127. Ayurvedic Principles: Breathwork, Gut Microbiome, Epigenetics & Hormetic Stress | Jyoti Patel, MD

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Hello everyone. Today, our guest is Dr. Jyoti Patel for those of you who have been a lifelong listener of Medicine Redefined with us from the beginning. You may remember Dr. Jyoti Patel as she was our third guest. And if you're new to Medicine Redefined, I highly suggest going back to that episode and learning about Dr. Patel's journey into integrative and functional Medicine as it's truly unique. And as you'll see in this episode, Dr. Patel just has an amazing way of communicating everything that she believes in and how she teaches patients to live their best lives. But who is Dr. Patel? She is a triple board certified physician in integrative pediatrics, internal medicine, as well as integrative and functional medicine. She was named one of the top docs in Phoenix Magazine, 2009, 2016 and 2022. She was internist of the year in 2011 by the American College of Physicians by the Arizona chapter. And she received the Women in White Coats Hero Award in 2019. She spearheaded a community garden in Fountain Hills, Arizona, and she was award the health care provider of the year in 2017 by the Fountain Hills Chamber of Commerce and volunteer of the year award in 2018 by the town of Fountain Hills. She is certified in functional medicine by IFM. She is qualified in MBSR teacher through UCSD and a Chopra certified Ayurvedic lifestyle practitioner. She has a special interest in corporate wellness, Ayurvedic retreats, integrative medicine, functional medicine and mindful based stress reduction, as well as medical cosmetics. In this episode, we really branch out into Ayurveda, which is someone of, I wouldn't say a newer specialty that Dr. Patel has gained, but definitely has an added framework to her already, as you heard extensive database of certifications and awards. And so through this episode, we're going to be talking about things like breath work, the gut microbiome, epigenetics, as well as for medic stress, things like heat and sauna as well as the cold and the new phenomenon of cold plunges. So as you'll see throughout this episode, there are a lot of resources that we mentioned. So be sure to check out the show notes if you're interested in any of the research articles or books or the breath work practices that we recommend. All right, enough of me talking. Here's Dr. Patel. Dr. Chauty Patel, welcome back to the show. Hey guys, thanks for having me. It is so exciting to finally connect with you again. Now, I know it's been, I think probably a little over two years, the last time you were here and we were just chatting about the different things that we're doing. I mean, you know, actually it was pre-COVID. Yes, it was. It was pre-COVID, holy moly. So that, I don't even know what that world was like. So maybe just for us and, you know, for our listeners, just catch the listeners up to kind of what you've been up to. You're still out on the West Coast. We're on the East Coast still. So you're enjoying the sunshine there. But what's new with you and any updates that you think are worth sharing? So I know you guys know this, but I, you know, I'm more certified in both internal medicine and pediatric. So we see both adults and kids. And, you know, along with that, I've put a few more feathers in my hat with integrative medicine and being a mindfulness teacher and also doing the functional medicine training, as well as my last feather is, I really practice and practitioner training. So it's been a nice journey and health care for me. I've been able to expand my palate of tools that I can help my patients with. And I've changed my practice model from a primary care model to a more consultative model. I find that there's a gap where chronic disease patients need more time and need more investigation and they need a little bit more compassion. And now my current practice gives me the space to be able to do that. To take a deep dive, figure out what the root causes are, their symptoms and be able to give them a more comprehensive program. And I have a little bit more bandwidth to work with our specialists as well. So I'm really enjoying life. Awesome. You know, one of the things that resonated with me after our last discussion was we spent a lot of time talking about connecting with people, right? And I think that that's something that I have started, I appreciate is probably far more important than a lot of the things that we spend our time through a medical school and training learning about the minutia and the details, which of course are important, right? You have to have a baseline level of knowledge. But when it comes to things about just being a human, right? Humanism scores that sometimes you get scored on a different test and stuff. These are things that are taught very little or not as much as they should be. And so that was one of the favorite parts of our conversation last time. What we're going to talk a little bit about today and well, probably a lot about today is connecting with yourself and maybe connecting with your environment and really actually utilizing, you know, that insight and to see how we can make one self resilient. I mean, we've gone through COVID, we're not COVID is completely gone. It's still here, but there are other stressors throughout our lives. And you know, one of the things that you mentioned offline, your passion about is how can we use these things, both bridge the gap between, you know, ancient wisdom, new philosophies, Eastern medicine, Western medicine, and how can we kind of zoom out and look at it and say, okay, let's incorporate everything into our practice just to be better and to be better for our patient. So with that said, where do you think it makes sense to start with respect to talking about, you know, our environment and how we can use that to build resilience and to be more stressed tolerant. So again, when we talk about health and wellness and thank you so much for remembering our last conversation and the fact that we are all humans and we need to connect at the human level, especially in medicine. So thank you so much for for saying that it truly does speak to my heart. So when we talk about now going inward and taking care of ourselves, understanding that we're in continuum with our environment. So everything in our body, you know, is affected by the people we hang out with, the work that we do, the things we eat, the things we see, the things we hear, the connection that we have with our environment. So it's so important to kind of bring that back. And this is not a new concept. It's a concept that was derived over 5,000 years ago in Ayurveda, which is one of the ancient wisdom practices that I'm more curious about these days. And what we know about that and stress resilience is that the four pillars of health, stress management, sleep, nutrition, and exercise have an impact on our epigenetics. And so when let's just break it down with stress, stress is a really important piece of how we function. It's a good word. It's the thing that we need to actually get things done. But what we now know in the Western culture is prolonged, chronic stress causes many health issues. So let's talk about what stresses physiologically, and then we can break it down as to what the ancient wisdom practices talked about. So when you are stressed, let's say you see a bear in the woods, the classic description, you get immediately within microseconds, you get a signal in your amygdala, which is the part of the brain that senses danger. And within seconds like lightning, there's a nurse signal to our adrenal glands, signaling it to secrete these hormones, cortisol and adrenaline. And within moments, our blood vessels are flooded like a tsunami with cortisol and adrenaline, causing every cell in our body to respond to fight, flight, or freeze. So you may have experienced this when, you know, standing in front of an attending and having asked a question, you don't know, or, you know, dealing with something very stressful, your pupils dilate, your mouth gets dry, your throat gets tight, your muscles tense up, your heart starts racing, you come a little nauseous, your breath becomes absent or shallow, your hands are cold and clammy, you start shaking a little bit, that's that normal stress response we expect during times of immediate acute stress. But what happens in our modern culture is we're chased by the bear every day. We wake up in the morning, we're thinking of the bear, we're eating breakfast, we're thinking of the bear, we hop in our car, we're racing to work, the bears with us, we're at work with the bear, we come home with the bear, we go to bed with the bear. So unfortunately, we have not learned how to unhinge ourselves from this chronic stress state. And what it causes is downward spirals of everything from our cardiovascular system, our nervous system, our hormonal pathways, our immune pathways, our gut health, everything is impacted by chronic, unrelenting stress. Now, stress is not a bad word, we do need to have some stress in our lives, but I reveal that again, going back to that ancient 5000 year old wisdom teaches us that stress is inevitable. You are going to be bombarded with stressors in your life. But what you want to do is be able to navigate those stressors in a way that brings you back inward. And one of the most fascinating things they taught their patients is breath work. Do you guys have a breath practice? Either one of you? Well, I know Darstas, I could be better. Okay, Darstas, are anything you do? Yeah, so I recently started doing soma breath work on YouTube, who's led by Nearajnaiak, he is like the main breath work guru for Mind Valley, Vishyan Lakhani's company. And it's a lot of apnic and rhythmic breathing. And because it's rhythmic, it allows you to go more inward. And as you get more apnic, you're really forced to be in the present moment. And so for the 20 minute session, it's like, I'm in a whole new world. That's amazing. What a wonderful experience. And more people do need have, need access to those kinds of teachers that teach the practice, because it really is part and parcel of how we connect as humans is teaching each other what we know. And what I also love about breath work is that it's got, it has to be personalized. You know, we've talked a lot about precision medicine and personalized medicine. I already talked about it 5,000 years ago. They said that breath work is not the same for every person and every situation. You use different breath techniques to activate different parts of the neuronal hormonal pathways. I find that fascinating. So let's break it down. If you're not familiar with either, I'm going to give you just a brief synopsis of what it means. They talk about how each person has a constitution. And that you can think of as your genetics. It's what you inherit from your mom and your dad. There's a term for it. It's called dracutti. You don't have to remember that. Just remember it's your genetics. It's kind of like the foundation, the blueprint of which you've made. But as you're exposed to your environment, and that was one thing that, you know, we just talked about is how's our environment affect us? It causes happy genetic changes, meaning the environment can stimulate genes to turn on and turn off. So you're not a victim of your genes. You're actually a victim of your environment. So if you want to change your physiology, you have to change your environment and your response to it. So in our Veda, you have three major constitutions. They're called vata, pitta and kafa. Vata constitutions are things like when you have an excess amount of vata, you get anxious, your heart starts racing, you're overwhelmed, you're overworked, you over commit, you become decision fatigued, you have trouble sleeping, you have gas, bloating, and digestion, you can have constipation. So when you have increased anxiety, they recommend doing breath work that activates the vagus nerve. And you guys are familiar with the vagus nerve, but maybe your listeners might need some more details. The vagus nerve is cranial nerve number 10. It originates in the brainstem. It comes through the ears, through the eyes and the nasal passageways. It comes through the vocal cords. It comes through the airway. It regulates our heart and it moves through our diaphragm to regulate our breathing as well as our entire GI tract and our GU tract. And then it also goes out to our limbs. Vega stands for wandering and Latin. So it's this wandering nerve. And it has a big impact on our nervous system. So when you take long, deep exhalations, you activate the vagus nerve in the diaphragm and that calms down the nervous system. And they recognize that early on that that type of breath is needed when you're having a panic attack or when you're anxious or worried. The second type of constitution is stress. You're overworked, you're spent, you have a short attention span, you're impatient, you're angry, you're irritable, you're angry, you find yourself getting argumentative, they call that pitta imbalance. And they recommended a different type of breath work for that because that is really a sense of increased cortisol levels. And so they taught people breath like shitali breath where you roll your tongue and you breathe through the tongue cooling your body. So by activating different parts of our nervous system, we're modulating the neuroendocrine system, which I think it's fascinating. The last dosha that they talk about is kafa. And you may have been this, you know, you're kind of reaching the end of your residency, you're becoming complacent, maybe a little lazy, a little less motivated. You find yourself dragging in the morning, nothing able to get out of bed. So that is really that flattening of that cortisol curve, right? That low levels of cortisol because of the prolonged stress that you've been under. The type of breath work you would use there is breath of fire or kalbati. So they use different types of breath work to increase adrenaline, to increase cortisol, to increase your excitatory neurotransmitters. So one of the things that your listeners can take away is this, your breath is the window to your energy. If you find that your energy is vibrating in a high frequency, you find yourself nervous, slow down and prolong your breath. And even like what you said, Darsh, just slowing down your, your apnic state. So kind of holding your breath for longer periods of time can actually then relax the body. And if you're finding yourself stressed, cool your breath down, if you find yourself complacent and lazy, increase your breath practice, increase your rapid breathing and that'll change in the trajectory of how you feel. So that, I know that was a big, long dissertation on the breathwork and pranayama in Ayurveda. But I find that now we have evidence in modern medicine to show that breathwork has a immediate benefit to reducing stress, no matter what your constitution. This is awesome stuff. But how do we get into the science of this, though? Right? You said these concepts with the words that you used and listeners may say, hmm, I have heard of pranayama, but you also go into the details now of these different constitutions. So how does this relate to the science? How does one think about breathing in oxygen, the relationship of carbon dioxide, and its effect that it might have on reducing cortisol? You know, does it work through the GI system? The heart, you mentioned the biggest nerve, that's the longest nerve that travels through the body? Can you explain a little bit about where this mechanism takes place in the body? So the biggest concept that we talk about in breathwork is the sympathetic, parasympathetic nervous system. So the two branches of our nervous system that, you know, you could think of them as the gas and the brake, right? So when you need more energy, you're going to activate the sympathetic nervous system. That activation of sympathetic nervous system is directly tied to your breath rate. Think about you running from a bear automatically. You're going to be read more shallow and rapid. That's that sympathetic tone. So there's a bi-directional lever from the brain to the body and the body to the brain. So you can activate or deactivate certain parts of the brain by changing the way you breathe, just in the same way you can change the way you breathe by how you think, right? So it's kind of the two levers of the same system. So you asked me, okay, well, how do we work through the signs of it? The parasympathetic nervous system, which primarily runs the vagus nerve, really regulates the activation of that parasympathetic response. The release of endorphins, serotonin and dopamine that helps keep us in a calm state. And how does it do that? It does that directly by impacting the adrenal plants as well. So I would say that the primary way that breathwork helps us with our stress response is through the vagus nerve and is by modulating the sympathetic parasympathetic. You mentioned apnex states. Can you tell me what do you feel that apnex state does for you in terms of increasing your CO2? CO2 retention, I should say. So let me first start out by saying that I am terrible at apnex breathing. I mean, I cannot hold my breath for that long at all. And there's this breath expert Brian McKenzie. And so he has this company called SHIFT. And they have a breath test. So it's just a test that you can do online just to see how long you can hold your breath for. And then they recommend an exercise to increase that apnex state. And so the first time I did this test, I scored in the lowest bracket. And the recommendation they made to me was to inhale for three seconds, three second hold, and then three second exhale. Now the longest I've ever held my breath was for four minutes. Now before people are like, wait, what? You just said you can't hold your breath for that long. It was through Wim Hof breathing. And so with his method, I really felt like a tingling sensation with that CO2 retention. And your body can sense it. And it's just it's a weird feeling like all the cells in your body are connected with that tingling state. And then you get into this meditative state. And so when I do rhythmic breathing now, there's this part where there's this breath hold. And it's a guided meditation. So they'll actually prompt me that when I feel the first urge to breathe to keep holding it, you know, push for 10 seconds, keep pushing, keep pushing. And it's almost like my diaphragm is about to spasm or something. But then through that exercise, I mean, I reach a state of zen just going inward and deeper. And eventually, there is no bear to fight or to even run from. You're just sucked into the present moment with your breath. No, that's perfect. And I don't I haven't really researched deep into the CO2 retention. But there has been some evidence to show that increased CO2 retention can also play a role in releasing those calming hormones. So the fact that you feel that euphoria with being more apnic is actually something that is real. So, you know, again, stress resilience comes from from practices such as that. But I also find that resilience comes from other things that your body is being bombarded with. And that is, you know, we can move on to the next thing that I had mentioned before our talk is this circadian rhythms. Another way. Dr. Patel, before we do that, I do have a follow-up question. And of course. One comment, one question. I do think it's really interesting that as we've further developed understanding of kind of our behaviors and states, the relationship with that. I think, you know, coming through medical school, we were taught, I was always taught, hey, look, you're, and actually this procedure medical school, right, just undergraduate, even high school biological courses is your autonomic nervous system is going to dictate the state of your nervous system is going to dictate your behaviors, your moods, etc. For instance, you know, if you're and if you're stressed, you are not going to be smiling, you're not going to be in good mood, you're going to be maybe more anxious, more jittery and that kind of stuff. And what we've come to learn now is that, hey, if you feel down, maybe just go about the world smiling, put a smile on and that's going to change the state that you're experiencing, which is very similar to kind of what you're describing here is change your behavior and it's going to change the state that you're in, right? And I think that's really fascinating concept that that's just really cool for us to appreciate. I do want to know a little bit more about how long one might do these breathing practice. For instance, you mentioned, I guess this is coffee, right? When you have that flat, low energy, and you might start increasing your respiratory rate. So for others, they think you start hyperventilation, right? Again, going back to our, you know, our renal physiology here and think about the respiratory alcous, all that kind of stuff. If you will start, you know, expending a lot of CO2, eventually your CO2 low is going to drop. And I think that will put you in some type of respiratory alkalosis. So for my medical students and not getting too much into weeds, I guess it would be important to know how long would one do this practice for before it becomes borderline concerning. And again, medical disclaimer, we don't want you to start doing this on, you know, just on your own. So work with a professional before you do any of these things. But I do think it's important to talk about that. And that's, that's key. Thank you for bringing that up. And so it's, it's important to always work with a teacher, somebody who can guide you, because it is important that you don't do anything that's going to harm you further, especially if you have underlying chronic illness, like you have written me as heart failure, you're pregnant, there's some other kind of condition that would deter, that would be more detrimental if you do these birth practices. Because it's important to know that yes, these are practices that need to be done under supervision and under training. If you talk to Dr. Andrew Wile, who teaches of 478 breath technique, he really recommends about six to eight cycles. This is that's just enough to allow for, you know, that resurgence of good, happy hormones and suppression of those stress hormones, being able to shift the narrative in about six to eight breaths. If you look at other practitioners, they might say a five-minute breath practice in the morning is sufficient. So it doesn't have to be a prolonged state of rapid breathing or a prolonged state of deep holes. It's really just what you can build up to, the resilience up to with guidance. That being said, I'm a big fan of not just doing that practice in the morning as like you would do meditation, but just to carry that with you mindfully throughout your day and recognize when you switch from yummy to yucky. And so if you are yummy all day, you're smiling, life is good, you know, you got everything going greens for you. Now all of a sudden you get that red light and now if suddenly you've gone from yummy to yucky, first of all recognize awareness is the pathoalmus, recognize you've switched over from yummy to yucky. How do you feel in your body? Is your heart pounding? Is your mouth dry? Are you getting tense? Angry, irritable, scared, and then ask yourself, where do I feel it in my body? So it might be in your chest and your throat and your belly, and then ask yourself, okay, what's the story I'm telling myself? Can I take a few deep breaths? So you've heard of the rain acronym, you've heard of the stop acronym in the past. These are acronyms very commonly used to help us navigate stress moment to moment, not just in a standard breath practice that you do in the morning when you first wake up, which is a great idea, but just taking those five to six deep diaphragmatic breaths in the moment when you feel uncomfortable, when you've gone from yummy to yucky. So that's a long answer, but I would say use the breath practice, not just as a practice, but just as a way of being. Notice that you've stopped breathing and take a deep breath. That's it. That's that simple. Do you actually mind just going through those acronyms? I've never heard them before. Oh, okay, okay. So stop stands for, I love it. Stop stands for stop reacting. So let's say your significant other says something to you like, thirst, why didn't you empty out the dishwasher and all of a sudden you're ready to charge in and you know, defend yourself. Stop. That stands for the S. T. Take five deep breaths, okay? Why are you doing that? You're activating the vagus nerve, you're decreasing that sympathetic response, you're activating the sympathetic. Oh, observe what you feel. Identify the emotion. Do you feel judged? Do you feel criticized? Do you not feel loved? Are you afraid that this is going to escalate into an argument and you're fearing confrontation? Observe what you feel and where you feel it in your body. And then ask yourself, what's the story that you tell yourself about your significant other in this moment that's causing you to feel that way? She's a terrible person. She doesn't appreciate me. She doesn't know all the other things I've done. She hasn't emptied the dishwasher. There's all these little questions that you say to yourself, right? And then ask yourself, is it true? Can the answer is no. She's a wonderful person. You're a wonderful person. She's just asking you a question because she's coming from a place of stress as well and maybe you're coming from a place of stress. So having compassion for yourself, that's P. Proceed with kindness. P is proceed with kindness for yourself because you're stressed and suffering. You had a long day. You're tired. You don't ever feel appreciated. You also feel judged. You also feel fear when you get when somebody points out something that you're not perfect or you haven't done something. So have compassion for yourself. Have compassion for the other person because they're stressed. And now the P also stands for proceed with proceed down a different path. So let me ask you, when you get into fighter flight, are you a fighter? Are you a flighter? Or are you a freezer? I'm a born runner. So I am sprinting and flight away avoiding confrontation. Yeah, that's probably more. So then in that moment where you choose a path, take a deep breath. Acknowledge that the story you tell yourself is not true. This person loves you. You're in a loving relationship. This is just about the dishes not about your self-worth. And then yeah, and then and then choose a different path. Maybe you can say, you know, you can you can explain where you've been or what's going on. You ask more questions. You show sympathy and compassion. You say, I understand where you're coming from. This is where I'm coming from. So you can you can ask for more space. You can avoid a confrontation. You can engage a conversation. But that's where the P comes from. So the rain is very similar. It's recognize what you're feeling. Allow that to come in, investigate why that's showing up, and then stands for nurture yourself back to health. So again, these techniques are taught in mindfulness classes to help people navigate stress moment to moment, not just in a meditation retreat or yoga retreat or on vacation or on the weekends when we crash on the couch after a long week of work. It's moment to moment awareness. Are you feeling stressed in this moment? Now, can you take a deep breath? Can you reanalyze what you feel? Can you reframe the story you tell yourself? Can you find other versions of the truth? Can you ask for what you need? I love that at the hotel. Actually, while you were telling us or relibrating on that acronym, I was thinking about our previous guests a long time ago, Dr. Nietzsche Englien. And you know, when we asked her about her definition of mindfulness, it was kind of what you just described right? The awareness of oneself and moment to moment. And I think that is such a powerful thing when people who master that aspect of it, that, you know, when somebody comes at them, right? And as inflammatory of a comet, it could be they can just pause, right? For instance, I remember recently, probably with somewhere on social media, somebody was talking about some monk giving an ancient story where monks walking through the town and just one of the the people in the town or in the village start screaming at them, cursing at them, and this whatnot. And the monk says to this person, he's like, let me ask you a question. When somebody gives you a gift and you choose not to accept it, who does that belong to? Of course, the person is extremely thrown off. And the person says, well, or no, he says, when you give a gift to a person, and they don't accept it, who does it belong to? And the person says, well, I guess me, because since I bought it, it's my gift. And then the monk responds, well, yeah, of course, you know, that's exactly what this is. You know, you're choosing to bring your anger and I choose not to accept it. And so that belongs to you and it's going to be destructive. That's a little potential, but it reminded me of that. But what I think is what I'm trying to make this pragmatic, right? I think that second step, take five breaths. I'm wondering if you've been able to get to the point where you don't have to sit there and take five deep breaths, right? If I try to implement this into my day to day interactions with people and somebody comes and it can't not be my wife, right? Maybe let's just take these micro-aggressions or discussions that work when you have a conflict with somebody and they say something, you can't just take start taking deep breaths. It's certainly going to look awkward. That person's going to obviously know that, hey, okay, you've been irritated. And I've always been curious about those people who can just pause and not react. Because I'm a fighter, right? As opposed to to Dar's here. And so this is something that that's, you know, I'm personally interested in selfishly. And I'm wondering if, if over time, with practice and mindfulness practice, that step of taking five breaths is abbreviated or truncated. If you've been able to experience that yourself, what are your thoughts? I think so. I think it could be modified. And now that I've, you know, I've been immersed in mindfulness for a few years, my reaction time is a lot longer. Take a lot longer to respond to somebody. And there's nothing wrong with taking a pause and not saying anything. I think that the urge to speak and to intervene, to defend, to, to, to converse, it's not necessary. Oftentimes if somebody is coming at you and says something, it's okay to pause for a moment. And in that pause, you have choice. If you don't pause, you're activating the amygdala, the primal limbic system that is programmed for survival. And you're acting from the space of fighter flight. But if you stop and you do give yourself some time to pause. And maybe in that moment, you're not doing deep size. But you are taking time to breathe. You can then, in that very moment, run through the whole thing I told you. Take a breath, even one. See what, see that you just switched from Yamidiyaki. Notice where in your body you feel tight. Ask yourself, what's the fear? It's always tied to fear, by the way, because survival is tied to fear. It's a fear of not being light. It's a fear of being wrong. It's a fear of not being perfect. It's a fear of somebody finding fault in you. It's a fear of being embarrassed. There's a lot of things that tie us to that fear. And so acknowledging that for yourself, it's kind of like what they're said with the breathing. You go inward. And that's what the breath does is it gives you pause to go inward. And it doesn't have to be five long deep size. It could just be a breath giving you pause to think. And I think it does get faster as you do more of it. And you're a little bit more self-aware when you meditate. And in order to talk about meditation, but that also is a practice that's 5,000 plus years old. And this regular practice of meditation has been shown in many studies to help with cognitive health, with memory, with focus, with stress reduction, but also with, I think, stress resiliency. Because in that practice of meditation, things pop up. You may have memories of something bad happening to you, but you're sitting still and really focusing on your breath, or a mantra, or whatever guided post you're using as a milestone for your meditation. So you write people do feel like they have to react immediately, but the truth is that's not necessary. You have time to take pause. You can become curious. You can ask more questions. You can ask them why they feel that way. You can even empathize with them. I'm sorry that you feel that way. Clearly, you know, this bothers you a lot. That gives you enough time to be empathetic to the other person and also then be curious about your own experience. So I invite you to give it a try. I will. I will. And I will report back to you. I'll let you know it goes. I love it. You were transitioning to circadian rhythms. Let's do that. Okay. So another way of building resilience through our environment is through our sleep wake cycles and sun exposure. And this is not just me talking. The 2017 Nobel Prize for medicine was given to scientists that delineated the genetic connection to our biological rhythms. So what they've figured out was that when we wake up in the morning and we expose our eyes, specifically our eyes, because they're the windows to our biological clock, when we expose to, you know, 100,000 lux of light from from the sun into our pupils hits a retina, it actually triggers a very specific light sensitizing cell that activates the super cosmetic nucleus in the entire hypothalamus. We call that the master clock. So the SCM basically regulates 50 trillion clock genes in our body. And this is, this has an impact on our hormones, like cortisol, like our cortisol awakening response at 8 a.m., our thyroid secretion, our sex hormone secretion, our detoxification pathways, 80% of our liver cells that have clock genes, our digestive pathways are all in rhythm with our sleep wake cycles and our feeding cycles. And that's, you know, you've probably heard of Dr. Walter Longo and his work with fasting and in such an panda, his work with circadian rhythms. A lot of, a lot of what, when we eat, how we eat, when we wake up makes a difference in our biology. So why do I love this with Ayurveda? 5,000 years ago, they already called it a name. They called it Dinacarya. And it was your daily routine. And they actually also have different times of the day that are vata times, pit the times and kafa times. In Ayurveda, they would tell their patients, doctors would tell their patients, when is the appropriate time to eat? So in Ayurveda, the best time to eat is when your digestive fires are as great as which is midday. And they discouraged eating early in the morning and late at night, which we now know can affect our metabolism and our health. They also recommended that how you prepare your food, the mindset that you're in, who you share your food with, what you're doing when you're eating, like you're on your phone scrolling on social media, or you're watching TV, or you're on your laptop doing work, or maybe you're doing all three and trying to eat at the same time. Unfortunately, in Ayurveda, that shows that the doctors will teach their patients that that distracts from the parasympathetic activity we call digestion. And now in modern medicine, we know that to be true. Activation of the vagus nerve helps us with digestion. And that only happens when we're not in sympathetic hyperdrive, doing work, scrolling, watching TV, being distracted, having an argument while we're eating. So eating can have calm state, eating an mindful state, taking in our food with all five of our senses, really slowing down and chewing. So remember when I said that you were, when you are in sympathetic, your mouth gets dry? What happens when you're in parasympathetic, your mouth gets moist? Saliva is the first thing that happens to break down our food, our digestive enzymes, such as amylase live in our saliva. So if we're not masticating, we're not chewing properly, we're eating a rush state, we're not producing saliva, we're hindering the digestive process. And then if we are stressed, that vagus nerve increases the secretion of acid in our stomach. And we're not producing enough acid for proper digestion. Not only that, but your brain sends a signal to the liver, to secret bile, and the gallbladder also gets a signal to contract, as well as the pancreas get signals from the vagus nerve when it's time to release insulin or even digestive enzymes. But when you're in a stress state, all those processes are hindered, and in our survey, that 5,000 years ago, they knew that your digestifier depends on your state of mind and your environment when you're eating. And not only that, we didn't know about the gut microbiome, but we know this, that when we eat in a stress state rushed, the stress itself can hinder our gut microbiome, which can then affect our digestive process. So it's important to wake up with the sun to get that light exposure. It's important to turn off your heavy lights at night to decrease that light exposure, to increase melatonin to help us with sleep and resiliency there. It's important to eat at the right times of the day, and it's also important to eat in the right mindset. So I love the fascinating web of what we know now in, you know, Western traditional medicine, and what they knew then back in Ayurveda 5,000 years ago where physicians taught their patients how to eat, when to eat, when to get up, when to exercise, when to rest, when to meditate based on your constitution. Isn't that fascinating? It is. I'm also thinking about we were talking off line how I'm wearing multiple halves, right? So I'm a clinician and academician, I do some administrative stuff. And so with the busy clinical practice, any meetings that I have to put in, they always go at the lunch hour. So I always have a lunch hour meeting pretty much four days a week. And so I'm scarfing down lunch in between patients between the 1255 and, and, you know, one or 105. And I'm sometimes running between my first and second patient seeing that. And I'm starting to rethink that maybe that's not the best thing after what you just described to me. But I'm also, I want to get tactical for a second, right? What you just described trying to, I mean, that's every patient, every physician, every any healthcare provider, look at the OR nurses or the surgeons trying to just, when I was in orthopedic surgery, we would just take a scoop of peanut butter and an apple between a case and go back to the next case, right? When you're in the ICU, same thing. So every single healthcare professional has been through some version of that. And the modern world that we live in, right? It's most most places are going to be nine to five, right? That midday falls dead smack in the middle of that window. You mentioned maybe eating earlier in the morning. That a great idea. On the East Coast here, the sun is now rising around 5.30 a.m. Sets around, I don't know, eight o'clock. And later in the day, when if it let's just say you go from 8.00 a.m. to 6.00 p.m. So if you're not supposed to, it's not ideal, let's just say according to that wisdom, to eat after 6.37. And it's not ideal to eat prior to 7.00 in the morning. And it's not ideal to eat when you're running around seeing patients in the middle, doing all the meetings. How does one bridge that, right? In working in high stress environments, which is what all three of us are doing in some capacity. Darshan is a resident. So he probably experienced that more than even us. I think there needs to be a cultural shift in how we do things. If you look at the studies, especially for shift workers, you may have heard this, but the World Health Organization labels shift working as a class two person. There's been lots of studies to support this in terms of increased risk of cancer, increased risk of cardiovascular disease, increased risk of neurodegenerative diseases, as well as anxiety depression and substance abuse in people that are expected to work at this high capacity. And these include police officers and firefighters and first responders. And that's part of the work that I've done here in the valley is working with first responders, firefighters and police officers and helping them mitigate some of the negative impacts of their poor circadian cycle. As they too experience high levels of stress, not only that, but they have erratic schedules and they also are sleep deprived. Which again, we know that has increased, those populations have an increased risk for cancer and cardiovascular disease. And so there's clearly something we need to do as a culture to change our mindset about the striving, driving notion of sacrificing self for work. That being said, my suggestion would be to if you have control over your meetings and you can set it to start maybe 15 minutes or 10 minutes after the hour. If you have the control over that, if you don't, it's hard. But if you have the ability to start the meeting 15 minutes or or pull aside 10 minutes before your next meeting, block that in your schedule, shut your door, put a do not disturb sign or tell people to turn off your phone and then find a quiet place to enjoy your meal or sit down in the cafeteria at the hospital with the colleagues or friends or if you're at home, you know, make the time to sit down with your loved ones. If you can pull aside 10 minutes, 10 minutes of really mindful eating, you should be trying to pull aside 10 minutes in your day. If you can't find 10 minutes in your day for self-care, we have another conversation to have. I love that. It reminds me of the saying, if you don't have time to meditate once a day, you need to meditate twice a day. So, you know, a lot of people need that. But when you were explaining all that, I was glancing at my phone for the paper you sent over to us, titled The Microbiome and Health and Disease from the Perspective of Modern Medicine in Arirveda, which we will link into the show notes. And one of the things that fascinated me after reading this was talking about leaky gut syndrome, right? Such a common term that has been just thrown around recently. But coming back to ancient wisdom, I mean, there was a word for this. It was called umma, literally meaning uncooked food, but used in the same sense when they were talking about leaky gut. So, in addition to breath work, which we know can affect the gut, are there any herbs or specific diets that people can look into to heal dysbiosis and increase gut permeability? Yeah. So, again, to fix leaky gut or to fix increased gut permeability or dysbiosis, it is a longer process than just a quick herb. But, you know, in, there are several steps that I take to help my patients restore their gut health, and I can briefly go over that. But it does, it is an individualized, personalized approach to each patient. So, I wouldn't want to say this herb everybody should take because it is very precision medicine based on what's happening with the patient. But the first thing is to remove anything that might be getting in the way of pepper digestion. So, there might be infections that they may have, or they may have food sensitivities that they may have, or they may have certain additives, preservatives, colors, dyes, chemicals that come into their diet that can cause, you know, destruction of the gut microbiome. So, I clean up the things that may be getting interfering with their health. And then, you know, again, like we just talked about if they're lifestyle, they're eating in a rush state, they're eating in a stress state, they're eating in, in a quick erratic pattern, I will try to remove those kinds of lifestyle things that are barriers to good digestion. And then I will replace them with good habits. I'll tell them, take that 10 minutes. Really, if you're having a hard time getting your digestive tract started, eat something better, have a lime or a lemon or a piece of ginger or ginger tea, something that's going to trigger the senses in your tongue to release saliva. Remember, the mind tells the body to shut down, but the body can tell the mind you're relaxed. So, take five deep breaths. We're maybe one for you. Take a deep breath to kind of just get that vagus nerve started. So, you're activating the vagus nerve through the smells and the sights and the sounds and the taste of your tongue. You're also taking that deep breath to activate the vagus nerve. That's replacing that stress state that you're in. Make sure that your food is whole, plant forward. I'm not, I'm a flexitarian, I eat everything, I never demonize food, but eat food that is in conjunction with what your body needs. So, in a more conventional way, we might take, we may put, we'll on an elimination diet or give them certain foods. In our Veda, we would use thirdosha to figure out what foods they need to eat based on their constitution. You want to re-enoculate the gut. So, again, with replacement, you want to replace fiber, by the way, because fiber is that prebiotic that helps set the tone to help with the gut healing. And that can come from foods or supplementation. So, there's that prebiotic supplementation that sometimes people take with inulin and chicory root, but you can also get it from rice starch, potato starch, artichokes. You can get from onions and garlic. So, those prebiotic fibers are rich and nutrients that help feed your gut bacteria. The next R is re-enoculate. So, you can re-enoculate your good microbiome to replace the bad microbiome with fermented foods. So, there are two ways that you can do that. You can make your own, which is what I like to do, or you can buy fresh fermented foods that you can buy in the refrigerated section of your grocery store. Sour Crout, kimchi, nato, miso, kombucha, sourdough bread, apple cider vinegar that's fermented. You can use any of those things, yogurt, dairy, lussi. You can use any of those things to help increase your probiotics, which is the bacteria that you're trying to bring into your gut. Now, of course, you mentioned supplementation. There is a billion dollar industry. Obviously, there's lots of probiotics on the market, and I don't recommend just one. Oftentimes, I will look at their gut microbiome, I look at a stool test to delineate where their imbalances are. Also, look at what kinds of problems they're having, systemically, to see what kind of probiotic I want to recommend for them. The next thing is repair. So, you mentioned leaky gut, and one of the markers for leaky gut is an increased zonulin level. So, we can get us to zonulin to see if there's leaky gut. You can also do a lactual host test to see if they have leaky gut. If that is present, then I definitely focus on food sensitivities, removal of toxins, but also replacement of certain nutrients that are super important for leaky gut, vitamin A, zinc, glutamine, and sometimes people will add an immunoglobulins, but also I like demoltsense, things like slippery elm and marshmallow root and licorice that help heal the gut lining. And then the last step is restore. And we've talked a lot about this in the first half of our talk, but restoring that balance in your daily living, restoring the balance of your meal times, restoring the balance of when you wake up and when you go to bed, and restoring your mind body, you know, stress resilience. So, that's really it there. I know that's a really long explanation, but that's what I would do to help somebody with leaky gut. I'd love to spend a little bit of time talking about movement and how it can augment or maybe manipulate the microbiome. Where are you, or, you know, what do we know about that? What is the ancient wisdom speak about that? And what do we know about that in our current understanding of microbiome, whether it's relation to exercise or, or maybe even the opposite, maybe even sedatory behavior? So, such a good question. Of course, I, of any practitioners didn't know about the microbiome, but they understood that the gut was the seed of all health. And everything that they recommended was primarily based out of the GI tract, which was interesting to me. And I know you read the article what recent research even shows is that when they tested the stool of different types of dosias, the vata pitangafa, they actually found a difference in the microbiome. So our epigenetic environment not only influences our genetics, but it also influences the genetics of our microbiome. And we're more bacterial DNA than we are human DNA. And remember that microbiome that lives on our skin, in our orifices, on our organs, in our GI tract, it communicates with ourselves on all levels. It regulates our neural systems, production of serotonin and dopamine, 90% of serotonin is made in the gut with our gut microbiome, 50% of dopamine, and our gut microbiome. It regulates our immune response. We've learned that through COVID. It also helps us with our hormonal pathways, especially with estrogen metabolism, and also communicates through the vagish nerve, like a bi-directional telephone to our brain. And it's been linked to, again, cognitive health or even neurodegenerative diseases. So your specific question was about exercise. And interestingly, exercise is a hormatic process. So hormisus is where a small amount of stress makes us stronger. So think of that blueberry in the wild, pelted by rain, attacked by bugs, having to live through sun and cold. That blueberry basically is stressed on a small amount every day, and it creates the most powerful antioxidants and most resilient state to keep itself alive. In the same way, we have hormatic stressors, like exercise, that send signals to our body to actually make us more stressed resilient, to make us more survival resilient. And so the gut microbiome senses everything in our body, and the ancient wisdom doesn't really speak to the microbiomes, so I don't want to extrapolate to that. But they did understand the importance of yoga and movement and mind body connection. And now we know that cortisol high stress levels can decrease the health of our gut microbiome. And high cortisol can actually decrease to diminish the proliferation of good bacteria, and may in fact be causing some of the dysbiosis that we're seeing. So when we exercise, we release natural endorphins. We release serotonin and dopamine, and happy hormones. It makes us feel more rewarded and more happy. That decreases our cortisol levels. That in fact would then signal to the microbiome that we're in a survival free. We're in a good state of mind. We're in a relaxed state of mind. All processes can start up again. The microbiome starts to proliferate, starts to communicate, and starts to put us back into balance. So that's the only connection that I can see. But again, I can't speak to the IV-thick practitioners and what they thought about with movement. But they definitely believed in it because we have an amazing yoga practice that helps us with not just flow and breath work, but so much more making the mind body connection happen for ourselves. So what's your experience with exercise? Well, I think for me, the most potent of fact is the mental health benefits of it, right? And you've already elucidated on multiple occasions, not just today, but even our first discussion back about the bi-directional relationship with serotonin, dopamine, and we know how powerful, right? And so that exercise high that people tend to get something that I'm a huge fan of. And so is it being modulated in the central nervous system? Is it being modulated in the gastrointestinal system? I don't know. I'd be curious to kind of learn more about that and see. And I do think that I think there was a paper that was published maybe a year or two ago by the International Society of Sports News just talking about the athletes got microbiome. Certainly, we've learned that people who have more sedentary behavior, and if there's a, I hope I'm not getting this wrong, like some type of a fecal transplant from an individual who's been much more active and vice versa, can change physiologically, right? They're phenotype after the fact. So we know that there's a powerful effect in that regard as well. Are you familiar with this? I think maybe if a previous guest has mentioned this or this is much more your world. Yeah, yeah. You know, I'm trying to think, I think there is research out there going back to what you were talking about about how physiology precedes psychology. So by changing that phenotype, you're going to see that serotonin dopamine, other neurotransmitters change to match whatever the donors were, you know, in a way. Yeah. So, but yeah, yeah, I mean, I think that they're, we're just scratching the surface when it comes to the microbiome. I, you know, a couple of guests have talked about that. And in this relationship to all these other four pillars, right? Some were further ahead, right, with respect to stress. And I mean, in the sleep, sleeps another topic that I'm sure we could talk a lot about, but I don't know where the research is. And of course, there's a ton of confounding variables when it comes to that. And so it's hard to isolate where it's affecting. But, you know, on the topic of a Hormetic Stressors, I really want to get your thoughts a lot about cold exposure therapy, something that we want to talk about. I think that's all the rage, something that I haven't been able to get myself to, to partake in as much. I have dabbled in it, not more than 20 seconds or so. And, but before we do that, I just want to see if you or Darce have anything else along the lines of things that we're discussing that you think is worth elaborating on for the listeners. So we're talking about epigenetic changes, right? We're talking about changes to our genomics. But food is a big variable to either turn on or turn off inflammatory pathways. So it's a big deal, especially if you look at Ayurveda, the practitioners actually would give them a customized meal plan based on what was out of balance in their body, which I find to be fascinating. So if somebody came in with Avatha Constitution, somebody with an autoimmune disease, somebody with gas and bloating or leaky gut or insomnia, they would actually give them foods that energetically would balance their imbalances. They would tell them to eat more calorie dense food. They would eat foods that are in the sweet sour salty category. They would have more oils and grains and moist warm cooked food, which I've used in my practice when I had a patient who was, she was a entrepreneur, 40-year-old, super lean, ate all the eight sporadically eight snacks, had terrible anxiety, panic attacks, and she had trouble sleeping. And only thing that I changed for her was her nutrition, according to the Ayurvedic platform. And it was amazing how she came back, really intuitively saying that's what my body needed. And it helped her calm down and be more relaxed and be more nourished. And she felt more rest today, even at night, by increasing her carbohydrate intake and eating warm cooked foods. On the other hand, they also looked at constitutions that we would call pit-a. And they would prescribe foods that limited the amount of sour salty and spicy foods. And so if you think about somebody who has acid reflux or inflammation or rosacea, we in our now Western medicine would tell them to cut out alcohol, tomatoes, citrus, spicy foods, hot food, oily foods, because they would exaggerate their acid reflux. Well, this is what they would recommend for a pit-a-balancing diet. So in the end, Kafa, as well, they had a different, I have a 75-year-old lady who sits at home, who's retired, who has become sort of complacent with her health, doesn't want to work out, likes to eat processed foods because it's convenient. And she finds herself semi-sluggish, decreased energy and depressed, and giving her more lighter, fair food, salads and smoothies, and having her eat less density foods has seemed to help her with her mental physical state. So it's interesting that the epigenetic platform that they were talking about 5,000 years ago seemed to be modulated by the foods that they were recommending. And this is where we'd love for us to be able to go, instead of recommending a keto diet or paleo diet or vegan diet for everyone to do. And this one-size-fits-all kind of recommendation to really look at what the imbalances are in the patient and to be able to delineate which foods are going to actually support them through that process. And that's really what I find fascinating about the gut microbiome differences that they found in different constitutions. And could that be the reason why different foods help different conditions? Anyway, that was my thoughts on that. You know Dr. Patel, I'm starting to realize that as much as lifestyle medicine is on the rise, as well as integrated and functional medicine, they tend to focus on pillars. And sometimes I see those pillars as separate in the way that we teach them, where you have exercise, nutrition, mental health, adverse, you know, smoking behaviors, and risky substances. And in the our evaded world, we're seeing these same pillars, but just kind of combine into one. And as I look into my own practices, I always ask myself, how do I combine these habits? Right, so there's a book out there called Breath by James Nestor. And he talks about when running, how to actually create more CO2 retention to get into flow so that you can actually run longer. Andrew Wile, for example, right, the 478 breath method to help go into sleep using that to calm down. Even Andrew Huberman, when he talks about doing breath work while cold plunging and he'll do both of those things while getting morning sunlight. So I realized that all these things work together and that it's more of a synergistic pattern rather than just doing three things at once, right? I think it's about building that inertia and momentum. But with that, let's transition actually to convincing ultimately to do cold bats. Okay, so here's the thing with that. So there are hermatic stressors, like we mentioned with the blueberry, that help us become more stressed resilient and also become more survival driven. And cold and hot exposure has been used for centuries to help us drive those genetic pathways upward. So when we get exposed to cold stress, what science now tells us is that increases dopamine and endorphins, you can even help support our immune system and make us feel more calm and happy. So these are the chemical biochemical benefits of cold, cold plunges and cold stress. If you're not thinking of a nice bath, you can even just finish your shower with a quick cold rinse. That in itself helps them. Let's say you're not even thinking of that. You can even put your hand in cold water and that's enough hermatic stress to give you the benefits of cold plunging. You can even do a cold splash on your face or put your head in cold water and that's enough of a trigger to your nervous system to signal those survival pathways and to kick in all the things that we're mentioning or help benefits. If you like heat and infrared sauna or a sauna in general has been shown for again, a millennia in many cultures to help with detoxification, to help with immune resilience, to help with overall mental wellness. So you don't have to do it all the time like you said. There she doesn't have to be, I need to check 10 boxes a day and I need to do all of these things. But just being mindful, moment to moment, did I step outside for a few minutes today? Did I take a deep breath? You know, if I'm taking a shower, was it feel like to just take a cold rinse? And then of course one of the other hermetic stressors that have been in Ayurveda for thousands of years is fasting and that's all the rage too. And so whether it's fasting for five days, for others fasting for two days and eating five days or whether it's time restrictive feeding, eating in an eight hour window or a six hour window or four hour window, any of those kinds of things creates a small amount of hermetic stress that again drives up our survival pathways and wakes up that epigenetic inclination to live. And so we want to be that hungry wolf once in a while. And that what that does through science, of course, looking at Dr. Longa's work. It helps with autophagy, helps with mitophagy, meaning recycling our old cells, recycling our mitochondria. It helps us with longevity genes. It helps us with metabolic problems such as diabetes and heart disease and hypertension and even some studies suggest weight loss. But I don't recommend it for weight loss. But fasting is a great way to intermittently throw in a little bit of stress, just like exercise intermittently causes a little bit of stress and cold and heat intermittently causes a little bit of stressors. The problem with us now is we live in sheltered places that have a controlled thermostat to keep us at the same temperature. We wear warm clothes, we have comfortable surroundings. We have abundant food. We can go to the grocery store, we can door dash. There's just no scarcity in our life. So unfortunately, those survival genes don't get the attention that they deserve. So when we incorporate some of these hermetic activities, we are keeping up with what our ancestors used to survive. Yeah, I think it's important to mention how sheltered we are right now in the US. At the time of this recording, there's a heat wave. How does someone record? And of course, a lot of deaths do occur for the elderly, so precautions are needed. But I think for the majority of us, the rest of us, it's mainly just uncomfortable discomfort. And this weekend, being 98 degrees in the northeast, you know, I have to remind myself that sauna is harder than this, right? And I just try to shift my mindset, that perspective. And I think by doing the ice plunges, the sauna, the hard work out, the fasting, yes, there's health benefits to it. But it's also more of just going back to being an ancient human, right? Like how do we connect back to those roots? Think about what we're doing. I'm sure evolutionarily, like we weren't eating the way we are now, sleeping in perfect temperatures and the end temperature. So it's about bouncing it out. And it's definitely an important message to send to people about being uncomfortable. Michael Easter has a great book out there called the comfort crisis, you know, and he even talks about boredom. Like we have such a tough time letting go of technology for even five minutes. We can't sit with ourselves, you know, and that's what meditation is. So I just wanted to share my thoughts on that. No, that's a good suggestion that we have so many comforts in our lives. It's time to bring ourselves back to our evolutionary roots to keep those genes alive and keep us living longer. And of course, all the work that people are talking about now in terms of longevity, you know, Peter Tia's book and Mark Hyman's book, you know, there's just so many books now on longevity. We're talking about the same thing. We're talking about how we can activate those genes through epigenetic behaviors that help us live longer. But in Ayurveda, the wisdom was that not everybody needs to do hormises all the time. So if you take that first patient of mine, the anxious entrepreneur, the mom, the two children eating sporadically has a lot of anxiety, always on the go, not eating at proper schedules, not sleeping very well. For her, Ayurvedic practitioners wouldn't recommend aromatics stress. They wouldn't tell her to fast, they wouldn't tell her to exercise intensely. In fact, we would have her do the opposite. We would have her to slow down, do more restorative movements like yoga and breathwork and grounding. We would tell her to eat warm, nourishing meals at regular intervals and not skip meals. So it's important to personalize even hormises. If you take the executive, the the hot-headed executive that came in that said, pit the quality, you wouldn't want to put him in an infrared sauna. He's already overheated and putting him in a sauna is not going to help his metabolic state. It's actually going to push him further away from his metabolic state. So that hormatic stress may not be right for a pit the personality or a pit the excess. And then you've got the kafa, the 75-year-old woman that's at home getting weight, eating processed food, complacent, not feeling energetic. For her, yes, fasting would make sense. And even maybe doing a little bit of sauna for detoxification would make sense for her. And you know, increasing your exercise would make sense for her. So even when we decide to do hormises, inner body matters. What season it is, what time of your day it is, and even what's going through your life, what's your environment like? You want to meet her, hormises based on that. Love it. Well, Dr. Patel, as always, it is a pleasure, incredibly enjoyable for us and also informative. So thank you again for being an awesome guest and just be willing to jump back on and to educate us and our listeners. My takeaways here, I got four main ones is I think number one for me is going to be to pause and ask more questions when appropriate, right? Work on breath work, but also the different states, right? Not just for me, I'm going to be that first person, right? I think it's a vata that we talk about right to the vagal toning. But I thought it was pretty interesting how you had talked about that you have to go through different stages, different times of the day. And so you can kind of weave in and out of all the different states. And then food, as you mentioned, is kind of the anchor for manipulating your microbiome or at least as far as we understand it. We don't know as much about some of the other pillars. And last but not least, you know, get comfortable being uncomfortable, but context is everything. Not every single state of discomfort is going to be for everybody at every time. Darshan, anything to add on to that? A little summary for anybody else? No, not much to add. I love that. I think you nailed a lot of it. But again, Dr. Patel, thank you so much for educating us. You know, are you vata is home for all three of us? You know, I think we've all heard about it growing up, but we never actualized it. At least I haven't. And I never learned the different terminology, the constituents. And so it's amazing to see how a lot of the lifestyle functional medicine research coming out is based now on these ancient principles of are you are you vatig medicine? And that are you vata had a lot of this right from the beginning? And so I'm anticipating how these principles can be incorporated into medicine 3.0 as we transition into that. But with that, I do want to ask you, you know, it seems like the core to me about are you vata is balance and energy. But with precision medicine, we are looking specifically at lab markers such as cortisol you mentioned, we talked about got microbiome. What is your standard routine or panel when you see a patient? Are you recommending specific lifestyle interventions off the bat? Or are you looking specifically at lab markers and then specific interventions based off their dosha and then retesting? So good question. But I do a comprehensive history first is really important whether you practice traditional medicine or any other type of alternative practice. It's really good to make sure you know who your patient is. Every patient is an individual choosing a personalized customized approach to health care starts with really understanding where your patient is, their environment, their habits, who they live with, their their stressors, their sleep habits, their eating habits, their movement practice. I do a comprehensive history to start followed by an examination. Again, either the practitioners would look at their pulse and we might look at things like their heart rate, their vital signs, their weight, their body analysis, their in-body machine or any other type of Texas scan. We might look at their blood pressure, we may look at their cardiovascular system. So doing a full exam from head to toe is also an important part of medicine that I don't want to skip over. Once I have a good history and a good physical, then I will recommend specific testing to help me get more data. And data points are really important for me because it helps me put together a comprehensive plan for the patient. But it also gives me a good understanding as to which systems are out of balance. So are they dealing with in their history? Are they dealing with more gastrointestinal symptoms? Then my test may be more driven towards checking a SIBO test or checking for dyspiosis. I might look for H. Pylory, things that might help me figure out more about their GI tract. If their problems are more metabolic cardiovascular, then I would do a more comprehensive inflammatory testing, cardiovascular testing, look for fasting insulin and hemoglobin A1C and advanced cardiac markers. I might even recommend scans such as a cleary scan or a coronary calcium score to look or a CAMT, your carotid test, to see what their carotid metabolic states are. But if I see a woman and she has more hormonal problems, she's parrymenopausal, opposed menopausal, and she's experiencing hair loss and weight gain and depression, then I might do a more hormonal panel. And that might include a salivary four point cortisol test, DHA, melatonin, sex hormones, thyroid. So doing a more comprehensive hormone panel. And then of course, if I feel like this relates to the patient, I might do a micronutrient test to see what nutritional deficiencies they have, and then any conventional tests that help me. So maybe it's an autoimmune panel, if I suspect autoimmunity. And a lot of these test stars, I can do through cenorequester lab core. So oftentimes, the misnomer is that your doctor is going to order all these very expensive tests, which is true. It can be expensive. But for a lot of my patients that are Medicare or have private insurance, these some of these tests are actually covered through mainstream labs. So it doesn't necessarily have to cost the patient a lot of money. And then once I see what the tests are, I've got a good understanding of what the patient's underlying root causes or problems or system causes are, then I might recommend a mix of both conventional prescriptions if indicated or supplements if indicated. So it is, and if it's outside of the scope of what I practice, I work with a network of subspecialists in the valley. And so I might suggest a colleague that can help dive a little deeper into that system to help me and the patient restore health. Love that, right? It's about being comprehensive and then that combination of Eastern and Western medicine. Dr. Patel, if our listeners want to get in touch with you or follow you for your educational videos on social media, where can they go to find that? So on Instagram, I'm Dr. Jody Patel, MD. On TikTok, I'm Jody Patel, MD. And on my website is aimsforwellness.com. So that's my practice here in Scottsdale, Arizona. We're, by the way, we're at 120 degrees. So, you know, now you can feel better about the 190 car you mentioned earlier. So here in Scottsdale, Arizona. So it's aimsforwellness, a-i-m-s-f-o-r-w-e-l-l-n-e-s-s. Thanks forwellness.com. Great. All of that will be in our show notes. So it's been some time since we asked you this back to episode three. I'm going to ask you again because maybe there's a new perspective. How do we add the health back to health care? Again, it's coming back to our more personalized, customized approach to patient care. Moving away from the one-size-fits-all cookie cutter medicine that we've moved to and moving back to creating that human connection that we talked about before, really understanding our patients and listening to their story and then weaving together a comprehensive plan for them that not only includes conventional medicine, but even other ancient wisdom techniques that have been passed down through the ages and have merit and benefit. Well said. Thank you so much for your time. Thanks Dr. Patel. Thanks for having me. And that's all from us folks. Thank you so much for taking the time to tune in. I'm really hoping as Western medicine evolves, it starts to take more of the principles from Eastern medicine because I think that balance is truly needed in today's state of health care. If you enjoyed this episode and you know somebody else that will as well, please go ahead and share this with them and if you have the time, please rate and review this podcast on your preferred platform as the algorithm really helps us out. Thank you to our team, Ethan Jew and Herita Yeppory for the production of this podcast and of course our disclaimer. Everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No physician, patient, lay, ship is formed and anything discussed in this podcast does not represent the views of our employers. We recommend that you see the guidance of your personal physician for going any specific health-related issues. Until next time.