Hype vs. Reality: The Biggest Health Trends of 2025

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamash Raja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in healthcare. Welcome back everyone. This is our first live episode, 2025. So happy new year to all the listeners out there. Hope you got to share the highlights of 2024, let go of the demons, and or it will create a better version of yourself here in 2025 alongside Dr. Altamash Raja and myself. Alt, how are you doing? Good, I'm not sure if I let my demons go, but otherwise pretty good, I like that, I like that opening. Cool, so this episode will go through some trends, like we did last year, but before we talk about 2025 trends and what we think is often coming, it might be the biggest winners and losers. Let's go through what we predicted in 2024 and see how that panned out. So if people want to check out that episode, it's probably, I think it was done the first week of February, February in 2024, and we essentially just asked each other a what trends do we first see, then what fads do we first. So we kind of took turns here, and the first thing you said was digital health. We had a guest on at that time too, talking about digital, we had multiple guests actually talk about digital health, but we think how do you think you did there in terms of digital health in 2024? Yeah, change takes time. Hey, if I had the double down on it, I'd still would today, I think that is still going to continue to, in fact, I think later, probably when we talk about what's going to happen, I'll probably have some variation of that. I think it's important for people to go back, I figure, oh my god, you did the solo entry interview for digital health with RJ, RJ Kedziura. Yes, yeah, Kedziura, right? Exactly what digital health is, not just kind of only from the aspect of telehealth, but I think, especially as we talk about, our last discussion between you and I in terms of the insurance based model and what everything happened with the United Health Care and insurances and the transparency in that now that's becoming a more evident for everybody, I think that consumer mindset of medicine being transacted much like many other things in this capitalist society is going to become more rampant, and that's where I think digital health really goes up and those companies like eight sleep is one which is now considered a medical device by many things, right? We talk about true med and how you can get your FSA for eight sleep and so that qualifies into that and then the integration of that into the traditional medical model in terms of hospitals and clinics, that'll take a very long time. I do not think that a year from now will have this conversation. In fact, I can guarantee that there's no way I'm going to be a year from now and say, oh yeah, because we're still using facts, old school facts to get records from outside institutions, so that'll take a very long time. Yeah, I agree. And I think, yeah, this year there's definitely been more talk about the integration of AI in terms of health and obviously that's going to continue to grow. So cool, for me, I said in 2024 that recovery rooms, especially bathhouses, would be a trend. And so as I look back on that, what's been interesting is I've seen people take that into their own hands. So rather than recovery rooms popping up, which they are now, actually, being in Tampa, I just spoke to somebody that just opened up a recovery room with infrared sauna compression, ice plunges, all of that. And there's another one actually right down the street for me that just ended up as well. I think people, at least in like New York City and even here in St. Pete, they would throw their own parties with saunas and ice plunges at coffee shops. And it's just a good way of networking, getting to know people that are like minded. So that I definitely saw a big increase in. So interesting. You did say that you were going to start up your own bathhouse though. I did. I remember hearing that. Yeah, that's good. And they're just still looking for some land. I guess I got beat to it. But yeah, awesome. But what else do we say here? So okay, this one's good actually. You said actually from health wearables. So you thought there would be at least more of a report or more actual tips that we see from maybe companies like Apple, Boop, AIDS, late, whatever it might be. Yeah, I haven't seen much on that in there. I think there's been so much excitement with health tech and not a health tech. And in terms of AI in health care and I feel like all the people who wear more in health tech have been focused again how we can incorporate AI and incorporate and just be better and more thoughtful in terms of how we calculate data. But it hasn't been more actionable in the sense of practical implications for them. I suppose that's a trend, right? So people, you're going a certain way and all of a sudden a new technology just has been around for a long time. But it's really taken off exponential rise in terms of usage and people like, how do we adapt this? We were just talking about this with our team yesterday. So I'm not really sure how I've seen that like my Apple watch hasn't changed. In fact, if anything, it's regressed in terms of the data that it gives me from action availability. Like it's so hard for me to look at my weekly summary. I don't even know if it's possible for me to look at my weekly summary for how many steps I've taken, which is really annoying. But at the same time, we were talking about you sent me that thing with Mark Cuban. We know that cryptocurrencies, something that's been really big. I know I'm making a very hard left turn here. But Apple's like making their own tokens for that stuff. So interesting how different large big companies see these phase shifts in terms of what the people want, what consumers want. And they start putting more efforts to what that it's supplying to man economics 101. I suppose that makes sense. Yeah, I think it's funny. I follow this guy Adam. Data driven on Instagram. I think it's like an MIT grad or something. He talks about the newest health, tech innovations and trends and stuff that's going on. And I think maybe last month, he mentioned exactly this action ability from help wearables. I think this is what all the companies are starting to get now from an AI perspective. And now actually shoot out like, hey, this is what you should do in the morning. This is what you should so like hyper optimization essentially. And then tracking the certain variable that would affect that whether it's HRB or heart rate or you know, stress levels or whatever. I don't know if it's subjective or like something that's going to be coming. So I don't know how I feel about that, though, man. Like when life becomes so prescriptive, it's not life anymore. Like you're not living. If I have to have my health tech tell me how to function or how to breathe or when to take a sip of water, when to go to the bathroom, I'm not really sure. Yeah, absolutely. And it's what's crazy, though, is I think in like when we look like three, four hundred years from now, I mean, we're all going to be robotic essentially, you know, I mean, well, it's going to be like an episode of Wally in the sense of we're all just got to like optimize primary. We are going to be AI ourselves in a way. And I mean, Brian Johnson's been doing this, right? This is what he does. Like I think of me watching like you listen to him and stuff. It's fascinating. The one man experiment that he's running, or I guess he's running with his son too. Yeah, some of it as well. Yeah, there's a documentary that came out on him actually don't die. Yeah, right. I caught bits and pieces of that. And it's like the, um, look, everywhere that I hear him, the guy says, I want to do this. And I'm happy. I love it. It's certainly and by all means likely that that brings you joy in that being your award. Like that's by all go for it. But I don't know. I mean, I, you know, I go back and forth about this thing for a long time. There was, there was a study that I was coming across. There's another guy can't think of this. He's a really prominent person who shares evidence-based fitness and health information. And this study that he shared today. I'll send to him on on Instagram where he talked about sleep regular sleep regularity is far more important for all cause mortality than sleep quantity. Like we know that seven to nine, ideally average eight hours of quality sleep is important. But like Dr. Matthew Walker talked about QQ RT, right? Quality, quantity, regularity, like going to the bed the same time every single night and waking up roughly in the same like within a 30 minute window, that actually shows to have even a more significant impact on all cause mortality. So I was looking at this and I was like, uh, crap, like in. And the reason I bring that up is because like social jet lag, the concept of that for those people are not familiar with it. Let's say you're going to bed at 10 o'clock to the weeknights. But then on the weekends, like you're out with your family and you're spending some quality time and you stay up till 12 o'clock midnight. Um, I always get super stressed about that. And one, I am a morning bird, right? And so I want us everybody to get up 530 and hang out. But that's not the society we live in. Everybody in my family, my siblings, they want to stay up later. And so with the holidays, just right behind us, I was privileged and blessed enough to spend some quality time with my family. But they all wanted to hang out late. Like every time I just passed out on the couch, like I just can't hang. But you know, what I tried to remind myself is not to stress out about the fact that my sleep is off. Quote unquote. Right. That time with family is just irreplaceable. You know what I mean? And so, yeah. So always like back and forth and back and forth about this. Like I know what the data says. I know what the science says. But sometimes violating it isn't the end of the world because again, as we said before, like physiology is complex and human beings are complex and it's a one to one person thing. Yeah, absolutely. Fair enough. Let's be here. Okay, I guess the last thing I said was I thought there would be more traffic into DEXA slash VO2 max clinics. And I think there's, we talked about those DEXA fit in Philly. There's some around here that for clinics that measure your bone density and through that data or muscle mass as well and through that data, you know, PDRT is a big bit of this. You can look at whether you're overnourished, undernourished, whether you need to wait lifting, you can kind of set your own protocol up for that. And then also look at VO2 max. I see more and more gyms now offering VO2 max services where you can actually, you know, put the respiratory device on, go on a treadmill and see what that is. Yeah, I think it was a little bit more of a trend than I see something that's more stable. I know more people are talking about it, but I don't think more people are getting tested, essentially. I've been twice. So I can tell you, you're right about me. And two decks for DEXA fit. Interesting about that. I actually, when we later talk about muscle loss after disuse, or disuse atrophy, particularly getting the annual DEXA scan was the thing. I think I'm going to make it a bit more frequent now, just because I've lost quite a bit of muscle mass that we'll talk about later. Dad, I'm curious because the first time I ended up getting it was this place in Philadelphia. Second time I was out in Orange County, California and I got it. I know it's not supposed to be like, you ideally want to use the same system and all that kind of stuff in the same tech, but I the experience was night and day in terms of for the first technician, how we sat down and talked about the body composition, what that meant. So it was just like the first time tech was like, all right, here's your results. Okay, it'll be in your portal. And the second time, I think she was like a master's level exercise science, I don't know, technician. And she was like, oh, do you know what this means? This is what this means. These are the implications of this. This is how you might consider this. And I was like, man, this experience is also the second one was far cheaper. So I wish that place could be closer to me. I think maybe now we can start talking about the next thing. That's going to continue to increase. What I talked about earlier in terms of people taking help into their own hands, seeing some of the nonsensical stuff that's happening with insurance companies, that compiled with the fact that all these anorectic drugs are great for weight loss. They are slashing down lean body mass. That's happening. I'm seeing this in my patients. And I've prescribed it a couple of times too. And I'm recommending body composition beforehand. Can everybody afford a dexascan, which could be in the neighborhood of $1,500, maybe a little bit more? No, but some type of body composition has to be done. And if you're not tracking body composition and you're starting anorectic, that's bad news. Or if you're prescribing an anorectic and you're not encouraging your patients to start or get body recompositions, then that's not good practice either. Yeah. Okay. I like that. Let's see. So let's get into the 2025 trends here. So we'll break this into categories. So first up, the biggest winner that you think of 2025. And this can be a person idea concept, whatever. It's so easy. It's so easy to stay on the health trend, right? Because that's just so we're so inundated with that day and day out. Oh, man, the Trump is the biggest winner of 2024. I actually didn't know I was going to say that until two microseconds ago. I don't think anybody saw him winning. Or at least I don't remember people talking about. In fact, even people within the own Republican party, I think I was watching the interview with Bill Mahern the other day. He's going to lose. He's absolutely going to lose. And I think this was from maybe October or some point. So I don't I think everybody including the Republican party just thought that was going to be it and they were preparing for that. And so that was surprising because not only did he win, he won by landslide and very strategic, right? So no matter what your thoughts are about this individual, brilliant individual to run the campaign in the manner that he ran, recruiting the teammates and getting people on his side as opposed to having opposition. I think it was awesome. So I can't believe we went there in terms of political. Hopefully we haven't lost half our audience at this point, but I think that was interesting. Yeah, it's funny. You mentioned that my biggest winner is the concept of truth. And it was going to say, or at K, but I think it all ties it at Donald Trump or at K the truth. And I think obviously the American people you and I were all looking for the government to come out earlier and admit mistakes, but also bring out the data that they probably already have and that they just haven't released. And that could be, you know, regards to vaccines, it can be in regards to wars, it can be in regards to whatever people have issues with or whatever the country's going through. And I know they pledged to at least bring out some lists and go through some documents, open up some things as well, open the vaults, so to speak. So we'll see how that happens in 2025. I mean, Trump is getting, I think by the, when we release this, actually, I don't know when we're going to release this, but he's probably going to be inaugurated by then. But yeah. Yeah. And when you say the truth, I think, again, Mark Cuban was talking about this, how one of the biggest reasons, let's shouldn't say maybe biggest, but a large portion of the young, young male population, maybe not middle age, but young male population that had the Democratic Party lost that vote. And maybe not just male, but also just younger, like 20s and early 30s and maybe even younger than that 18 years. It's because of those things that we talked about, right? Like transparency, same thing with the crypto idea. There's so much transparency with crypto, which is something, this is the reason that it's favorable, because you can see the entire transaction of something that's been there, like we're Bitcoin, Ethereum, whatever it might be, whereas you have no idea what's happening with stocks and index stocks, like what those stocks are. And so that, that I think it really adds to that. So, yeah, fascinating. Next one, the biggest loser that you think 2025 will be the biggest loser. I'm going to stay on this. I think that the traditional, the old school fee for service models and healthcare, again, this is going to take time. And maybe this is a recency bias, it's probably his recency bias, like the method of going to insurance companies and not being able to advocate for it and just paying when you're told like you're going to pay this. Look, there are people who are not going to be in a position and who are not going to be knowledgeable enough, aren't going to be driven out enough to be able to advocate for themselves. But if you look at even poverty, everybody has a cell phone. And now information, even though we're inundated with it on social media, there is good quality information and it spreads pretty quickly. Twitter, Instagram, TikTok, whatever you have. And if the whole Brian Thompson thing and then the people's responses on social media is any indication of how people actually feel, like you talk about people celebrating a win of justice being served, not necessarily somebody getting murdered. I think they're going to be more inclined to question why something is the way that it is. Believe it or not, I've actually I have it a side business where I see patients have people calling back and be like, hey, listen, I can't pay for this and stuff like that. And you don't really have a choice. But you're like, okay, fine, you don't have to worry about paying. I don't know if you knew that by the way. You can just like, yeah, so I don't encourage anybody to do this because medical bills is the number one reason for Bank of America as far as I know, unless the data has changed recently. But you can oftentimes not pay these medical bills when you have predatory billing practices happen. And you are so incredibly protected. Or you can get bills like drastically reduced if you just say, hey, listen, I can't afford this or write a letter and they're doing that. And that's one of the reasons actually they're marking up these bills like drastically. So yeah, I think that's going to be a big loser. So yeah, Mark, you've been actually talked about that. We drive the costs up to make more and quote unquote subsidize the entire market for health insurance. Yeah, look, I'm giving you 800% discount. Yeah, right? Yeah, crazy. That's funny. I swear to the audience, we did not collaborate on this beforehand. But my biggest loser was insurance companies. I just think the death of Brian Thompson, making insurance companies shake their boots a little bit, you know, and obviously we saw Anthem try to pull a fast one by putting time limits on surgeries and revoked. And so I think they're going to be taking their time to make any more policy. I think there's going to be an uprising of people talk about these things when fraud happens, when there's injustice with health care, I think more people are going to be talking about social media is going to be more aware now too. And I think the whole event of Brian Thompson has really just permeated through social media these different topics. And then you have people like Marty McCarry writing books on this topic, essentially, with different types of corrupting within health. So I'll put that as my biggest loser of 225. All right, next one, most over high trend, let's say in 2025. What do you think if you have one? Why don't you go first? Let me think on this a little bit. Okay, I'm going to say all in one wearables. So, you know, the whole talk about optimizing everything from having wearing a watch deck and tracker sleeve, tell your HRV, tell you how to work out tracker calories. I think there's companies out there and maybe some that already know like Apple and things that are trying to do this. I just don't think it's to be productive enough. And I already like, for instance, we've talked about this where I've used who you use trackers to before just like after a while, you tend to get more stress from it or you already gain the knowledge you need and you don't want to be robotic. And so I think it's going to take a long, long time before these wearables can actually do something helpful. But I think there's going to be heavy marketing around it. And I just don't, I just don't, helpful. I agree with you, but I think I've decided a different reasoning of why I think it's going to maybe be biggest loser or in the most overhyped. When you try to do multiple things and you end up not being good at any one thing. So, for instance, R-Ring is really just calculating sleep and it's predicting HRB from that. And so for from a sleep standpoint, it's actually very good. The Apple Watch is trying to do multiple things and it's not highly accurate or precise in any one of those. And considering everything we've talked about thus far and how people are going to become more data driven, I think they're going to want the best data. And they're not going to go for one thing that's going to point them in the general direction, which actually might be a better idea. Because if something like an Apple Watch can point you in the direction, but maybe not be as precise as maybe a combination of a hoop and an aura and a morpheus, like that. But that's multiple things, right? That's to your point. It's before you know it, you have a gadget on every single finger and I'm not interested in that. So I think that's actually one of the reasons why it's what I agree with you. No, I agree. The right. Because if you can take the data and go to a position, if you're going with inaccurate data or something that the position can't really trust, it's pointless. If it comes down to true hell, whereas I feel comfortable taking my weekly data, let's say I'm going like a PCP and being, hey, this is what is going on. Because I trust it. Do you have anything as far as overhyped? No, I'm just going to piggyback off yours. Okay. All right. I like it. No worries. All right. Next up, we have breakthrough technology in 2025. What do you think is going to be the next tech? This is so easy. And again, it's a recency bias, but I think AI and machine learning in every facet of what we do, particularly in medicine. That's the one that affects us the most. But you and I, we talked about this daily, how we're just so incredibly impressed with all types of AI, how it's dare I say revolutionized, how I even just approach any and every problem. And it continues to get better and better. I think, I don't think I know the limitation at this point is just how I can incorporate and use it. And the rate of the development is overwhelming. Let me ask you that. What do you think the, what do you think that like breakthrough is going to be the like, what's the next thing that you, like, so 2024, I think was a breakthrough for open AI and stuff. What's the next level that you think? I think true integration into health. So for instance, open evidence is a really good one. I think you had sent that to me, but a couple other students are sure that with me, open evidence is an AI based model for research and for almost an admin person you can use to help build communication with insurance companies. If you have to have medical necessity letters, create plans for you and that kind of stuff. If you're a health care provider, it's free. Now, I remember one of my previous attendings and a friend told me like, I forget what the thing is, it's actually built into Epic. So it's AI based scribe. It's journey or dream or something like drag. I use drag. Drag is a dictation software, right? Yeah, but also it's a dragon. What they're doing now is you dictate. It'll take your progress. No, get the highlight keywords and like, hey, ethnicity, ad acuity. So it'll tell you like what you're missing to like make your billing even higher, which is interesting. Oh, oh, I need that upgrade. I don't have that. But he was talking about, you'll go into the room, you'll click on the patient's chart and the IQ app, which is just an app that you have for the EMR and you'll just leave it. You'll let the patient know, hey, this conversation is being recorded by AI and it's going to help. It's going to function as you're scribe. He tells me by the time he walks out of the room and he gets to his computer 20 feet away, the entire note is written better than any note that he could write. And a little tongue in cheek there, but in the sense that like to be able to calculate or capture all that data and put it down would take you so much time. And so the AI model is trained well enough to understand, hey, these facts coming out from the patient's mouth are critical because they're going to help billing, right? So people, some of the people have this misconception, they don't understand really how billing works, right? You know, generally in the traditional model, you can do like time-based billing, which is very simple. How much time did you spend doing certain things, not just with the patient? People think that like they see something's level four, it's like you spend 35 minutes, there's no way doctor spent 35 minutes with me. No, it's a bunch of things that you have to do. Like they could have spent looking at your chart for 30 minutes and talked to you for one, they could bill for 31 minutes, but I digress. The other thing is in terms of like problems and chronicity in terms of complications and things they talked about and those are all the things that it'll capture. And the example that he was giving patients that, oh, I've taken talent on the past, but currently I take some anti-inflammatory like celacoxid, but sometimes that irritates my stomach. The AI was able to discern that hey, this isn't potential adverse effects and the doctor did mention, okay, you want to stay away from that because it's going to also hurt your kidneys. Something in passing that I say a hundred times, every single time we talk about NSAIDs, I almost never document it because it's just one of those things, you know, like the AI won't miss it. And that's just, you know, you're talking about a complex decision making it can help up there. And so I think this is where hospital and healthcare-based systems they have to invest in that. And I do think they will continue to do that because it's about the bottom dollar. It helps up their billing. I mean, yeah, how often are we just sitting in front of the computer typing, trying to, not even typing, trying to think about what else can you add to prove medical decision making? I think you're busy and that's the struggle of half the stuff, right? Of doctors, of what we do. So yeah, I totally agree. I think that's going to be something that was it's going to be time saver and it'll be awesome. So awesome. Oh, my breakthrough technology. So I think virtual reality workouts, there's this new company that I found called Sandbox that's here in St. Pete. Now it's virtual reality gaming. She go into like this big room, they hook up like an Oculus sensors on your arm's feet and you can play like a multiplayer game. I think, and this is, I, this Friday 5% chance is actually not be a breakthrough tech, but I think virtual reality for workouts is going to be the next thing too. We're already seeing group classes, we're seeing all these things as virtual realities are some proof. I think they're going to go into the fitness industry. I like that. Two more here. One is comeback trend. What is a trend that we have maybe lost that will come back in 2025? I think if it's already started too, it's just walking. Good old walking for exercise. Get it your steps in. I know that there are some people, some prominent figures in the health and wellness industry who are talking about walking is not really true exercise. Aside from that one person that that we're thinking about people again, on the train of being more active participants in your care and being healthy and tracking your stuff, I think just good old walking as activity. Again, I'm also going back to the fact that, okay, that's something that's going to help preserve your muscle mass and you're not going to be doing cardio to lose weight and lose muscle because now we're taking all these antireptic drugs. A lot of people are, whether for better or for worse, walking gets something that just for exercise and that's her coming back. Nice. Okay. Mine. What age did you get your first cell phone? Oh, I know where you're going with this. 15 maybe. Okay. Yeah. I think I was 13, 8th grade. So minus five. Yeah. I think I was 13 when I got mine. So my thing is I think we're going to see a return in delay giving kid cell phones. So looking at the data, right now the average kid is about 11 years old before they get there for cell phone. And it actually has been like that since about 2010, 2012, maybe 20, 2005 is kind of when we saw maybe 13 years older. So there's like campaigns out there called weight until e. So you want to delay giving your cell phones cell phone up until 8th grade. So obviously, I'm sure the audience getting it for why, right? We look at the mental health benefit because they're going through bullying ADHD, you know, just all these things that suck out their attention and don't let them interact with the quote unquote real world. So I think now with this new generation of parenting, there's going to be, I think I'm going to throw this out there. This year will be instead of 11, maybe we'll see 11.2 or 11.5. We're going to uptake in the age as far as the age of the first cell phone. Yeah, I've heard this actually. I've also heard that a lot of the younger generation, they're going back to blackberries and they're going back to flip phones and getting away from his smartphones. Yeah, what's interesting? So I've heard the same thing about even kids being like, oh, I don't want a cell phone. I'll wait. I thought, look, which, which kids are saying that? I don't know these kids. I was like, so I don't know what I think deals my phone or my wife's phone every chance you get. So I don't, she's three. So she's definitely not waiting until she will. Nobody's getting her own phone. But, I don't know what kids we're talking about here. Yeah, yeah. But I just think I think parents are more aware now. And I just think they're going to, you know, make that decision to make it later. Of course, there's always the issue of, well, my kid needs, you know, after school, they need to call me or do this or the thing is everyone's got a cell phone now or everyone, everyone in school is using iPads and things like that. Like I don't think safety is as much of an issue. Again, as it used to be. So I still think we live in a safer world now, although it may not see it with the news and everything. I do agree. I've given this some thought, obviously, right? This is a conversation that we're seriously going to be having in my household in the next couple of years. And there are ways around that in terms of safety. Yeah, sure. There's lots of phones that you can get that can make outgoing calls or the biggest part is not to have the internet in your pocket accessible. I mean, where you can really get access to anything and everything. And so you have the pros, but you the concerning part is the harms, right? Who was it that was on the author? I think Anna Limpke who talked about dopamine nation and she was talking about just addiction. And we talked about ADHD or you mentioned ADHD, but I know you're also implying in terms of how do you tease out what's true pathology versus students get which is getting distracted. It's an addictive device. We talk about just I get stuck on TikTok all the time or Instagram reels all the time. So yeah, not having the internet in their pocket and the world that they're disposing that regard. I think that's the big thing that we want to stay away from. Okay, last one here before we switch topics, new trend of 2025. Are you go first? So did you recently see the CDC come out with that alcohol guideline in the risk of cancer? No, tell me. Okay, so they did it. They put a really good like seven page infographic out there talking about the risk of alcohol and dissociation with cancer and really just broke down like the seven types of alcohol that are seven types of cancer that you're likely to get with alcohol, but then it broke down women's risk versus men's risk and just a whole bunch of things. And so a lot of people are now starting to share that on social media and it was honestly a pretty good quote unquote scare tactic. It's the perfect timing, right? Because a lot of people are trying to do dry January myself included. I'm actually cutting back a lot of alcohol this month. So my new the new trend that I think that's going to happen in we're going to see a really big intake of altered altered state-inducing drinks. So things like kava, things like lion's main mushroom teas. I know there's tropics coming out like a big push to change dopamine states, a seal quality, you know, all those things that can act on the brain to kind of just put you in a different brain state. And so I think alcohol could also be a big loser of 2025 and I think we're going to see an uptake of companies as well as users using these types of drinks. Yeah, I actually had it. It's funny that you mentioned that I've patient recently told me about the certain general talking about this, how it increases cancer and she was shocked and I was like, yeah, that's actually true. There is a correlation that increases, but trying to tease out causation and the pros that you and I have talked about in terms of when that might do for somebody in terms of social lubrication and connection and et cetera, et cetera. I've thought of something actually. It's could have gone into biggest loser too, but I think old fashioned pain management in terms of specifically opioid prescription medications. That's we've been backpedaling because the opioid crisis for the last 15 years or so and the rules are very strict. So people who are not quote unquote experts will defer from prescribing long-term opioid use, but I think what's turning up more now are alternative ways or substances to help manage pain. We recently had a discussion about psilocybin on here, right? That's role in pain. In the very near future, we're going to be talking about ketamine and it's role in some mental health disorders and mood disorders depression, but ketamine is also a very potent analgesic, right? So from pain relief from that regard, the amazing research I started to come out for these substances for even marijuana and CBD for pain relief, given everything we've talked about in terms of insurance is people's distress of the medical system synthetic compounds, appeal to nature fallacy. I think the opioid market is in a continuum go down and probably for better. Yeah, I totally agree that. I mean pharmacies call me now if I give anything more than three days and they're like, hey, what's going on here and you know, authorize and say this, so it's for and this is why. That's interesting really. Yeah, I get calls. We're so we're only allowed to give that three days supply. I don't know if that's for the rule or not or if they're asking. Probably is. Yeah, in New Jersey, it's a five-day supply you can give before you do like a formal agreement and stuff. Gotcha. Okay. Okay. That's pretty strict. Yeah, yeah. So all right, that was pretty exhausted. That was good. I just encourage listeners if you're at this point best, you know, when we those reels out on Instagram and you have thoughts about your own perspectives, feel free to comment, let us know what you agree with, disagree with, or even your own thoughts. So I'd love to engage with you and kind of predict 2025. I think this is fun for everyone. So cool. All right, let's take a left turn here and talk about poster recovery, a story of yours and how you're doing overall. So tell the listeners a little bit about the recent surgery you went through and maybe let's let's go before let's go. I came to talk back in time and talk about the symptoms you are having and the problem for having. Yeah, I'm actually just thinking about this today. I'm tomorrow, eight months post-op from hip arthroscopy, femoral, control osteoplasty and what that means is it had a little bit of bony overgrowth. So we shaved that down, repaired the labrum, which is cartilage deep in the hip socket, gives it a little bit more seal suction, stability, that kind of stuff. This is a very common thing. The femuracetabular impingement is the main term for it. Something 20 years ago was like, oh, this is an incredibly rare thing, but that now it's incredibly common. The thing with hip arthroscopy is that with respect to orthopedic surgical procedures, it's still in like the toddler hood. Like knee arthroscopy, shoulder arthroscopy, we've been doing that for a long time. The techniques are pretty revised and people are really good at that. Hip arthroscopy, it's arthroscopists are few and far between good ones. It's a very technical procedure. It's a very advanced procedure and I got multiple opinions and went it up to go into New York City to see this guy who I think is a world class. And yeah, the stuff that I was having is that your pain, particularly with deep hip flexion. So if you're and with loading stuff, so maybe sitting for prolonged periods of time, but where it really bothered me was squatting, right, deep lunges, really bilateral squatting, so it seems to bother me too. I had these symptoms since 2016. At that time, a surgeon told me, hey, listen, kick this can down the road as far as you can, because hip arthroscopy is not where you want it to be right now. Unfortunately, my labrum got shredded to a point where I just didn't have any options and I was having what we call mechanical symptoms, where not only was I haven't clicking the popping, but like my hip was giving out. And so I might sit for five minutes and do a scan of patient and I'd get up into the patient room and I almost fall over because like my hip would give out or lock up on me. So that was no longer sustainable and we got scoped, got taken care of. I feel good now. I'm glad I did it. If you had talked to me two months afterwards, I'd say hell no, this is horrible, but a humbling experience and I learned a lot and what I really wanted to talk about, I started going down the rabbit hole is the importance of preserving muscle mass and some of the strategies that I think that need to be employed. We know that when it comes to any type of surgery, people talk about techniques, what's the best approach to do some type of procedure? What are what medications should we be using? We're all focused on the actual thing, but what can you do before? What can you do after? Everything we've talked about, that's right. And so the goal for most people I think after they have surgery is they want to be in less pain, but they really want to have better function. The problem is, depending on the intensity of the procedure, you're going to have some type of immobility. Something's going to be immobilized. You're going to have some precautions. You might not be weight bearing. As in my case, it took me six weeks to fully weight bear without any crutches or assistive device. You're going to lose a lot and you want to minimize the loss that you have of healthy lean tissue, right? So a lean body mass is anything, basically anything, but fat mass. The data is pretty clear on this. There is lots of literature. If you look at that, in general surgeries within 48 hours of immobility, muscle atrophy begins and studies die volume decreases by 1.7% after two days and up to 5.5% in seven days. That's cross-sectional area. Not only does this affect your muscle mass, but these studies show this affects muscle strength in orthopedic surgeries. And this is where total knee replacements or total hip replacements, they see that in older adults, they have muscle atrophy in the quadriceps and hamstring muscles that can reach to up to 20%, 18% or 20% within six weeks. That's pretty profound, especially as you get up in the years, like you can't afford to lose 20% of muscle mass in your thigh. Those are your locomotions stuff. That's going to help you get off the floor when you fall. There are implications to that, in terms of how healthy you're going to be and the ability in sarcopenia down the road. And so another study that I came across where they talked about individuals after, again, these hip replacements during the first two weeks, they might lose up to 1% of muscle volume globally in the operated leg, right? So in the hip replacements they had. So all this to say is that we want to do everything possible to mitigate that. And nobody's talking about that. For instance, the standard darts that's been when somebody's having a surgical procedure. What did this say is NPO after midnight? If you're surgery scheduled, sorry, to ask you questions about there, but if you're surgery scheduled for 2 p.m. the next day, they'll say don't eat anything or drink anything after midnight. So yeah, okay, so you're going to do a 14-hour fast. Did you know that the guidelines say that's actually a bad idea? Like actual guidelines for nutritional and stuff. Yeah, they say actually you can have solid. If you're having a GI procedure, that's a different story. But any other procedure, and if you're having like an oncological procedure, they'll even advise you to eat up to six hours prior to the procedure, solid food. You can drink, right? Clear liquids up to two hours prior to the procedure. So where this NPO after midnight comes from is this absolutely asinine. And so not only does it from a surgical perspective, but even after injuries, if you look at the data, and I'm going to link a couple of papers over the last couple of years to talk about how immobilization after surgeries, but even after acute injuries, you can have a fracture and stuff. You can have muscle atrophy. Not only do you have localized atrophy, but you also have systemic atrophy. And the reason for this is like these type of stressors, surgical procedures, big significant injuries, they put your body in this hypermetabolic, catabolic state. And that has hormonal implications, right? So you're going to have increased breakdown of muscle protein, so pretty lysis. You'll have decreased muscle protein synthesis. We talked about how important that is for building muscle. That's going to get you to, if you're going to be losing lean body mass, you're going to have increased cortisol, right? Which is going to be utilizing, you become insulin resistance, not only in that actual tissue that you're not using, but generally insulin resistance. And now you start shuddling instead of into muscle, you're putting it into fat. And so that becomes really scary, where it became problematic for me. And the reason I did the dexoscan is visually I could see myself being drastically different. So I had lost some weight, but I was like, man, I've lost, it looks like I'd lost so much muscle mass. Sometimes I'm California, I was like, I just want to get this done. It turned out that I had lost 18 pounds on lean body mass in those seven months, right? So I did it in March and then I did it in December, 18 pounds of lean body mass. But here's the worst news. I gained 12 pounds of fat mass. Yeah. So that was a really big wake up call for me is, okay, not only did I lose a lot of lean tissue, I also replaced it with unhealthy adipose tissue, whereas like before I was very blessed to not have any visceral adipose tissue. And now I've got like 0.64 pounds of visceral adiposity that I need to take care of. So I got to really dial it in. So I'll pause there to see if you have any questions. If not any of me, I can talk about some strategies to help mitigate, you know, that muscle loss, because you got to hold onto it for dear life. It is what I learned now from my first anecdote. I guess my question is when we talk about that NPO, is there data to show that, like you said, the guidelines say you can even do up to six hours, was there a show that, hey, if you actually hold it up to that six hours, you come out recovery-wise better or anything. Yeah. So it's interesting, right? So because of the reason that I mentioned to you, after that hypercatabolic state, you have insulin resistance. Actually, they'll recommend that I think this comes from this paper where they have, let me see here, this paper that I have, they pulled up, they pulled up my news. Yeah. So this is the Espen Practical Guidelines from Clinical Nutrition and Surgery, right? So the Wineman 2021 paper where they talk about prolonged fasting discouraged and clear liquids are allowed up to two hours. And what they also even say is carbohydrate drinks. So leading up to the night before you want to supplement with heavy carb drinks and basically carb loading they're talking about, the week leading up to surgery, 800 ml's the night before and 400 ml's, two hours before surgery will help reduce insulin resistance and improve recovery in major surgeries, right? So if you're having a big hip surgery recovery, so like just getting good carbohydrate drink could be a good rate, could be some version of that, right? Like you're actually, now you might come in a little hyperglycemic, but that's going to help reduce. And again, your body's going to need all that energy and it's going to help recovery far better. So where this comes from where you are about to go in a hypercatabolic state and we're putting you in a catabolic state of fasting for, and look, a surgery schedule for two in my, by the time you come out, like depending on the procedure is you're not eating till four, five, depending on how long surgery is, right? So like you just, it's just piling on. Yeah, and I wonder if that, you know, the initial rule that I've always heard why it was NPO at the night is in case the case that pushed earlier, or if there's an emergency or something that they have to do, like, you know, surgeons go in early morning, I've always heard it from that case, but nowadays, I mean, everything seems to be schedule, you know, but you're outpatient or something. So I, I can tell you that almost never happens. Cases don't get moved earlier. They get moved late because if it's an elective case, if it's an elective case, and an emerging case comes in, the elective case gets bumped to the end of the day, you know, 100%. Yeah, I like, yeah, yeah. Yeah. So like that all, that's usually how it goes. And that's what I'm talking about. I'm talking about, obviously, the only ones that you're planning for is elective case. But when you look at all these guidelines and you look at the different papers and a couple of them, then I think are really important for people to check out. They're talking about, but you have nutritional things that you can do. Every single one of them is talking about preoperative carbohydrate loading, as much as 8 grams per kilograms per day for three to four days to reduce insulin resistance and improving recovery. They're talking about supplementing essential amino acids, whether you're getting it from whole foods or you're doing supplementation to reduce muscle atrophy. Creating, we've talked about that. It's a role that actually hasn't been as well studied for this specific thing. But another paper it published in a spine journal that I came across when I was cruising through as I think was published in last year, where they looked at the combination of 10 grams of BCAAs as well as a vitamin D 2000, I use a day helped people recover and lose less muscle mass over like in a week period postoperatively after spine surgery, right? Because of a spine surgery, like you're losing core, you're losing, you're going to be so immobile depending on what you're having. And so like there are a bunch of strategies, other nutrition stuff that I employed because I want to throw everything but the kitchen sink at vitamin D omega-3 fatty acids. Something about omega-3 fatty acids, important to note is that early on, you want a little bit of inflammation, right? That inflammation is part of the healing cascade. Omega-3 fatty acids have a ton of benefits, but anti-inflammatory benefits are one of them. If you do that too early and you blunt the inflammatory response, you might actually compromise that. So you got to take that for what it is, same thing with things like curcumin or other antioxidants, you just have to be cautious with that. Part of the my surgeon's protocol was to supplement with zinc and vitamin C for better wound healing. A month prior, I was taking one gram of vitamin C. He wanted me to do that. And so that, I was really excited about that he had that. I remember my pre-op appointment where the internal medicine was like, okay, stop this medication, stop this medication. I was like, can I continue to create changes? No, I was like, yeah, I'm going to continue to create changes. Yeah, I don't care what you say. I had known about, I wish I had known about this carps supplementation. I wish I had known about being able to eat because my surgery was scheduled for 11, 11, 30, and by the time I ate something, it was like 3, 30, you know, 4. So yeah, really interesting stuff. Better prepared for next time if it happens. And this has actually made me think about how I'm going to suggest like my post-PRP protocols. That's the most intense procedure I do while I should somebody down for a couple of days. And you don't really do a lot of immobilization. But if you do like a lot of PRP and a rotator cuff tendon, that shoulder is going to be hurting for four or five days or like an Achilles tendon or a big procedure like that. And if you put them in an ankle boot for five, six days, I might consider some supplementation. The one that that I had never taken before, that I tried H&B. Have you heard of H&B? I have not, H&B now. Yeah, so H, so probably one thing I should say is of all the ones, it should be lower on the list in terms of the return on investment and how much benefit that it might give. What does it stand for? Yeah, protein supplementation, probably number one, amino acid supplementation, carbohydrates, all those are going to be critical. H&B specifically, what's the full name for it? It's a metabolite, what's in a breakdown amino acid of lucine. So, lucine is a range amino acid rate. And it helps something. Yeah, what is it? Yeah, it hydroxy. Yeah, it's a very long name. But basically, some metabolite of lucine, which helps promote proteynthesis and suppress muscle protein breakdown. So it makes it very beneficial for preserving muscle mastering periods of inactivity like post surgery, post injury, and that kind of stuff. And so, actually transparent labs, no affiliation whatsoever, they've got a good product where they've got a combination of creatine and H&B. And so I took that for about a month or so and even put it in my PRP protocol when I had my cuff done not to long go. That's what I took to. That's nice. Tell me a little bit about the physical activity that you did. So obviously, your bilateral upper extremities were free of moves. You didn't have any surgery there. So you were obviously able to put weight for body. It was your right hip, right? It was my right hip. So the left was free too. Tell me a little bit about the data you found about still using your left leg as well as just general principles. Yeah, that's a great question. I think I am of the people who probably needs to be pulled back. As many athletes are people who are driven to bounce back and I needed somebody to pull me back. But it's okay, you're not going to lose because I was freaking out about that. As early as, let's see, my surgery was on a Thursday. I think that Monday, I was in the gym. Actually, one of my colleagues that I worked with saw me in the gym, like all walking around on my crutches and my big hip brace and doing rows, like cedar rows and stuff. I continued to drain. So day four, day five, after I was doing upper body workouts, probably did it too soon. And the reason I say that is because, I don't know, hindsight's 2020, right? And I think my recovery was delayed a little bit. And it could have been because of all that core activation. So I think this is where, like, you can't be your own coach, you're going to have somebody else do, like, we can dial it back. But I, it's very clear. Like, we talked about the cross-training effect. If you have an injured extremity or an immobilized extremity, you train the contralateral extremity. The injured extremity is going to hold onto more more muscle and more strength. So we continue training the left leg. I continue in the left leg. Dan Pope, previous guest has a really awesome post hip arthroscopy protocol. I think there's two podcasts that he has where he shows a case study of somebody he's training. And like, a week after their hip surgery, that person's doing single leg already, also the other side. And you do it with some support. You can do single leg extensions, single leg curls, like you continue training. Like I said, there is a localized, atrophy and localized disuse atrophy you're going to get and muscle loss. You can only do so much about that. That's where things like BFR, blood flow, researcher training, tremendously helpful. But you have to minimize load. But the systemic loss, you got to do everything possible to prevent that. And that's where you continue training the other extremities. And the prehab is also critical. We didn't even talk about that. But like, training to gain as much muscle before you go into surgery. So you can hold on to that. Right. How long did it take you, how long did it take for your right leg to match in size? And maybe somewhat in strength. It's probably not at size. Interestingly, I had a pelvic MRI, just so many injuries. When did I have this? Beginning of December, where the radiologists read that my left piriformis was hypertrophied. When in fact, my right piriformis is probably atrophied. Interesting. So he thought that the left piriformis was hypertrophied with piriformis syndrome or something. But it's probably that my right side was atrophied, right? Because of their rotation and stuff. When that Dexha that I told you that I got in December, so about seven months after showed about a there was like a 1.1 pound difference in my right leg versus my left leg. So I'm still not nearly eight months out. I'm curious, but I'm still probably still not the same side design. Well, cool. See anything else you want to add that would be beneficial. I mean, I'm sure this topic and your learnings will come up in future episodes as well. So yeah, no, I would just again, I think if we had to emphasize is just always question what you're being told. There's a way to go about that. If you feel like the clinician that provided that you're working with isn't giving you good logic, good reason for doing something and they're just saying, oh, we just do that. Like, for instance, we go back to the the NPR rule when it's like, oh, don't eat anything after midnight and you said, what, why can't I not have anything? And they can't have a good answer for that. Then maybe we just question what that makes sense. And in this particular case, this is something you've always been taught. This is something I've always been taught. Hell, I even did it this time. Had I known this when the nurse called me, I would be like, no, actually, that's going to compromise for Columbia. I'm not going to do that. And so I would just remember that nobody has more to lose with something than you. So your health is in your own hands. Yeah. I think again, as we talk about trends and AI, I mean, everyone can do this now, right? I mean, you don't have to be an expert in research. I know you love to deep dive things that are pertinent to you. But for those that are like, man, where do I start? I mean, we listed some of those websites, go in and just start searching and use AI to to benefit. And you'll be surprised by how much you can learn very, very quickly. So yeah, awesome. Well, yeah, this was a really, really fun episode of things for sharing your story. I learned a great deal to that. I can't wait to actually utilize my patients. I mean, especially if they're coming post-urgical to the rehab hospital. I'm going to make sure they have vitamin C on, you know, if it's if it's beneficial and the risks aren't there. So there's certain things I'll take away for sure. So thanks, Ben. Yes, sir. Awesome. All right. Well, we'll see you all next time, Ben. All right, man. Have a good one. All right, man. Thanks for listening to the other episode of Medicine Redefined. 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