52. Melissa Mondala, MD: Lifestyle Medicine Across Cultures & Building Relationships With Patients

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Welcome back everyone, we are going to be touching on the big topic of lifestyle medicine with Dr. Melissa Mandala, who went to medical school at Roslyn Franklin University in Chicago, and she received a Master's of Biomedical Sciences and Health Administration. She even trained at one of the Blue Zones Loma Linda University for family medicine residency and lifestyle integrated medicine fellowship. To be more in depth, she is a triple specialist in family medicine, lifestyle medicine, and primary care physiatry. She's a holistic plant-based physician, nutritional and wellness expert, health coach, mental health advocate, and recipe inventor. She's been featured in popular media such as Forbes, local news outlets, and social media. She helps clients improve their lifestyle to optimize their health to achieve their goals and develop sustainable habits to live a healthy and balanced lifestyle. She is also the co-founder of the Dr. Lifestyle Clinic. In today's episode, you will learn about Dr. Mandala's journey and how she has even practiced medicine not only in the States, but also internationally. She talks about how she grew up on, quote unquote, a carnivore diet where she used to eat a lot of meat, but how she has transitioned from that to eating more plant-based. She'll also talk about her current practice, what direct primary care means, and how she is actually coaching and teaching a lot of clients to live better lives. Without further ado, let's get to the episode. All right, welcome back everyone to Medicine Redefine. We have a special guest with us today, Dr. Melissa Mandala. How are you? I'm well. Thank you so much. Happy New Year to you and glad to get connected and an honor to be here. Absolutely. Thank you. Happy New Year to you as well. And yeah, I mean, I'm so glad this has been some time to making. So we had your husband on Micah for episode 22, and you're probably going to be somewhere around episode 50 or so. Thank you. Thank you. Thank you. Thank you. So, you know, I'd love to start with our guests talking about the roots, the beginnings, because I think it sets us up well for a good framework in regards to kind of the perspective we have on medicine and kind of just how you developed your practice and the way that you think. So if you don't mind, take us through how you thought about medicine at an early age. Is that something you always knew you wanted to do? How'd you get into medicine? Yeah, of course. So, you know, a little bit background about me. I grew up in California and over here, you know, California. I'm Asian American by my background. And when it comes to health, sometimes we kind of forget as humans that whatever we do eat and our daily lifestyles are actually a big part of us. And I actually had my health journey started in my teens when I noticed that, wow, I have a lot of bloating. I have a lot of, I would say, new tools after certain foods. I couldn't really pinpoint it. When you're a teenager, you're just out there having fun. I was a cheerleader. I was just very, very active, but I thought that was healthy, you know. If you can move, if you can be in a place where you, you know, you can perform and enjoy life. That was enough. But really, when you realize that your health is not only a thing that matters, but things that get worse. So, you know, my, it ended up being to the point where I had lots of bloating, sometimes nausea and these tools and getting the diagnosis of air roll bowel syndrome was kind of what I discovered through my, not just high school years, college years, but then as I pursued medicine, not only are you in a stressful environment because I demand lack of sleep and poor health access, you know, I went to medical school in Chicago where you just eat tons of, eat the hot of them and fried foods and fries and, and you kind of almost try to self-medicate and it becomes this cycle where I feel bad, I don't feel good, let me just eat more. And the thing is for me, I just ate more and more. The end up being the wrong foods that made my symptoms worse. And so for me, I felt that I needed to really get a hold of the connection between nutrition and lifestyle and figure out that it's not just a diagnosis and here's a medication because yes, I was offered medications and those helped temporarily, but it didn't really help the root cause. And that's where I love the lifestyle, integrative realm is because you're kind of going beyond the diagnosis and the treatments, but you're going to the prevention part so it doesn't happen again. And that's what I was thankful to know that there was a direct relationship between not just, you know, with reflux and some of these diets out there, they say take, get rid of processed food, which is a great first step in spicy food. Definitely dairy has been a big trigger. So cheese, eggs, cow's milk. And then also when it comes to the whole food plant base, I would say committing to that was really when my symptoms were completely relieved and also exercising routinely and then meditating. All these things became more natural after you get through and push through some of those barriers. When I saw to her myself, it was just life changing, but also I knew from the ERs and the hospitals and that people just kept getting sicker. It was almost like this revolving door and you kind of treat one thing, but something else becomes an issue and you need another medication for that. And so the medications just kept adding and adding. And so for me, I just, my goal was to essentially minimize medications through lysine integrative methods. Absolutely. You know, taking a back, you said in your teenage years, you kind of had these symptoms. Was there a specific point in your life that you remember where not necessarily a flip of the switch, but where you knew you had to make a change, right? As you said, try to find the root cause and how did you kind of turn around your health? I know you named some of the pillars of lysine medicine. Yeah, no, you know, when you kind of go in your life and you're looking around you and you're like, oh, they can eat all this food and but why am I struggling? Why am I having this essence where I found myself bloating and missing like social occasions? You know, I couldn't really drink and that like most teenage college students, I, you know, everything kind of was just so agitated, cold water would mess me up too. And so I would say just going in and knowing like, you know, there, there has to be a connection between food and my health conditions. And so I just said, you know, let's just try something different. I went to the American College of Lifetime Medicine, conferences, pantheon conferences. I went to a little Linda's, my training, some of my family medicine doctor, and then I did residency at little Linda and to just see how, wow, people can be okay without eating heavy, I would say processed foods or animal products, how, it was just nice to see that they can live longer and be on less medication. So to me, it was, it was just important to make that change because I didn't try the exercise. It helped temporarily, you know, I, my husband, Micah, he was like, okay, let's go run and he loves marathon in five cases, that definitely helped me felt great, feel good, I mean. And then of course, I'm practicing breathing and I love doing biggest nerve exercises to calm the breath and to calm the nerves because 90% of our gut is made out of serotonin nerve, all transmitters. And so just resetting that really helped me. So eventually I committed and that's when I saw the law, law, I would say the life, you know, long lasting change. For sure. So I'm always fascinated by how people choose lifestyle medicine and really get into it because I mean, now as a PGY2, I'm seeing a lot more lifestyle medicine, right? I mean, I tried bringing lifestyle medicine curriculum over to the program so that we can get board certified. But when you were going through it, I feel like, you know, there wasn't as much awareness as there is now. So you, you're, you're board certified in family medicine. Did you know that this was the route you wanted to take when you were, you know, an M1 or an M2? Definitely not. I would say even during medical school, I was kind of curious about nutrition because I like, you know, well-being, hand that whole space, feel good lifestyle, but it was just more and beyond like, for example, I think I did take a nutrition class now that reminded me as an M1 and it was, it was just so incomplete to be honest, it was so basic. Here's the protein, here's the carbs, okay, calculate your PMI and then what does that translate into? I mean, not much because that's now thankfully, yeah, that is becoming more basic knowledge, but that's still not to the point where you're helping put a stop to disease and prevent disease. I definitely didn't have any idea. I was a psychology major in college, so I love just studying human behavior and I love studying how we develop habits and sometimes even our mind kind of just plays tricks on us. Like if you think about the food addiction out there, we just people self-medic with food or they just, they realize, oh, it's all to each degree, I want more and more and it's kind of hard to kind of put that under a pause and to the point where, yes, some people can have all the willpower and be as positive as they can, but they still really, truly struggle, struggle with their way in disease and so definitely it was not something I committed to in the beginning, it was just thankfully something I was actually just searching for because I knew there had to be something different. I went to conferences, read the studies, read the documentaries that demonstrated lifestyle and I was part of the trainee, so I'm so glad that you're incorporating that at your school or trying to write just the, it is, it's all about just literally people knocking on every single door and saying this consistent messaging showing the evidence because, you know, as a trainee, even I was blessed to be at Loma Linda, but still the hospital is not, you know, there has much, you know, we have a lot to improve on still. I was going to ask about Loma Linda because if the audience doesn't know, it's a blue zone, correct? So was there, was there much incorporation of lifestyle intervention then knowing that, you know, Loma Linda was a blue zone, social connection, all these things? Yeah, you know, I would say if you go back to the history in the early 2000s, they tried to incorporate, we call it like a centerium, which basically is a place that emphasizes lifestyle methods to healing, but then as traditional medicine came on board and like, well, you know, with the insurances, I would say with procedures and medications, it kind of just blended all those efforts. And so yes, the Adventist community practices more of a lifestyle approach, but then of course, we get it into the medical realm, so into the doctors, into the healthcare teams and the systems and the big tertiary system is, you know, it's like moving the mothership. That's not always easy if the healthcare system is not built to reverse that way, if it's not built to reward and incentivize that. And so that came with a struggle, I think finally after almost five plus years, we finally have whole food plant-based options in the hospitals, which is great. They have, I think, now the clinics for life-summonism is probably on its three or four-year-old birthday. I think they just celebrated that, and they have intensive lifestyle change programs that they're launching to. But imagine, they've been, you know, Loma Linda University Medical Center has been around for a long time, but they just started this. Well, yeah, so Ultimaugh, who unfortunately cannot be here tonight, he's training a geysinger. And from what I've heard, geysingers, like also in the forefront of kind of this lifestyle and medicine track, they actually have something called the pharmacy that starts with an F. And so they teach their patients actually how to go grocery shopping, you know, at this location called the pharmacy to really teach them about, you know, whole food plant-based and nutrients. And it's just, it's super fascinating. I'm excited to see how AC alum can really, you know, drive more of these projects across the nation. So you're from California, you're back in California now, correct? Okay. But you've practiced in other countries. Yeah, so, you know, it's been a joy to, I love not only just traveling, yes, my husband, I love backpacking, and we've almost traveled every continent. I'm really hoping for Africa, I just, you know, it'd be nice to go there. But at the same time, we served in, I would say, I served in my home country and literally took me 20 plus years to go there and see the, just the disparities, literally people there. They're bagging themselves to give themselves oxygen. They don't have enough gurney, so family members are carrying them from one room to the other. The lack of resources is real, and it's probably even more devastating now because of COVID. And so I would say it was, it was just nice to see, not only to see, but to contribute to that effort. So in the infectious disease realm, I would say that's where I, the department, I saw a lot of TB and infectious diseases that you probably would not see here and that are late end stage in the US compared to the Philippines. And then I went to Guam, and that's where I was able to practice a lot of lifestyle medicine and do some tobacco cessation group classes and also implement lifestyle medicine into their clinics and urgent care. So that was a lot of fun to kind of see it on another level where literally most people came with obesity, gout diabetes, hypertension, and knowing how to kind of deliver lifestyle medicine in a very direct five to ten minute visit versus like a half an hour, it takes some practice, right, and some skill. Absolutely, yeah. I'm super interested in learning about how you manage the cultural differences, right? I mean, lifestyle medicine, even here in the US, is so hard to get across to patients where, you know, you can speak English, the body language is the same, we understand the cultural norms, how did, what was your approach when, you know, you're talking to patients in Guam about these things? Yeah, I would say to them, definitely food is cultural, it's social, it is the foundation to a lot of conversations and you know, sometimes you just literally have to break the ice and say, you know, what triggered your gout or your high blood pressure, do you know what, what the cause is? A majority of people will say, no, at first answer and they're like, no, I really don't think so, it just happened, but if you keep just asking and asking it in different ways, they end up just saying, yeah, you know, I think it's something I hate. They kind of point that to, oh, maybe it's that seafood or that meat or maybe because I'm not exercising, but I think it takes someone to kind of take that time and ask the right questions. And then also showing them that, you know, exercise is something that helps heart health and brain health and also, you know, we need to protect our sleep because then we'll be less stressed and also our mood and energy will be stable. And then the food is always, like I said, a hot topic. So just demonstrating, literally, we would have, I think it was, it was so fun. It was like, tomorrow, a month, it was like their national month, where they would have their festivities. So the whole hospital actually was plant-based. So they were able to cook meals and show the history of their country and have the festivities. And of course, there, and there was other types of festivities, but they had the option, right, just to demonstrate and model that for them that there are people who can thrive off this way, and you know, off this type of lifestyle. Mm-hmm. Now to transition back to Cali, you've practiced what's, have you Spanish-speaking populations that correct? Now, do you, are you fluent in Spanish? I would say majority, like 70% enough to get like a whole medical visit and do that. Okay. Gotcha. So even then, right? I mean, if you're going to be practicing lifestyle medicine, are you seeing that these patients have to come in kind of dedicated with some willpower and initiation to want to change? Or is it more so of you trying to force it upon them a little bit more because of maybe that communication barrier or language barrier, whatever it might be? I, you know, it's a whole range. I think the practicality of demonstrating what the power of lifestyle medicine is is, yes, to show them that there's direct link to their lifestyle, to their disease. And also saying, yeah, I've seen this get better. You know, you have diabetes, but if you, you know, minimize the, the process foods and you start to exercise, have a smoothie every day, increase your salads, I've seen this happen where patients will have their A1C go from 9 to 7 to normal. So giving them just like these patient testimonies help, sometimes like if you come with a research book, an article, start reading that to them, if they will just go over their head. If you tell them to maybe watch a documentary or read a book, maybe that will inspire them. But the most important thing is just looking them in the eye and saying, you know, there is, you know, there's another way and, you know, this can be free of side effects. This can help you. It's something that you can just give it a try because your body will thank you and not only that one organ will thank you, but everything else will benefit. And I, and with the language barrier, I know you mentioned that, yes, there's culture and language barrier. But, you know, even just speaking like 50% or, or even 10, 15% of the language just helps so much, showing a lot of pictures, saying things slowly and repetitively can help. And, and I think, you know, there's a lot of, I would say educational handouts that have translations now and books that you, that you can look at. And just, you know, Plentish and Project, I was just doing a podcast in which a day in Dr. Scott's soul, they're actually having a new initiative to record, use all their recordings for their conferences and, and make that available worldwide. And that, at no cost for medical students. So I think that is where the power comes from. And you're truly trying to change our world where it's accessible, where people can know that this is a way of healing. And it is a method, and it is evidence-based, and it is science scientifically proven. And so I think that's the beauty, ACLUM 2 is definitely global as well, but when you just have more and more organizations supporting each other, and you think that's the hope that we have. Absolutely. I find your experience is fascinating. I mean, the only time I've gone abroad was my second year medical school where we did a underserved trip to El Salvador. And man, I feel in love. I mean, that's definitely something that I want to continue. You know, whether it's doctors outboarders, or just even going back to my school at VECOM and being like an alumni doctor who can go with the students and teach. I just think that's fascinating. Looking back, though, at all your experiences, kind of abroad and early training days, what are some of the lessons that you've learned from those experiences? Yeah, you know, I think the real deal is, you know, don't give up on whatever it is. If it's your vision, your passion, if it's that one test, that one concept, you just stick to it. And you try it over and over again, and it will come through. There's a reason why you're in the place you are. There's a reason why something is calling you, and there's a magnet towards what you do if it's P and R, if it's, you know, cardiology, GI, there's a reason for that. And I would say just, you know, continue the path, take a lot of good care of yourself, and may take time to relax, take time to rest, and of course, celebrate. And then when there's something rough and hard, and when you're grieving because there's hardship in our world, there's devastating news left and right, or maybe a loved one that you picked, I would say, you know, be present there too, and get help when you need to cope with those hard times, because a lot of doctors, unfortunately, are poor patients, meaning they, if you do serve their surveys, that they only practice, I would say, 2.7% of physician's practice health, healthy lifestyle, so that's even too extra, as I sleep, emotional, well-being stress management, we're just as bad as patients, sometimes maybe worse, depending on our training period. And so, yes, you know, residents are on call, 24, plus hours, sometimes breaking, duty hours, because of the call of the pandemic and the shortage of healthcare workers, and so my thing is just always, you know, find time to do what you love, value yourself, and then you'll just be brighter for your patients, meaning you'll just be more present and you'll think clear, you'll be able to strategize for them, and then eventually that dream is the reality, and I don't think people, I don't think people have to limit themselves, and just keep remembering who are living the dream. So true, so true, we have a lot of pre-meds, medical students, residents who listen to this, so I'm just going to tell all you guys, go back and listen to that answer again, you know, I think we tend to make healthcare as an excuse, right, or long hours, and the studying, we tend to use those as excuses, but I always say, there's no excuse, right, like if you can start as a pre-med or medical student to live the way that you're going to tell your patients, like you said, it becomes a reality, and you don't have to figure it out in the midst of, you know, later down the road in residency, or as after, as an attending, and just gets harder to do, so if you can instill those habits now, you know, as an early trainee, you're going to, you're going to love it, you're going to go down and see the evidence base as well, and it'll just make you a better practitioner in the end. So you're used to eat a lot of meat, I've heard on podcast, right, when you were younger, you're, so you quote, unquote, a carnivore, and you've now transitioned to a plant-based diet. How long have you been plant-based for? Yeah, I would say a total of going on five years, so four to five years, and you know, I would say it was literally that immersion experience that I had at these conferences, and where I saw people eating like that, and I just tried it for myself, and you know, first thing you notice is, yeah, you don't get the meat sweats, and you don't get the bloating, and you don't get those, even those headaches after, like a lot of processed food just has tons of artificial flavoring, and this, gee, it's hyper-stimulated, it's just like media, they throw everything in there, so that you are engaged, and you just want more and more. And so that's why I do a primary care psychiatrist, I love serving those with depression, anxiety, addiction, OCD, PTSD, because that's just definitely, you know, they say about 70 for four percent of people have mental health conditions, and once they're in the primary care office, so that means, you know, that's important, but literally we kind of are under treatment, and under diagnosing them, so they say up to even 50% to 60% is undiagnosed and not treated, and then most of those people who are treated, if you look at those statistics, they say they may not even qualify for treatment, they may not even need it, and that's because they are probably jumping to the medication, rather than addressing the lifestyle conditions, and their habits as well. To go back to what you said, right, 90% of the serotonin is in the gut, we know there's the gut brain connection, we know that by eating plants, you're getting more fiber, right, so you got the prebiotics, the probiotics, if you guys want the in-depth analysis on the gut, you guys can go to episode 16 and 17 with Dr. B, Wilbur Switch, we go into death on being like fiber field, but this is exactly what you're talking about, right, I mean, mental illness in some way, if you want to get down to the root cause for a lot of these things, can also be the gut, so just eating that, you know, becoming plant forward. Now, are you vegan or vegetarian? Yeah, I like to say I'm whole food plant based, and you know, just because, you know, I even, you know, I corporate vegetarian vegan meals and all of that, and I would say, you know, I love my vegan friends, my allies, they're awesome, but I'm not someone who I don't have, not leather proof, and sometimes there's also things that we don't realize that's inner food, that's kind of hard to, like, I would say, pinpoint, but you know, at the same time, I think when it comes to just being healthy, there's a lot of, I would encourage people, there's a lot of fads, there's a lot of diets out there, there's even some times where some people do extreme diet, extreme restriction, where it does eat to eating disorders or what we call oral frexia, which is basically people's obsession over health, that they are doing it to the point not just because they're losing weight, but they just have the wrong idea about health, and so we definitely are, those are the things I scream to as well, and so when we think about, they got brain connection and immune connection, so a lot of people after COVID, you know, are having, I would say, mental health conditions, anxiety depression, ADHD has been seen a lot of, I would say, gastritis, worsening of their Crohn, so that's kind of happening left and right, but I would say at the end, we need to support all systems, because that's why I'm a primary care doctor, and it's all connected to me. Absolutely, I love that, and I love the fact that, you know, it's not about the labels, right, it's about incorporating more plants, which mean ultimately I try to talk and try to preach on here as much as possible, you know, whether you eat meat or you don't, I don't think anyone, I mean, I know there are people who are out there who can argue that plants aren't good for you, quote unquote, but I think majority of the data everywhere it says get more plants in, it's probably going to help you. So now when it comes to your practice, I mean, you know, you're obviously treating typical chronic illnesses, what are some of the atypical diseases that people may not think about that you're still advising a plant-based diet for? Yeah, you know, so in my practice, you know, I would say either in the acute setting, because someone thought they had appendicitis, or they even thought they had, I just had a patient who had an umbilical hernia, and I think his mesh is probably not as stable as we wanted to be, and so those things, initially, what does everyone say? You know, eat, you know, drink, drink lots of water, liquid diet, and literally avoid these high fatty foods. Like if you think about the most acute scenarios, even gallbladder disease, like the recommendations are to avoid fatty foods, and usually these fatty foods, where does it come from? It comes from animal products. And so high cholesterol is in, you know, that's where I would say, cholesterol is made as an animal, and that's why humans have cholesterol, too, is because we have that naturally within us, but also we are overconsuming it, too. So in the acute setting, those are like where I, you know, I've seen some of those crazy relief that, you know, may not see everywhere, or in there's not a lot of, I would say, these are anecdotal, but at the same time, the more the robust studies happen, you know, in the hypertension, high cholesterol, the diabetes, the overweight, those are the typical, but then it's so nice to see it in relief when it comes to fatty liver, to anxiety depression, allergies, asthma, and I just, so Dr. Scott, so this is like a big announcement. We just went live with him, and so he has this book on disease reversal, and it's real people, real stories on hope, and from A to Z literally, you can see how these people had many conditions, anywhere from ear infections, from pancreatitis, from panic attacks, PTSD, a lot of our rheumatoid arthritis, their derma, kidney disease, stage four, stage three, nephritis, all these things, gingivitis, and in one person, Esther was her name, she had 18 diseases, and all of that went away, so it's just the possibility, right? It's definitely hard work, it's commitment, and I don't like to oversell and give, like, for example, that everything will go away, but I would say the majority of chronic disease can be improved unholy even reversed, and then at the same time, in the acute setting, things can at least be better mediated, just like when people have COVID, I'm not telling people to go, it tons of stake in burgers and hot times, because it definitely are, you know, they have pro-inflammatory components that really aggravate the immune system, so we, I would say, we just have to be mindful and recognize that there is a deep connection. Absolutely, and the body is connected, right? Like, I think we're to learn that more and more, you've got to treat holistically, more often than not when you treat once symptom or root cause, or let me put it this way, you treat a root cause, you see more than one symptom go away, right? I think what the U.S. health care system does in the training is we tend to compartmentalize different symptoms and different ailments for a specific specialty in a way, right? So if it's the heart, it's got to be cardiology and they'll take care of that, and let's not get it mixed with GI or dermatology and et cetera, and, you know, I think what makes a great practitioner, someone who can step back and say, hey, like, how are all these things may be connected looking at the patient's lifestyle, right? How do they get here in the first place? So I think that's just, yeah, super important connection, and we'll definitely link that book in the show notes. I wanted to ask you because, I mean, I'm a vegetarian myself, or let me say plant-based, so I've never eaten meat because of religious reasons going up, but I mean, I'm pretty secular now, but still continue to eat that way. And one of the most common questions I get is, how do you get your protein? Now, I mean, I've lift weights, I'm pretty fit, I'm pretty good at strength, so it's a really funny debate at times, you know, when people have to ask me, but I can only imagine that some patients might be asking that question as well when it comes to eating plant-based. What do you tell them? Yeah, no, great question. So people think that protein is their number one, I would say macronutrient that they have to have on a day-to-day and the largest amount that they need. And I would say actually, you know, our, our body only needs, you know, so it's really calculated by weight. So it's your own point for a case per egg, and you have to, or mix per cake, and you have to calculate that, and about 97% of our populations over-consuming protein, and only 3% gets their fiber. And so I, you know, where you get your protein is definitely tons of, I would say, vegetables, like kale has a great amount of protein and not just kale, but, you know, edamame and also tofu and lentils, like gooms, nuts and seeds, literally all plant-based items have protein, and it's just a matter of, you know, maybe people don't realize that they're missing that, and it's usually because they're missing the sugar satisfaction, that simple complex, or the simple, I would say carbs that they were meant to be getting on a day-to-day because that's what they were telling themselves. So I would say simple carbs through chips and crackers, those are the things that satisfy the brain. Also, when it comes to what the simple carbs are found in, they're actually the sauces covering the protein as well. When I say protein, that's like chicken and, like, and beef and everything else. So that covers it. So when you cover that component with that animal product, the brain is missing all of that, but when you have the plant-based component, it's not just like you're getting less satisfaction, you're actually getting more nutrients, and you're getting away from those addictions that were, that you were kind of, you know, dependent on. So I always just like to encourage people to get, you know, if you get, you know, two servings, I say, one of two servings of beans or lentils a day would be great. If you get three, I would like to say five servings, five to even eight servings of vegetables, that would be great. Three to five servings of vegetables, that's another layer. So just think about what you want to do when you build your plate, but you definitely need a balance. Sometimes people say if you're vegetarian, all you eat is on one item, which is like they should say, like veggies, and that's it, but they forget their nuts in their soup, or they, or they think, oh yeah, you eat just completely raw, and that's their imagination, but now you can have some really amazing cooked dishes that is flavorful with turmeric and herbs and spices. I'm a big fan of veganizing my meals, or even Asianizing my, my, my meals with a, with a way where, you know, I'm satisfied as well. Absolutely. And, you know, speaking about the protein and overconsumption of Walter Longo, who's doing a lot of research on longevity, his book The Longevity Diet talks about as he's studying blue zones that most of these blue zones, they're actually only taking in like 0.3 to 0.4, makes for a kid, as he said, and then they maybe ramp it up to the 0.5.6, once they reach like 60 to 65 in order to keep kind of the muscle mass. And then interestingly, David Sinclair, who a lot of people might know, lead, one of the leading researchers on anti-aging and longevity up at Harvard, he actually switched to a completely vegetarian vegan diet, and is doing like a low protein diet almost too, because he's saying that the body in order for longevity has to be stressed, and it has to understand that when it's in a low protein environment, it's going to upregulate like the mitochondria and things that will promote anti-aging. So, super fascinating stuff. I'm really excited to see kind of what the data shows moving forward. So, you mentioned cooking, you mentioned recipes, I know on your website, there are, do you hold courses for cooking? Or I know you have a bunch of recipes on there for sure. Yeah, so I collect all my recipes, and I have like e-cookbooks, and I have a YouTube that I'm restarting again to show my cooking, and then I also, I had some courses within my clinic that I was providing for, and I think that's, you know, I love through classes. It's just amazing, because you can give each other feedback, you can one try something that works for the other, and then I'll be hosting another series of. So, stay tuned, I'll be having more online classes that I'll share with the public. That's not just internal to my clinic, and then eventually, I'll be having cooking classes 101, but one step at a time, that's next year's project. Yeah, absolutely, I can't, I'm going to have to take a look at those recipes, some of them just look amazing. So, and we'll definitely link those again to the show notes where I wanted to check out. I wanted to transition to your half, Dr. Micah Yu, because I know he's had an incredible journey as well with the Enclosing Spanelitis, shares similar values to you, and you know, when the, when your patients come in, obviously, your family medicine, right, you take care of generations, you take care of families, as well, partners. How important do you find it that families or spouses or, you know, whoever need to share same lifestyle values in order to find success? Yeah, no great question. I think, you know, usually it's one that starts and one finds the the alternative way of eating, and then does the cooking and the heavy lifting, and that's, you know, I did that, and then my husband was able to just observe, because like, is this real, is this worth it? Is this going to be something that we can commit to? And then essentially, he was able to kind of appreciate some of the, I would say, changes in him and the science, and yeah, I think it's really nice to do it together as a couple. I think it's nice to do it with a friend if you have like someone you can convince or someone who've already been on that path, and then you can just learn from them. And I think it's just, some people go through ups and downs, laughs, laughter's about themselves, and just new self-discovery is like, oh wow, it's kind of like I've done intermittent fasting before, too. You were like, wow, I just have these cravings. It's like unconscious habits, you don't realize that you have. So to have someone there on buyer's side to also go to certain restaurants because they're more plant-based friendly, it's nice that you can do that in a group setting. It's not absolutely critical. I know people who have they're alone in this and they, they've done well. So you said a word there, journey. I love that, right? Because we're so data-driven in this world and I think we're always trying to chase a certain, you know, fat percentage, a certain BMI, a certain weight, a certain biomarker, whatever it might be. But it's important to realize that we should just not be chasing, but living, right? In the present moment when it comes to our health and enjoying that journey and enjoying the ups and downs, I mean, it's not easy, you know, every day trying to be on point, trying to get the best sleep and the best diet and best exercise. It's not going to happen, it's not possible. But to understand not to get down on ourselves, right? And to really just enjoy that journey and that slow roller coaster ride that takes you up and up and up. So definitely love that word. I've wanted, so a lot of our guests that come on here that are lifestyle medicine based practice, you know, either in a concierge way or direct primary care way, but a lot of them don't take insurance. And I believe that's the way you're practicing. What advantages have you seen with that model, you know, compared to the traditional healthcare model of taking insurance, 15 to 30 minute visits? Yeah, no great question. So I train in an academic center and these centers, there are times where you have 15 minutes, sometimes five, 10 minutes, because you're just constantly running behind because of the complexity of health condition that the patient has, you have to literally send someone to the ER, you have like 10 orders to get or it's just a fast piece environment. And so when not only one, you're running either, you're running behind because of something in the system, so that just shrinks your time. And then you only are able to address the patients, I would say, important need of the day. And usually it's just one or two things, but literally sometimes you need to adjust five or 10 things, because you won't see them technically maybe in six months or a year later or years later. And you know, I think that's where unfortunately don't have enough, I would say points of contact with our patients to see the sustainable change. So even if they were trying to take their medications, you know, surveys show that up to 60% can be uncompliant. And so meaning that they're not taking their medications either completely not taking or inappropriately or not understanding the right technique to take it. So I would say when it comes to the health care system, there are just so many layers, right? And of course, it's great to have a multi-disciplinary team with a social worker, with a behavioral therapist, with now they're incorporating health coaches. That's all great. But I think as physicians, we are the driver of that the system and we need more and more time with them. And so I love the fact that so I worked in FQHC in the academics and I worked in urgent carriers as I mentioned. And I just really enjoy spending a whole hour with patients, being able to hear, like I said, their journey, their story, their wise, their house, getting to know their personality because not every personality wants to know the labs right away. Literally some people are hiding from their numbers. Other people want their numbers 10 times a day. And maybe that's not healthy for them. Maybe they don't need to look at the scale all the time because they feel defeated. So I just think that having that freedom to practice one hour through a direct primary care model, including lifestyle and all that we do not only gives us more time, but then also we're we're not keeping up with all the billing that's happening. There's lack of reimbursement, there's coatings like you literally for vitamin D, you have to put bone loss for them to like cover that lab. And I am using essential vitamin, not just for bones, but for gut health, mental health, immune health. And so it's just a lot of battling. If you can, there are, you know, healthcare systems and like I saw practices that know how to beat the system and have strategy, but it takes a lot of not only time to learn it, but it takes a lot of staff. It takes a lot of I would say patience to you and everything, right? Not just patience, but it takes some tact, but I'm, but I always think there's a there's a system for everyone. And you just have to find the path that you, I would say, can see yourself actually living according to your own lifestyle, you know, but also it's not forever. You can always change your mind. Absolutely. Yeah. We just recently brought on Dr. Peter Valenzuela. He just wrote a book called Doc related and just talks about the broken medical system and, you know, how he got an MBA and now that he's in this position to make change, he just sees how many layers deep, you know, the or how broken our healthcare system is. And it really is a shame. And, you know, for me, the reason I chose Pima Nara was kind of exactly what you're talking about in terms of building that rapport with patients, right? I mean, in the rehab hospital, patients can be there up to a month. And, you know, I loved kind of just being that life coach and mentor to these patients. And really, you know, talk about these things after a couple of days in terms of lifestyle intervention. And how do we prevent a stroke, right? Now that you have a spinal cord injury, what can we do to reduce the anxiety and depression that may come along with it? So I totally agree, agree with that. Now, I know that you're a, well, you like to be a mentor. You like to teach as well. There are a lot of pre-medical students right now who have this thought that going into medicine means healing, right? And lifestyle intervention, like we're talking about. But I feel like sometimes there's this rude awakening when you get into medical school and you realize there's only 23 hours of nutrition teaching, right? There's no real stress relief teaching. No one's really teaching you these things. You kind of have to go outside of the curriculum to get either hands-on training or just a better understanding of true healing in the sense of lifestyle intervention. What advice would you give pre-medical students right now going, you know, that want to become doctors and want to practice this type of medicine? Yeah, you know, I know that you're just trying to see in terms of how do we, you know, make time for this? And how do we not only make time, but how do we stay on track and how it becomes practical? You know, one of my favorite times are at the rehab, actually, where I was spending time not only getting to know patients, because they were there, like you said, for weeks and sometimes sounds feels like months of, because they keep coming back. And they just had, they just have complications with their TBI or their HIV and HIV or their stroke that just progressed. So I would say those are the times where I say, you know what, this is something that the disease keeps happening and we just need to keep going. In the matter of it's end, like people in their, their older or late stage, there's still a place and a time for it. And that can be literally now. And that's what we do, is lifestyle medicine is now. And to teach and get back and mentor, there's, there's definitely phases, right? You, you know, I always think we, we learn, we, and both, and people think you have to learn everything in order to share. And yes, you can develop a certain competence by getting the certificates, by getting be broad certified, going to conference, but I think you don't have to wait to share the possible therapeutic interventions, meaning you can share. Yeah, let's, let's talk about nutrition. Let's talk about maybe some healthier options when you go eat out. Here's some things I would recommend on the menu. Here are some things that you can cook at home, or you know, here's this quick, you know, I would say exercise that you can do in your chair. Because if literally sometimes it takes people so long just to get to their physical therapy appointment, right? Because of access. And, and, and they sometimes forget to you. So repent repetition is so important to just say the same message and do it early. I love that. Have a theme. That's kind of what I did during my residency interview. So I had a theme and that was creating value and being a mentor and life coach and stuck with that during, you know, all the questions that they asked. So I like that. What is next for you? I know the inception of doctoral lifestyle was not too long ago. So congratulations. And what's, what's what's the upcoming goals? Yeah, thank you. So basically, so Dr. UNI, we have our in-person clinic and that's also telemedicine. We serve I serve California in Florida, seen patients in different countries. He definitely has a breath of state licenses and other, it's like almost every continent for him as well, in terms of people who he served. Content Ford is another big I would say announcement. We developed that and that's a telemedicine multi-disciplinary specialty platform. And so we have GI, Dr. Vanessa Mendez. We have Dr. Nicole Hart who's a lipidologist, preventive cardiologist. And then we have two registered dietitians, Amanda Sabia. And she's based on intuitive eating and mental health. And the other one is Natalie Castro. And she does a load of the autoimmune and GI disorders. And then we have a health coach on board. That's Jackie. And we're also recruiting to you. So we're on our second phase of recruitment. So we're just excited about that. Dr. Hughes launches a YouTube already. We have, where I would say we just like to be in the pulse. And in everything that that lives in brief lifestyle and plant-based and prevention, because the wavelengths that are really, just keeps extending. It's like when you have a wave, you can literally go from a tsunami, right? It's a tsunami effect. It goes to the other things that surround it. So we just want to be part of those initiatives. And we're just great to have you also elevating the message. So thank you. Sure thing. Yeah. We actually just recently had Dr. Nicole Hartkin on here. So we're actually waiting to do a two-parter with her. And we'll be releasing that in the near future about lipidology and plant-based for being heart healthy. Where can our listeners find you? Awesome. Yeah. Well, basically, I'm on Instagram. I'm pretty active on there. I'm Melissa Mondale. MD. And then also on Facebook, you can find our clinic Facebook there. You can definitely email me if you need to, you know, www.mulsamandalemd.com. I'm sorry, Melissa Mondale. MD at gmail.com. I'm pretty accessible. I've been helping a lot of, I would say, students, residents and people who are just pretty health wanting to have some mentorship. So thank you. Absolutely. We'll link all of that. And I just really want to thank you for coming on here tonight. This has been amazing. You're probably one of the first, first few lifestyle medicine doctors that I started following on Instagram. So I can definitely test to what you're sharing on their right. It's not only just the knowledge behind and the research, but also just everything that encompasses being a doctor in lifestyle medicine. So thank you so much for doing what you do. Thank you. Thank you. Thank you, Josh. It's, it's always a pleasure. And you, you always inform me what's new with you. So I can support you. And we, we, we need more PMR, um, lifestyle oriented. Absolutely. And I think, I think there's more of us coming out there now. There's a, there's a big, um, coalition. At least Dr. Beth Freides is a rehab doctor. Now she's trying to make a bigger push, um, for rehab or for lifestyle medicine within rehab. So excited to see where that goes. I do have one last question for you that we ask all our guests. And that is how do we, how do we put the health back in healthcare? Uh, that's great. I, you know, I love that question because obviously, I think this is the theme of today's talk is it starts with us. It starts with you and me. It starts on a day to day that habit that we need to break or the new habit we need to develop, um, is something that is, is very real because our patients look to us and we could only relate to them truly if we, um, practice it ourselves. And then, um, I would say with, you know, we mentioned PMR that we are some of our applicants at for Loma Linda. I was part of the lifestyle medicine fellowship on some of them. We're getting a breath of different specialty. So that's family PMR, Peds ER surgery. We've had just a whole host and I think literally don't, you don't have to limit yourself when it comes to, um, wanting to imagine what lifestyle medicine looks like and really that's where it is. You be you and, and you stay healthy by, um, incorporating these lifestyle changes each and every day. You be you. Love it. Thank you so much, Dr. Manila. Yeah, my pleasure. All right. Well, if you're a patient or you're even a healthcare provider or a student V1 and you want to learn more about lifestyle medicine, maybe how to incorporate it more into your life or even into your practice. Highly recommend checking more of the episodes out on this podcast, almost all of our guests touch on the topic of lifestyle medicine, but we do have a few individuals who are lifestyle boarded. Also, another big resource that Ultima Sh and I recommend is the American College of Lifestyle Medicine or ACLM for short, where you can find handouts, PowerPoint slides and just different resources to understand how you can incorporate this into your life. Now, as always, if you loved this episode and you think others would benefit from it, please share it. We know that 86% to about 95% of issues in terms of healthcare are due to chronic conditions and we can mediate these issues if we just go back to the fundamentals, which is what lifestyle medicine is all about. Please like and also review this episode if you enjoyed and as always the disclaimer, everything in this podcast is for educational purposes only, it does not constitute the practice of medicine and we are not providing medical advice. No physician, patient, 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 physician regarding any specific health related issues. I hope you guys have an awesome week.