Lessons Learned: Will Bulsiewicz, MD, MSCI and Beth Frates, MD

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. All right guys, welcome back to another Lessons Learn where Darsha and I are revisiting the insightful conversations with our recent guest Dr. Beth Freides and Dr. Will Bolsox. But before we start, I have a quick question for you. Have you ever considered a different way of practicing medicine? Whether you are burned out, need a change of pace, or are looking to supplement your income, low count tendons might be the solution for you. Not sure where to start. Locomestory.com is the place where you can get real, unbiased answers to your questions. They answer basic questions like what is low countenance? To more complex questions about pay ranges, taxes, very specialties, and how low countenance can work for you, go to locomestory.com or Dr. Podcast Network.com slash low count story and get the answers. Well guys, like I said before, I cannot recommend the original episodes with Dr. Beth Freides and Dr. B enough because these are some inspiring individuals who are leaders in their respective fields and they have a great deal of knowledge to share with you. So here, Darsha and I recap some of our key takeaways and offer our own insight into several points made by both these individuals. We spent a good deal of time discussing stress and its role in cardiovascular disease and overall health. We reviewed the six pillars of lifestyle medicine as Dr. Freides mentioned and elaborate on the less common ones that are often overlooked but extremely important as evidenced by the recent fears of the world. We then shipped gears to discuss the microbiome, talk about the archaea, touch on some cool studies that we recently came across and how they're related to both these discussions. Lastly, we add some context to the plant-based diet including some environmental benefits that were discussed by either of our guests. So without further delay, please enjoy this Lessons Learn episode. All right, welcome back everyone. We're doing another Lessons Learned here with myself and Dr. Raja. All too much. How are you doing today, man? I'm doing well, buddy. How are you? Good, good. You all settled in to a unique place? I wouldn't have settled in, but moved in for sure. Stressful stuff, man, I absolutely hate moving, but so you're ready for fellowship then, huh? Well, you started your life first? Yeah, yeah. I mean, I'm pretty much done with residency or I mean, graduated officially, but we got our formal virtual ceremony tonight that'll be wrapped up and then taking a little break just like you are, going on a little vacation and then getting ready, setting for boards too. Yeah, yeah. Fun stuff. Fun stuff, man. Last look forward to. Awesome. Well, you know, our previous three episodes were absolutely fantastic, right? Some pretty prominent names in the field of medicine, each doing something a little different. So, you know, first up, we had Dr. Beth Rates, the pioneer of lifestyle medicine, the president elect of the American College of Lifestyle Medicine. Awesome episode. Tell us a little bit about what you took away from that. You know, my first takeaway was that I really enjoyed her inspiration to go into medicine, right? Her story, patient zero being her father, who was just a new worker to his core, you know, like she said, he walked fast, talked fast, did everything fast and just never considered his lifestyle and it's always just go, go, go, which of course we can relate to as residents and health care practitioners, but really anybody in today's day and age, no matter what the profession. And when he faced that, we'll call it a diversity of having a heart attack and a stroke simultaneously, it really made her reconsider her whole approach so much so that, you know what, initially, I mean, at the time she was 18 years old, right? And it's difficult when you're a teenager and you, somebody you look up to like a parent who is a role model, a hero, you know, we don't think about their mortality, especially at that age. And something devastating like that happens and you kind of have to watch your patient, parent not being able to function as she said her job was to make sure that he gets wreckings function in his hand, that's pretty scary. So I'm always interested to learn about people's story, you know, what makes them who they are and that one kind of struck home with me. Yeah, no, I completely agree. I mean, her, she calls it patient zero, right? Her first patient being her father, which really gave her this exposure into life's, well, what she now knows is lifestyle medicine, right back then. It was kind of just like, oh, a heart attack stress stroke, how do these things happen? What's the root cause of these things? And, you know, it's a sign of the times where we're at now where everyone's in this rush pace, you know, you just said as residents and it's funny, man, you know, I just finished on my intern year earlier this week and, man, it just feels like a thousand pounds have just come off me. Like, it's unbelievable. Like the day after my last day, I was so physically and emotionally drained. I was just like, what am I feeling? And it was just literally like this catharsis of the last year, you know, going through COVID, working 70 plus hours just constantly on the go and these like last few days have just been unbelievable in terms of just having that, you know, rest, knowing that, you know, I'm going into PMNR. So, you know, it's just, it's a constant reminder of, hey, we need to slow things down because when you're in that go go rush, it's, it's so tough to just pause and, and reflect at what am I doing right now? Right? Cause we're so caught in that quote unquote flow, I guess we can call it, but yeah, no, I definitely agree with that. Yeah. And, you know, what was interesting about that is that kind of inspired her to kind of look at the field of cardiology. But then as she started interviewing experts in the field and what their life is all about and, you know, what their life style is all about, she came across a physician who, you know, again, some things that she knew she had insight to what was important to her, such as having children that was really important and how, how does that all work? She started to see a lot of similar patterns as she mentioned that her dad had and then quickly realized, okay, this isn't the right approach for me because she knew what she didn't want to do, which path and this path was getting off the close to the path that she didn't want to walk down. So let's shift gears to talk about just, you know, we're kind of alluding to this concept of stress and how it impacts cardiovascular disease. And I think it's extremely well documented and there's tons of literature to support the effects of both acute and chronic stress on the cardiovascular system. And most people can probably appreciate blood pressure and then, you know, that goes in hand to hand with different types of stroke, right? And what people don't might not be as familiar with is the heart attack component, right? The coronary artery disease, like the plaques and those types of things just for lay purposes. And that kind of gave her this idea of looking at this thesis and, you know, how you can have EKG changes. So I thought that was really, really cool. What do you remember from that? So I know, I just want to take a step back when you talk about stress, I think what people need to realize is that stress plays a role with every other habit, you know, in your day to day, right? So not only on a physiological level where we can say, okay, stress is going to raise that blood pressure. It'll cause your, you know, sympathetic nervous system to always be activated, your muscles to get tense and et cetera, et cetera. But when you're stressed, do you binge eat, right? Yeah. When you're stressed, how are your relationships? Are you more angry? Right? How is stress playing a role in terms of all the other factors when you're stressed or you're work out, healthy? Are you even working out? Right? So I think that's what people need to start understanding is stress is not just stress. It's this thing that is, you know, everywhere in everyone's lives and it just permeates through our daily habits, right? So I think that's why stress reduction is so crucial because it literally affects every other thing we do. You know, I would actually challenge you on the concept to say, and I think that what you, I know what you mean is, I don't, I don't really know if we can reduce stress to be honest with you. I think we can become stress resilient, right? Sure. Yeah. Yeah. Yeah. Because I, I think the stressors are just not going to stop. Like we're talking right now, you know, for those who don't know, we've been trying to schedule this and re-schedule on this and now we're pinched on time too because you got a pack and you got to, so that's just not going to happen. I think that as the older we get, we learn as we just get more and more stressors in life. But I think it's building stress resilience and, and yeah, like you, like you just mentioned, it's really a cascade of events that happens. And so, you know, so you zoomed out for a second, but I'm going to zoom right back in and at the risk of being myopic. I was kind of looking at the literature because I am fascinated with cardiovascular disease and I came across this study in, in nature, reviews cardiology, which was published in 2012, just looking at the effects of stress and, you know, the cardiovascular system. Some of the key points from it that they were talking about psychological stressors, which contribute to cardiovascular disease at, you know, several stages, stages, including both acute and long-term development of coronary heart disease. And they also noted that looking at some of the epidemiological data, that acute stressor trigger cardiac events, like myocardic ischemia, which is heart attack, right? I think that both of us have read in our fans of Matthew Walker and in his book, and some of the AHA, he has even documented that just daylight savings time, that loss of sleep, the sleep deprivation, which is an acute stressor, the rate of heart attacks increases by like 20-something percent from what I recall, right? So, so many of those acute stressors, that can happen, it could be a massive breakup, it could be divorced, something like that. So, these psychological stressors can cause, just acute stages, can cause these events, right? In this paper, they also talked about how chronic stress at work, and in private life, again, is associated with 40 to 50 percent increase in the occurrence of coronary heart disease in prospective observational studies. I mean, that's not insignificant, right? Yeah. And then the last piece of it, indicators of elevated long-term stress, such as social isolation and work-related stress are associated with poor prognosis among patients with established coronary heart disease. So, basically, all of 2020, socialized work, right? That's right, yeah. And Dr. Freddie has mentioned to that, right? In the podcast, like, she really emphasizes how social isolation this year can be a huge contribution to ailments and things, right? And I guess that kind of takes us down the six pillars of lifestyle medicine, which is the foundation, right? And so, I can just quickly list these off, right? So, the first one is adopting a nutrient-dense plant predominant eating pattern. Number two, optimizing and individualizing physical activity plans. Number three, improving sleep for managing stress with healthy coping strategies. Five, forming and maintaining relationships. And then six, cessation of tobacco use and other unhealthy habits, right? So, that's what this podcast, you know, medicine redefined, essentially talks about, you know, every episode is one of these pillars. And, you know, oftentimes we like to just delve into these. But to go back to that social isolation, I mean, yeah, that's absolutely huge. And I think we're starting to realize that now, you know, as if we could say this pandemic, if there's any blessing behind it, it's to show us how much our health matters, right? Not only just with COVID and our lungs and the cardiac component, but also this intangible component that we can't measure, right? These social relationships. Yeah, and I think I mentioned at the time, and both we talked about kind of our five pillars of health, right? And one we don't emphasize or give its own bucket is the social isolation name. Again, because it's hard to prescribe, right? Like, go spend 20 minutes with your wife. Like, what, what? Like, that's your case. She's not going to be happy with that, with that prescription, right? So, you know, but I think we need to pay a lot more attention to it, because she had mentioned some of the early work from Alameda County, which is out in the West Coast. And we know that the blue zones, right? The, the one, oh man, the, like, orderly Linda California. Yeah, yeah. If there's, yeah, the seven blue zones across the, across the world, but what are the main pillars when they look at these centenarians, right? People who are 100 and beyond, is they're looking at that whole social piece, the spiritual piece. That's a big component of it, right? It's not just simply what they're eating, what they're exercising, but this is a big component of it. And so, I think we need to pay a lot more attention to this. And, and obviously we've seen, you know, like that, Fredy says, it's hard to say people who are thriving, but you definitely know when it's broken, right? When somebody's, and over the last year or a half or so, it was broken and people were feeling the effects of it. I was feeling the effect of it. And, you know, I think that, actually, another one, Adam Grant recently talked about, I remember he made a post on, about, you know, Netflix binging and how that's a temporary escape from reality. And it's not necessarily a cure. You know, people tend to do that a lot. I mean, I tend to do that. This is why I love Marvel movies. This is kind of an escape from reality. But I'm going to quote him, he had talked about, you know, passive engagement in a fictional world doesn't offer a lasting sense of meaning, mastery, or mattering. Flurshing depends on active participation in the real world, real world, creating, connecting, and contributing, right? And he's talking about like finding those people who are close by you, right? Physically, maybe touching him and beyond just like holding hands and stuff like that, and how that causes like these endorphins and chemicals release your body, that's going to put you in a better position. Overall, and it's going to just have magnitude of orders of benefit for your health. Yeah, absolutely. You know, Adam Grant's great with that stuff too. It's always great to hear his perspective from like a psychological perspective, especially as we contribute to society, right? And that that's kind of what he focuses on. You know, going into kind of our next topic that Dr. Phates talked about was, how she interacts with her patients, right? And you asked her, you know, from a reductionist standpoint, what is that like the lowest hanging fruit? Is it diet? Is it stress resilience? Is it sleep? What is the first thing that she would focus on with her patients? And she said it depends, right? A lot of times you don't figure it out at that first visit. It takes the second or third visit, where you start to build that rapport and they start to drop hints, you know? And she talks about how the one patient she had talks, says, hey, isn't it normal to kind of just down on a bottle of wine? Nightly is that what people do? And she's like, oh, you know, there's the red flag, you know, you're probably drinking too much and this is kind of your escape. So, but the thing is that she didn't want to focus on cutting down the alcohol. What actually made her feel better was it was the improvement in diets. And, you know, when you improve your diet, she started to see the effects of cutting down the alcohol. And so Dr. Phates talks about, you know, when you have your patients in front of you, it's about meeting them halfway, right? It's not about forcing a prescription down their throat. It's about figuring out what is it that they can best do, you know, the next day, the next month, next week. And then the next year and then kind of add on to that. Yeah, I absolutely love that. And, you know, people, I know a lot of times, people hate hearing that answer. It depends because I don't have such a cop at answer. But it's honestly, it's all about context, right? And we keep going back to this one, where it might be the theme of our podcast. And, you know, again, we as clinicians and healthcare providers have to understand our biases too, right? For me, again, the easiest thing to do is exercise. That's just thing that's imprinted in my DNA and from an early standpoint. And so for me, it would be like, okay, it's easy to prescribe. That's the first thing that I would tend to ask about. But maybe that's not what the patient needs, right? And it doesn't even matter like what, if we can figure out the efficiency standpoint, like which is going to have the most bang for buck, which is going to have the most benefit when it comes to health spend or lifespan, does it even matter if the patient can't do it? Or if the patient isn't ready for it? No, it absolutely freaking doesn't. So you have to meet the patient where there are. I mean, we've talked about this with multiple guests. We've talked about this with Dr. Arnie. We talked about Dr. Malanga. We've talked about it with basically everybody who's come on. So I mean, people keep seeing these recurrent patterns and our colleagues can understand, hey, maybe that's what it's about, right? Absolutely, yeah. And like, last point here, I just want to talk, you know, where I know we have a lot of colleagues who listen to this is that the mission of lifestyle medicine now is to kind of spread it throughout different institutions across the country. And, you know, we've talked about getting board certified eventually. You know, it was something that I'm trying to bring to my program here at Hershey. And hopefully that's something that can happen in the near future. And for you, you're going to do the experiential pathway. I can't say that, I can never say that word. But, you know, you'll get board certified eventually once you're in practice. So for anyone who's up and coming to those pre-medical students, the medical students, even, you know, residents, if you're interested in this type of stuff where you can get lifestyle certified, I highly recommend going to the ACLM website and see what you can do, right? These people are super helpful. You've been in contact with them, ultimately, and they've been nothing short of exceptional in terms of guiding you in the right way. Absolutely. Yeah, yeah. They've been really, really awesome. And I love what they're doing. Again, one of the challenges is, you know, we could, on an individual level as clinicians, we could educate ourselves. And I mean, that's part of it. But the other part, cool thing that they're doing is the advocacy component, right? Getting in front of the people in front of, in Washington, and making systemic institutional change, that's going to help reform the system a little bit better. And what the cool thing about that, is when it comes to, you know, medications and some of the quote unquote, conventional times of medicine, it's not dismissive of that. Like, how can we use all the tools in our tool belt to make it? And, you know, it really starts with foundational components, which are the six pillars, but then also using some of the insular stuff and what the traditional sense of the model is. I know you're short on time here, so the last thing. So actually, let's switch gears. Let's talk about Dr. B, because I think this is the topic that you've been waiting for. Basically, since, you know, we started talking about this, I know there were so many gems in here. So Dr. B, man, I'm going to give you the first word on this. Dude, what a cool guy, man. Right? Like, what a cool guy. I listened to the episode probably like two times, because there's, oh my god, like, he's such a prolific speaker. Like, he just knows how to take the research and put it into what lay people want to hear, right? As well as practitioners. Like, there's so much knowledge in these episodes. And for those of you guys listening to this, if you haven't listed the episode 16 and 17, like, please go back and do, because there's no way me and Altamash can do justice in terms of talking about gut health the way Dr. B does. But, you know, the first thing I kind of learned is just the importance of gut health, right? And why? And I mean, we can take this in so many different directions, but just starting, you know, very basic is what our gut does, right? You know, you take this food, but not only that, but it's also linked to our brain, right? People have heard of the gut brain connection. We know about 80% of our immune system resides in our gut, right? So it's a huge play there. And then just talking about IBS, right? IBD, mental health, all these issues, a lot of it couldn't be triggered by the gut itself, right? And especially with all these new FAD diets coming out, where we talk about being in a carnivore keto, well, the food has to go summer, right? It goes to the gut. And so I think people oftentimes forget about what is the gut doing with specific foods, whether it's dairy or gluten, what she talks about. But man, I mean, I can take this in all different directions. I'm going to put it back to you. Where do you want to start? I think that just at the sake of kind of making sure that we appreciate the and use the appropriate terms. I think for most people, we just use the word microbiome, right? And it's important to understand that the microbiome, and when people think that they think bacteria, but as we know, because we kind of fall experts in this space, there's much more in there, right? The microbiome is kind of this genetic expression and the environment versus the microbiota, which are the actual bugs, the actual bacteria. I mean, you also have viruses, right? You get the viral in there. You've got the microbiome, right? As the fungi. And then the archaeo, which is something that is fascinating, these single-celled organisms that kind of have been around for billions of years, what was really fascinating to me, again, kind of tying it back into coronary artery disease, what we've been talking about at the beginning of it, is how, you know, they, one of the purposes of the archaea is to kind of help break down TMA, right? And which has been implicated coronary artery disease. And of course, you know, me being the novice that I am asked him the question about, hey, like, you know, do you think that, you know, what kind of, what's the purpose, right? Could this be help like a preventative thing? Because that's what the scientists do, right? That's what we do. Again, this is that myopic point of view, which is why it's important to talk to the experts and in his response was, you know, its context is more their behavior. You can't isolate them and say, hey, whether they're going to be beneficial or they're not going to be beneficial. But guess what? I found a study in a quick research, just a quick literature review. This paper was published in 2014, got microbes called Archaeobiotics. It's a proposed therapeutic use of archaea to prevent tri-methylaminorrhea and cardiovascular disease. And I haven't read it yet, but we'll link it in the show so if people are interested. Because that's what we try to do. And I think from an academic standpoint, again, this is just me saying without having read the paper, that I think from an academic standpoint, it's one thing to kind of look at it from that perspective. Okay, these archaea help metabolize or increase the expression of TMAO, right, which is helps with the CAD. But that might not necessarily be the way they behave in isolation, right? The context of the analogies that he gave of how we hang out with our buddies and how we behave differently is really, really important. Yeah. Absolutely, yeah. I mean, you know, going further on that, you know, he talked about short-chain fatty acids, right, which is kind of this backbone of gut health, right? And for those of you guys that don't know, Dr. B is the author of a hit book, which actually it was a New York Times best seller called Fiber Field. And I read it and highly recommended to everyone out there to read, because again, it's not a preachy book. It's not telling you, hey, you need to do this. It gives you a suggestion and then talks about a lot of research behind why plant diversity and fiber are so important. And one of the things we know is that fiber helps these short-chain fatty acids get produced. And with these short-chain fatty acids, as a research keeps showing so many different effects, right, it helps to protect something from what we call leaky gut, right, which is intestinal permeability. So those tight junctions can actually stay tight in your gut. Other things that we know short-chain fatty acids do is help with the gut brain connection, right? Things with serotonin, dopamine, the neurotransmitters. And then again, also with the immune system. So this is, you know, I just think the future of GI is exponential, you know, there's so much coming out, there's so many companies coming out trying to individualize gut health, right? And I think that's what's important is that we know everyone's microbiota is like a fingerprint, it's so individualized. So for me to take, you know, a line probiotic is gonna affect, you know, is gonna affect me differently than let's say you take it all too much. And this is why I think the, you know, why we can't just take probiotics, right? There's so much more to it. I don't know if you got a chance to listen to Dr. Rhonda Patrick's latest episode about the glucose monitoring. So you know, he, yeah, it's a fantastic episode where, you know, he just talks about, I think it was Dr. Michael Snyder where he talks about gathering so much data. And, you know, my ears really perked out when he started talking about GI and letting it in the data way that we can use with, you know, stool samples and things like that. But again, super, super individualized. And all these things are gonna be connected. We know that the food you eat, you know, I could eat white rice and might not be affected whereas ultimately I don't know if it's true for you, but if you eat white rice, hey, you might be in the bathroom five seconds after, who knows, right? So I think we need to start paying attention to the foods that we eat and how we feel after, right? Like, we have to be more attuned to our bodies because those tests are so expensive right now. There's no way you can do them daily or monthly. I mean, some people obviously can. But right now, the best tool that we have is using our intuition in ourselves and really understanding how our body feels after eating certain things at least. Although, you know, in terms of the cost of tests, I will say that it's getting better. Actually, Dr. Mark Liemann's podcast recently published, what's it called? Dr. What pharmacy? The Dr. Pharmacy with that. Pharmacy with that. Yeah. He actually had an expert, I forget what the name is Daniel, something from Stanford as well. They talked about personalized medicine and personalized nutrition type stuff and they talked about how he used to be, I don't know, hundreds of thousands of dollars back in the day until now it's like a couple hundred bucks where you can try to afford these. In fact, in a second, we'll talk about the American Gut Project where how you can participate in that for just 99 bucks. But this concept of dysbiosis, right? I feel like you got that you're talking about. One of the things when we asked about gluten and lactose, which is a can of worms that we probably shouldn't have opened, I mean, there's so much to touch on. But anyways, you know what I found interesting was him talking about how both lactose and fruit tense, right, are great prebiotics. However, people don't tolerate them. I think people kind of look at it and it's like, oh man, these cause me trouble. And the way he explained it is, the issue is that the guts are so far gone, they're already so damaged that they're not capable of tolerating this strong prebiotic. Right? And fruit tense similarly are very good. But again, our guts are so damaged that they're not capable of handling it. Obviously, some people can, it doesn't bother them. Like my family, right? I've got a couple of folks that don't tolerate, lactate is always sitting there. But to me, like it seems to be doing okay. So it can context is everything, right? And it's the way I look at it is kind of an advanced trained protocol, right? Trying to bring it back to exercise for myself again, right? If you, if you get into the gym and you just, like, will just use squatting as an example, and you throw 300 pounds on the bar and you've never squat in your life, unless you're just genetically this Hulk type creature, it's gonna be a problem. Like you're gonna crumble into the bar, you're gonna get hurt. So you have to kind of build up, right? And that kind of applies the same thing. It's the same thing with swimming. If you just jump right into the deep end, you've never swim in your life, like things are not gonna end up well. So you kind of have to train to get there. The best part about training the gut though, it's pretty easy to do. Of course, going back to diet is the number one thing that we can train our gut. What we was really encouraging is him talking about the return investment on to change these gut bucks. It's really, really short and it's really good, right? So because they're creating, they're procreating a new generation every 20 minutes. So within 24 hours, you can drastically change your body, you know, the diversity of the microbiota. And after that was really cool, man. Yeah, absolutely. I do want to like warn people though, right? So it's 20 minutes. But as like we heard in Dr. Michael Snyder talk about this, you need long lasting change in order for that microbiota to stay healthy, right? So, you know, I think this is the toughest thing for people is that they'll eat very fiber rich one day for maybe a week. But then oh, let me get that Hershey's milk chocolate out and this and that and oh, well, you know, it's about the consistency and it's about the long haul consistency, right? So that I think is very important. But yeah, no, I'm really glad he brought up the whole dairy and gluten though because man, I see it everywhere in marketing. My own family like brings it up a lot in terms of dairy and stuff. And I'm glad that, you know, he's not villainizing that's a word, clue in or dairy, right? Again, like you said, it's about the context. I do want to shift gears into fiber though, right? Cause that was episode 17 was very much about fiber. And I found it super interesting when he brings up the Hudson tribe, right? So this is a tribe out of Africa that doesn't chop at grocery stores, right? They hunt and they gather. And their poop is known to be probably in the world the most diverse, right? Of bacteria, of the microbiome, I should say. And we also know that their microbiome is constantly changing with the seasons, right? So now it kind of brings up this concept of eating seasonally, right? And which is something we don't do in the US, right? You go to the grocery store, you can get blueberries all year round. You can get strawberries all year round. You can get whatever you want all year round. But they're not always good though. That's a great, exactly, right? Yeah, you can taste blueberries in the summer versus in the winter. And they taste completely different, right? I mean, again, it comes back to just being a tune. And like something I've been trying to do a little bit more now is just look at when I should be eating certain fruits just so I can like seasonally eat them. Cause again, I mean, we can take this into so many different directions with pesticides and stuff like this. And is it really being grown artificial or organic and stuff? But that for me was really interesting to talk about in here about the odds of tribe. I agree, man, I think that, you know, I know we gotta come to a close here because we're short on time. But the actionable thing from it when we're talking about therapeutic dose, although he mentioned the recommendation by the RDA, which is a different topic in itself, it's what 38 for men, grams of five grams for women. That's not, he doesn't recommend that in his practice nor does he count fiber for himself. What he does count are plants, how many plants he eats. And I think he said that he tries to get as many as possible, although I mentioned him in the past talk about trying to eat more than 30 plants just to try to improve that biodiversity, which is what you're talking about. And where does that number come from, right? This number of more than 30 plants comes from this really cool study called an ongoing research, basically, study called the American God Project. And for those people, I mean, we can link the information in here who don't know, basically the American God Project is kind of, it's like the first large population-based citizen science and this concept of community science is, it's based out of University of California San Diego. And they're collaborating with a total of like 42 or 44 other countries. So basically it's 45 countries where you can kind of just sign up for like a hundred bucks, send your poop in and they kind of analyze it for you. And ultimately what they found is individuals who ate more than 30 plants per week had the most diverse microbiome, right? And individuals who ate less than 10 didn't have a robust or near diversity. Similarly, there were some other cool things that they found across this, you know, people who had antibiotics for the last month had less diverse profile. What was interesting though, paradoxically, they also found that individuals, I think who were eating maybe a lot more, oh no, people who did have antibiotics had a lot more chemicals in them, right? Which kind of is something needs to be explored a little bit more. So I think that's where it comes, right? That's the therapeutic dose that you're trying to get more than 30. When I'm trying to relate that concept, sorry, when I'm trying to relate that concept back to what Dr. Beth Frady said, she also says she tries to do eight a day, right? She tries to do two fruits and six vegetables, right? You do the math on that. If it's six different vegetables, right? And two separate fruits or different fruits if you're talking about seasonally, that's what eight a day, time seven days, we're talking 56 plants, killing. It's pretty awesome, man. Like, dude, the toughest thing for me is food blogging, right? Like I've used my fitness palette, but it's so easy with packaged foods, right? Cause the scan code's there. When you're talking about organic vegetables like broccoli and stuff like, man, that stuff is so hard to put. And then me with my like data analytic mind, I'm like, well, is this actually a medium apple or a large apple? Like I don't know. And that stresses me out, right? So I mean, hopefully the science gets there, but I think one of the best ways to reach these goals again is kind of what they're doing is, you know, Dr. B has this concept of plant points, right? From his book. So you get a certain point for whatever number of plants you get and, you know, your goals to try to increase that, at least get 10, 15 and so on. And so that's what a lot of people like on Instagram do is they put, you know, they'll tag him and put how many points they got in a certain meal. But I think that's just a very achievable way of going about getting fiber. So yeah, I like that. I will say though, just like for disclosure, like again, I am what, before I tell you that, I want to ask you cause you are, are you vegan or vegetarian? I'm vegetarian. Okay. What is the reason? Is it more from like ethical perspective? Is it health related reasons? Is it more religious reason? Like what's your reason? Yeah, it's kind of all three. So grew up vegetarian because of religion, but I'm not religious. So that kind of went way side. Then for me, it was kind of the ethical and just like health reasons for it. And, you know, yeah, yeah. For me, just kind of, it was more plant based. It was just easier for me to do, you know, there's obviously the research on like meat and all that is very just like gray area. But for me, I always thought like, hey, I might, like there's nothing wrong with just eating plants, right? Like I haven't found anything wrong to just do plants. I'm pretty physically fit, you know, I can out run most people, I can outlive most people. I have good genes for longevity, hopefully. And my grandparents are doing well, you know, my grandma celebrated her 91st birthday two days ago. So nice. So, you know, that was, that was mainly the reason for me. I think a lot of it comes from the ethical standpoint of it though. Yeah, it's interesting. You know, I always go back to again, which lens are we looking at the problem from, right? And that's how you come up with the solution. So, are you supplementing with protein as well? Or no? Yeah, I do. I do protein bars. I do protein powder, yeah. I see. That's always been an issue like, you know, in my previous life when I was working with clients and stuff and they were asking if they were vegan or vegetarian, that's one of the struggles that they get, right, is how do I get to get a protein? And I, you know, again, ISSN, which is my favorite resources when it comes to dealing with athletes and my sports medicine world. We're talking about athletes and again, the appropriate amount of protein intake for performance, for health reasons, but also for just, you know, hypertrophy when you're talking about dealing with bodybuild and stuff like that, people who are consuming upwards of 250 grams of protein, it's going to be very challenging to do that only on a vegetarian diet or plant-based or plant-per-nominated diet. So, I always had some hesitancy about, you know, going completely plant-based, but I think that there's a difference being, this is what saying plant-based versus plant-only, right? Right. And I think that it just, it comes back to, we have to look at, you know, okay, when we were looking, okay, is plant-based good? Or not? The question we need to ask is, for what purpose, right? It can context is key. For one thing, I think one thing worth mentioning, his point of view was, he said that I am looking at it is how can we optimize health? When we're talking, we're looking the body of the literature and we're looking at, for the purposes of just health span, right? Getting more plants in our diet is going to be beneficial. And one thing, you know, that I do want to mention, is I kind of recently read this article and called the credit issue from ACLM. They had put it in there and in this article, they were looking at just what the effects are of eating a lot of meat, which we do in the western diet. And also how our environmental factors can change, right? Currently, the food production consumption contributes to 20% of greenhouse emissions and account for 90% of freshwater consumption, right? And our current population is 8 billion people. By 2050, it's expected to go up to 10 billion. And so the demand for emissions and the demand for agriculture land is not going to be compatible with the need for like better environment and in turn better health for us as a species. And so the plant-based industry currently is 14 billion. It's expected to grow to 1.4 trillion, right? We were talking about the on-barkers, those kinds of things. Yeah. And so actually, this is a really cool article we'll link in the show. They actually show how people who are in a vegan diet, vegetarian diet has significantly less emissions from that type of stuff. So I think from that argument as well, I'm coming a little bit more to this idea. I still like my chicken though. I still like my meat though, man. And so it is a little bit challenging, but again, the purposes are different. I will say though, you know, what at least, I don't want to speak for you is what I will say. I'm not encouraging everybody to go completely vegan or for whatever purposes. You have to, everybody have to make that decision. I'm not interested in convincing. I think that the evidence does, when you're looking at just health, when looking at coronary disease, when you're looking at overall better gut health, the evidence does support that getting more plants in our diet is going to be beneficial. I think there's no questions about that whatsoever. Yeah, absolutely. And I'm the same way, man. I tell people, you got a self-experiment. If that means eating meat for a week and only try it, see what happens, right? If that means going vegan, try it. Like the only way we know what's best for us, and again, everything comes down to the individual is by self-experimenting and figuring out what works for you, right? It'll be a little bit different than the next can or something, right? So I think everyone's truly different and we just kind of have to figure out what works best for us. Yeah, that's perfect advice, man. All right, buddy, I know you got a pack and you're gonna enjoy Europe and eat all this great food and cannot wait. I'm incredibly jealous of you, but fly safe, man. Yeah, absolutely, thanks, man. Yeah, everyone, thanks for joining in here. Again, episodes 15, 16, 17, we're amazing. Hope you guys felt the same. And if you guys haven't listened to it, definitely go back and listen. And as always, we're coming with you. We're coming at you with another episode on TV Monday. So, man, getting tongue-tied here talking so much, because I'm not used to it when we have guests. But all right, everyone, take care. We'll see you next time. Later. Well, guys, such a great show with my buddy, Dr. Darsh Shah. And before we finish up, I want to give a major shout out to Darsh for not only completing his intern year, but doing it with class and starting this amazing project with me to bring you guys great content, weekend and week out. For those of you in the medicine field, know how difficult and grueling internior can be. And throughout the entire year, this guy continued to bring so much good to the world, not only by getting the message out on this platform, but he also continued to make the world a better place on all over his social media. And anytime you have a chance to have a conversation with him. So, I would highly recommend that you go follow him at doctor.darsh on every social media platform, and you will be better for it. Now, before we go, don't forget to visit LocomStory.com or doctorpodcastnetwork.com slash LocomStory to get real unbiased answers to all your LocomTennis questions. And for this important disclaimer, please remember that everything in this podcast is for educational purposes only. It does not constitute the practice of medicine, nor should it be construed as medical advice. No physician-patient relationship is formed that anything discussed in this podcast does not represent the views of our employers. But if you enjoyed the show, please remember to subscribe, review and share with anyone who you think will gain value from this as well. And until next time, thank you for listening.