171. Microplastics Are Everywhere But Should You Care?

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamash Raja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in healthcare. What's up everyone? We're back here. Altamash and I in the studio. Alt? I have no idea what we're going to be talking about today, so where do you want to even start? Where do we even go from here? Yeah, I do. Something that's been on my mind that I think is worth discussing, but let me ask you how much do you know about microplastics based off? You weren't in the conversation with the bond that we had, right? I was not. What do we have? I forget what episode she was on, but she's an expert on microplastics and she's a toxicologist. So we had her on the podcast. And then just from that and really just listening to some documentaries, Peter T.S. podcasts and some other people have come on. That's not knowledge. I've been done any deep dives though, aside from that. I'll have to go back and listen to it. I thought she primarily talked about PFAS and these forever chemicals, what is microplastics are different? They don't fall under the first PFAS that she had talked about. And yeah, certainly a good conversation for people to listen to, so we'll pull that in the show notes, but let me tell you why this peaked my interest. I got a letter from my township towards the end of the year last year saying, our water system violated a new Jersey drinking water standard. And as our customers, you have a right to know, yeah. And I was like, oh, shit, okay, I need to pay attention to this because if the government is telling me that the water system isn't good, then, you know, I'm definitely below average if you know what I'm saying. And as Tracy Duce had a lot of time to go, we try to go for a good, better, best and I'm always trying to be in the better best. And so if I'm not even good according to government standards and I have some concern for myself, but I thought about this and I was like, this is clearly a cause for concern. So I should mention that in this notice, they didn't specifically talk about microplastics, but they talk about some they're called PFNA, which is per floor, nonatic, nonatic acid, which falls in the category of those PFAS, right? So I'm not going to talk too much about that, but I was familiar. I think we've told people that I use a burky. We primarily use that for a drink, although after I went down to rabbit hole about getting RO filters, turns out, maybe I need to upgrade from burky standards, burky isn't maybe the best thing to do. There's better stuff out there. But I think that and just in general, I've been a bit more conscious of air pollution. My daughter, she's got eggs in my, she's got some allergies. And I don't know how much you know about eggs in my still, but like, of course, for those who don't know, it's a skin condition, it's reactive to different thing and different allergens can flare up and the skin gets really irritated. We noted that when we went to either Morocco or when we went to the UK multiple times, she didn't. Great, man. And then when we come back as, hey, what's this all about? Is it the carpet? Is it the exposure? So so that's where I started. I was like, okay, I really need to look a little bit deeper into the environment and how to mitigate some exposure for multitude reasons for self, for her, for health and that kind of stuff. And so I started learning a little bit more about it. And turns out it is something worth paying attention to. I guess I'll tell people what bioplastics are. It's all over social media or people have heard about it. As the name suggests, there are tiny plastic particles, typically less than five millimeters. Now, five millimeters is pretty big, right? It's half a centimeter for us non metric users, which is about a little less than half an inch. So you can see it with the naked eye. Typically when people are talking about microplastics, they're talking about nanoplastics, which are less than one micrometer, and that is typically not visible to the naked eye. And so that's where most of those are. And the fact of the matter is you can't avoid them. So if you think you're going to avoid microplastics or nanoplastics, you're not going to, they're every single place in the environment, anything that you can think of, like they're probably infiltrated into it. They're found in water, food, fruits, vegetables, like anything. And just, of course, air, and the primary way they're getting into our bodies, which is what we're concerned about is to either ingestion of our foods or do inhalation of air. And I think air exposure is probably the biggest one. And so that's where I know Yvonne had talked a lot about one thing that she had mentioned is about indoor air quality is even worse than outdoor air quality, and because people don't spend enough time opening other windows, especially in the winter, like I'm here in the Southeast now, I'm in the Northeast, that's something to be mindful of. But then absorption through ingestion of either water or the fruits and stuff they're eating because it infest the infestation of these microplastics into our foods is through the soil. That's another interesting thing. Yeah. I guess I'll pause there to see if you have any questions or which way we should go about this, because I think one thing is when I started people on social media will just blow something out of proportion, really pay a lot of attention to it. But when I started digging deeper myself for my own knowledge, I was like, oh, okay, there's actually a reasonable amount of evidence to suggest that this probably doesn't belong in our bodies. And look, chemicals and things going in our bodies all the time, it's unavoidable. They do provide some good, otherwise they wouldn't be there. However, as the saying goes, where there's smoke, there's usually fire, and I'm not really sure if there's going to be fire with the microplastics, but there does appear to be a smoke signal. And we just one thing I should caveat about saying this, we don't know enough about them yet and how they, but I heard different people on podcasts talking about how they're in the placenta. And I think when you say that, people start freaking out a lot and they're finding, the fact the matter is they're found in every single tissue that you can think about. And we don't really know exactly how they adversely affect our health, but it's something that's worth paying attention to. So that's what I've been diving deep over the last month and a half about, and I'm happy to talk even more about it if you think that's of interest. Yeah, no, definitely. I think, yeah, it's a good starting point. And I think what you mentioned was sources, right? So a lot of the audience might be like, okay, you mentioned error. And now they're thinking about what did they live next to? I'm sure people who live in cities, me are getting affected a little bit more. I got true shifts outside of my place and they're always low in smoke and go outside and about me and you just see this black thick layer on our furniture out there. So obviously, air, you mentioned soil, which is probably through the water itself as well, right, precipitation, but also first learned about microplastics through sea spheracy, that documentary on Netflix. Yeah, if you're eating pitch, you're actually getting more microplastics because of how polluted our oceans are. So why don't you talk about a little bit about what you're doing now to prevent or reduce the amount of microplastics from both of those sources or any other sources? Yeah, that's the key word. I think reduction is something that's important. There's prevention is impossible. And it should also be noted that some of the low hanging fruit, so to speak, that people can start to adopt into their lives is going to give you the biggest bang for buck. So the simplest thing is, and this is something that we've been working for a long time is trying to minimize how much of our food is stored into plastic containers. That being said, when you got a little kid at home, she's going to school with food and stuff like that, there's only so much you can do. But I think at this point, it's pretty well known that you don't try to microwave anything in plastic and that kind of stuff. So that's not something that I've done, but I do know people who still do it. Like people will never for some reason warm up a coffee in a styrofoam cup. They know that quote unquote will cause cancer, even though that's not exactly right. But they'll warm up plastic. And so trying to avoid extreme temperatures with plastic is a big one. So the other thing is one thing I've had a point is not to put if you're putting food away in the freezer, like leftovers for a week or something, not to put it in plastics in the freezer. I don't know how glass does in the freezer. So I don't have an alternative solution. Maybe you can tell me if that's what you're doing. What do you do? Do you leave leftovers for a week or two or no? Can't hear you about muted. Mears are not a big fan of leftovers. So I try to eat everything in a day or two because if you left the cook at a birthday fresh, but yeah, otherwise, if we're buying stuff from the grocery store, like it's pre-packaged stuff that would be on meat patties, things like that, frozen fruit, those are all going to be these type of plastic eggs, essentially. Yeah. I purchased a couple of HEPA filters, true HEPA filters. I got portable ones actually looked a whole house or whole home HEPA filter that would connect to the HVAC unit. Turns out they're pretty expensive. And they were from $1,500 to $6,000. It wasn't quite ready to make that investment yet, although I think maybe at some point down the road, that might be something worth considering. One predicament I've gotten to is I told you that I went deeper into that rabbit hole about looking at reverse osmosis filters. Again, not for just my plastics, but also for piece of ass and some of these other chemicals, the forever chemicals that you've on talked about to try to get them out. I wanted an under the sink filter, so I have more counter space, but I need an outlet under the sink and don't have that. So now I got to decide if I'm going to get the electrician to come out and shift an outlet, run an extra wire for an RO. Under the sink, you're saying, correct. Yeah, got you. OK. Yeah, that's how it operates. That seems to be the best way to get it. Like the best quality ones are out there. Although there are some over the, over the counter, counter top ones. It's slow and convenient. And I wasn't planning on doing it for every single one of the faucets. I'm not going to do it in the bathroom. I think just the main drinking water I'll do. So those are the two big changes. Oh, one thing, one more thing I want to mention. Yeah. But invested in a really good HEPA filter vacuum, one of those like cordless stick ones. And so now we can vacuum a bit more frequently. And because we have synthetic carpets in our house, and they tend to retain a lot more of these outbout and these, oh, interesting. I didn't even think about that in the vacuum. So I guess my question I was going to ask is, so there's two different types of reverse osmosis symptoms, or systems, correct? There's one that does not remineralize the water, but then there are some that are more expensive that will go back and remineralize. So have you thought about, I'm, you know, the price differences on those, but maybe thought about what's easier. No, yeah, the remineralization part wasn't something that I was super interested in. I think it changes the pH of the water a little bit to make it a bit more alkaline when you add those minerals back in there. I know some people will talk about it. And I'm sure Tracy can come back here and talk a bit about more about why that's important. I'm not super concerned with my magnesium and calcium that I'm getting from my water. I'm getting it elsewhere. So I'm not, yeah, you're eating, like, should take the place of the remineralization in a way of the water. Like you don't actually have to go and buy those specific electrolytes and minerals. Those are expensive. I know that come in those glass bottles at least. Yeah. My thought was the more contraption you start because maintenance costs on this thing adds up. It's not it's our filters like the best ones. The ones I was going to end up getting was going to be like 540 bucks. But then there's an annual cost to it too for maintenance, right? So you're looking at like 150, 200 bucks. And so it really adds up over time. And so if I get more gadgets and gizmos on it, I just didn't want more hassles. And here's the other thing too. If it's a countertop, you have to fill the water. And then what maybe only a fourth or a third of that water is actually drinkable. So, yeah, that's yeah. So for a family, yeah, they're big. They're bulky. They take up space and you're filling it up a lot more over and over. So certainly an investment, but I think go back to that good, better bet best concept that she had to trace you talked about is this was for people, if they're freaking out about microplastics yet, they're not exercising a minimum of four times a week. I'm not really sure. We're looking at the wrong thing or if they're not getting their adequate on foods of vegetable, at least 500 grams a day of fruits and vegetables. I know EC likes 800, but 500 is a minimum, I would say. I'm not sure microplastics are going to make much of a difference like you putting stuff in non plastic containers and getting an RO filter. So I think this is definitely going to be a more of an optimization. And again, the other thing is because the friction and how inconvenient it might be caused aside trying to avoid plastics, you have to have a really strong signal why it's worth it. And I'm not sure we have that data yet. Yes, there have been correlations. Some because there's the accumulation and brain tissue and they say it's getting you through the olfactory bulb, right, through inhalation. But what does that mean? Like some, I remember a newspaper article that it's linked to Alzheimer's. It's supposed to come up, bro, we everything's linked to Alzheimer's, right? We don't, yeah, absolutely. So yeah, that's interesting. So I'll say I live in apartment, but I'll do something similar where I have portable, the HEPA filters that you can just plug in, you'll collect a dust and everything. And then I'll try to even vacuum those to get a little bit longer shelf life. And then I actually have an under the water, just it's a company called clearly filtered, but it's not RO, but the water here in Tampa is so freaking hard that they say for two people, it's the last about 15 months. I probably have to change it soon. It's only been seven months. And then even our shower filter, we had to change just because the water is so hard and there's data or something at least out there that people talk about. Where it can lead to hair loss and things like that just by how hard the water is. So we've got Jolene filters to use as often or water. Actually, we've noticed the difference in our hair quality, but just through that. Cool. Sorry. Oh, speaking of the HEPA filters, did you know, when you bought your HEPA filter, this is me getting the weeds a little bit, when you're looking at your HEPA filter, were you looking at the square footage as it's advertised? Like this is good for maybe five or square feet. Is that how you purchased it? That's how I did it. At least it was also priced to it. I was like, oh, for an apartment, two bedroom, like it should be able to put in different rooms. Yeah. So it's a, the marketing is really interesting. You have to be cautious of that. Not saying to go through it out, but it might not be like, for instance, if you live in a, if you have a 500 square feet that you're trying to cover, and then the filter that you're looking at says, Hey, it's good for 600 square feet. You're like, I'm golden. I'm set. Actually, what you should be looking at is something called clean air delivery rate. And there's a catter rating on it, so CDR. And what you want to, so basically you want to overshoot, right? So if you're trying to cover an area of 500 square feet, you want something that might be like closer to 800 900 because it's how many times can you recycle that air and filter it out and out? And ideally, ideally, depending on what you're going for, I told you the problem. I'm trying to solve for is my daughter's allergies and just that's the biggest thing. So I want that air to be cycled out four to five times an hour. So you want something more powerful for that. But if you get something that's just going to cover the square footage, you're not going to get that you might get one hour once an hour. And that might not be sufficient. Gotcha. Cool. Question though, sauna used. I know that's been something that people have talked about. Can you sweat out these microplastics? Yeah. Great question. I'm not sure we know. Yeah, they are small enough where they probably could exit through your pores and through your sweat glands. But I don't know, I didn't come across anybody looking into that specifically. I think you would have to be in the sauna for quite some time to be able to have drive a substantial amount of sweat. And I know people feel like they're sweating a ton, but enough that you're excreting a substantial amount. You certainly can excrete it out through your bowels and your urn. And that's what a lot, which brings back an addition point and antidote for it. Fiber. Yeah, that fiber, both fermentable and non fermentable fiber will bind to that and help you excrete some of these some microplastics out. But again, it's like you should just be eating fiber because it's good for you anyway, for a million other things to do it. By all means, please more apples. Absolutely. Very cool. What's interesting? I know we'll just go back to P passes, but the raw, the Patrick episode, the one fact that blew my mind was if you hand sanitize, you're actually increasing the absorption of the P passes. So if you're like touching a receipt and you think, oh, I'm going to hand sanitize to get rid of it, you're actually increasing the absorption of those P passes into your body. So it's like, wow, yeah. What are you doing about these receipt situation? I find this to be really I leave it. I leave I just leave it after I so a lot of itself check out now, right? So I just leave it there and I see a lot of people doing the same. And when I actually, if I see like the people who work there, the associates, I let them know, and I'm just like, Hey, you might want to wear like a glove and natural glove when you're working there to take these receipts out. But I try to say I don't need receipts or text the receipt to my phone or something. Yeah, they can text it. Sometimes I can email it now. I forget. I think it was on that episode with Chris Williams and where she had talked about the study where they looked at these people who were, it's not clerks, what's the word I'm looking for at the registers cash registers. What do you call them? Check out people cashiers. Thank you. Yeah, yeah, sure. I don't know where I cleared. I think some of the studies looked at cashiers and the overall exposure after handling receipts pretty much all day was negligible. And so if you're touching one receipt a day, I'm not really sure that's something. Again, I don't think it's going to be that receipt, right? It's really going to be you going home where you're synthetic carpets or if you're driving home and you hit the brakes real hard, just the off-gassing of the tires. That's the exposure. So that's why I think if somebody needs to pay attention, where are you spending more your time touching that one receipt or at home for five hours, eight hours over the night, sleeping. So maybe a happy filter in your bedroom might be a much wiser move than receipt. I'm always freaked out about my last four of my credit card. You know what I mean? A victim of identity theft, not too long ago. I'm not trying to get that information anybody. Another hack here, we'll just keep this episode on hacks was I read this on Facebook actually about when driving if you're stuck in traffic, you're actually accumulating a lot of that pollution, a lot of those micro plastics. So keeping the windows, but recycling the air within your car. So that's like the bottom with the arrows are continuous. So no, we went to use that button and turn on the recyclable air in your car. So if it's hot, what you want to do is put down the windows, turn the AC on, wait till the hot air can actually come out and then put the windows and then use the recyclable air, but when you're stuck in traffic, you actually don't want to put your windows down, which a lot of people will do because it's not windy because they'll hear the music or whatever it is. You're listening to and you're still getting some nice air out. That's the one thing to be careful that Fred. So let me, you're saying the recyclable button when you are in traffic. Why is it pretty much cruising you? You can use it if you want, but I'm just saying most people put down the windows when they're probably below 25 per hour, you know what I mean? If you're going 70, you usually have the windows up because you're trying to listen to the sound or whatever you're playing. So that's just something to watch out for. If you're a bomb or a bomber, you know what? Yeah, that is interesting. Yeah, like you said, like the off-gas saying everything with a gas yet. Yeah. Huh? Yeah, that's interesting. Other things I think people can do if there are, um, if you're looking to purchase carpets, that's another one or any type of flooring in the house, that's these VOCs, right? So volatile organic that are released of pretty much all the products that we have, all the synthetic stuff. And they'll release some of these forever chemicals as well. A ton of because they're great like preservatives as well as microplastics. You can look for some very stringent certifications. So something that I came across called green guard gold certifications. They have very strict criteria of minimizing VOCs. Certainly things like pure wood is going to be better, but that's expensive, right? But if your carpets is a big one, I'm a big carpet person. I like that. I such like a little roll around on the floor. And wool carpet turns out is very expensive. I don't know if you knew that they don't look good. They look very ugly, but they're good for you. They're good for you. So you guess you could always do that if you're willing to pay $12 a square foot, which adds up, but synthetic carpet. That's another thing you can look at is certain certifications that have more regulatory mechanisms built into protect you. Cool. Go from here. Well, what else have you listened about? I could tell you about this interesting study that I came out. Did we ever talk about, hey, I'm going to ask you, do we ever talk about? There's this amazing paper that came out. I think it was regional anesthesia last year, last fall, that where they took the UK bio bank people and they put them in MRI scanners and really wanted to see if adipose tissue visceral fat and subcutaneous fat around the abdominal abdomen. Abdominal region contributes to or has a correlation with widespread musculoskeletal pain. Do we ever, do we ever talk about this? I think we might have, but I think we did. I think we did. Yeah, about the visceral pain and, yeah, for some reason came back across my feed and I was looking at this and it's like, man, I don't remember it the first time I'm looking at it to see what the sample size and that was. It was quite large. Again, just an association study just for the listeners, just to catch you up of the new listeners that we have. So the UK bio bank is just this did data bank that they have that they just from time to time will check different things on. They collected tons of data. I think Dr. World Bolsoids came back and talked about that as well, right? When they were looking at them, got microbiome on that. And what they wanted us to see is these people, they brought them back and asked them if they had pain in multiple locations of the body. And it very anywhere from neck pain back pain shoulder pain to lower extremity joints, both axial and appendicular skeleton. And they put them in MRI scanners and wanted to quantify visceral fat. And that's that fat deeper inside around the organs. That's what we call them more dangerous fat. It's considered to be it's like own organ, like an endocrine system almost. The inflammatory markers, it'll secrete. And then the subcutaneous fat, which doesn't look good. That's the one people are going for with plastics. However, it's much safer, more inert. Either way, either one was more detrimental. As you can probably imagine, visceral fat was more problematic. I think in women, like there was an odds ratio of 2.04 with every standard deviation. That's pretty high odds ratio in terms of that in correlation to pain. In men, a little bit less, both for visceral fat and add up to things like somewhere in the less than 1.5 for both of them. But I think that's really interesting because the conclusion the authors had is, oh, we should actually be looking at a topic fat as retreating people with pain. Okay, obviously, but I don't know, I don't know what to make of that. Yeah, how do you breach the topic of weight loss with patients? I find this very difficult, at least in the setting of inpatient rehab and like skill nursing facilities, because so many have eat light joint pain fibromyalgia. As such, what you're talking about, right? In this correlation with how they're feeling overall, but also just pain itself and knowing that, hey, if they lost some of this weight, it'd be in much, much better shape. I gotta be honest with you, I don't think I can't remember the last time I ended up bringing up patients bring it up to me. And this goes to show like they know what they need to do. It's just hard to do it, you know, like majority. I know I was humbled by that one experience in fellowship where the person didn't know fruits and vegetables were good for you. But most people know that's good for you. Most people know the chocolate's not good. So when I'm treating people with neosteroidase or hip arthritis, just chronic pain, they'll say, I know, I'm sure if I lose some weight, it'll help. And that's where I jump in. I was like, yeah, we could, you know, what are you doing about that? Or would you like to talk about that? That's an opportunity because they just gave me an in invitation to explore that topic. I got to tell you, I being in PM and R, we're typically third, fourth opinion, right? We're never the first, first opinion. So that's where as long as you develop that rapport with somebody, they will bring that up. Seriously, yeah, I've never had somebody yet come up to me, admit it to say that, hey, I think I need to lose weight. And I don't know if it's just the difference in setting, like all patient, maybe they're a little bit more ambulatory, they're in more of the community, they're able to have that insight and that struggle of walking from the parking lot to your office versus for me, it's an ambulance just taking them from the acute care hospital to here, they think they're going to get better just through rehab. And that's all they're really focused on is moving forward, rather than looking inside and have that insight to see what they need. So I just found that interesting. I think maybe one thing now that we're talking about this, when I am discussing the importance of physical therapy, which is glorified strength training and exercise, and I'm telling them how they can protect their joints and their bodies by building muscles, so you have these active stabilizers to create more resilience. So those tissues can tolerate load better. Then they start understanding, oh, okay, so I got to build muscle. Oh, okay, muscle is good. I have all this thigh mass here. If it's not muscle, what must it be? It's a cue to them that, oh, I need to do something about this. I think that might actually help us. I do that with my diet medications a lot, definitely talking about how muscle can be the metabolic sink and actually improve and get them off insulin stuff. So yeah, we're learning a lot of interesting things about metabolic health. I think there was, I got to find this to, so don't quote me on this, but I do remember coming across a paper last year that talked about how people with metabolic syndrome or just metabolic, the unhealthy, which we know is, I don't know, greater than 80% of America at this point, close 90% according to that one study, two years ago, they tend to have more tendinopathy and their healing potential is far lower with tendon injuries, which our diamond does. When we're having conversation about, I do a lot of PRP and other biologics, oh, is this treatment going to work? Am I going to be good in six weeks? Am I going to be good in eight weeks? That's another great opportunity to be like, actually, this is giving you the raw factors, right? Like body still needs to put them in the right places. You need to still do these things, but this is just like the building blocks that we can give the healing and stuff. That's up to you. What are you going to do? Are you going to be in an inflamed state overweight, right? Metabolic and healthy, eat bad sleep poorly, because it's not going to be a good environment for healing. Yeah. Yeah. Hmm. I'm sure. Cool. What also the agenda? Oh, here we go. I've got a, I've got a bone to pick with Adam Grant. So you follow him. You follow a lot of this quote. Sad he puts on love and stuff like that. I'm a big fan of Adam. I want to bounce, I guess, this idea off of you or at least try to understand your thoughts, your perspective. I guess 99% of the world will agree with this. It's going to be an unpopular opinion for my end, right? But he has a quote right about reading. Pete says, you shouldn't finish every book. You start abandoning a book is not an admission of failure. It's a sign of wisdom. You've decided to let go of some costs. The purpose of reading is to be entertained and informed. If a book doesn't bring joy or insight, it's time to move on. You agree with that? I want to agree with that. The overachiever in me has a hard time. I've only abandoned one book in my entire life, even though there's lots of books that I've never liked and that was sticking fast. Thinking fast as love, okay. Thinking fast as love is very long, man. That's the only book I've ever abandoned. Every other one's I've gripped my teeth and got through it, even though I'm like, man, just because I don't feel good about myself. And I'm like, maybe there's some gems at the end waiting for you. I look at a lot of people, wiser than me, smarter than me, have said this. He's a big fan of the sun cost fallacy, right? He talked about that and think again, too. And we talked about the somebody like going to neurosurgery like six years in there, they won't quit because sun cost fallacy. Lots of my students have, I had this for a long time. I agree with that concept is that just because you dug a hole, it doesn't mean you should dig a deeper because you're like, I just wasted so much time. I think it to directly answer your question, I agree with that. I have to, I want to get myself to be able to do that, though. I haven't been so executing it. What are your thoughts? That's good. So I agree with sun cost fallacy. I just do. So I want to separate the two. There's fiction and there's nonfiction books. I think with fiction books, it's a little late because you're typically reading for entertainment when it comes to fantasy, sci-fi, things with fiction. For personal development, self-help, nonfiction, people tend to read the book one because they think it's going to bring value into their life for the current moment. Two, they've seen other people read it and see how it's changed their lives. Three, they've seen recommendations and ratings at least from friends or something that said, oh, you got to read this book, et cetera. I, I believe it's like vacation in a way. So it's like you where if you don't stick with the book, you don't know if you're going to hit that gem. I always think of that cartoon of the minor, who's trying to go through a cave, but he's so far in that tunnel and he's, I'm done. He's going to walk back and then right below it is another minor. He's going to do that cave and he hits the actual diamond just because he went one inch further. Yeah. I guess my issue with the whole. Sun cost fallacy with reading is when do you know when to stop? When do you know that you're not going to get value or insight? Because a lot of times as an author, if you're writing, and I'll say this because I would write a lot of poetry, the ending is what connects the beginning. And you, you know this as a writer is that you are trying to, the ending is what makes people zoom out and say is what the essential concept was or that's what the value was. And now I can have a person on every little chapter and say, okay, this is how it all relates. This is what I can take away. And so I don't think it's on the, is the Otis of the reader or sorry, of the author. It's on the reader to extract what they can, not necessarily for themselves to say, I'm reading this and this book didn't help me. But now thinking about why it didn't help you, you know what I mean? So I feel like there's always something you can take away. It just depends on the reader to buy to that perspective. And I understand not everyone's going to be at the point of quote that level to try and dissect books and try to figure out the themes and the human condition and all those different things. But that's where my mind goes is that if we expanded this to, let's say medical school, we talked about how a lot of students have some cost fallacy. I'm pretty happy now as an attending. I obviously didn't know if I was going to be. It just took getting to that level. Knowing when to quit a medical school is so tough unless you know what's at the end. There's not as much risk, right? With medical school, there's more risk. It's your life, but there's not as much risk with a book. And so I'm a big believer of actually having the grit finishing the book. And then seeing why one, you might not have liked it too. What the insights were in three is zooming out and seeing why the hell did all three even write this? I don't know. That's just kind of my thoughts on. Yeah. That's awesome. It's a very unique perspective because what you're suggesting there is that if you read it and you hated it, you so it's still go back and reflect about why you hated it and stuff. That's a lot of work, man. You're asking for a lot there of people. I think and maybe I'll just speak for myself. I feel like when I read a book, I'm developing this parasocial relationship with the author for a while. Like I'm really getting into it and get I'm like, let's take Ryan Holler. So I really, I loved his first two. I did not like stillness of the key. I don't know how you felt about the trilogy there. That was my, yeah, that was your favorite one. That was my favorite than obstacle in ego. Yeah. Yeah. So mine was ego is my first one. And I think what that speaks to me is even though you and I like we do have some similar thoughts and many of these things that we talk about is different messages resonate with people differently, right? We believe that why you have to find a, if you have a coach, you have to find that fit, clinician, whatever you might have. And so if somebody is investing in that and at some point, you're like, this is just not a good fit. Yeah. Do you cut those ties and move on to something that actually might serve you better, right? Because let's just say if we just put some numbers on it, right? Let's just say it's, it's take somebody 20 hours. You're also a very fast reader. Not everybody's like that, right? And people that take classes like you did. So the average and let's just say it takes somebody 20 hours. And if 10 hours in, you decide, hey, listen, I'm going to take 10 hours I have left and I'm going to do something else productive. And now you've done put that towards that and you've actually cut those to some call. So to speak to your point, it's like, yeah, when do you know when that is? Do you quit one hour in like in the event you could five hours in? I don't know. I don't have an answer to that question. I think there's just something so gratifying. They're like finishing this book and then getting to another, did more difficult book. And I'll say a few years ago, I would never have read Dostoevsky. Like the greatest, the greatest novelist of all time from Russia. He's wrote a crime and punishment in all these other books, right? So I just read one of his books notes from underground and it was drooling. It was drooling. Like it is very difficult to read, but you come away with an appreciation once you've built up to that. And you don't know until you pick up the books that you like and that you think you'll like and actually finish those because you picked it up for a reason. You know what I mean? I think, no, that's where I just like, oh, it makes me a little antsy. Or if so, what he says that. Yeah, I think, yeah. Another point to consider is because a couple of people say, Hey, this is a really good book. Might not be the best reason to read the book. There's a couple of books. If you'll suggest a book to me, I'll put it on my to read list. And then I will, when that book speaks to me, because I know enough about it or I've explored the topic and I'm like, okay, I'm, I think I'm ready to try this. Because I think that's another point as well as there are certain times and certain phases in your life that a book is going to different to you. Like when I read obstacles the way I loved it, but I was going through actually something difficult in my life at that point. And that was the book that I needed when if maybe times are really good and I go back and read the book, maybe it doesn't hit me the same way. So I think oftentimes people will just read a book because it has really good reviews. And it's right now that's not the book for you. It's you're not going to pick up that message. You know, what's it? What's the saying? It's when the student is ready to teach or will appear for some version of that. Yeah, when the student is ready, yeah, the master will appear. I think books are like that in some sense is to your point of those really deep ones, there's some lesson there. But if you're not yet, you're not ready to extract that lesson. You're going to think it's a terrible book. No, I totally agree with that. But I think a podcast too, right? And this is how I talk to me about this all the time because just like, how do you consume some of the podcasts? How do you retain the information? And to me, and I'm not going to say this is like a life worth living, but a life that's more interesting is being able to listen to things that you may not be interested to or that you are interested in, but learning perspectives and putting them into your rolodex so that you can share with other people. If you want to become your communicator, you listen to people who can communicate. It's all modeling in the end, right? If you want to be smart, you listen to smart people. And over time, you're going to start to talk like them and have the same cadence as them and whatever it might be. But it's very difficult to read nonfiction and think you're going to personally develop without the ability to extract even if it's something that may not be relevant in the current moment, if that makes it. It does. Now, that's a really strong point as well. Speaking of consumption and retention, are you still using snipped? I'm not. Why you didn't like the UI of it. I just need that. And I also, I'm pretty good at retaining and talking about the podcast that I'm not, I just know myself. I'm not going to go back and look at it fair enough. So I'll tell you what I did. And for those who don't know, so sniped is where did I hit? I heard Kevin Rose talk about it somewhere. Um, and it's a podcast app where you can actually clip a little portion of and it'll create, it use artificial intelligence to create a little insight of whatever you thought was interesting. Some topic is that perfect. Sometimes it'll catch like weird things that I don't want to catch. So you have a little manual work to do, but it links to read wise. And I think I'm doing the free trial, but I'm going to invest in read wise. And then that'll pump out, send me emails periodically, and I'll look at those. I think actually that's that I wanted to make a better point of is because I would always go back to my notes app and write stuff down. I just want to be quickly able to click it and then like if us some other time, I'm there for training or something like that. I'm just sitting there. I can go through my read wise app and like, okay, I'm going to keep this. I'm not going to keep this. I think that the application piece, which is something that I told the PQ folks. I was like, this is something that I want to work on a lot, actually, because or consuming knowledge is not a problem for people like recently podcasts. The videos I were watching and that kind of stuff at a different type of rate. But it's okay. How do you execute this over and over again? Application wise. This is what's interesting, right? PQ. So like you said, I'm a pretty fast reader. I've learned good gym, quick and stuff. And I used to just blow through personal development books. I went back to listen to the Hormuzi Chris Williams in podcasts, the 21 truths and they talk about sitting with books and actually enacting what they're talking about, right? And not moving to the next book until you're able to do that. PQ has made me realize that I need to start doing that. And like you said, you have to choose a book that is, I guess at our level now, something that's actually going to affect our lives and that we're going through. And so currently I'm reading essentialism by George McEwan. And you know, that book is not hard to read. I could finish it in two, three days, but it's not been two weeks really taking it in. And I'm actually reading a lot more fiction now to fill in the gaps. So that way I can really soak in the essentialism and and enact it day by day. And actually every day, look when I'm meditating, when I'm doing my PQ. And for people who don't know a PQ is, it's called positive intelligence. And so it's similar to emotional intelligence, social intelligence. It's a framework to become more positive in your day and reduce your saboteurs. And we'll do another episode on this in the future. Yeah. I'm just going through it. A course right now that I just completed, but it's been life changing for me. And I've done a lot of good things, but it's been interesting. How that course has actually changed the way I now choose what books I'm reading and how quickly I'm reading them. Yeah, just for clarification, PQ is positive quotient quotient. Yeah, positive. Yes. People are going to like these guys are so ESL, but these books aren't helping them. Yeah, they need to read some more. Yeah, same concept with Zhang, right? When he was on steam Bartlett's talking about Hey, Media application. I remember I love that guy. He's got so much energy and infectious. I immediately was in patient rooms applying the speech thing. Actually, I did it at home. And I'm really my wife was like, Oh, I don't like this. I don't like this. Stop it. I slowed my rate of speech down because usually it's much faster. And she was like, I don't like this at all, which is funny. Cause Vin said that's exactly what'll happen. And that was great. And Jeff Jefferson Fisher, you liked that one too. He taught until I started employing some of those strategically stuff is really hard for me personally. I was thinking about picking up his book. That stuff is what Vince talking about is it is more of an instrument. What Jefferson is talking about is almost like a superpower. If you can bet on that in 100%. Yeah, it's definitely death. What's funny? You mentioned those two. So yeah, I always say there's three people, right? So Vin, Jefferson Fisher and Vanessa Van Edwards. I think like the track factor, right? If you can have the body language, the words you're using and then you have the voice and communication behind it. Yeah, you can definitely start a live round. Yeah. Well, hopefully people will at least check those out. Hopefully people stuck to the end of this episode. So they can learn about those gems that we're going to share. And if people haven't heard it already. But yeah, Vin Zhang, Jefferson Fisher, Vanessa Edwards, see it on multiple episodes, great stuff. Cool, man. Should we should we hang it up here or anything else? Yeah, nothing else on my end. He's always fun. So we'll see what's in store. Go for me. Love it. Check your hape of filters. Yes, sir, yes, sir, until next time. Thanks for listening to the other episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms where you can find more content like this. You can follow us on Instagram, Twitter and TikTok at Med Redefined. We also want to thank our team for the production of this podcast. Arita Yeporian social media, Zana Blugmani, our research and Sarah Han for newsletter. If you enjoyed the show, please be sure to subscribe, review and share with anyone who you think will gain value from this as well. Now time for the ever so important disclaimer. This podcast is intended for general public use and is for educational purposes only. It does not cost you the practice of medicine, no should be construed as medical advice. No physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal position regarding any specific health related issues.