3. Jyoti Patel, MD: Journey Into Integrative & Functional Medicine

Hello everyone, I'm Dr. Darsha Shah, 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, this episode is being brought to you by Physician Wealth Services. Physician Wealth Services, PWS, is a fee-only financial planning firm devoted to the financial well-being of physicians. Ryan Inman, founder of PWS and creator, host of the Financial Residency Podcast, developed a sense of responsibility to help physicians with their financial goals after witnessing how vulnerable his wife was to poor financial advice during residency. He was shocked at how many advisors try to take advantage of her and her peers. Ryan started PWS as a fee-only practice so he could work exclusively with physician who could truly benefit from unbiased, quality financial advice. Working with Ryan is simple and transparent. There are no assets under management fees, no products being sold or commissions being paid out. Everything is included for a flat monthly fee, the way it should be. To work with Ryan so you can feel more in control of your money, contact him and his team at doctorpodcastnetwork.com for slash physician Wealth. Alright everybody, today our guest is Dr. Jothi Patel. Dr. Patel is triple board certified in Integrated Pediatrics, Internal Medicine, and Integrative and Functional Medicine. In this episode she opens up about her personal journey as a cancer survivor and how she unexpectedly fell into the fields of Integrated and Functional Medicine. You will also hear about her unique approach with her patients, which is definitely something that is different than the way conventional medicine is usually practiced. Her goal is to empower her patients with knowledge so that they can take control of their own lives. And then if you stick around until the end of the episode, you get to hear some tips on how you can boost your immune system, especially as we all try to protect ourselves from COVID-19. Alright, let's get to it. Alright guys, welcome back to another episode of Medicine Redefined. Today we have Dr. Jothi Patel with us. Dr. Patel, how are you? I'm great. Thank you for having me this morning. Awesome. Awesome. I got to say that Darshan and I have been working on this project for a couple of months now and when we were just brainstorming right off the bat, he had mentioned your name. And at the time I wasn't familiar with your work, but since then, I have been following you and I've been very impressed both on social media and kind of what you do over in Arizona as well. And you've been juggling so many things and you're kind of like a master of multiple different disciplines I'll say. So for those of the listeners who don't know what you do, why don't you tell us a little bit about yourself, your journey and how did you get to where you are today? Yeah, well, first of all, thank you so much for having this platform for physicians and for patients to learn about integrative and functional medicine and any other alternative type of practices. So thank you so much for creating this platform. From my own journey, again, I am traditionally trained, conventionally trained in internal medicine and pediatrics. So for those that don't know that it's a dual residency, it's a four year program where you're bouncing back and forth between internal medicine and pediatrics every few months, training with both internal and pediatricians. And so I'm more certified in internal medicine and pediatrics and I practiced primary care for now going on 17 years. I started my journey in integrative medicine, which for those who are listening today don't know what that is. It's a comprehensive, personalized approach to healthcare. It's looking at not just disease processes, but also looking at the patient as a whole, looking at their lifestyle, looking at their nutrition, looking at their movement practices, their sleep, their stress, their purpose, their passion, their spirituality, their people in their life and putting that together in their comprehensive treatment plan. So I really went on this adventure about three years ago, went down to Tucson to the University of Arizona and completed a fellowship in integrative medicine. For those that are listening, it is a certified, recognized sub-specialty, so it's board certifiable. So any physicians that are thinking of doing integrative medicine, just to know that it is blessed biomedical industry as a valid specialty. And during those two years, I learned a lot about myself, but I also learned how to take care of my patients a lot better. From that point on, I went on to do certification in functional medicine and for those that are listening that are not familiar with functional medicine, it's in the same vein, but it's looking at the root cause of disease. So when we in medicine see somebody with a rash, we automatically call it a name and then we give it a drug. But in functional medicine, we look at that rash and then we start to investigate what is causing that rash. What is the root cause of that disease process? It didn't just erupt and it doesn't just have a cortisone deficiency that caused the rash that we're going to apply now to this rash. We need to find out, is it a gut imbalance? Is it dyspiosis? Is it stress? Is it something they're putting on on their skin? Is it toxins in their body? Are there other underlying root causes for that disease process to ensue? So functional medicine really spoke to the scientist and me. I really loved relearning biochemistry and the Krebs cycle and looking at nutritional deficiencies, looking at where vitamins and minerals and in micronutrients actually help support the system and how we can then use these tools along with conventional medicine to help the patient heal and prevent disease. So I know that's a really long answer to your question, but I really, I'm excited about medicine again. I did go through a paic phase of burnout where I was practicing traditionally and I was sitting in the exam room for 15 minutes with each patient just trying to figure out what prescription I'm going to give them so I could go to the next room and stay on time. And I know that sounds like a morbid description of medicine, but I found myself in that sort of rap race of just getting through my patients, my charts and my notes. So functional medicine and engraved medicine gave me an outlet to really try to help people at a deeper level. That's all I love that that's that's a great definition. You know, I get asked so many times, well, what is functional medicine and me and ultimately are physical medicine rehab doctors? So they think functional medicine has to deal with more of moving around, which sure that's like that can be a whole nother definition, but like you said, root cause and that's something as as in right now I'm doing my pre limb year internal medicine. It's not something that we get to do in the hospital and like you said, you're kind of in that rat race. You're almost thinking just getting done with the patient, figuring it out and that leads to the burnout. So what was the conversation in your head? What kind of led you to choosing integrated functional medicine and going down to Tucson? I think it all depends on the people you surround yourself with, right? So if you can imagine your time through college, what led you to go to medical school? It probably was the environment, right? You could have gone in two different paths. You could have picked people that were not motivated for partying all the time and lost track of where you wanted to be in life. Or you surrounded yourself with good people that were interested in medicine and interested in you and believed in you and then pushed you to go to medical school. And then what led you to the specialty that you decided to go into? It was probably some influences from the people around you. You may have shadowed somebody who really influenced you or you had a personal story or a personal injury that kind of drove you to that subspecialty, right? So we are sort of creatures of our environment. And in that same way, I could say that's what happened to me. You know, I had friends that were starting to go through burnout. Other physicians, hospice, and Tarnas, you know, they were going through burnout. They were starting to get frustrated. One particular friend in particular, she had a bad outcome when she was on call one night and it really took her down emotionally and she started to find her. She wanted to go find herself. She wanted to quit medicine. First of all, she wanted to quit medicine. And she went through the program and when she went through the program, she came and talked to me about it because I helped her through the burnout. And she said, this is amazing. You have to look at this. And at the time, I was sort of drinking the Kool-Aid. I was like, I'm fine. I'm working hard. I'm doing what I need to do. This is all about everyone else. All the other people are suffering. I'm actually doing what I need to do. And then I went through the program and I thought, holy crap, I'm going through this too. I'm also not taking care of myself. I'm also, you know, stressed out, not sleeping, not eating well. I'm telling other people to do this. I'm not doing it. And, you know, I'm not loving the way I feel and I'm not passionate anymore. What's happening here? So I think it's a combination of external environment that sort of shows you the way. And then this internal reflection that you start to like realize you need something different. So it's a combination of those two things. And everyone has to come to their own point at whatever time it is for them. So if I'm talking to a doctor and she or he is not there yet, they still think that the rat race is really what they need to be. I'm not going to be able to change their mind, right? They have to really feel that this is the path for them. They have to feel that they need to change their way of practice. They need to look at why they're in medicine. And they need to really investigate whether they're doing the best that they can and serving your purpose. And so that's how that's what I would say to anybody listening is, you got to find it yourself, man, because I was hit wall for years and not even know that I was hit in the wall. And until I did. Yeah, Dr. Patel, that's so cool. I mean, I couldn't agree more about there's always some type of influence that you have, whether it's your personal journey. Like you said, you know, could it be injuries? And that was the case for me, right? I've been an athlete. Dar's going to relate to this. I knew that I wanted to support some medicine. And it was, you know, surgery wasn't really the way for me. And I realized that, hey, non-surgical approach, there's so much we can do in musculoskeletal medicine. And that's where I connected with Permanor. Not only that, but the osteopathic philosophy of looking at the person as a whole, right? That very much holistic care, you know, body's intrinsic ability to heal itself. Those really resonated with me. And Permanor or physiatrist more so than anybody else were kind of speaking the same language, if you will. And so that's, that was the reason for me. You alluded to your friend's story. Were there any own personal experiences that you had to overcome and the adversity that you said, hey, this rat race, this is not the right way to approach? I got to take a step back and revisit how I'm approaching medicine for myself and maybe my patients. Yeah, and definitely there, we all come from our own personal stories, don't we? And for me, it was during residency. I was a third year going into my fourth year. And I had a diagnosis of thyroid cancer. And at the time, I just, you know, I knew a lot about it and thought, you know what, this is just a nuisance. I'm just gonna have the thyroid removed to the radiation. I know what needs to be done. I'm gonna check that box, right? And keep moving. And I did. I went through the residency while I was doing the treatment didn't care, didn't really put any emphasis on why I was sick, what caused the illness and what this meant for me. And right as I was graduating from residency, my oncologist asked to do a PET scan. And to my surprise, I actually had metastatic disease. It was a variant, a tall cell variant of papillary cancer, which is not common. So I ended up having to have a radical neck dissection, which they did sort of an apron cut for my ear to my ear. And I had to do lift nervous sections. I ended up with a recurrent nerve palsy. So I actually ended up with, you know, inability to move my right arm and my right side of my face. And I still, at that point in my life, did not believe that there was any connection to my lifestyle and my disease process. It was still a nuisance to me. I still was like, don't it? I got a job to start into weights. I've got graduation. I've got to move across the country. This is getting in the way, right? So I go through the physical rehab. And thank you to all those people that do that work. To recover my vocal cords still paralyzed on the right, which is fine. But my face, you know, is not asymmetric anymore. My arm, I can use my own well. I still did not think that my disease and my lifestyle had anything to do with each other. I took a very high stress job, worked long hours, incurred two more recurrences with metastases now to the opposite side of my neck, had to have two more surgeries to have lymph nodes removed. I still didn't make the connection. The health and disease have everything to do with our choices in our lifestyle. I was working godly hours. I was pushing myself. I wasn't eating well. I wasn't taking care of myself. I definitely didn't sleep well. And so to answer that question, it wasn't until that fourth surgery and that breaking point. And my employers telling me, we're going to rescind your partnership because you've been sick. And I was like, that's crazy. I'm working. I'm here. I've never missed a day of work. How can you do this to me? But it was the best thing. It was the absolute best thing. It was what I needed. I needed that door to slam in my face. I needed a kick in the pants to really kind of see, like, look, you're not doing yourself any favors by pushing on the gas pedal 24-7. What are you trying to prove? What are you trying to achieve? At this rate, you're going to be doing nothing, right? You're going to end up paralyzed, maybe with a stroke with your next surgery. And this isn't going to get you anywhere. And so I left that practice and I sort of reset. And I decided to start my own business, my own practice, leaned on my family, leaned on my parents. And that's another thing. Doctors hate to ask for help. We're super human. We think we're super human. We think it's a sign of weakness. We think it's for the patient to be sick and need us. We don't really need anyone else. It's maybe somewhere down deep. When we needed somebody, we didn't have somebody. So we learned how to cope with that by showing strength externally, even if we had to fake it to make it. And then when we go through residency, again, it's that whole facade that we're super men and super women, because we're trying to prove ourselves worth. And I had to just kind of have this coming to Jews moment and say, you know what, that's just BS. I need a break. And nobody told me. And that's where I talk. Every resident that comes to my clinic, you deserve a break. If you need a break, take a break. If you need to take an afternoon off, just pretend you're in clinic. I won't tell anyone. Because I really think that that is needed in our training. We really need to give ourselves time to reset. And I did that. And then of course, I built up my clinic the way I wanted to. I loved my practice. I loved my patients. I was a small town doc. I had the ear of every patient that came in to my clinic. They loved coming in. I loved seeing them. And then I have to say, managed here, I started to come in a little bit more. And the pressures started to rise. And there was so much more intrusion in my little tiny oasis of a practice. I wasn't able to do what I wanted to do anymore. I wasn't able to spend the time, get to know my patients. I wasn't being reimbursed for my care. Now there's metrics and there's algorithms and there's things that I had to submit to get paid. I had to follow protocols. I had to cookie cutter medicine. And so then I started to reevaluate. And here's another lesson. It's never too late to reset again. Yeah, I thought I met my moment when I quit that practice and I started my own practice, but then I reset again. Because I was like, no, this is not what I want to be in life. Let me start over. So, you know, you're always starting over and it's okay to do that. I give you permission to do that. Wow, Dr. Patel, that's so crazy. I figured there was some adversity, but I wasn't quite ready for all that. But, you know, it's so impressive. Just to your point about resetting, I think that, okay, I'll give an example. Last night, my internet was not working well. And I hit the reset on my mode on like six or seven times. So easy to do, we don't think about it twice. But when we're talking about hitting the reset button on our life, it's terrifying, right? Especially in the field of medicine, when you kind of, you put your head down. Yeah, I tell people all the time or people who are pursuing medical school. I'm like, you know, it's not complicated. It's, you just need to be really patient and you need to be resilient. Because it's a long road. You just gotta keep jumping one hurdle after another. And it sounds like you really had gotten almost to that finish line, right? It's after residency, you're ready for your first job, is that right? And I wonder if it wasn't for that adversity, that battle with cancer, that kick in the pants, as you said, if you would have hit the reset button, because I think a lot of people might have similar struggles, but because they don't get that adversity, they don't have to take a step back and say, hey, what the heck is going on around me? This isn't right. And I wonder how many people go through it. I know that I've seen a lot of people, a lot of physicians 10, 20, 30 years in, who maybe needed some type of kick in the pants to hit the reset button. Do you come across those in your colleagues, have you in your experience? Yeah, very much so. But until they get that epiphany, until they decide that that's what they needed to do, there's nothing you can do to break them, because they have this mindset, right? It's all about a belief system. The belief system is tethered to what we feel we mustn't do. I'm only worthy, if I'm a doctor, I'm only worthy, if my patients love me, if I get a five-star rating on Google, if I, you know, all these things, right? If I'm popular in social media, if I have a car, if I have a house, if I have, you know, things, if I can, you know, bling out, whatever it is that, and it doesn't even pertain to doctors, I'm next, span this to everyone that is listening, we all have this belief system that gets us tethered to what we must do to achieve worthiness and acquire things, and acquire objects, and acquire wealth, and acquire recognition, and acquire accolades, and certificates, don't look at the ones behind me. And so we find that there's a sort of constant chasing of worthiness that we're all doing, but until you realize that you're already worthy, until you have created enough in your life that makes you feel loved and protected and safe and enough, you're still going to continue to chase that thing. So yes, I meet a lot of doctors who are constantly in that mode of, look at me, look at my title, look at my letters I have, look at my certificates I have, look at what I've accomplished, and I'm accomplishing more, and this is how many books I've written in, and that's how they define themselves. And unfortunately, until you change that belief system, and you recognize that you're not tethered to what you do, but who you are, until that happens, there's no change in that algorithm. It's all based on that internal belief system. So I love that you talk about stress resilience. Thank you for bringing that word up, because I think the public thinks that we have to be stress free, right? That we need to just zen out and meditate for 14 hours a day, and that would just be so good. And then maybe if we just did a yoga class, and we were doing all these poses, life is just gonna be perfect then. And I feel like that's also a misnomer. We find that we're looking for external distractions and escape from stress, but what we really need to do is build up that vessel of resilience just as you describe. There's going to be obstacles, there's going to be hurdles. You just have to be able to move through them, right? At a study pace. So what I describe is a vessel of resilience. If your vessel of resilience is a cup of water, and your stress is a table full of salt, that water is going to taste free salty. But if your vessel of resilience is a hundred gallon tank, then that tablespoon of salt is going to taste like nothing. So how do you build up that vessel of resilience is really what we need to teach ourselves and our patients. And that comes from a practice of everything in your told out that could be sleep, that could be people in your life, that could be purpose, that could be your spiritual beliefs, that could be your daily routines, your nutrition. It could be self-love and self-care. That's the vessel of resilience. When you have all of those pillars really fortified, then you get this little stressor. It's like this tiny, right? Little tiny residency blip, you know? That's just like, yeah, you had a bad day, you got yelled by an attending, where you diagnosis, where your patient didn't make it. Whatever that is, how big or small, you're able to sort of see that stress come up and then you're able to bring yourself back down the baseline, right? And that's how we get through medical school and that's how we made it through residency and that's how we're going to make it through the rest of our lives. He's learning how to build that stress resiliency. I love that, you know, going through medical school and all of us going through it, we learned and we know that there's no magic pill and we try to say that to our patients. But yet, it's almost as if we act like there's a magic pill for stress, you know? And being in this Western culture, where it's so dominated by go, go, go. And then, you know, if you work hard enough, you'll see the results. But, and I'm guessing you're what you kind of just said about this vessel, that's something you teach your patients as well. So can you tell us a little bit about what your current practice is like? Yeah, so my practice is not primary care anymore through the traditional insurance track. It's consultative practice. So when patients come to me, I think of myself as a Sherlock Holmes of internal medicine or pediatrics. So as a Sherlock Holmes, I am their investigator. They come in, they get a full hour, I want to have with me. Through that time, I spend most of the time listening to their story. And here's the other thing I've learned. 90% of everything can be solved just by being a good listener and being a good observer. So I sit and I listen to their story from where they grew up, maybe even what their stressors, their parents endured. What are the big milestones in their life where they may have had adversity and how that may have affected them? We talk about their nutrition, their sleep habits, their exercise habits, the people in their life, the stressors that they endure. There is spiritual mental wellness. We talk about that. And then I do a thorough exam. And it's not just cursory like it used to be. You know, it's like you've got two minutes to do a heart-lung exam. It's just to get to the plan part. I'm looking at their tongue. I'm looking at their nail beds. I'm listening to their heart and checking their pulse. I'm examining them. I'm truly looking and I'm present. And then we come up with a diagnostic plan. And this is where we are living in the best times. We have all the wealth of knowledge from Eastern medicine, whether it's traditional Chinese medicine or a Vedic medicine or medicine from the past. And we have all the modalities of modern medicine. We have genetic testing. We have diagnostics. We have imaging. We have even advanced functional testing where we can look at the micronutrients. We could look at food allergies and sensitivities. We can look at gut health. We can look at the health of the microbiome, which we didn't even know about. Maybe about 10 years ago, right? We didn't even talk about it. Now we have all these diagnostic tools that are fingertips. So then I talk to the patient about the diagnostics. I tell him it's not necessary. But if they want to dive deeper into the root cause of why they're sick, let's do these things. And then I give them a comprehensive plan based on what they are wanting to fix. Cause it's really important to find out why they are there. Cause if you are going in with your own agenda and you think they need to lose weight, but that's not why they're there, you're gonna lose the patient. So you need to find out what is it that they want? They want more energy than I focus on that. And then with that, I come up with a comprehensive plan which may include conventional medicine, but it also includes a nutritional plan. A movement plan, tools for them to help them improve their sleep, their stress resiliency. And anything else that they want to work on if it supplements or any other type of modalities that can help them get to better health. But the other thing that's really important is to hold your patient's hand. It's not just a one time visit where you see them, you tell them all these things and then they magically change their life, right? Cause it's about motivational interviewing. It's about getting to the root cause of why they got sick and how you're gonna walk them back to health. So it's giving them small, smart goals so that they can work on things on their own, giving them confidence that they have control of their own lives, empowering them with knowledge so they know how the body works. And then diagnostically showing them where things may need to be repaired and then giving them those tools. I don't ever dictate care, I give them information, I give them the tools to help them reverse their disease. And then I monitor their progress and I'm their cheerleader when they're successful. I'm like, you know, rallying behind them, showing them how wonderful their labs look, whether it's their CRP that went down, whether it's their lipids or the A1C went down, it's really about supporting their patient. We can only do that if we have time. So here's where my practice model has changed. I have a luxury of spending an hour and a half with my patients. I typically attract patients that are interested in finding the root cause. I typically attract patients that want to get away from the model of medications and supplements. And you know, surgeries is the only choice of treatment. I attract patients that really want to reverse disease or prevent disease before it happens. So yeah, my practice model has changed a bit. Yeah, that's so cool. So as a fourth year med student, I got to shadow a functional medicine practitioner and it was so mind-blowing. Like you said, hour to hour and a half visits, we're not doing that five minute history taking, five minute physical exam, five minute assessment plan, all right, out the door next. So it was really cool to actually see that physician patient relationship form cause as premeds were taught, oh, you need a shadow so you can understand that relationship, but in all honesty, you're not really seeing that. You're seeing that more so though in a functional medicine clinic. And the other thing I learned is it's all in the details. Like you said, and when I was shadowing, I learned, hey, you even have to ask, how are they born, vaginal C section, growing up, childhood traumas, all these things. Can you explain a little bit about the model, like the matrix that there is in functional medicine? Yes, of course. So it's looking at root cause medicine, of course. And there's an algorithm that the functional medicine, education, the certification teaches you. And it's about different systems, right? So in the core, in the center of the matrix, if the matrix is a circle in the core of it, is the connection between your mental, spiritual, and emotional wellness. So we always kind of come back to that as well as part of looking at why the patient is ill. Then we look at different components. We look at their assimilation of information, which can be through the GI tract, or the respiratory tract. Are there imbalances there? We look at their immune system. Are there imbalances there? We look at their detoxification processes. When we talk about detoxification, the body has an innate ability to care rid of toxins. And it's doing it all the time. It's not like you have to do a seven day detox and automatically get clean. Your body's cleaning all the time. You're cleaning through your skin, you're cleaning through your liver, you're cleaning through your gut, you're cleaning through your kidneys, you're cleaning through your lymphatics. So there's a whole section on detoxification. There's a place where we talk about energy. And if you remember back in the day, we talked about the mitochondria as the powerhouse of the cell, and it produces ATP. And so we go deeper into that, because the mitochondria, amazingly, are biological organisms that have been engulfed into ourselves, and they have their own DNA, and they have their own interesting intelligence about them. So we look at mitochondrial health and energy production. We look at transport, cardiovascular systems. We look at hormonal health, and you guys would be very happy to know, we have a whole section on just structural health. We look at the structural systems as part of the matrix. Then what you're talking about is a timeline. And when we input your patients, we ask them where they grew up, what their parents were like, if the mother had stress during pregnancy, if their grandparents endured stress, if they came from a very traumatic childhood, if their parents had diseases or addictions or predilections that may have impacted their being. Then we look at their timeline through life, but we also look at their nutrition, their sleep habits, their movement habits, their relationships. We look at all of those factors stress to see what might be the problem, the underlying root cause. So when we spend all this time gathering information, along with their exam, then we're able to put together a bigger picture of where the imbalances might be. So somebody might come in and have a lot of things that are going on in their gastrointestinal tract, where they may have a lot of imbalances in their immune system, where they may have problems with energy production. And I might say, okay, let's start where you feel like you need the most help. And that's how functional medicine really looks. Sorry, that was a really long answer. Oh, no, that's good. And functional medicine is comprehensive as it is. It makes me so happy to hear that and to know that once I'm done residency training, this is what I have to go through and look forward to. So it's absolutely amazing. Yeah, thank you, Dr. Patel. No, I couldn't agree more. I mean, I think that that's what we have to do, right? Yeah, to Darcia's point, I mean, there's no way in 15, 20 minutes you can actually hope to get all the answers, or at least like most of the answers, enough answers to actually make some substantial change, long lasting change, right? Perhaps maybe for an acute thing, if you look at some quickly look at potassium, that's low, you can correct that stuff. But if you're trying to actually look at, again, and PM and R, we are taught that, hey, patients function matters so much more. It was interesting because we're doing residency interviews now and somebody, one of the candidates said to me that the reason that PM and R appealed to him was because patients don't care about what their lab values are like. Obviously at dangerous levels, they matters, but what they care is about is, are they in pain? Are they stressed out? Is something going on with their bowel regiments? Things like that, these are things that actually look at function and kind of you need to take a step back and say what really matters to patients and you're doing a lot of that stuff. But I imagine that we kind of talked a little bit about, hey, you had to reset. There had to have been challenges that you first met, whether it was trying to explain what it is that you do, try to build your practice it, practice, try to communicate with colleagues to send you referrals, what were some of those challenges and how did you overcome them? That's a really good question. So I come from a family of physicians, of course, Patel, just a gazillion of us in the university report, but if you start about like hurdles, just convincing other physicians in my family that I'm not a woo doctor, it's interesting. Again, when I make recommendations for nutrition as a prescription, they sort of have an eye roll that this is not real medicine or it's a woo-woo in some way. And to convincing just my family that there's validity in this type of practice, it's been interesting. That's where I typically will bring an evidence-based information. So if I have a discussion at Thanksgiving with a family member that's very sort of conventional, I will bring in research and I will bring in evidence and I will present them with scientific journal articles that support what I'm saying. So I think that that happens at the level of family for me and then of course it comes at the level of colleagues. When I shifted from primary care to integrative consultations, I did lose a lot of referring doctors support because I think they valued me as a primary care physician, but they didn't quite understand how that was going to change or whether I was going to be able to provide that same level of service as an integrated physician. So convincing them is another level of a hurdle or an obstacle constantly talking to physicians, even my friends and saying, here's what I'm doing now, I'm still a physician, I'm still a medical doctor, I still see patients in a conventional way, I still treat acute diseases, but for chronic disease, now my tool belt has increased. So I tell them it's not that I've stopped doing what I was doing, I've just expanded what I'm doing, right? So I'm more than what I was doing for. So if you loved me as a primary care doctor, I'm now even better I think at what I can do because I have more tools in my tool belt. And I had to do that with my patients. So when I decided to sell my primary care practice, I had four town hall meetings, four separate nights to invite my patients because I love my patients and one of them didn't know where I was going and what I was doing. So I had four town hall meetings where I was just available to them to answer questions or questions you have for me. And we spent the hour talking about everything from my new practice model to my belief systems or anything regarding health. And I still continue to do that. I think that the online social media platforms that I created are for education purposes. I want people to know what this is about without any financial gain, without any need to have that translate in any way in my practice, just to get out there to educate as many people as I can. So I talk about gut health and I talk about the importance of sleep and mindfulness and meditation and movement and nutrition, of course. I spent a lot of time, as you guys know this, but spent time in the community, built a community garden about three years ago, and that project came about because I wanted to bring health education into the community outside of the exam room. So the more physicians like us give education to people and physicians and medical communities, and we do research in this particular field, the more validated we're gonna feel or people are gonna believe in us a little bit more. So the work speaks for itself. I'm already a believer. I don't need to do anything else to believe in this type of medicine, but I think the obstacles like you described are to convince traditional, conventional doctors that there's merit in this and to educate the public that there's merit in this. And that's what my journey is now. It's just being a bot leader and an educator and coming on platforms like yours to talk about how this can help everyone. Yeah, that's so cool. To your point about convincing your own family, yeah. I had a similar struggle, but it was more, you know, when I went down to the root of osteopathic medicine, I think that Dar's can probably relate to this as well. Yes. But you know what's interesting, all of us kind of have this South Asian background, and I know that you are a proponent for turmeric and I remember recently discussing with my co-residents about the value of curcumin and how well it's studied in osteoarthritis, right? Especially with orthobiologics is a big thing in musculoskeletal medicine today. And we're looking at all these things that we can offer instead that won't do harm. And it has really stood the test of time, thousands and thousands of year. And to me, that speaks volumes as well. But you know, at the same time, yeah, I agree with you. I think that we are too much on the side of taught as scientists and the art of medicine is probably not taught as much. And that's kind of what you have been talking about for the last however long you've been here with us today. But you know, on the note of, hey, evidence, anecdotal evidence is I think a pillar of that evidence-based triad as well, right? So I think that highlight a little bit of what you might do and it's worked well. Are there any cool patient stories that you might wanna share with them? Again, we understand that it's only one or two cases, but maybe if there are some medical students who might learn about, hey, exactly like what a day is that Dr. Patel was doing or somebody else functional medicine might be doing. Yeah, yeah. So again, anecdotal medicine was value in that. But clearly what I've seen in my own practice is that patients that come in with, let's say diabetes, very simple, everybody can understand diabetes. It's where we're unable to regulate our blood sugar. There's several different levels of diabetes type one, type two and then in between. But generally what's happening is the sugar, let's talk about type two diabetes to make it simple. So my type two diabetic patient comes in, okay? He's this six foot to big guy. He loves his food, his wife sends him in. He's a type two diabetic. And she sends him in because again, he needs to have his diabetes control. And he's a very funny sweet man and he's listening to me. And he's like, but Dr, I love my food. So the first step is of course, understanding motivational interviewing. When you see a patient, what is it that they're going to be motivated by? Because I might think that he's going to be convinced because diabetes has all these huge side problems. Cardiovascular risk, stroke, losing his eyesight, circulation, feet, neuropathy, all these things, right? We know failure. He doesn't care about any of those things, right? Just like you said. So anyway, I talked to him about what he wanted. And do you know what he said? He said he loves his wife and he loves his daughter. And he wants to be around for them. And he wanted to make them proud of him and make them happy. So we work with that, right? So I say, okay, so when you do motivational, and you engage in with the patient, and then you guide the patient to see what is it that they really want to do? And then you elicit like motivation, right? So he's like, okay, Doc, I could do this. I know I want to make my wife proud, okay? I'm going to help you. So what is it the one thing you can work on? So we come up with a plan. And he was a Japanese man that loves his race. And he loves a lot of rich food. I said, what can you substitute? He goes, I could eat more tofu. And I know that sounds like very trivial and very small. But it was enough for me to get that mind shift for him to want to change. He has to have reason enough. And that reason has to be more powerful than his desire to eat or to enjoy life, right? And his love for his wife and his daughter was greater than his desire to do that and making that connection was part of that journey. So anyway, long story short, he decides then to really implement the diet plan that I put him on. Very simply, just taking out carbohydrates, this concentrated carbohydrates, low-line fruit, you and I would be like, that's a no brainer. But for him, that was a big deal. He comes back three weeks later, three months later. His A1C had dropped an entire point in a half, okay? That's a big deal for this guy. He was like shining. He was like a 10 out of 10. He was just so happy. He was excited. He wanted me to know how good he felt. So he comes in specifically to say to me, thank you so much. I am on this. I'm gonna keep doing. So the next thing we talked about is movement. I said, okay, now let's add another layer to your success. How can you move more, okay? So I know these are not genius things. These are not like amazing silver bullets. I prescribed cinnamon and all of a sudden his life improved. It's not like that. And medicine shouldn't be like that. It's about changing the patient's mindset and getting them to see what is it that they want and then showing them how they can get there and then bridging the gap for them, okay? So this diabetic who clearly comes in uncontrolled with a joy and a love for a food showing him that there was something that he values even more and then giving him the tools to be able to get there. And then telling him, you did a great job but you did this all on your own and you could do so much more, right? So I love stories like that because it's not like, it's not rocket science and it's not a lot of it. It's just a little bit of heart, a little bit of ear and then advice and motivation. So that makes a big difference. There was another case where had a lady who had severe endometriosis, okay? And she had severe endometriosis since she was 16 and she'd been on birth control pills for a very long time. She had gone through infertility treatment and had twins but then still suffers from endometriosis and she came in and we did a stool analysis and we did a food sensitivity testing. And interestingly enough, we found out that she had a lot of gut dysbiosis and food sensitivities and when we made the shift and I was very nervous because I wasn't sure before it was gonna make a difference. This is a person who's in her 30s who suffered for a decade and a half with endometriosis. Anyway, we made some modifications to her diet based on the tests that we found and we reset the gut and she comes back and I'm a little nervous because it's really her toddlers that were coming in for a visit and I wasn't sure if I should ask her how she was doing and she looked at me and she broke down in tears and she was like, I haven't had pain in over a month and she goes, I'm shocked. Is this what's been going on all this time? Have I missed all of this in my life because this was the answer? And I said, well, I'm sure there was probably more to the story and there's many other reasons why people get sick and we don't know what it is but I'm just so happy that you are feeling better and your cycles are better. And those kinds of things, when you can find something that really turns it around for the patient and then they really put their heart into it when they start cheating, which they will, they may become more intuitive with their own bodies and that's what I wanna teach them. I'm not gonna create a perfect life and now they're gonna ride off into the sunset, right? It's not gonna happen for that Japanese man and it's not gonna happen for that woman with endometriosis, they're gonna follow the wagon but what I hopefully have done for them is really sparked those neural synapses that allow them to have awareness and awareness is the path of health and now that they're aware that they can feel better and they have hope and that this kind of created that path when they stray off that path and they get sick, they've made that connection too. So they're reconnecting to their bodies and they're understanding how disease happens. Yeah, that's so fascinating. I just, I love hearing stories like that. Like I've heard my fair share of function medicine stories I've seen them but these types of stories are just touching, they're gratifying, they add more fuel to my fire at least, you know, when I, when I eventually practice and it's just such a stark contrast to what we see in the hospital, right? Where we can treat a patient but there's not much of that teaching, motivational interviewing, all we, like, what I really see is when we treat the patients they come back in about three, four months, right? Heart failure, COPD, diabetes, just as constant recurrence of them coming into the hospital. So can you touch a little bit on what your main approach is aside from, you know, motivational interviewing, we know there's a connection with gut health, immune system, mental health. Is there some sort of approach you take, especially in maybe a more complicated patient where you're not really sure what might be going on? Hmm, well, it's always the same algorithm for me. So I put this name pattern. I do a thorough, this is sort of like I said, it's Sherlock Holmes, every patient is a new patient for me. I walk in the door with a clean slate. I walk in with no bias, no judgment, no pre, you know, whatever the previous doctors diagnoses were, what other doctors have said about them, what they feel about themselves, all these things are sort of, I lay them low because I need to keep a clear mind. So when I walk into the room, I'm a clean slate. I look at the patient from ground zero. I listen to a lot of what they have to say. I review past, you know, labs and imaging and I put everything into context. And I'm almost like putting a puzzle together in my own mind and I'm putting pieces together. And then I try to figure out what are the top three areas that I feel like this person has dysfunction in? Is it their hormones balance? Is it their immune system? And so when I see that, I say, okay, there's a pattern here. There's a gut immune hormone pattern for this person. Then I will then approach them and say, okay, this is where I think we need to start to help you with and that's always coming back to what they want me to fix for them, to help you with energy, to help you with your cycles, to help you with digestion, to help you feel better. This is where I need you to start. To get a little bit more information, I would love for us to be able to get these tests, but it's not necessary, okay? And they say, okay, well, let's go ahead and do the test. While the tests are coming back, I automatically have a plan to give them goals to work on. So then I say, let's come up with three smart goals. Specifically, tell me what is it that you wanna do in terms of lifestyle change? Give me a measure of what that's going to be. What action you need to take to get that done? Is it realistic, right? You're not gonna hit the gym seven days a week. That's not realistic if you're going zero and it's COVID. So let's talk about how you're really gonna realistically get there. And then time wise, when is it that you're going to start this move, right? I'm going to intermittent fast. Okay, great. What does that specifically mean to you? Okay, well, I'm gonna stop eating at 6 p.m., and I'm gonna start at 10 a.m., great. What actions do you need to put in place to make sure that the kitchen's closed at 6 p.m., right? What accountability are you gonna put in place so that you know that that's gonna happen? And they have to verbalize that. And then all of a sudden is that realistic. Well, maybe not, you know, we have family time. Okay, then how many days a week can you do it? Maybe three days a week, and when are you gonna start? So the plan to investigate what the underlying root causes comes through my diagnostics. But the lifestyle changes, the foundation that you talked about earlier is always the same. If somebody's needing to work on sleep, I'll ask them to set goals for that. If somebody's needing to make time for movement or nutrition or relationships or purpose and make time, I tell them to do that part. Let's see, I'm trying to think of there's anything else that comes into play. Do I use ancillary people? I do. So if somebody comes in and seriously has some mental health issues that need to be addressed, before I can do anything that is physical, then I do partner with a mental health specialist that she works out of my clinic, and I'll have them see her. So there's trauma, if there's underlying relationship issues, if there's other disorders that need to be handled, then I definitely coordinate with a mental health specialist. If somebody really wants to work on nutrition, and that's the only focus that they've come in for, I do have a functional nutritionist that works in my clinic, so I will refer my patient to her, and then they can work on simply just the nutrition part. I do have a physical therapy place that I will send to my patients to, so if somebody really is coming with chronic pain issues, or they have something that really needs a PM and our type specialist to come in and help me with that, I partner with people with physical medicine as well. I do like acupuncture for certain people, so it will suggest that at times. So I think that it's knowing that you're not by yourself, knowing that you are not the only person that can help the patient. This patient may be served by a team of other people, and being humble enough to recommend that is also part of the game here, and humility is something that we have to learn in medicine. We are not gods, we can't cure everything, there are things we don't know, and many a time I will say to my patient, you're very interesting, I don't know what's going on, what I'm going to put my mind to it, and I'm gonna come up with something to kind of help us, and medicine is never a straight line. It's always like this, right? So you may come, you may think you got it, you've got the diagnosis, you're gonna help this patient, and then you're like, that didn't work out, the test didn't collaborate with what you thought this patient had, you were sure she had rheumatoid arthritis, she didn't, okay, fine, start over, right? So part of that humility is knowing that you're not always gonna be a superstar, you're not gonna be a silver bullet, you might have a lot of talking terms that you'll have to take with the patient, and figure out that goes for diet as well. You know, there's so many things out there right now, you know, people are on paleo, and keto, and vegetarian, and vegan, and this and that, and everyone's promoting a different diet plan, and not everybody is genetically this game, and not everyone will do well on that diet, and even that same person may have done really well on a vegan diet, but maybe something else is going on in their bodies, and they're not gonna do well with a vegan diet now, right? We may cause more inflammation. So I understand that medicine is fluid, and I understand that my treatment plans may need to be changed, and I also understand that my investigation may take me some dead ends, and I have to turn around and come back, and that's where medicine becomes interesting and fun. Wow, Dr. Patel, I mean, so you're talking a lot about individualizing your approach to every single person, and certainly not easy to do in a 20 to 30 minute visit, so I think it makes sense, but, you know, we've talked about this crazy concept of listening, a couple of times now, and, you know, from your story, at least on your website, and I think you had mentioned something about your journey, your background, your adversity that you dealt with, and you mentioned that the journey allowed you to experience vulnerability, humility, and it gave you a deeper insight into how it feels to be a patient, right? And then after that, it also, you said, cultivate a compassion and deeper understanding for your patient's suffering. In one word, that sounds like empathy to me, right? And in medical school, as we're training, that word is used over and over again, that that's the most important, maybe, trait for a physician to be able to learn and use, but in my experience, and please correct me if I'm wrong, I don't think that's something that can be taught. I think it can be learned, I think it can be acquired over time, but it can't be taught. I imagine though you're talking about education, maybe you have some medical students who wrote to you, with you, shadowed you, maybe you have some trainees, how do you impart that this valuable lesson that you've talked about so many times about, hey, you gotta listen, you need to understand every single patient, their journey, and learn how to exhibit that empathy. It's modeling, modeling, I can only model good behavior. And so when my residents and my medical students come through my model, what I believe, and so when they see me in my style listening to my patients, then I'm hoping that in the four years that they've been following me, they will then do the same thing. That's the only thing I can hope for. And when I hold my patient's hand or they give me a hug at the end of the visit, I can only hope that creates a desire to have that same kind of relationship. And so you're right, I can't teach that. I can only model it. And you can only understand what it's like to be a patient until you've been there. And you've mentioned your own journey with your own illness and how that has motivated you. And I can sincerely say that now when one of my patients is in the hospital, I truly feel for them. And I call out to them and I go and I visit or I call because I know how hard it is to be there. And even right now in the air that we're in right now where people can't have visitors and it's very tough and it's very scary, that's where we can be human. We don't always have to be a doctor. We can be human. And we can say, I know it's scary to be where you are. And I know you're lonely and call me or let me know if there's anything I can do because it is scary. You're in the hospital and as residents and I can say this myself, I didn't understand what it was like to be on the other side until I was. You know, the 4 a.m. blood draws, who the heck invented that? You know, the constant vital signs, who are the vital signs all the time? You know, the IVs, the wanting to go to the bathroom but can't get up, right? Can't detach from all the equipment. But you have to just basic necessities of humility of covering up when, you know, you're wearing a gown that covers nothing. All these kinds of things, when you've been on the other side of it, you start to see it a lot more and you cover people up. You give them warm blankets. You know, ask them if they need the water closer to their table. You ask them if they need help. You know, you're less sort of guarded and living on the other side of the fence. You're more like, okay, I'm human and they're human. And they're just going through this. This is not their life. They're not just a professional patient. They have a life of their own. They're just sick right now. And they need me to help them get better. So I think until you walk through that and until you learn it, being a patient that is, you may not have that introspection, but you can still model the behavior of residents, the medical students, and as physicians to attendings, to residents, of how to make eye contact with your patients. How to pause, have a listen, how to smile, all right? It's fruit. And just, you know, being able to say, you don't know, and being okay with saying, you know, I understand. Sometimes I go a long way. So I just model as much as I can. I love that. And I know I speak for the both of us when I say that we couldn't agree more. I mean, we've been so lucky to have some really great mentors throughout our early careers, which is part of the reason we're here today that inspired us to do this is, you know, we know that there's so many great people out there. And what I'll say is, even on the flip end, you know, I've also learned sometimes what not to do from, from, you know, people I've worked with. And I think that's been just as valuable for me. And when I say, hey, that's not the way that I want to approach in the future. And that's a lesson that I want to learn. And when I teach, and I hope to work with medical students and trainees and other practitioners, that this is something that I'm not going to do. Hopefully I'll remember those lessons 10, 20 years from now. But I certainly think about that. And one thing I want to say is, you know, when I around on patients in the morning, especially on the rehab floor, and they tell me that they didn't sleep well last night, because they kept getting their vitals checked. It drives me absolutely insane. It's like, why would we wake somebody up to check their vitals when they're stable or whatever? So, but yeah, so there's so many issues with that. Probably another podcast can't tackle them all, but I, the one thing that it's to stand out to me is, you do this mindfulness-based stress reduction program, right? And you do that through UCSD. Is that right? Yeah, quite ticker through UCSD for MBSR. And if you're familiar with MBSR, it's a mindful-based stress reduction. It was coined by John Kabinzen back in the 1970s. He was at UMass in Boston, Massachusetts, and he was working at the hospital with patients with chronic disease, HIV, chronic pain. And he did this eight-week program. And now there's over thousands of studies published in medical journals to support the use of this eight-week program in patients with chronic pain, with PTSD, anxiety, depression, chronic diseases, all kinds. And so I'm certified in teaching that, and I teach that here in my clinic. The premise behind it is mindfulness is the act of being present with all your senses on purpose in a very specific way. So when you're present, you are present with your breath, your present in your body, and you bring attention to your thoughts and your emotions. And you recognize when you get disconnected, because it's that very moment that when we get disconnected from our present being, that we are in fight or flight. So when we're stressed, and now describe fight or flight a little bit more for those who don't know, when you're stressed, you have a thought, right? You're running late for a meeting. You're a migdala, which is in the limit part of your brain, lights up. And like lightning, it fires an electrical impulse to your adrenal glands. And within seconds, your body is flooded like a tsunami with cortisol and adrenaline. And 50 trillion cells all receive a message that you are an imminent threat, right? You are an imminent danger. So what happens is your pupils dilate, your mouth gets dry, your throat tightens up, your neck tightens up, your heart starts pounding, your breathing becomes shallow, your stomach becomes queasy, your hands become clammy and sweaty, become tremorous, your brain stops working, right? We've all been there. You might have been right before a test. You might have been, when attending asks us a question, we didn't know the answer to, or whatever it is. But that responds, when we get tethered into fight or flight, puts our body into a place where we're either ready to fight, ready to flee, run. And then the last ditch effort is to freeze, to completely sort of shut down. When we stay in fight or flight, day after day, after day, year after year after year, our body is in a perpetual state of fight or flight, causing inflammation and disease. And we get further and further disconnected from our breath, our body, our thoughts and emotions. And we escape. We remove ourselves from our present experience. We escape into work, we escape into substances, we escape into food, or drinks, or alcohol, or addictions, or social media, or anything else that keeps us distracted and keeps us away from dealing with what we're dealing with, which is fight or flight. So we wake up and we're with the bear. We're brushing our teeth, but we're thinking about the bear. We're eating our food, but we're still being chased by that bear. We're driving to work. We're still on that gas pedal running away from the bear. We come home at night, we're trying to sleep, but the bear's still next to us. So when people are in perpetual states of fight or flight, it causes downstream problems, inflammation, chronic pain, anxiety, depression, addictions, diseases such as diabetes, obesity, hard disease, stroke, hypertension. These diseases didn't just manifest. They were a downstream effect of us being in fight or flight for perpetual amounts of time. So when mindfulness, what we teach people is how to reconnect, how to be present, to come back to our thoughts and our emotions, to come back to our breath and our bodies. If you're experiencing pain, close your eyes and just sit with it for a few minutes and take five deep breaths. Just by bringing attention back to that space, without judgment, without anger, without resentment, you might notice that the body actually relaxes into it and it becomes and the volume of pain starts to come down. So in PM&R, I'm sure you've dealt with other practitioners that do mindfulness with their patients. And I truly believe in the science behind it. And like I said, there are thousands of studies now published showing that the practice of mindfulness can help mitigate so many things. And large companies like Microsoft and Google have embraced mindfulness in their workplace because what we found is that people become more creative. They become more efficient, become more effective when they're out of fight or flight. And when they're in their parasympathetic realm, which is the rest and digest. So I know that's a lot to talk about. That's another podcast. Yeah, I know I certainly agree. I mean, I think that one of the benefits of our specialty is we work so closely with neuropsychology. At least in my program, we have fellows and residents. So I love having these conversations and they're used in MBSR on a daily basis of their patients. But yeah, everything you described about waking up with the bear sounds like every single day in medical school and residency. So certainly, I think that in a future time, we're gonna talk about some strategies to kind of, maybe get the bear out of your head or run away from the bear. But one thing that I wanted to bring up is I know that recently you've been talking a lot about gut health, right? And I think often gut or the interac nervous system is referred to as a second brain. And we know increasingly there's literature coming out about the role of gut health and the microbiota with psychiatric disorders, mental health and neurodevelopmental disorders. What are your thoughts about that? I mean, where do you think in terms of like the literature? And obviously, I think from a basic science point, we know that there's neuro transmitter receptors there. A lot of times people take medications and have some side effects from GI related stuff. Do you focus on gut health when you're in your, not necessarily MBSR, but people when you're working towards mental health, things of that nature? Is that something that you're approaching as well? And could you talk a little bit about the interplay between the two systems? I love that, you're speaking to my heart now. So the interac nervous system is a second brain. It communicates with the central nervous system in our heads through the autonomic nervous system, right? So we talked about the sympathetic, sympathetic neurons. And there's more communication going from the gut to the brain than the brain to the gut. 10 times more information comes from the gut to the brain than the brain to the gut. So we are more gut brain than we are head brain, if that makes sense. And most people don't realize that 90% of our serotonin production is actually from our gut. And 50% of dopamine is produced in the gut. So if we are going to address mental health, we have to address the gut. And these neuro transmitters are made by our gastrointestinal track in cohorts with our gut microbiome. And for those listening that don't know what the gut microbiome is, each trillions of organisms that live in your digestive track and your colon. And these can be yeast, parasites, bacteria, viruses. And they live all in harmony. I think of them as a tropical rainforest. And they all live at different layers of the gastrointestinal track. Some lay really close to the lining. Some lay really into the movement. There are many different functions. Some actually work to help support our body. They make nutrients. They make vitamins like K and B. They help detoxify our body. They communicate and they help us with hormonal and neurotransmitter production. They help us with absorption of nutrients. They help us with fighting off pathogens. So there are these good, commensal bacteria along the lining of the colon that help us with that. There are some neutral organisms that do nothing but just hang out. And there are some pathogenic organisms that are there to try to invade us. So within this tropical rainforest, we have this huge, immense amount of knowledge that we still have to accumulate. There are studies, especially animal studies, to show that manipulation of a gut microbiome has impact on mental wellness. There was a study done on rats where they did a fecal transplant. And they found that the rats that were sort of sluggish and depressed had a different gut flora than the ones that were happy and bouncing and running around. And when they did a fecal transplant and they transplanted the fecal material from the happy bounding rats to the depressed rats, it changed the neural behavior of the depressed rats to become more happy and bouncing. So there are some animal studies to show that the gut microbiome has a key role to play in mood balance, probably via two factors, the production of neurotransmitters and the communication through the autonomic nervous system. So this gut microbiome has this huge, we have so much to learn about it. I think that we're still very preliminary in our understanding and treatment of it. So I try to stay humble when it comes to that. I don't always throw probiotics at people. I know a lot of times people will say, well, what probiotic can I take to be happier? What probiotic can I take to be skinnier? I don't know if I have that answer. What would I say? There's always the pill. Somebody always needs a pill. It always goes back down to a pill, right? So I tell them, here's the thing. Your gut flora, you inherited from your mom, okay? And your family. And then you've accumulated new colonies along the way. If you want to facilitate a healthy gut microbiome, you've got to change your food intake because the fiber from plant matter feeds the gut microbiome and feeds the good commensal bacteria. So if you want to have a healthy cohort with lots of diversity and lots of volume that is going to be protective for you and is going to help you with making good nutrients and detoxifying and purifying your body, you need to feed that gut microbiome healthy food. And that comes from plants. Interestingly enough, there are specific types of oligosaccharides and fukusaccharides. We call prebiotics. This might be getting into the weeds a bit more, but these prebiotics actually feed the gut bacteria. So when you consume lots of onions and garlic, which we like, South Asians like that. So onions and garlic and we eat cabbage and carrots and we eat artichokes and asparagus and soybeans and potato starch, all these kind of commensal bacteria that live in our gut microbiome, they love this food. And when we feed them the good nutrients from these plant matters, they thrive. Now, here's the magical part. When they thrive, they ferment this fiber and feed that fiber back to our gut lining. And we call those postbiotics or short-chain fatty acids like butylate and propyleneate, you may have heard of these things, but these short-chain fatty acids actually feed the gut lining. And then our gut lining gets stronger and like a fence, it can keep out pathogens and products that causes disease. So there's this sort of cycle of life when it comes to that. When we feed our gut microbiome healthy fibers, they ferment that fiber and feed it back to our gut lining. That supports our gut lining, that helps protect us even more. Those gut microbiome help us fight off pathogens, detoxifiers, support our hormonal systems, our immune balance, helps our neurological systems. There's just immense amount of benefits when we take care of our gut. I love it. I could talk, I could talk gut health all day because GI was actually my first love. That's another story, because it was because of the explosion of the microbiome and looking at it from the functional medicine standpoint. Everything you just named, especially those fatty acids, I hated biochemistry and I'm starting to love it again because of the tie-in it has with functional medicine. I kind of want to talk about, so with social media, people are starting to understand more about gut health, people are starting to understand more about meditation. Yet, I was told functional medicine has been around for a while, probably even in the 90s, it really started and talking to the leaders of functional medicine, they thought it was gonna take off in the 90s, maybe in the 2000s, but it really hasn't. And we still have a tough time convincing people, like you mentioned earlier, actually on Instagram, I was told by a famous female cardiologist that functional medicine was quackery. And I was definitely taken aback. So why do you think that is? And do you think that awareness is coming out more and more? And another question here too is, why are people so afraid of investing in their own health? Especially when you might have a cash-based practice, there's a lot of pushback I feel. Is there a reason for that, you think? So the first question is, how do we validate what we're talking about? It has to come through research. So the problem with research is it's funded by people that have invested interest in making money off the research, so it could be pharmaceuticals or it could be organizations that are gonna benefit financially from it. So nobody wants to study the benefits of cuckermen or turmeric, because it was gonna benefit from that, right? So that's where the problem sometimes lies, is being able to show evidence-based information to support some of the things that we're talking about. And with everything in science, it takes a while for things to happen. If you think about hand washing, something that we talk about all the time now, there was a time where physicians didn't hand wash, right? There's a great time in an era where they connected infant mortality, perinatal mortality, to the physicians that were digging in cadavers before they delivered the babies, and they realized that the mothers that were being delivered by folks that weren't doing that had less mortality, and they realized that hand washing was a big deal, but that was blasphemy. That was blaming the doctor for causing infant mortality, but then until they did the research, and they found out, yeah, hand washing germs do exist, and that does make a difference. So with everything in science, it takes a while to prove things, and to do enough research to convince them, and I'm okay with that. I don't fight back, I don't get angry when somebody has a different opinion than I. I feel like we try to hide people that have different opinions, and we should just embrace them, we should break them out, and have discussions like we are doing right now, right? I don't wanna just be in a cohort of people that all are like-minded. I want to have that challenge. I want to talk to a doctor that doesn't believe, because they're gonna poke holes in my theory, and it's gonna make me then go and find more information and be stronger in my belief, or debunk that theory, and then say, oh, you know what? I thought that was true, but you're right. There isn't any evidence for that. I'm sorry that I thought that. And being humble enough to change my mind, I think that's where we sort of get divided on a lot of things. Is this this bank and this bank? These people feel this way strongly, and this people doing this, there's the answer somewhere in the middle. So I think the answer with how do we address people that don't believe in functional medicine? It's finding the evidence to support what we're trying to say. For instance, I had mentioned intermittent fasting in one of my videos, and I did perceive a comment saying that that wasn't evidence-based, and I went back and I looked, and I found references, and I posted them, and that's okay. I'm okay with that, because maybe that person didn't have that information, and now they do, right? Or I say something, and then I have to take it back, because I realized, well, maybe I reached a little too far on that one, and I need to pull back. So I think not being afraid of confrontation on social media, not being afraid of people that might not see things your way, and then finding evidence to sort of support your statement, because as leaders in medicine, we're educating the public. So we also bear the responsibility of making sure that what we say holds merit, and if it doesn't, then to correct ourselves. So I think humility, and that is really important, and keeping an open mind. As far as investing in ourselves, that's an interesting question. I don't know what you can do to that. I've said this before, people will spend money on their animals, they'll spend money on their cars, they will chain up the wardrobe every few years, they don't care about the thousands of dollars that they spend on food and drink and vacations. If they get a spa treatment, and then the minister says it's 250, they're like, yeah, I'm worth that. But when it comes to their health and the medical care, there's a certain sort of barrier that allows them to see that that's investing in themselves as well. But I think it's coming around. I think there are people that are willing to invest in their wellness, they're seeking out doctors like us that are outside of the box thinkers, they are finding resources in their life, even if they don't have a lot of money, they're finding resources where they can allocate towards healthier eating, organic foods, investing in workout equipment, or at least making the time to do that. So I think all we can hope for is, as you have created this platform for education, the more we talk to the public about the importance of self-care, and the more we talk to them about investigating the root cause of why they're not feeling well, the more they're willing to invest in it, people need to know what they're buying before they buy it, and that's okay too. Yeah, no, Dr. Patel, those are very wise words. I love your approach, and especially today, where there's so much as cancel culture, where we find disagreement, and once we find it, we just cancel it. And I think it's very important to have that discussion be open, because that's the only way we really move the needle forward, and we find more evidence, and we poke holes in theories, like you mentioned, it's the only way we grow as people as well. So for me, as an intern, I was looking into doing, like, IFM, Institute of Functional Medicine. However, I have to wait till I complete a residency. Is there anything that pre-meds medical students, or even me as a resident, can do to get more involved in functional medicine? There are besides IFM, of course. There are other, like, A4M as another one. There are some courses that can be taken. If you're looking for certification, clearly you have to wait for when you finish. But if you're just doing it for general knowledge, I don't think there's any barriers to taking any of those classes or courses, or participating in that. I know that the University of Arizona, the integrative medicine fellowship that I'm part of, they do have online courses that people can take, whether it's through motivational interviewing, nutrition, any of the other topics that we've mentioned here. I think they even have COVID curriculum right now. So for folks that are trying to find out more information, they can go into their website and join online classes. If you're looking for certification, then I think that you have to prove that you've completed a residency, or you have credentials to get certified. But I don't think there's any barriers to taking the classes. In any way. Makes sense, cool, okay. That's awesome. Yeah, and to your previous point about, I think investing in healthcare, I think that you kind of alluded to, people aren't incentivized to do research and studies on curcumin and things of that. And I think that very much in our world, the orthobiologics is another big one, right? It's all cash-based right now, PRP, adipose tissues, like these cellular treatments. And that's why it's so important to do research in those realms as well. So insurance companies can start reimbursing. And you've kind of touched on that a couple of times. But to follow up on Darcia's question, you did a fellowship of the Integrative Medicine and a separate one in functional medicine, right? So that's two years of your life that you kind of sacrificed, if you will. And then on top of for your residency, for your medical school, it's such a long road already. And then again, there's such subtle differences between functional medicine, Integrative Medicine, lifestyle medicine. I'm sure there's more out there than I'm missing. Why should, on something that's such a long road already, you're already sacrificing your 20s, and maybe some of the 30s, why should somebody, a medical student who's considering this, consider doing a fellowship in one, two, maybe all three, and somebody just listed to this podcast or other podcasts like this, follow you and kind of learn these things and start incorporating to practice, like what value would a fellowship add? Yeah, I think it goes back to what Darcia said before it's credibility. So in order for me to rise above, just being an online learner, which is okay. But there's so much misinformation out there, right? And you can follow different people and get different information. And you don't know if they've vetted that information or if they've researched that or there was just something that they picked up from someone else, right? So it's that chain of information on online learning that you don't always get the real deal, you don't get the real information. So there were two parts to that. One is I wanted to create credibility for me, for myself, so that when I come as an educator, as I come as a thought leader, if I do corporate speaking, or if I speak to a group or I teach my patients, I want them to know that I'm coming from a place of authority. So that's one reason. Second is I really do want to know what is BS and what is real. I do want to know what evidence-based and valid and what the great lines are, because I don't want to practice medicine in sound bites. I want to make sure that I'm really getting to the deep material I'm looking at the research and I'm looking at the real deal before I make a recommendation. So I wanted to learn about herbal medicine. I wanted to learn about nutrition. I wanted to go back and look at the Krebs cycle and the pathways. I wanted to learn it because I am a learning addict and I would be a professional student if there was a career there. But I do love learning, but I also want to make sure that what I'm learning, I have a responsibility to my patients to make sure that I'm doing the right thing by them. There's again that value, that ethical boundary that I don't want to cross. I don't want to just give them any information just because it's gonna, again, make me money and that's not what it's for. I want to really learn this information well. I want to know what's out there that's true and valid. I want to know what's evidence-based. I want to know how it can help my patients. And I want to learn from other people that have done that hard work. So that's why I would say, if that resonates with you and you too want to have credibility and you too want to have the education. Because the same thing would be said about medicine who says who's to say that somebody can't just start practicing medicine by online learning. But you wouldn't want them to go through the triggers of actually going through medical school and doing residency and actually practicing medicine, where you want them to have that experience in that same way. I feel like if I'm gonna practice functional medicine or integrative medicine, I do want to have that education and that learning before I implement it. Yeah, nobody wants to be a YouTube doctor or go to a YouTube doctor. That's right. I mean, Ultimation Eye are on the same wavelength as you were both hungry for learning, hungry for knowledge, hungry to implement that knowledge once you learn it too. And for me, right now being residency, I'm looking to navigate and figure out what kind of fellowship do I want to do and what not. So it's really great advice. Thank you for that. So you definitely have a social media presence. I know you're now on TikTok, I believe, right? Yeah, I see you're doing a lot of tips and tricks, especially during like right now COVID season, flu season, are there any one, two, maybe three things that the listener should know to really build a better immune system? Yeah. Yeah. Yeah, let's do it. So COVID-19 immune systems, you cannot build an immune system, you can only support it. The immune system is there to protect you. So if you give yourself the advantage of having a strong immune system, then you can maybe not avoid the infection, but maybe shorten the duration. So I don't want to say that this is a cure for COVID, but it's to help you if you are finding yourself wanting to do something to support your immune system. So it always starts at the gut. So make sure you're eating those five wrist foods, 30 grams of fiber or more. Prebiotics support that immune system from the gut up because your gut lives in your immune system. That's the other thing people don't know. Is that the majority of your immune system lives in your gut. And that's the goal, the gastric associated lymphatic tissue and that lives in the GI tract. So when you support your gut microbiome and when you support your gut, you actually support your immune system. Second is there are certain nutrients that can actually support your immune system as well. And you've heard this before, but vitamin D3, track your level. Make sure it's between 50 and 100, optimize that. That has been shown, and again, have it in space here to help support the immune system. So take that vitamin D if you need it to the level of 50 to 100 in your blood. Vitamin C, you don't want to overdo the vitamin C, but you do definitely want to eat your fruits and vegetables that are colorful in nature. Things like citrus and kiwis and bell peppers. You can add these things, even potatoes have vitamin C in it. So increasing your intake of vitamin C, increasing your intake of zinc. You've heard a lot about zinc with COVID-19. It helps stop the entry of the virus into the cell. So increasing zinc intake, which could be through seeds and nuts and beans and legumes and oysters, if you're like them. So zinc is a good place to start as well. So certain nutrients can help. Stress modification. We've talked about resiliency when it comes to stress. Stress can affect your immune system in a negative way. So you want to try to work on breathing throughout the day. You want to work on time and nature. You want to connect with people in your life. You want to journal, read, disconnect from social media, disconnect from television. Try to be internal once in a while with your thoughts in your own body. Sleep. People don't give sleep enough credit. But during those seven to eight hours of good quality sleep, that's when your body is restoring and repairing. That's when your immune system is working. So working on good sleep hygiene, right? Sleep is not a place you go to. Being less awake is being asleep. So work on that hypervigilance. Work on that hyperarousal at least an hour or two before bed to kind of dim the lights. Slow down your activity. Shut down the technology. Stop eating and drinking at least three hours before bed. Cultivate a practice, a habit of getting to bed on time and waking up at the same time. Get 15 minutes of sunshine every morning. So live your life the way you see fit. Try not to get into arguments and disagreements and living in anger and resentment and sadness because that also affects your immune system. So find gratitude, find positive things in your life. Focus on things that are going well instead of constantly talking about things that are not going well. So that's it in a nutshell. And movement because you guys are PMR. PMR. Yeah. So you have an absolute fear. It helps with regulation, helps with some house with desacrification. You can't go wrong with it. Yeah, though. Those are awesome tips fully supported by research as well. We're not just making this stuff up. So along the lines of that, with motivational interviewing, empathy, becoming a better listener, are there any resources that you have, maybe some books that practitioners can read to become better listeners? That's a good question. I don't really have anything off the top of my head, but I will send something to you. And then you can maybe share that with your viewers. Definitely will. Awesome. So before we let you leave here, Dr. Patel, this has been such an awesome episode, such an awesome conversation. It is evident that you've been through the various of health care system as a patient, as a burnout practitioner, and now somebody who is loving with purpose, living with purpose and passion, really making a difference in the lives of your patients. This was an awesome introduction to functional medicine as well as some in-depth topics, but we would love to have you again in the near future and really go into some more of these detailed topics. Before we let you go, where can people find you? So my social media handles are all my name. So Jody Patel MD, you can find me on Instagram, on Facebook, on, I'm not very active on Twitter, but I have a Twitter. And then of course, my TikTok. Right. Right. And then Patel MD. I think Patel MD. Awesome. Well, thank you so much. Yeah, I just wanted to echo what he said. I mean, this has been so informative. I am so inspired, again, you know, like you had talked about, you know, it's some, you said that you were modeling for the people that who come and see you in clinic, but you're modeling for us and, you know, and not this is this conversation and social media. And I just want to thank you for everything that you're doing, that everything you're in a continuity to do. And, you know, hopefully we can kind of shed some light on all the cool things you're doing, and people can learn from this as well. And I thank you both for doing this, taking time out of your busy schedule, doing residency, which we all know is very, very difficult to provide a service to the public. And I wish you guys both the best of luck and the biggest successes in life. And if there's anything I can do to help you with your journey, don't hesitate to reach out. My purpose is to be here for anyone that needs me. Thank you very much. Thank you. Bye. Wow, that was such a great show with Dr. Patel. But before we end, don't forget to reach out to Ryan, Casey, and the team at Physician World Services by going to DrPotCastNetwork.com, forward slash physician wealth, to help you with your finances in the same way you take care of your patient's health as well as your own. Just a reminder, guys, that everything in this podcast is for general information only. It does not constitute the practice of medicine, and we are not providing 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 a personal physician or coach regarding any specific health-related issues. We really hope you learned something in this episode. If it provided any value for you, please please subscribe, share, rate, and review. And of course, share this with anyone who you think will benefit. It really does help us out. Thanks again, we'll see you next time.