass on to you and see what you think. Is there any industry that will make money on us as a society losing weight?

1:13:14And I couldn't think of one. So if you do, I'm going to be impressed. Certainly some niches within the food and drink industry will because you just have a, you now have a new gastrointestinal environment. So, high density, low volume, I think if you can make protein. But those companies are making those foods. They're not going to be selling as much of the foods period. So, agreed. Agreed. Agreed. If you have, I'm thinking more disruptive. You know, a single small startup, a number of small startups that get to come in and disrupt Mars or whatever, and they make something which is, which is. Let's make it more industry focused as opposed to company.

1:14:02Yeah. It's really going to be hard. The only thing I could think of would maybe be companies that make sportswear stuff because sportswear is a kind of clothing, I'm aware that I'm like niching down again, so I'm breaking a rule. But sportswear is a kind of clothing that people who are more in shape tend to wear. And yeah, they're going to make... Did they do that thing? Is it more expensive to buy bigger people clothes? They probably flattened the price, right? that would be a huge social campaign. If the 3XL was twice the price of the small, that's definitely gonna be like fat tax accusations thrown around.

1:14:40I don't know, I think it's really hard to think of one. Because people with sport stuff, like is there a world where people go to gyms less because they're lower weight and they're not worried about their weight? What are they doing? Here's a question, what are people doing with that time? Where does that time go if they lose weight? If they lose more weight, what is it that they're doing which is different. Yeah, I don't know. I'd love to see something better than my anecdotal answer on it because, you know, I have patients on the medication, but that's not representative of the entire problem.

1:15:12What have you seen? What have the results been and the response is good and bad? Largely people lose weight. their numbers improve from a cholesterol standpoint. Their sugar control improves. They're happier, less musculoskeletal issues. A large percentage of those people either have had issues with side effects, like nausea being the most common. Some, the nausea is mild, persistent, but manageable to them and a valid enough trade off. I haven't had anyone personally as a physician where our patient had such a bad side effect that they had to stop it, but I am aware obviously that does happen.

1:15:59Fascinating, man. This is the most, I think, interesting development that we're going to see over the next few years. I agree. And I think it's largely representative of how society has been reacting as of late. And a lot of people who are smarter than me come on my show and point out that when I'm concerned about a new problem They're like, ah doctor Mike, there's always been new problems. There was horse manure problems And now we have cars and then there was pollution problems and now we have electric cars and we constantly are problem solving When problems solving itself begins to be owned by private equity It becomes so weird in that look like we created hyper palatable foods that were junk foods, processed foods that were very tasty, non -saysheating.

1:16:55So we're always hungry, want more of them, they're dicting. That was largely driven by private equity. Then we created a medicine to solve the obesity epidemic. Is there a world where these private equity companies are creating apps that are making us hyper addicted and shortening our attention spans, where now more people are requiring to take ADHD medicine. Maybe. So are we now seeing private equity in telling people, well, look, if you really want to take care of your health, you really got your get your testosterone up. And if you want your testosterone up, you got to look like this person, look at the muscle you can maintain their erections, whatever.

1:17:33And you need to have this level. So let me give you some testosterone. Now they're selling you testosterone. room. So like how many times his private equity going to create a problem and then sell you the solution? That is a very good point. Yeah, I am the it's like starting a fire in someone's house and then offering to put it out for a fee. Yeah, yeah, yeah, yeah, and charging them for the water. Yeah. I don't know, man. I'll be very interested to see what happens over the next few months with with GLP once. I think that it's the it's going to make a very interesting moral challenge. It's going to create a moral challenge for a lot of the people who have been a part of the body positivity movement.

1:18:15And I think that that's one of the most interesting sort of social elements to this, that when maintaining a heavier weight becomes a choice, i .e. you have more control, more direct control over whether or not you maintain that heavier weight, I think that it's going to put many people into a catch -22 situation that a lot of people who have been very pro body positivity and, you know, promoting big, alive styles, I think that they're going to be faced with a very difficult decision because so many of the members of that community that were that compatriots are going to elect to not do that. And I wonder how many people that were a part of that movement were doing it because they tried dieting, it really hadn't worked.

1:19:12So I'm gonna be a part of a group of people that accept me as opposed to one that villainizes me. I'll say that I'm wrong or undisciplined or whatever. You don't know, fuck you, I tried to diet. Like a huge percentage of diets don't work for people and I get that. But when you can just take the shot twice a week and you can dial in your weight to the poundage that you want by just increasing the dose or decreasing the dose. I also want to point out that's not exactly realistic. Most people still don't have access to the medications. Can you explain what that means about the access? I'm not familiar with that.

1:19:49But the medication's very expensive. Insurancees largely aren't covering it for weight alone. I've had plenty of patients struggle to get coverage for it where they have to pay for it out of pocket or pay a company out of pocket to try and get access to the medicine. So access is a huge issue. And why it's like kind of an exponentially problematic issue is that the people who struggle with access to that medication are also the same people that food industry targets the most with junk food. So they're getting doubly harmed. And it creates this cruel irony where if you take a king from the 1400s who was overweight because they had access to unlimited food while their populace was starving, they come in now and they must think everyone is rich.

1:20:41When in reality, it's the people who are struggling with finances that are being targeted with crap foods that live in food deserts where they don't have access to good quality fruits and vegetables. Our government is disastrous in that they put out, let's say, an accurate recommendation of like, hey, you should eat mostly fruits, vegetables, plant -focused foods with some lean sources of protein, and they'll say the percentage is correctly as per science, but then on the other side of their mouth, issue subsidies to the corn industry or to these other industries that make the necessary components for either animal feed or for junk food and processed food.

1:21:23So these people who are struggling with finances are getting hit on so many angles in ways that is visible and invisible. It's very, very problematic. And then the second thing is the idea of dialing in weight with these medications. Okay, the medicines are good. They're not that good. Like, I have patients that have taken the medicines, have lost significant weight, but to say that I can get them to their goal weight so easily to the exact weight number, and that's, we're not there yet. Hmm. I'd spoken to some of the smart friends that were evangelists for this new category of drugs. one of them's on tezepatide.

1:22:03And I can't remember what the next generation one is after that. So the first one, semi -glutide tezepatide, which is fixed the glucose problem, I think there was a glucose issue with one of them, glucose regulation, and then there's another one. And that was the terminology that he used. So I may be speaking out of turn, maybe it's something that the future generations of these drugs will allow you to do more carefully. Yeah, and he probably will. Yeah, he probably will. I just want to point out that the reality where people live these days, because what happens is that's how stigma forms, right?

1:22:37People here on the news that these medicines are largely available. People can choose their own weight and that becomes commonly said over and over and repeated. And then as a result, the people I can't afford the medicine that are being targeted by food industry don't lose weight and then are ostracized or shamed because it's like, well, why didn't you do that? It's like, whoa, wait. It's even more of a choice now. Yeah, exactly. So, will there be... Be careful of how people are treated these days. Understood. Will there be a... dialing down of this... all things near accessible levels of cost over time?

1:23:19Right? Yes, it's more expensive now. Do you predict that in future, this will be pretty much available to everybody on pretty much every insurance plan? I hope so. I react to medical memes, man. I don't know.

1:23:32I wish I knew these answers. Logically, I think that as more people take them, it should come down. If it's up to the pharmaceutical companies, no. But hopefully we have some regulation put in place where we can fight back against that. And there's all sorts of not necessarily clear corruption, but just like gray zones where due to a lack of transparency, currency companies can get away with some really problematic things behind the scenes. Hmm. Speaking of medical memes, how was your conversation with Stephen Gundry?

1:24:07Great intro to that. It was bittersweet. I was excited to talk to him because he has these best -selling books that are influencing millions of people. So he goes on a lot of podcasts and he says things and people who and not challenges often as he should be. And I did and I had a great cardiologist, Dr. Danielle Blardo on who challenged him on a lot of his notions. And largely what I found is he's a person who's excited about innovation, but lets the lack of experience in mass communication, lead him to make statements that land with the audience in ways that he probably doesn't understand that they do.

1:24:59Like when you say to a parent that grapes are so problematic might as well give them a Hershey's, you're making a statement that's encouraging mothers to feed their children process sugar as opposed to a fruit. And that's a problem. And he might be talking about how fruit is now raised in the nutrient content has changed and the intricacies and all that. Great talk about that. But the way that the message is delivered, I think ultimately misleads people in their understanding of what science and healthcare is. The problem of short videos, I wonder whether this is a bigger problem on TikTok and Reels and YouTube shorts than it is on the slightly more long form stuff.

1:25:43Just that when you do pull a Gary Brecker clip of a protein shake stays in your body for 75 years, this is how long it takes for your body to process it or whatever, maybe I don't tend to watch those podcasts in full. Maybe there is more context and maybe he does explain that it's to do with the way that grapes are now farmed and they've been changed from their original grape form and what do we put putting on them in terms of their fertilizer. But certainly when you see it on TikTok, which is obviously affecting, like disproportionately affecting a much younger generation. But then you also see the same thing happening, you know, how long has it been these crazy adverts on Facebook that are impacting our parents' generation?

1:26:27And you know, they're seeing like just wild boomer misinformation and get deployed through Facebook. So yeah, it's a medical misinformation at the moment is, I think it feels like it's picking up. It feels like you've got a big harvest to get stuck into. Yeah. And look, you're saying that maybe you're doing actually a very psychologically healthy thing right now where you're exhibiting charitable thinking. And I like to do that as well, where you're saying that, well, you know, maybe Dr. Gunnjian, the long form of the information gives the context to that statement. Now, that's partially true.

1:27:02He does give context and explain some things. But then when presented with the fact that people are misunderstanding it, he will not walk the statement back and correct himself and say, oh, I can see how one have misinterpreted that. I should give more context. Folks, if you're taking it that way, don't, but he does it. And that's where I really, really need to push back heavily. Yeah, that's not cool. come on, Stephen, play the game. It's not a load in that again. This isn't a single person problem. It's more of a problem with our day and age of social media. And it's not just short form. There's a ton of misinformation on long form podcasts all day long.

1:27:46Yeah, I think, you know, certainly for me, someone that's been in and around the health and fitness and wellness space for a very long time, I quite liked the corner that we seem to have turned maybe about three years ago, just out the back end of COVID, where I think, especially Andrew Cuban is sort of a spearhead of that. I'm aware some studies have got dodgy p -values and they've got low n numbers and so on and so forth. But what you what you had to me was someone who made the biohacking community kind of the old school biohacking community look quite silly, look very experimental, look very kind of inevitable space.

1:28:21You had someone who was coming in and you know the first whatever two seasons are so two years that Andri did his show. It was like basics, sleep, nutrition, training, caffeine, nicotine, concerns for menstrual health and fertility and stuff like that. All right, yeah, these are big, big, big boulders, right? And then I wonder how much of this sort of wake behind that popularity of content has opened the door for people who are just prepared to kind of say whatever sounds sexy, something that seems to be really cool. This is a, like, the demonization of individual foods. And, you know, the answer is boring to this, which is most things don't have a sexy answer.

1:29:08Most of the solutions that you're looking for require a moderate amount of willpower and discipline. Your environment design counts for an awful lot. You have a genetic predisposition, which people don't really want to talk about all that much, but the people that do want to talk about it too much. Also, they're kind of overselling you on something too, which is victim -hard narrative as opposed to the kind of self -made man narrative. But who's listening to that? That's not a good 60 -second real. Go fuck yourself. A lot of people listen to my podcast and that's exactly what you do. I think over the last 20 episodes, we averaged almost a million views just on YouTube alone.

1:29:44Good man. That is true. I want to prove to people and why I started the YouTube channel is that you can make science, nuance, sexy, without overselling it. Yeah, with that style, downright you can. With that jawline and that beard, downright. Look, everyone uses their own gifts to certain ways. And I make my silly corny humor. I actually, I remember like men's health did a top 10 medical influencer list. I think actually Hubert Min was number one on that list. And they gave like some people a page and then some people I gave a byline to and to us they gave us a byline and they said, you know, the OG medical influencer, Dr.

1:30:27Mike, uh, can get cornea at times. I love it because instead of taking medical information and corrupting it, I get cornea. That's how I get views. Are those that that's the spectrum goes from corruption to cornea? Yeah, well, you know, it's like Batman, like how long do you live as the hero before you become seen as the villain or whatnot? So I, you know, I see an individual like Cuban and, you know, controversy and all that aside with personal life. I don't think that's up to me to talk about. I haven't fully dug in to see the research, but on one hand, I'm very excited that he's gotten this whole swath of people excited to talk about health, to learn about health, to learn about research, talking about sources and pathology.

1:31:19And then on the other hand, I see like irresponsible statements made on a decent amount of times on the show. And I'm like, why does that happen? And I don't have the answer to it. And I wish that wasn't happening as often as it was. Well, I'm sure that you guys will cross paths at some point. And that would be one hell of a conversation. Yeah, absolutely. The invitation is open. and I'm very excited to have that conversation because I think people will benefit from it. I don't think this is an ego thing, at least it's not for me. I never planned to be popular on social media. I didn't want to do it by giving up anything.

1:31:58I still practice medicine and I don't say it often, but I practice for free three days a week, two to three days a week in my hospital because I love what I do. I work at a community health center. Could I go quit and not work can just make a great living on social media, yes. Could I get a concierge practice where I charge six figures a year for me to be some celebrities, Dr. Yes. But that's not what I started this. The reason I started this is to help people who struggle with their health, who have real problems, like how I grew up as an immigrant. The things that I was facing as problems. That's what I ultimately set out to do.

1:32:32And even when I had my viral moment of popularity, there was times where selling out was so easy. I was in debt as a med student. I was in debt as a resident, making the $10 an hour, as you mentioned earlier, working 80 to 90 hours a week. It was tempting to take some deals where I would talk about a powder and how it's going to give you all the nutrients that you need. It's tempting to take those deals. I understand why people do, but for me, the reason of why I started this doesn't let me do that. And I hope more people can look at what I've done and do it better and say, oh my God, I don't need to sell out and do all these things to be financially well off.

1:33:15There is a responsible way to do this. And I just wish more health influencers looked at it that way because otherwise folks get into a lot of trouble. How do you find being the personal doctor whilst being the public doctor now? How many complications are you encountering as your online fame grows? Are people requesting that they want this doctor Mike because they know that he's over there and he's the person I watch on YouTube? The patients that I saw During my residency they're my patients and I built them up sort of as my portfolio patients I've seen them I'm treating them. There's some babies that I've delivered that I'm still treating and now the six seven years old.

1:33:56It's pretty amazing But I also work in an urgent care capacity I also see patients of the other doctors that work in my practice that may not be available same day. So we work together as a team in that regard where we can plug holes, plug scheduling issues and because of that, I'm very grateful to where I work and the ability to help those individuals. It's just, it's such a different world. Like the things that are discussed on social media versus the problems my patients have in their everyday lives are just completely different, completely different. And that's why I think I've had a lot of success taking what my patients tell me in the office and then bringing it to YouTube because it's so relatable, it's so honest to what people want to know, what they want to see debunked, what they're being misled by.

1:34:46And I hope to continue doing that as long as possible on social media. Does it feel like the human social equivalent of touching grass? us. It's definitely a humbling experience. You're constantly challenged. You're constantly taught that there's so much you don't know. My staff that I've been working with for over 10 years now, I can't believe I've been in the hospital for 10 years. They humble me all the time. They make fun of me all the time. It's a big family. You know, I even had one of my nurses that I work with for 10 years on my channel the other day to talk about how I helped her with back pain, much in the same way that you had with your specialist.

1:35:29And it was great to be able to show that side because people see what's on camera, but social media is not always real. And when you are able to have a long -form conversation with someone that's known you for that long, that's special. I treasure those moments. And anytime social media gets dark or I get down, the biggest value in boost, in mood boost and happiness is when I do mundane things as a practicing doctor at a community health center. Oh cool. Dr. Mike, ladies and gentlemen, I did. I really appreciate you. I really appreciate the effort that you're going through. The fact that you're doing three days a week, pro bono is a really good credit to you.

1:36:09I'm very, very glad that we've got people like you giving us health advice on the internet. Well, look, I'm really lucky with social media. So don't give me too much credit. But it's still, it's still, I I probably gain way more value from doing and practicing medicine on like a spiritual personal side than any kind of financial benefit I could get. Time right. Why should people go? They want to keep up to date with all of the things that you do. I've somehow been able to corner the market on Dr. Mike. Dr. Speldout, because DR Mike is the great doctor Mike. The diesel doctor Mike. Dr. Mike is the doctor.

1:36:45He's your doctor. He's your doctor. I just had on my podcast and you did as well. Yeah, he's great dude. I really appreciate you. Thank you for the day. Thank you so much Chris