20. Dr. Rangan Chatterjee: Burnout Is Rewiring Your Brain—Here's How to Take Back Control

Are you stuck in a relentless cycle of stress that's draining your energy and joy? Burnout isn't just about feeling tired—it's a chronic state that rewires your body and mind, often without you realizing it. In this episode of Extend, I sit down with Dr. Rangan Chatterjee, a trailblazer in functional medicine and best-selling author, to explore how modern life has hijacked our stress response systems. Together, we unpack why today's constant pressures—from overflowing inboxes to endless social media scrolling—are leaving so many of us overwhelmed and disconnected from our true selves. We dive into Dr. Chatterjee powerful strategies for addressing burnout, including the surprising benefits of micro-habits like a 5-minute workout or a tea ritual. We also discuss the profound impact of aligning your daily actions with your core values and how these practices can transform your well-being. Dr. Rangan Chatterjee is a globally recognized pioneer in functional medicine, the author of six best-selling books, including Make Change Last, and the host of the widely celebrated Feel Better, Live More podcast, which has over 250 million downloads. With over two decades of clinical experience, he has empowered millions to take control of their health through practical, sustainable lifestyle changes. We Also Discuss: (00:02) Functional Medicine Foundations (11:55) Understanding and Combating Burnout (23:11) Creating Sustainable Health Routines (50:37) The Power of Intentional Living (01:47:14) Personalized Health and Data (01:06:46) Transforming Health Through Self-Discovery (02:25:37) Rethinking Healthcare and Advocacy (02:33:23) Revolutionizing Health With Functional Medicine Thank You to Our Sponsors: Timeline: If you are looking for a boost in a cellular level, Timeline is the secret to unlocking your mitochondria's whole potential. Go to: https://www.timeline.com/ TruNiagen: Whether you are looking to stay sharp, feel more energized or simple age better, go to https://www.truniagen.com/ IFit: If you are looking to elevate your home gym fitness experience with the best in fitness tech, choose IFIT. Go to https://www.ifit.com/ NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Vitaboom: For supplements you can trust and wellness solutions tailored to your health, visit https://vitaboom.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Rangan Chatterjee: Website: https://drchatterjee.com/ Instagram: https://www.instagram.com/drchatterjee

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Do you ever feel like you're doing everything right for your health, but you're still not seeing results? Or worse, you feel confused by all the conflicting evidence out there? Well, you're not alone. One of the biggest challenges in modern health is understanding how your body responds to food, stress, and lifestyle choices on an individual level. So in today's episode of Extend, I'm going to be sitting down with Dr. Rangan Chatterjee, a pioneer in root cause medicine. And we're going to dive in to how you can get your specific results using tools like CGMs and wearables, and how these tools are revolutionizing healthcare. We also discuss why CGMs are powerful beyond managing diabetes, and how they empower healthier choices,

• 1:32Dr. Darshan Shah?

  and how to interpret wearable data without becoming overwhelmed or obsessive. The connection between chronic disease and its long-term effects on blood sugar, and how they affect your overall health have been underappreciated. And traditional medicine struggles with chronic disease. A proactive approach can bridge this gap, and you're going to learn many actionable strategies to start improving your health right now in this interview with Dr. Chatterjee. Dr. Chatterjee is a globally-recognized physician, author, and podcast host. He's passionate about empowering people to take charge of their health. He has six bestselling books, a successful podcast, a very popular one, and Years and years of clinical experience.

• 2:12Dr. Darshan Shah?

  Dr. Chatterjee has become a leader in functional medicine and also a leader in just helping people achieve lasting change through lifestyle medicine and through mindset shifts. His groundbreaking work has inspired millions of people to rethink how they approach wellness. I can't wait for you to hear this episode. Let's get started.

• 2:38Dr. Darshan Shah?

  Dr. Rangan Chatterjee, it's such an honor to have you on the show with me and thank you for coming.

• 2:44Speaker 01

  I'm really excited, Darshan. Thanks for having me.

• 2:46Dr. Darshan Shah?

  Yeah, so I told you the story in the car right over here that I shook your hand eight years ago at the beginning of my wellness journey. And you were onstage speaking to a giant audience and I was just like so enamored with what you and Mark Hyman and other people brought out into the world with functional medicine. You know, back then, eight years ago in my journey, I hadn't even heard about functional medicine, being a Western medicine trained doctor. And it's mind blowing to me that still like people don't really know what functional medicine is, right? Root cause medicine is.

• 3:18Speaker 01

  Yeah.

• 3:19Dr. Darshan Shah?

  And I'm, you know, I'm, you set my health journey off, you and Dr. Hyman and Jeffrey Bland, set my health journey off in a completely new direction. And I got myself healthy and I thank you for that.

• 3:33Speaker 01

  Hey, I'm delighted to hear that. And I hope the whole world can start absorbing messages like this and go, wow, there are things that we can actually do.

• 3:41Dr. Darshan Shah?

  Right.

• 3:41Speaker 01

  That really will make a difference to our health.

• 3:43Dr. Darshan Shah?

  Yes, yes. And you know, you and I talked about this a little bit and it's so funny, we ran into Jay Shetty and we had, I had the same conversation with him. Is that there are many aspects to health. It's not just physical. You have the mental aspect. You have what's going on in your heart, your relationships. And I'm curious, big picture, what are two or three things people can just start doing today that are easy? That can get their health headed in the right direction, whether it's physical, mental, emotional?

• 4:10Speaker 01

  Darshan, I've been a medical doctor for, I think, 23 years now. And during that time, I would say my view on health and wellbeing has evolved. It continues to evolve. Today, as things stand, I would say that the number one thing that people can do for their health and wellbeing every day is have a daily practice of solitude.

• 4:32Dr. Darshan Shah?

  Hmm, I've never heard that before as being one of the top things.

• 4:35Speaker 01

  And I'll tell you why, because we can say, oh, we need to do this, we need to eat this, we need to lift weights, we need to make sure we're prioritizing sleep. And these things, of course, are very, very important. But we're living in an era now where we're being bombarded with information.

• 4:51Dr. Darshan Shah?

  Yeah.

• 4:51Speaker 01

  Health information, good quality information, poor quality information. But nonetheless, there's a barrage of noise around us and I see patients in the public getting confused. So if you don't have 10 or 50 minutes to yourself each day, and when I say solitude, this is not something where you're getting locked up in a prison cell. All right, this is time for yourself. It could be a walk around the block. It could be 10 minutes of meditation. It could be five or 10 minutes of journaling. But essentially, why I believe a practice of solitude is so important is because if you spend too long in your life without stepping outside of your life, it's very hard to see the big picture, to see, well, what do I need to do now?

• 5:36Speaker 01

  What has been going well in my life? What's not been going so well? Where do I need to change things? So yes, food is important, movement is important, sleep is important, managing stress is important. Of course it is. But for me, if I had to say one practice that sits above everything, it's a daily practice of solitude.

• 5:55Dr. Darshan Shah?

  Such a fantastic answer. As you were saying that, I'm thinking in my mind, when was the last time I did that? And honestly, I think it's been maybe two weeks ago. It's been a long time since I personally have done that. And you're right, because when you don't take time to step back, it's hard to evaluate all the information and what's working for you and what's not, and where you need to focus your attention.

• 6:16Speaker 01

  That's the key, what you said there, what's working for you.

• 6:19Dr. Darshan Shah?

  Yes.

• 6:20Speaker 01

  Right, so going alongside what I just mentioned about that daily practice of solitude. One of the things I believe that patients and the public are getting confused by is the barrage of often conflicting information, right? So for example, they may hear from one doctor or nutritionist online who they really like and admire that a plant-based diet is best for their health. They may have another doctor or nutritionist who they admire and respect, who's saying a low carb diet is good for health. Now, I have this all the time. I've been hosting a podcast for seven years now. And what I would find, Darshan, is that sometimes if I had a guest who was talking about one

• 7:04Speaker 01

  kind of diet and a different guest who was talking about a different kind of diet, I would get a lot of DMs on Instagram from people saying, "Dr. Sash, I'm really confused. I don't know which expert I should believe." But I think that's the wrong question. I think we've outsourced our own inner expertise and wisdom to outside experts. And I think we need to start asking ourselves, why do we no longer trust ourselves? Here's the reality, some people thrive on a plant-based diet, but some people don't. Some people thrive on a low carb diet, some people don't. And if you're a practicing clinician, if you have seen patients for years, as I have,

• 7:46Speaker 01

  as you have, you actually see that different people respond to different things. There is no one perfect diet. And so what I'm really passionate about is helping people understand that I believe that they, at a core level, know what's right for them. Sure, listen to their doctors, listen to experts, but then put it through your own filter and go, "Actually, you know what? I don't feel good when I eat like this." Or, "I do feel good when I eat like this." Does that make sense?

• 8:14Dr. Darshan Shah?

  It makes total sense, yeah. And you know, I'm thinking about when I sit down with my patients, before I start giving them advice, the first thing I say is, "Listen, you're an N of one."

• 8:24Speaker 01

  Exactly.

• 8:25Dr. Darshan Shah?

  Right? What works for you is not what's going to work for your wife or your children. It's different. So as I sit here and I give you information about what I Think you should head your diet in or your sleep patterns, et cetera. You need to be tracking yourself. How do you feel? Maybe using some of these tracking devices and seeing what your body is telling you is working for you or not, right?

• 8:49Speaker 01

  Yeah, you have to pay attention.

• 8:51Dr. Darshan Shah?

  To pay attention, right?

• 8:52Speaker 01

  You have to pay attention. I had this case a couple of years ago where this really health-conscious lady. She was your classic example, someone really interested in health. She was listening to podcasts, she was buying books, she was reading blogs. And she had heard a couple of experts in the UK say that you have to be having thirty different plants a week for an optimum gut microbiome. So she's trying her best, right? She's trying to have thirty different plants a week and she's getting bloating. She's having stomach cramps. She doesn't feel good in herself. She's having constipation. And she came to see me and I remember talking to her and I said, listen, no piece of health advice, no matter how good, is going to work for everyone.

• 9:38Dr. Darshan Shah?

  Right.

• 9:38Speaker 01

  Right? So that health advice from that expert, I'm not saying it's not true. The question is, is it true for you? And so I helped her make some modifications and experiment with different diets. And for her, at that stage in her life, again, that's a key point to this. She needed a more low carb diet with maybe five to ten different plants a week. When she did that, she had no bloating, her stomach pain went. She's got energy, vitality, her blood test looked fantastic as well. So that was the right diet for her at that point in her life. And I kind of feel we really missed this, Darshan, across certainly in Western medicine. Because our whole model is based around the randomized controlled trial.

• 10:23Dr. Darshan Shah?

  I was just gonna say this, right?

• 10:25Speaker 01

  And you know, I understand why. The randomized controlled trial can work really well for certain things. So if, for example, we say, does this pharmaceutical drug work well for this condition? Okay, what we're gonna do, we're gonna put a hundred people on the drug and a hundred people not on the drug. And we'll compare the results. On average, we can determine, does that drug have efficacy should it be brought into the guidelines? Great, but the problem is, even with that example, is that even if we say the drug works, there will be some people who it didn't work for.

• 11:02Dr. Darshan Shah?

  Exactly.

• 11:02Speaker 01

  And that's the problem, right? And the problem is, is that these big population studies, these randomized controlled trials, they're fantastic for averages.

• 11:12Dr. Darshan Shah?

  Right.

• 11:13Speaker 01

  For the population as a whole, but one on one with the person in front of you.

• 11:18Dr. Darshan Shah?

  Exactly.

• 11:18Speaker 01

  It doesn't always translate.

• 11:20Dr. Darshan Shah?

  Right.

• 11:21Speaker 01

  And I think that's where a lot of these online debates that people get stuck down rabbit holes. It often comes from, I would say in my experience, people who haven't spent years seeing patients.

• 11:34Dr. Darshan Shah?

  Exactly. That's such a good point because it's easy to shout from the rooftop what works for you and think it's going to work for everybody. But when you're like us and you're seeing patients, you realize everyone is somewhere on the bell shaped curve. And randomized controlled trials tell you what works for the average person, not the people that are one standard or two standard deviations away.

• 11:54Speaker 01

  Yeah, and let's take it one step further. All of us have got a different history.

• 11:59Dr. Darshan Shah?

  Yeah.

• 12:00Speaker 01

  Right? So we've been on differing amounts of antibiotics in our lives. We might have different cultural backgrounds, different diets, different health scenarios. So all of that's going to play a role in the current state of our microbiome. What foods we're going to tolerate, what foods we're not likely to tolerate, what are the levels of stress in our life? And today, here in America, in the UK, you know, we're living in stressful times. There was a study recently in the UK that is suggesting eighty eight percent of UK office workers have experienced some degree of burnout in the past two years. Now, I don't know whether that eighty eight percent statistic is applicable across the

• 12:44Speaker 01

  whole population, but it's still pretty alarming. What does that say about the state of our society?

• 12:50Dr. Darshan Shah?

  Absolutely.

• 12:51Speaker 01

  If eighty eight percent of people have experienced a degree of burnout.

• 12:54Dr. Darshan Shah?

  I know. Could you dive into that a little bit more? How do you define burnout? Or how did this study define burnout?

• 13:00Speaker 01

  That study from recollection, I couldn't tell you for sure, if I'm honest. But the way, the way I like to describe burnout to patients or people I'm talking to is I say, think about the body's stress response. Okay, so there's nothing inherently wrong with stress. Okay, we need stress to function at our best. Okay, so a little bit of stress, for example, helps your brain work better. You can recall more things from your memory. You're sharper, you've got more focus. But if that stress is a little bit too much, you start to kill nerve cells in your hippocampus, the, you know, part of your brain that's responsible for memory amongst many other things. Right, so a little bit of stress is good for us. Too much stress for too long a period of time starts to become problematic.

• 13:44Speaker 01

  So the way I look at burnout is I say, look, if you're having stress in your life, you're responding to that and then you have time to recover, rest and recuperate, that's completely fine. You can return back to baseline. You can often get better at dealing with stress. But if you're chronically being stressed out by the state of your life every single day, by too many emails, poor quality food, staying up too late, watching Netflix, not getting enough sleep, you know, whatever it might be, day after day, then it's like a rubber bands, right? If you have a, or I think you call it an elastic bands here, do you in the US?

• 14:25Dr. Darshan Shah?

  We call it a rubber band too.

• 14:26Speaker 01

  Rubber bands, okay. So a rubber band's a great way of thinking about burnouts. If you pull a rubber band a little bit and then let it go, it returns back to its normal shape.

• 14:36Dr. Darshan Shah?

  Right.

• 14:36Speaker 01

  But if you keep pulling it, day after day, day after day, week after week, month after month, year after year. It becomes deformed. Okay, doesn't return back to its normal state. That's how I think about burnout. That's how I help my patients think about burnout because at that point, everything feels wrong in their life. They become cynical. They're not only physically tired, they're emotionally tired as well. They don't have any creativity. They can't get pleasure from day to day things. And and the thing about burnout that people don't realize is that this builds up gradually over time. You know this from your own life when you were a surgeon, right?

• 15:15Dr. Darshan Shah?

  Right, I I experienced burnout and it completely, I would say, changed my mental health, physical health, emotional health, even the health of my relationships. And I didn't realize it. I lived in burnout for five years, basically.

• 15:29Speaker 01

  Yeah, and and a lot of the population are living in burnout. And what people don't realize is that we see the world through the state of our nervous system. So if you are undergoing, experiencing burnout, you basically are undergoing chronic stress. Okay.

• 15:50Dr. Darshan Shah?

  So they're equivalent.

• 15:51Speaker 01

  Yes, your nervous system is highly wired. Right? So let's just back up a minute and explain what the stress response is. Because I I I do this with my patients all the time. And once they understand the stress response, they suddenly get why it's such a problem for them if they don't do something about it. So a few hundred thousand years ago, as humans, we're in our hunter gatherer tribes. We're getting on with our day. And then we might see a wild predator approaching our camp. Okay, right, we see the wild predator. So in an instant, our stress response kicks into gear. So all kinds of things start to happen. Okay, so so what sort of things happen? So when the stress response kicks into gear,

• 16:35Speaker 01

  our blood sugar starts to go up, so we can deliver more glucose to the brain. Our blood pressure goes up, so we can deliver more oxygen to the brain. Okay, our blood starts to become more prone to clotting. Why? Well, if a predator was to cut us and and and instead of us bleeding to death. Our blood's gonna clot, it's gonna save our life. Our amygdala, the emotional part of our brain, goes on to high alert. Right, so we're hypervigilant for all the noises around us. You know, a whole vision comes inwards. Everything is there because in that moment, that's what we need to occur. Right, so that's what happens in our stress response.

• 17:14Dr. Darshan Shah?

  Correct.

• 17:15Speaker 01

  That's not a problem if everything returns to normal. Right, and our stress response only used to be activated for, let's say, thirty minutes or an hour. Then everything comes back to normal. The problem today in twenty twenty four is that our stress response is no longer being activated due to a wild predator. It's been activated to our daily lives, our email inbox.

• 17:37Dr. Darshan Shah?

  Yeah, we're living in it.

• 17:38Speaker 01

  The three social media channels we're trying to keep up to date with, the toxic news headlines, the elderly parents we're trying to care for. At the same time, we're trying to bring up our young children without family support, whatever it might be. It's the same inputs. So those, those things that happen that are helpful in the short term starts to become really problematic in the long term. So blood glucose going up for half an hour, no problem. Blood glucose going up day in, day out because of the state of your life. That's gonna lead to fatigue, weight gain, and ultimately type two diabetes. Blood pressure going up for half an hour because there's a predator there or because you're doing a spinning class in your gym. No problem.

• 18:21Speaker 01

  Day in, day out, that raised blood pressure is gonna increase the risk of heart attacks, strokes, dementia, all kinds of things, right? The amygdala, the, the, the emotional part of your brain going on high alert. That's fantastic if it's for half an hour.

• 18:38Dr. Darshan Shah?

  Yeah.

• 18:39Speaker 01

  If you're walking down a Friday evening somewhere in downtown L A. Right, you're trying to get back to your car.

• 18:46Dr. Darshan Shah?

  Right.

• 18:47Speaker 01

  And you hear a noise behind you. It's completely appropriate for the amygdala to be on high alert for you to hear a pinpoint. You wanna see where the danger is. But if day in, day out, that's happening to the state of your life, well, that's kind of what we call anxiety.

• 19:01Dr. Darshan Shah?

  Yeah.

• 19:01Speaker 01

  Right, so the stress response is there for a reason. Short term stress that we can recover from, no problem. Long term stress that we don't recover from, that's a huge problem. Because then it starts to change the way you actually see the world. And at the moment where I appreciate, at the moment, I'm here in LA a week after your elections. Right, the amount of division and animosity you can see online from one group to another group. A lot of that, not all of it, but a lot of that is because people are living in a stressed out state. So when you're chronically stressed, you're not going to come from a place of compassion and kindness and empathy.

• 19:45Speaker 01

  If you're in a state of chronic stress, not only does that have a problem for your physical health, which we can talk about, the way you see the world is fundamentally different. You're looking for problems, you're looking for threats, right? Where's the predator? Where is the predator? Oh, it's online because someone's got, someone's what? They've got a different view to you. Someone's got a different opinion. In a world of eight billion people, some people see the world differently. Like, there's nothing wrong with that actually at its core. And if we weren't a chronically stressed out population, we'd go, oh, well, isn't that interesting? That person sees the world completely differently to me. I wonder why they see it that way.

• 20:25Dr. Darshan Shah?

  No.

• 20:26Speaker 01

  So once you understand the stress response, and it goes back to my first answer, Darshan. Why is a daily practice of solitude so important? Because if you have that daily practice of solitude, you will realise when you're starting to get stressed out. For many years, I didn't have that practice. Now I do, and I have done for many years. I know when my stress load is building. Do you know why? Because I feel a pressure in my right upper back. Now, I would have felt that for many years, but because I never had a daily practice of solitude, I never knew it was there. Whereas now, if in the morning I'm just sitting there and meditating or whatever it might be, and I notice it, that's a signal to me to go, oh, wrong, and you need to change something here. You've got too much work.

• 21:11Speaker 01

  At the moment, so you're not sleeping enough, you need to cancel some of your appointments, whatever it might be, it's a signal to me to say, oh, something's wrong here. I need to take action. And this is the key point about, this is the key point I think we're missing, even within functional medicine, is this real idea of empowering the patients, not only with external knowledge, but with internal knowledge as well. I want my patients to no longer need me. I want them to know what to do. I want to guide them, but over time, I want them to understand, yeah, you know what, I feel better when I'm living like this. I want to go off track. I don't feel so good. Does that all make sense?

• 21:52Dr. Darshan Shah?

  Absolutely, absolutely. Yeah, you know, what brings up to me is when I sit down with patients, what I find is even more impactful than all the health advice, looking at their blood test, seeing where their glucose regulation is, is really having conversations like this around the mindset of what they need to be thinking as they go through this health journey. And this is a massive part of it, right? Is the having some time in solitude to understand what your body is telling you, like feel the signs like you did of your shoulder, you know, and understand how to listen to your body and have time to just think through it and what's how this is affecting you and how this is bringing, how your body's trying to give you the knowledge that you need and communicate with you what it needs, right?

• 22:35Speaker 01

  Yeah, a hundred percent. I mean, your first question to me was like two or three of the top health practices.

• 22:40Dr. Darshan Shah?

  Yes, yes.

• 22:41Speaker 01

  And I answered with one.

• 22:43Dr. Darshan Shah?

  Right.

• 22:43Speaker 01

  Right. But let me expand on that if I may.

• 22:46Dr. Darshan Shah?

  Please, I would love it.

• 22:47Speaker 01

  Because what we're also talking about here is habit formation, right? Because how is it that you're going to have this daily practice of solitude? Right. So let me explain how I do it first of all, and then maybe I can unpick that for people so they can start to apply those principles in their life. So I start each day with a morning routine. Okay, now morning routines can become quite a cliched thing for some people, but I think everyone's got a morning routine. The question is, are they intentional about it or not? We all do things every day on autopilot, right? That is a routine. But your routine of having the alarm go off in bed, looking at your work emails, looking at the news headlines, going on social media for ten minutes.

• 23:31Speaker 01

  Nothing necessarily wrong with that, but there's going to be an impact from that. Yeah. Okay, whereas if you start the day slightly differently, you're going to have a different impact. Okay, so for many years, people would ask me, well, what do you do for your morning routine? And how can we create one? So I have this, I have this framework called the three Ms. And I've been using this with patients for years. The first M is mindfulness, the second M is movement, and the third M is mindset. Okay, so if people want some help on how to create a morning routine, I say, think about these three Ms. Now, the three Ms might be too much for some people, in which case I'd say go for one M. But how does that look like for me?

• 24:12Speaker 01

  Right, so I'm forty seven, I've got a busy job, I'm happily married, I've got two young kids. I also have to care for my elderly mother. So I've got a lot on my plate, like many people do. But I've realised over the years that I'm a better human being in every single way. When I have some time to myself each morning, okay, I'm a better doctor, I'm a better father, I'm a better husband. I'm just a better human being. So I've learnt, not because someone told me to do this, there's external knowledge and there's internal knowledge. The internal knowledge of me paying attention to myself has realised, oh, when you make a bit of time for yourself every morning, you're a better human being.

• 24:54Speaker 01

  Okay, so I have this three M framework, so I will wake up typically at five AM. So I go to bed early, I'm normally asleep by nine at the very latest, and I'm up by five. Okay, that works for me in the context of my life. And the reason I say that is because whenever you share what you do, it's not uncommon for people to push back and go, oh, that will never work for me. Okay, no problem. I get it, you have to find what works for you. But for me, that works really, really well. So at five o'clock, I get up, I come downstairs in my pyjamas. And the pyjamas thing is key, and I'll explain why. Okay. The first M is mindfulness. So this can be any practice of mindfulness. For me, at this moment in my life, I do a form of meditation.

• 25:39Speaker 01

  Okay, so for ten minutes, I'll do this meditation, okay? In the living room with my pajamas on. Then I go to my kitchen and I make coffee. Now, I'm very particular with how I like coffee. I weigh the coffee, I pour in the water and then I put a timer on for five minutes. Now, in those five minutes, Darshan, I don't go on email, I don't go on Instagram, I don't go on X. I do a strength workout in my pajamas. Right, I'll explain more.

• 26:10Dr. Darshan Shah?

  Five minutes.

• 26:11Speaker 01

  Just for five minutes, okay? And it used to be body weight, now in my kitchen, I've got a kettlebell and a dumbbell there. I'll do some combination just for five minutes. And then, so that's my second M movement. And then I've got a nice hot cup of coffee, the way I like it. And then I move to the third M, which is mindset. So whilst I drink my coffee, I'll do one or two things. I'll either write in my journal, again, I've got three questions I ask myself each day. Or whilst I'm drinking my coffee, I'll read a few pages of an uplifting book. I've got a few books kicking around my kitchen, I'll pick one up. And these are uplifting, positive books, okay? It doesn't take me long, right? That can be done in twenty minutes.

• 26:56Dr. Darshan Shah?

  Yes, that's the whole thing, twenty minutes.

• 26:58Speaker 01

  Twenty minutes. If, if I've got a bit of extra time, I might make it last half an hour. I used to do it in just ten minutes, a, a, a shorter version of that. But when I start my day like that, everything else goes better. And when I think I don't have time, ah, you know, I don't have time today, I need to get straight to my emails. I always pay for it later. I'm not as calm throughout the day, I hit the wall earlier with my work. I, look, I'm not perfect, but I've learned over the years that everything is better when I do that. Now, it's a simple framework. And you've got to understand, and a lot of people have to realise that our thoughts, our feelings, our behaviours

• 27:41Speaker 01

  are often downstream from the content we consume. So if first thing in the morning, you're consuming negative news. Negativity online, right? Is it any wonder that 20 minutes later, you might have a negative view of the world? You might be a bit reactive with your partner or your children. You might be not so motivated to do anything for your health and your wellbeing. It's not really, but that first thing we do, I kind of see it as a tap. It's a lever to turn. If you get that lever right first thing in the morning, the knock on consequences throughout the day are literally quite profound. Now, let's just take one M. If I could just take the second M for a minute, movements.

• 28:21Dr. Darshan Shah?

  Sure.

• 28:22Speaker 01

  I have realised this, Dosh, and I don't know if this has been your experience with patients, but often people will come up with many different reasons why they can't do something.

• 28:31Dr. Darshan Shah?

  Hundred percent.

• 28:32Speaker 01

  Okay, and I say that with compassion. I'm not having a go at people, but there's a million reasons why they can't do it. Now, let's take movement for a second and let's call it strength training for a moment. I do a five minute strength workout every single morning and I don't think I've missed a day in five years. And it's got nothing to do with motivation, nothing. That five minute strength workout follows the key principles of behaviour change. Okay, so there's a few rules of behaviour change that we need to follow if we want to create healthy habits. Okay, rule number one, you've got to make it easy. Why do you have to make it easy? You've got to make it easy because there's something called the motivation wave.

• 29:15Speaker 01

  Motivation goes up and motivation comes down. It doesn't stay the same. If you make your new behaviour really difficult, for example, I'm going to work out for an hour every morning. If you can do that, that's great. I've got no problem with that, but many people can't. If your behaviour is hard to do, you will do it when your motivation's high. But when your motivation's low, you won't do it. And your motivation will be low on some days. And the classic example of this is January, first two weeks of New Year, what happens?

• 29:50Dr. Darshan Shah?

  Yep, gym memberships go up and.

• 29:52Speaker 01

  Yeah, people say, I'm going to go spinning four times a week this year. And you know what? For the first two and three weeks of January, they do it. But then real life gets in the way. They have a stressful day, they're busy, they're tired, they've got one hour. No, but this is why my strength workout is only five minutes. Okay, it's easy. I can never say, never, that I don't have five minutes.

• 30:15Dr. Darshan Shah?

  Exactly.

• 30:16Speaker 01

  So rule number one, make it easy. Rule number two, where are you going to put that behaviour? So any behaviour that we do as a human requires a trigger. Okay, there's all kinds of different triggers. Now, one trigger could be your memory. It works, it just happens to be the most unreliable trigger there is. Okay, you can also have things like calendar notifications or post-it notes. That's better than memory, but it's not as good as the very best trigger. The very best trigger is when you stick on a new behaviour onto an existing habit.

• 30:49Dr. Darshan Shah?

  Habit stacking.

• 30:50Speaker 01

  Yeah. So my five fifteen AM coffee, I don't need my assistant to phone me to remind me. Okay, I don't need a reminder on my phone, say, don't forget to make coffee, that a coffee's gonna happen. Therefore, by sticking my strength workout onto my coffee habits, it happens. I don't have to think about it, it is just ingrained. Now, people say, what, five minutes? What's that gonna do? Well, let me tell you, it can do quite a lot. And I've been using this with patients for years. Why? Because it builds up momentum, it builds up self-esteem. So many people feel like failures because they can't do the things that they said they

• 31:33Speaker 01

  were going to do. Five minutes of strength training a day is thirty five minutes of strength training a week. Okay, it's what, one hundred and forty minutes a month? Don't get me wrong, maybe it doesn't meet the guidelines that we, the ideal guidelines. I'm not saying that's all I do. I will do other stuff as well, but for me, it's just like tooth brushing. Now, Darsha, no one, I hope, I hope everyone listening to this podcast right now is brushing their teeth two minutes in the morning and two minutes in the evening, so four minutes a day. They know that four minutes a day on their teeth health, on their dental hygiene, by and large, is gonna keep their teeth in good shape. Yes, there's checkers, there's cleanings, I get that. But the point I'm making is, nobody

• 32:18Speaker 01

  says, you know what, I've got too much work today on Monday, I'm too busy, I'm not gonna do it.

• 32:25Dr. Darshan Shah?

  I'm not gonna brush my teeth.

• 32:25Speaker 01

  I'm not gonna do it Tuesday, it's a heavy week at work this week, I'm not brushing my teeth. You know what, on a Sunday, I'll do a one hour deep clean. No one says that, but that's the principle we apply to our physical health and our mental health. And I'm saying, no, why do we need to do that? So I brush my teeth for four minutes a day. I also do a strength workout for five minutes a day. It's my equivalent of brushing my teeth and it builds a momentum. And look, I stay in pretty good shape. Okay. Because what that does is each morning is that you've done something positive for yourself, right? And that has a ripple effect for the rest of the day. You're more likely to go for that 20 minute walk at lunchtime. You're more likely to do other positive activities.

• 33:09Speaker 01

  And so I'm so passionate about that idea. And so the two rules are, you know, make it easy. Number two, stick it onto an existing habit. And there's a third rule. I mean, there's many rules we can apply. The third rule is, you know, have an environment around you that supports that behavior.

• 33:27Dr. Darshan Shah?

  Like the weights in your kitchen.

• 33:29Speaker 01

  Yeah. Now, a few, a few years ago, my wife said to me, said, well, I'm gonna eat, what, are you gonna leave like these weights in the kitchen? And I said, hey babe, listen, my plan is to leave them here because if they're in the garage, if they're in the cupboard, if they're in the attic, they're never gonna get used. But if they're here, I'm being visually triggered every single morning by them. Even if I just move them out of the way to get to my kettle, I'm still lifting it. And do you know what? She picks them up now. She picks them up in the morning. My kids pick them up because they see me doing it. Health is not as difficult as we've made it, right? The guidance for strength training may well

• 34:11Speaker 01

  be 40 minutes of strength training at the gym, two to three times a week. I'm not against that guidance. The problem I found, Arshin, is that so many patients would say, yeah, I just, I don't have time. I don't have time. I'm like, okay, let's try it a different way. Let's flip it. Let's try it with five minutes a day. And the patients who do the five minutes a day, within weeks to months, they're doing 10 minutes a day. They're doing other positive health activities. So I'm really passionate about it. And if people are skeptical. My challenge to anyone listening to this right now, if they're skeptical, I say, okay, pick one health habit that you think is going to be helpful for you in your life. Maybe it's journaling, maybe it's strength training, maybe it's meditation, whatever it might be,

• 34:55Speaker 01

  and follow those principles for the next seven days. Just try it and see how you feel in seven days. If you don't feel any different, ignore me, okay? Do it your way. But my contention is that you are going to feel different within seven days. You're going to have this self-confidence that, wow, I can actually do this. I'm starting to feel different. And business understand these human behavior rules, right? Amazon, rumors have it that, is it 10 years ago now? Whenever Amazon moved to one-click ordering.

• 35:29Dr. Darshan Shah?

  Oh, sure.

• 35:30Speaker 01

  Right? The estimates say that their profits went up by $300 million a year. Right? One move. Why? Think back to before one-click ordering. What did you have to do? Put everything in your cart, go to the next page, confirm, next page, manually type in all your card details, next page, place order, right? There's four or five steps before you place the order. Each step you have to take is a reason to procrastinate and pull out.

• 36:01Dr. Darshan Shah?

  Exactly.

• 36:02Speaker 01

  Now, one-click ordering, boom. You don't have to think, you've made the order, right? They use it to increase their profits. Why does Netflix run one episode straight into the next episode? Out of the goodness of their hearts? Or is it because they understand human behavior? If you make something easy, people will do it. So before you realize it's 11:30, I've got to be up tomorrow morning, the next episode is already playing, you're hooked. Business use these principles to make more money.

• 36:36Speaker 01

  I'm not having a go at business. They're doing what they should be doing. I'm saying when it comes to human health, we make it too difficult. We don't follow those principles. We think it only counts if it's a one hour strength workout. No, I promise you, you do five minutes a day, you will start to feel different. You will feel strong. You will see the changes in your body, which again builds momentum. So I'm really passionate about these ideas, Darshan, because I believe that every single person can be healthier than they currently are. I absolutely believe that, but we made it far too difficult.

• 37:10Dr. Darshan Shah?

  Yeah, yeah, no. My first solo so that I did for this podcast, I do a solo so that every week was on habit formation.

• 37:16Speaker 01

  There you go.

• 37:17Dr. Darshan Shah?

  Because of this exact realization that I had in my own life. I was trying so hard to get healthy by going to the gym three times a week for an hour, like you said. And I was trying to do all these big things, but life happens and you end up skipping big things because other things get in the way. But making it small and doing it consistently in a morning routine, like my mind is very similar to yours, Rangan. It completely changed the trajectory of my health and it happened really quickly too. And the way I like to explain to my patients is our brain is wired to want to make, save energy.

• 37:52Speaker 01

  Yeah.

• 37:52Dr. Darshan Shah?

  And the way it saves energy is by forming stronger neuronal connections. How does that happen? By doing the same thing every single day, right?

• 37:59Speaker 01

  Hundred percent.

• 37:59Dr. Darshan Shah?

  Right.

• 38:00Speaker 01

  And again, another point relating to that is that people often ask me, what do you do the same workout every day? It used to be yes, I tweak it now, but here's the key point. For years it was. Why? Because I'm trying to automate.

• 38:17Dr. Darshan Shah?

  Automate it.

• 38:17Speaker 01

  The behavior. Again, let's use tooth brushing as an example. When we were three years old, brushing our teeth twice a day was not a habit.

• 38:26Dr. Darshan Shah?

  No.

• 38:27Speaker 01

  When we were five, it probably wasn't, right? Our parents had to keep reminding us, I mean, it's important, you need to brush your teeth. But I think for most of us as adults, it is a habit now. What we don't do is on a Monday, we brush our teeth. And then on a Tuesday, we don't go. You know, I I brushed yesterday. I think I'm gonna floss today. And then on Wednesday, we don't go, well, I've I've already brushed, I flossed. You know, I'm just gonna rinse today. No, but it's a really powerful point because it's the same thing every day. You repeat it, it becomes a habit. There's no thought to it. Even this morning, Darshan, I'm in L A at the moment. I live in the U K.

• 39:08Speaker 01

  I'm in a hotel. I bring my little cafetiere with me. I made coffee in my hotel room with the kettle this morning. Put the timer on for five minutes. I did my workout, right? And there's a wider point there. Yes, it's about habit formation. But I think there's a wider point here, which is why do so many of us struggle with our health these days? Right? Why, when we know so many of us the right things to do, why are we not doing them? I think one of the reasons is because the world feels out of control. Okay, whether it's the political headlines or the negativity in the news. Everything feels out of control, right? And as humans, we crave a sense of control. In fact, the research shows us that

• 39:51Speaker 01

  people who have a strong sense of control in their lives, the healthier, the happier, they have better relationships and they earn more money. My routine every morning, it gives me a sense of control. So even though I'm here in L A and I'm on an eight-hour time difference from where I was at home, so now, you know, I've only been here for one night. I'd be asleep in the U K right now, okay?

• 40:16Dr. Darshan Shah?

  Which I really appreciate you being on this podcast during.

• 40:18Speaker 01

  No, no, but it's the point I'm trying to make is the reason I bring my cafetiere with me. It's a little thing, but A, I know how I like my coffee, so I bring coffee with me as well. But it grounds me. So I've got this little routine that I do at home.

• 40:35Dr. Darshan Shah?

  It's like an anchor for you.

• 40:36Speaker 01

  It anchors me. So even though I'm jet lagged, even though I'm here in L A, that little routine grounds me and it gives me a sense of control. And I think that's so powerful. I think that's why the small habits done every morning consistently. Yes, they're good for your health. I can give you what the strength training. Do for your hormones, for your muscle mass, for your brain health. Sure, we can go through all of that. And of course, that's important. But arguably, what's even more important than that is that sense of control it gives me over my life. It also shows me that no matter how busy my life gets, I still made five minutes to look after myself.

• 41:15Dr. Darshan Shah?

  Right.

• 41:16Speaker 01

  And that is priceless.

• 41:17Dr. Darshan Shah?

  Yeah.

• 41:18Speaker 01

  It's absolutely priceless.

• 41:20Dr. Darshan Shah?

  Yeah, I can tell you the number of patients I talked to and I ask them, when was the last time you did any self care in any way? And they can't remember the last time they've done something. And to have five minutes a day, even or fifteen minutes a day that you do it in the morning. It's transformative to how you just look at life and you view life to get some of that sense of control back. You have control of your brain.

• 41:40Speaker 01

  You change the way you view yourself.

• 41:42Dr. Darshan Shah?

  Yes.

• 41:42Speaker 01

  One of the most toxic things, Gosh, and I really believe this.

• 41:46Dr. Darshan Shah?

  Yeah.

• 41:46Speaker 01

  And I write about it in Make Change at Last, my, my, my brand new book. One of the most toxic things I believe us is to say we're going to do something.

• 41:57Dr. Darshan Shah?

  Uh huh.

• 41:57Speaker 01

  And not do it.

• 41:59Dr. Darshan Shah?

  Right.

• 41:59Speaker 01

  And this is common in health. We say we're going to do this for our health.

• 42:03Dr. Darshan Shah?

  Sure.

• 42:04Speaker 01

  And then we don't do it. But the problem is by saying you're gonna do it and then not doing it, you feel internally as though you're failing. Right? You build up this picture of yourself that, oh, I can't stick to something. I said I was gonna do it, but I didn't. There you go. I'm a failure. Guilt, shame kicks in. I've seen this. I've experienced this myself. I used to have these problems, right? A few years ago, I spoke to a body language expert on my podcast.

• 42:30Dr. Darshan Shah?

  Uh huh.

• 42:31Speaker 01

  And she told me that when we meet another human being for the first time, we're asking ourselves two questions. Can I trust them and can I rely on them? But Gosh, and what I figured out is that we're also asking those same two questions of ourselves every day. Can I trust myself? I can I rely on myself? If you say you're gonna do something and you don't do it, you tell yourself, you tell your body, I can't trust myself. I can't rely on myself, right? Why I'm so passionate. About five minute health interventions is in this chronically busy world where no one feels I've got any time, five minutes each day.

• 43:14Speaker 01

  It shows you that you're worth something. It shows you that no matter how much my kids need me, my partner needs me, my work needs me. I still found five minutes for myself. It shows you that you can trust yourself and you can rely on yourself. And I honestly believe it's one of the most powerful things that we can do. Yeah, I mean.

• 43:36Dr. Darshan Shah?

  It's a game changer. It's a, there's so many reasons to have some sort of routine in your life. And I think you've articulated it perfectly as to it's a responsibility to yourself. When you execute a routine that you've carried out and now you're told yourself that you can rely on yourself, you could trust yourself.

• 43:55Speaker 01

  And you've given yourself evidence.

• 43:56Dr. Darshan Shah?

  Yeah.

• 43:56Speaker 01

  You're not only told yourself, you've shown yourself with evidence.

• 44:00Dr. Darshan Shah?

  Right.

• 44:01Speaker 01

  That, yeah, I can do this. And it, I promise you, it builds up so quickly because you build up momentum. You change the way you view yourself. You're no longer a failure. Now you're like, yeah, I can do this. And people will still push back and go five minutes. What difference will it really make? I'm telling you, I've done this with patients for years and it can be the most powerful thing they do. On days where you have more time, you do more.

• 44:26Dr. Darshan Shah?

  Yeah.

• 44:27Speaker 01

  But even on busy days, you still do the five minutes.

• 44:29Dr. Darshan Shah?

  Right.

• 44:29Speaker 01

  That's the key. I have this thing that I do with my wife, right? It's called the tea ritual. And we know that human connection is very important for health. You know, we can do all the fancy blood tests and like the things that you've got downstairs. All that stuff is fantastic, but feeling socially connected is also a very key ingredient for health and wellbeing.

• 44:50Dr. Darshan Shah?

  Absolutely.

• 44:51Speaker 01

  And.

• 44:52Dr. Darshan Shah?

  It's the number one ingredient, according to that Harvard study.

• 44:54Speaker 01

  Exactly.

• 44:54Dr. Darshan Shah?

  Longest running study in.

• 44:56Speaker 01

  Exactly.

• 44:56Dr. Darshan Shah?

  Right.

• 44:57Speaker 01

  And, and I've realized a few years ago that so many couples, so many people are like passing ships. You know, so my wife and I, we live in the same house, got kids. But if you're both really busy and you don't intentionally spend a bit of time together. You can spend quite a few days where you're existing in the same location.

• 45:18Dr. Darshan Shah?

  Yeah.

• 45:19Speaker 01

  But you're not actually spending time together. So we have something called a five minute tea ritual. So every evening, once the kids are in bed, we have a commitment to each other that for five minutes, again, not half an hour, five minutes, we come into the kitchen, we put on a pot of fresh mint tea, and we sit and catch up with each other. Now, here's the thing, some days it is thirty minutes. But on some days, one of us will say, hey, I'm really busy at the moment, let's just keep it to five minutes. When we don't do it, even for three or four days, you can start to feel the friction build up, the little niggles over silly things.

• 46:00Speaker 01

  When we do it regularly, the closeness, the intimacy, the connectivity in our relationship is completely different. And I know it sounds ridiculous to hear this from a doctor, right? Why do we need to be hearing about this stuff? Well, smartphones, I think, are the primary reason, where we're all distracted because of what's on these damn things. So you can have a, two people in a relationship in the same location, they could be in the same bed, but if they're both on their phones, they could be a million miles away in their minds. And that five minute tea ritual, I've taught so many of my patients that over the years, and at least five couples over the years came in and said, Rangan, I honestly believe that may have saved our marriage.

• 46:45Dr. Darshan Shah?

  Yeah.

• 46:45Speaker 01

  Right? It's the small things done consistently that make the biggest impact. Now, listen, I'm not saying don't go for a one hour walk every day. I'm not saying that that stuff won't benefit you. It will. But if you're struggling, start small. I promise you it will make a difference.

• 47:03Dr. Darshan Shah?

  Yeah, it's so, such a powerful way to start anything, starting very small.

• 47:07Speaker 01

  Yeah.

• 47:08Dr. Darshan Shah?

  If you've never worked out in your life, just doing one push up just sets off a chain reaction where you're obviously going to do more, five maybe, and then you start working out and you start getting into the mindset that this is something that you can do. And so anything that you want to accomplish in life, starting small, I think is probably one of the most powerful ways to start the ship heading in that direction, for sure. Yeah, I completely agree with you.

• 47:37Dr. Darshan Shah?

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• 48:27Dr. Darshan Shah?

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• 49:09Dr. Darshan Shah?

  I do want to ask you, what are your three questions you ask yourself in the morning and journal about?

• 49:14Speaker 01

  Okay, so in the morning, the three questions I do this every day, actually, and I think they're the three most impactful questions you can ask yourself. So I put these all in a journal called the Three Question Journal, which so many people find useful. First question is, what is one thing I deeply appreciate about my life? Okay, so it's a simple question of gratitude.

• 49:36Dr. Darshan Shah?

  Gratitude, right?

• 49:37Speaker 01

  And- There is so much scientific literature now on the benefits of gratitude, whether it be for anxiety, depression, decision making, focus, productivity, sleep quality, whatever it might be. There's even some studies on gratitude that show practicing gratitude for seven days in a particular type of way can have impacts on your happiness three months later. Okay, so it's really quite remarkable. It's a simple question. What is one thing I deeply appreciate about my life? Okay, the next question, what is the most important thing I have to do today? That is probably my favorite question because initially you go, well, there's more than one important thing. Okay, there's there's some multiple important things at work, get at home.

• 50:23Speaker 01

  And here's the interesting thing, you may not know this, but when the word priority came to the English language in the 1500s, it only existed as a singular word. You could only ever have one priority.

• 50:35Dr. Darshan Shah?

  That makes total sense.

• 50:36Speaker 01

  Right, well, now we have multiple priorities.

• 50:39Dr. Darshan Shah?

  Right.

• 50:40Speaker 01

  Okay, now, what's the most important thing you have to do today? It's a really, it's a deceptively simple question because it almost doesn't matter what answer you put down, right? So if I say the most important thing I have to do today is make sure I spend some quality time with my wife in the evening, for example, it doesn't mean that my work is not important. It doesn't mean that my relationship with my children is not important, but it forces me to make a decision. And every day it's different. Some days it's the same. It might be if I haven't moved my body much for a few days, it might be I must go for a 30 minute walk at lunchtime, whatever it is. But what it does, it forces you at the start of the day to make a decision.

• 51:19Speaker 01

  And then if you act on the decision you made, let's say for seven days, if you do that, right, for seven mornings, you say, what's the most important thing I have to do today? And then you go and do it. It is inconceivable that your life will not change for the better. It's a simple question. It takes seconds to minutes to answer, and it changes how you experience that day. And why I think that question is so important is because we're living in an age, Darshan, where our to do lists are never done. Never. You could, in some sort of hypothetical worlds, complete all of your emails. Okay, you could do it. It's possible. And then you go and make yourself a cup of coffee. In the time you've gone to make that coffee and come out, you could have had another 10 emails.

• 52:04Speaker 01

  There's nothing you can do about it. If we wait in our lives to only do the important things when everything else is done, everything else is never done.

• 52:14Dr. Darshan Shah?

  It's never gonna get done, right?

• 52:15Speaker 01

  Right? So we have to define what is the most important thing I have to do today. And again, if anyone's skeptical, I say, try it for seven days. Just try it. You don't need to buy a journal or anything. Just write it down each morning with a cup of coffee. What is the most important thing I have to do? It's quite a fun thought experiment, right? It will change the way you experience life. So that's the second question. And the third question is, what quality do I want to showcase to the world today? Now, we've already mentioned, haven't we, that so much of what we do each day is autopilot, which is repeating what we did the day before.

• 52:50Dr. Darshan Shah?

  Yes.

• 52:50Speaker 01

  Right? So often we think that, oh, I'm reactive. I get quite stressed. I do this. Well, is that really true? Or are you just repeating what you've been doing for the last few weeks and the last few months? So what I love about this question is, it makes you really think about who is the person you want to be in the world. So for me, I'll often put down, I want to showcase to the world the quality of patience today, or the quality of compassion today. And by setting the intention that morning, it is so much more likely that you are gonna behave like that in the day. If someone cuts you up in traffic, an hour later, you are prompted to remember, yeah, you know what? This morning I said, I'm gonna, I'm gonna show the world the quality of patience today. So you're not gonna react. Or you get an email from your boss or your colleague that you don't like,

• 53:35Speaker 01

  and you're tempted to respond to, then you remember, oh, yeah, I said this morning I was gonna be compassionate to the world today. Again, doing it once, maybe the gold isn't there. You do it every day. You ask that question. That's where the magic is. That's where you start to change the person you are. And going back to all these behaviors that you're trying to help your patients with, that I'm trying to help my patients with for many years. Right? A lot of the time, I really believe this. And and this is how I start this new book. I say, knowledge for most of us is not enough. We need knowledge, right? But most people who are consuming too much sugar, they know they're consuming too much sugar. They don't need a new book saying that sugar's bad for you. They already know that. Same with alcohol.

• 54:19Dr. Darshan Shah?

  Sure.

• 54:20Speaker 01

  Right? What they need is more internal knowledge and self-awareness as to, well, why do I keep going to sugar? Even though my doctor told me I shouldn't do, even though my HbA1C is too high, why do I keep doing it? There's a mismatch there.

• 54:35Dr. Darshan Shah?

  Right.

• 54:36Speaker 01

  Right? There's a mismatch. And I submit that a lot of the time it's because we're living these stressed out lives. So sugar, for example, is our way of managing stress. So what I've realized in my many years of practice now is that too often, we try and change the behavior without realizing the role that that behavior plays in our life. So for example, if the way you manage stress is with alcohol, sure, you can go on a two-week detox from alcohol or a thirty-day detox. Great. But if the stress in your life hasn't changed, you're gonna be right back to where you were. We see this every January.

• 55:16Speaker 01

  Whether it's thirty-day off sugar, thirty days of alcohol, if you don't address the underlying cause of that behavior, usually you'll go straight back. So you either have to reduce the amount of stress in your life, or you need to find an alternative way to manage that stress. So this ex- an exercise that I put together to try and help my patients with this was called the three Fs. Can I share it with you?

• 55:38Dr. Darshan Shah?

  I would love to.

• 55:38Speaker 01

  So I think people might find it useful.

• 55:40Dr. Darshan Shah?

  Right.

• 55:41Speaker 01

  Do you have a lot of patients who struggle with their sugar intake?

• 55:44Dr. Darshan Shah?

  Almost, I would say eighty percent of people struggle with their sugar intake.

• 55:48Speaker 01

  Yeah, and people beat themselves up. And I think it's it's really unfair because we all love sugar. We're hardwired to like sugar, right? This it's not a failing of yours. Like, I have a rule that I don't bring anything into my house that I don't want to eat. Okay, I've been.

• 56:04Dr. Darshan Shah?

  It's a great rule.

• 56:05Speaker 01

  I've been recommending it to my patients for years. I say, don't use. Power up in the house.

• 56:09Dr. Darshan Shah?

  Right.

• 56:10Speaker 01

  You have to use willpower when you go outside, right? When you're in the shops, when you're filling up your car with petrol.

• 56:16Dr. Darshan Shah?

  Yeah.

• 56:16Speaker 01

  Right? You know, you're gonna try and buy a coffee at a coffee shop, but you have to walk past all the pastries.

• 56:22Dr. Darshan Shah?

  Yes.

• 56:22Speaker 01

  Right? You have to use willpower there. Don't use it at home, right? That would be my advice. But let's say with sugar.

• 56:30Dr. Darshan Shah?

  Okay.

• 56:30Speaker 01

  A common thing I would see with people for years is that they were pretty good in the day. I say, don't stress you, yeah, but at nine P M, I'm on the sofa at home. I've got the T V on. I just feel like some ice cream.

• 56:39Dr. Darshan Shah?

  Yeah.

• 56:40Speaker 01

  I said, okay, okay, let's, let's kind of, let's unpick that, figure out what's going on. So I created this exercise called the three F's. I said, okay, next time you're on the sofa in the evening and you're craving sugar. I want you to take a pause before you go and get the ice cream. I want you to ask yourself the first F. So the first F of these three F's is feel. Okay? So ask yourself, what am I feeling? Am I really hungry? Is it physical hunger or is it emotional hunger? Right? Am I really hungry or am I just stressed? Okay, then go ahead and eat it. But what I'm trying to do is help you start to build up that awareness of what's really going on. Again, it goes back to the solitude, right? The start.

• 57:20Dr. Darshan Shah?

  Right.

• 57:20Speaker 01

  If you don't develop this inner knowledge of yourself, you will never change these behaviors in the long term. You will for a few weeks or a few months, but most people don't just want change for a few weeks or months. They want change for good.

• 57:34Dr. Darshan Shah?

  Right.

• 57:34Speaker 01

  They want it in the long term. So the first step is.

• 57:36Dr. Darshan Shah?

  Change at last.

• 57:37Speaker 01

  Make change at last. Exactly. That's why, that's why it's the title of the book, right? So the first step is feel. The second F is feed. Okay, so the next time it happens, you've got the craving for sugar. You ask yourself, what am I feeling? Okay, I'm not physically hungry. I'm emotionally hungry. Or I've had a row with my partner and this is gonna make me feel better. Okay, whatever it is. Then ask yourself, how does sugar feed that feeling? So the first F is feel. So the feeling might be stress.

• 58:03Dr. Darshan Shah?

  Right.

• 58:04Speaker 01

  The second F is feed. How does the sugar feed that feeling? Oh, when I have sugar, I feel less stressed.

• 58:11Dr. Darshan Shah?

  Right.

• 58:12Speaker 01

  Okay, great. Go ahead and have it, but you're starting to really build up this self-knowledge now. The next time it happens. You go to the third F. So the first F is, what am I feeling? Second F, how does food feed that feeling? And the third F is now, the third F is find, okay? Can I find an alternative behaviour now to feed that feeling? Okay, so let's say you're stressed out from your day's work and you've identified that sugar helps you reduce stress, which it does, or it gives you the illusion that it does in the short term, okay? Okay, well, what other behaviour could I do now? Ah, well, I could, for example, if, let's say you're into yoga,

• 58:55Speaker 01

  you could do a five or 10 minute yoga sequence instead.

• 58:58Dr. Darshan Shah?

  Right.

• 58:58Speaker 01

  Right? Which will do the same thing. It will actually lower the stress without the negative impacts. That may be an option. It may be that you've been by yourself all day, or you've had a row with your partner, or you don't feel you've had any time to yourself, and this is a little treat for you. Maybe you can run yourself a bath. And instead of having half a tub of ice cream, you could go and lie in the bath for 15 minutes and nourish yourself in that way. That will, that will also help. And you could go on like that, but there's a whole host of different things that you can think about doing. Let's say you're lonely. Loneliness is huge these days, right? Let's say you've been on Zoom calls all day. You don't live near your family or your friends. You're feeling a bit lonely and you think the ice cream is going to make you feel better. Yeah, it probably will make you feel better in the short term.

• 59:43Speaker 01

  Well, perhaps instead, you could phone one of your best friends. Or you could spend some time with your partner if you have one. Or if you've got parents and you haven't spoken to them in a while, phone up your mum or your dad if you're lucky enough that they're still alive and around, right? Whatever it might be. And then you're feeding the loneliness, you're dealing with it without needing it. And I'm telling you, Dawson, like, patients love this exercise because they're empowered. It's not about me telling them, they start to figure it out. Doesn't mean you can change it straight away, but over time, I've seen this so many times, patients go, yeah, I don't, I don't need it. I need a way of managing stress, but there's other ways of managing stress that aren't sugar or alcohol.

• 1:00:28Dr. Darshan Shah?

  Yes.

• 1:00:28Speaker 01

  So again, nothing works for everyone, but for many people, that exercise is a really nice way of them helping to understand their own triggers. And you can apply that to alcohol. You can apply that to three hours of Instagram scrolling in the evening. You can apply it to whatever you want, because the principles are the same. What role is this behavior playing in my life?

• 1:00:50Dr. Darshan Shah?

  Yeah, I think coming at it with intentionality like that, you're decoupling the action from the thing that caused that action, right? And I think that's what's so important. It's kind of the opposite of what we were talking about before about neurons strengthening connections. Now you're pulling the neurons apart for things that you probably shouldn't, that you want to take out of your life.

• 1:01:11Speaker 01

  Exactly. That's a beautiful way of looking at it. And you're creating that pause between stimulus and response. Instead of it being stimulus, stress, response, sugar. Stimulus, stress, response, sugar. That exercise creates a gap. It creates a pause where you have a bit of space. You go, oh, I have an option here. There are many ways I can respond to this stressor. Sugar is one of them, and it's a valid one, but there's other ways as well. And actually, sometimes people may go, yeah, but today I just want the sugar. Okay, fine. But on other days, they'll choose something else. So little by little, your relationship with that behavior starts to change.

• 1:01:50Dr. Darshan Shah?

  Yes. No, that's so powerful. I love it that we've been talking for all this time about basically habit formations and how to make good habits and uncouple maybe poor ones. And it's so fundamental to our health. I always say, before we talk about, you know, how much protein you should have, how much weight you should lift, what your VO2 max is, that conversation almost means nothing without the ability to create good habits. Because like your book says, is if you can't create these habits, the change won't last, right? And so I think it's so important to make that fundamental in everyone's toolbox of some of these things that you're talking about.

• 1:02:28Speaker 01

  Yeah, for sure.

• 1:02:29Dr. Darshan Shah?

  Absolutely. So Rangan, you know, one of the things that I'm impressed by you is you said you've been practicing medicine for over 20 years now, right? And at the beginning of your Journey in medicine, you were trained like I was, Western medicine.

• 1:02:41Speaker 01

  Yeah.

• 1:02:41Dr. Darshan Shah?

  And at some point, you decided to go a different route and do functional medicine and learn more about root cause of why we have disease in the first place. I think that's what your first book was about, right?

• 1:02:54Speaker 01

  Yeah.

• 1:02:54Dr. Darshan Shah?

  And I'm just curious, what made you see the light? What made you want to practice a different form of medicine?

• 1:03:01Speaker 01

  There's a number of different factors, okay. As I reflect back, I qualified for Edinburgh Medical School in two thousand and one.

• 1:03:10Dr. Darshan Shah?

  Okay.

• 1:03:10Speaker 01

  And although I didn't realize it for the first few years as I was practicing as a doctor, I I can really realize it now, looking back. Things aren't always obvious when you're going through them, but on reflection, you go, yeah, this was going on. I think I always had a slight discontentment with elements of my practice. I always felt that we were never getting to the root cause, that we were just suppressing symptoms with drugs a lot of the time. And some of the time, that's very helpful, right? Depending on what the situation is. But things really came to a head for me in a number of different ways. Okay. So firstly, when my son, who

• 1:03:51Speaker 01

  is now fourteen years old, when he was six months old, he nearly died. So I remember this like so well, as if it was yesterday, but first child.

• 1:04:04Dr. Darshan Shah?

  Yeah.

• 1:04:04Speaker 01

  My wife was breastfeeding him for six months and we went on holiday to France for a week, just after Christmas. And the first night we were there, we were staying in a chalet in Chamonix in France. And he'd had sniffles all day, he had a bit of a cold. And then my wife suddenly called out to me, past seven in the evening, saying, wrong, and he's not moving. Basically, he went stiff as a board, his arms went back.

• 1:04:28Dr. Darshan Shah?

  Scary.

• 1:04:29Speaker 01

  Really scary. I thought maybe he choked because he had sniffles all day. So I turned him over, I tried to clear his airway, nothing was happening. And my wife, after a while, said, look, we just need to get to the hospital. So we rushed into this hire car. It had just snowed, so I think I nearly killed us all as the car skidded, because I'm trying to get to the ER really quickly. And in essence, we got to the ER in France. They were really confused. You could see how worried they were because, as you well know, at that age, you can have a convulsion if it's associated with a fever, what we call a febrile convulsion.

• 1:05:05Dr. Darshan Shah?

  Exactly.

• 1:05:06Speaker 01

  But he had no fever. So they were like, why on earth is this young baby having a convulsion? There's no fever.

• 1:05:13Dr. Darshan Shah?

  Right.

• 1:05:14Speaker 01

  So they stabilized him. Because we were in the mountains, he then got blue lighted down the hospital to a bigger hospital. My wife went with him, I followed in the car, thinking, what the hell is going on? And essentially, my, my son had a very low level of calcium in his body. Okay, so the normal range in that hospital of serum calcium was two point two to two point six. His calcium was zero point nine seven.

• 1:05:40Dr. Darshan Shah?

  Wow, why?

• 1:05:41Speaker 01

  And then a few hours later, his vitamin D came back and he hardly had any vitamin D in his body. So he had a vitamin D deficiency and that caused the hypocalcemia.

• 1:05:53Dr. Darshan Shah?

  Sure, sure.

• 1:05:54Speaker 01

  So here's the situation. We didn't know if he was going to make it that night. He had lumbar punctures, he had everything.

• 1:06:01Dr. Darshan Shah?

  Oh my gosh.

• 1:06:02Speaker 01

  Modern medicine saved his life for sure.

• 1:06:04Dr. Darshan Shah?

  Right.

• 1:06:05Speaker 01

  Calcium infusion, vitamin D, but then a few days later, they wanted to discharge him. And I was asking, yeah, but presumably this could explain why he's got a bit of eczema. Or he's got a chlamydia allergy and all these sort of things. Modern medicine just, it's not that they, they weren't that interested. It's like, oh, we fixed the acute problem.

• 1:06:25Dr. Darshan Shah?

  Yeah.

• 1:06:25Speaker 01

  You can go now.

• 1:06:26Dr. Darshan Shah?

  Yeah.

• 1:06:27Speaker 01

  Right?

• 1:06:27Dr. Darshan Shah?

  Exactly.

• 1:06:28Speaker 01

  And the truth is, Darshan, that really affected me because I've had perfectionist tendencies my whole life about myself. But also in the way that I parent.

• 1:06:36Dr. Darshan Shah?

  Sure.

• 1:06:38Speaker 01

  I thought I'd let him down.

• 1:06:39Dr. Darshan Shah?

  Mm hmm.

• 1:06:40Speaker 01

  Where I felt that, you know, with all my supposedly excellent qualifications from a really good medical school, my MRCP, which is the specialist exams, MRC, GP, the GP exam, like, I have an honors degree in immunology with all this expertise. I thought my son's nearly died from a preventable vitamin deficiency. There's a lot more to that story that, you know, if we had longer, I'd tell you about, but in essence, I remember we walked out of that French hospital. And I made myself a vow. That I'm gonna get my son back to full health as if this had never happened. So that was the commitment I made to myself. I became obsessed.

• 1:07:21Speaker 01

  I would spend three, four hours a day, I'd study vitamin D metabolism, the gut microbiome. I'd travel all around the world to conferences, to lectures. I needed to understand what has been going on in his body. What can I do to fix this? Right? And that's what led to it.

• 1:07:38Dr. Darshan Shah?

  Right.

• 1:07:39Speaker 01

  And so I went around the world. I learned all these things. I sought out the best experts and then I put it all together. I applied it with my son. He started to thrive and today he's a fourteen year old boy who's thriving. He's in excellent health. He's doing really well. I applied the same principles that I learnt with my patients. They're getting better. I'm using less medication than I've ever had to do before. I applied it with myself. I'm feeling better and I'm thinking, wow, there's so much out there that we're not taught at medical school. And so that really was one of those pivotal points in my career. I'd been sensing it for a while anyway. Right? I think I would have ended up here anyway.

• 1:08:22Speaker 01

  But when something massive like that happens.

• 1:08:25Dr. Darshan Shah?

  For sure.

• 1:08:25Speaker 01

  I felt I had no choice. I have to get my son back to full health and that was my drive, if I'm honest. Now, that guilt that led to me do that, I don't think it's a healthy thing in general. Like my son didn't need a dad feeling guilty. Right? So I've, I've done some inner work and I said, there we have let go of that guilt because it doesn't help anyone. Things happened, but now, and this is one of the reasons I feel so happy these days is that I kind of reframe everything in life in a very positive way. So now I genuinely see my son's illness as a gift.

• 1:09:06Speaker 01

  I feel that that happened and it forced me to learn things that I previously didn't know. And without that, I can't say for sure that I'd still be here. That with that knowledge, yes, I've helped him, but I've helped so many, I think millions now around the world.

• 1:09:23Dr. Darshan Shah?

  Exactly.

• 1:09:24Speaker 01

  Through my online platforms and my books and my podcast. And so I choose to see that moment as a gift.

• 1:09:32Dr. Darshan Shah?

  Right.

• 1:09:33Speaker 01

  And, and that's a very powerful reframe internally for me. It's helped me feel less guilty. Yes, do I wish it hadn't happened? It's interesting. I haven't really asked myself that question for years now. Five years ago, I would have said, yeah, I wish it hadn't happened. Now I'm not so sure.

• 1:09:50Dr. Darshan Shah?

  Yeah.

• 1:09:50Speaker 01

  Do you know what I mean?

• 1:09:51Dr. Darshan Shah?

  Right, because how would you have made this change in the direction of your practice of medicine if that had not happened?

• 1:09:57Speaker 01

  Yeah, but then as a dad, you think you you clearly don't want your kids

• 1:10:02Dr. Darshan Shah?

  Right.

• 1:10:02Speaker 01

  to go through any heartache. But then even me calling that heartache is me putting my perception onto something that he experienced. Well, maybe that's his journey in life.

• 1:10:14Dr. Darshan Shah?

  Right.

• 1:10:14Speaker 01

  Do you know what I mean? It's a bit more, I guess, a spiritual outlook.

• 1:10:17Dr. Darshan Shah?

  He probably doesn't even remember it.

• 1:10:18Speaker 01

  Exactly. That's the reality.

• 1:10:21Dr. Darshan Shah?

  Right.

• 1:10:21Speaker 01

  Do you know what I mean? So it's so I think, you know, my first book, I in the UK, it was called The Four Pillar Plan. In the US, it was called How to Make Disease Disappear.

• 1:10:30Dr. Darshan Shah?

  Right.

• 1:10:30Speaker 01

  But essentially, I I set out these four key pillars of health, food, movement, sleep and relaxation. And I said that these are the four core areas of health that not only have the most impact on how we feel in the short term and the long term, but also that we have a fair degree of control over. But if we take that relaxation pillar, which is basically about stress.

• 1:10:52Dr. Darshan Shah?

  Right.

• 1:10:53Speaker 01

  I guess where I've really evolved my view over the last few years, as evidenced in this latest book, is that stress can be external or internal. And when we often talk about stress, we're talking about our workload. We've got too many things to do. Okay, the external stresses in our life, but a huge part of stress is our internal stress response, how we frame things in our life. Right? How we view things. Like if someone cuts us up on the road when we're trying to drive to work, we don't realize that we have a choice in how we react to that, right? If you want to shout in your car that that stupid driver, they shouldn't be on the road. You know, they need their rise checks or whatever it might be. And and I I used to be that ten fifteen years ago. I I could be quite reactive like that.

• 1:11:37Speaker 01

  We don't realize that that's a choice. We're stressing ourselves out. That situation is fundamentally neutral. But the response and the the way we choose to frame it is determining and generating the stress response in our body. When you can learn to go, I don't need to respond to that. I wonder what's going on in that person's life. Maybe that person's a dad and his baby daughter was up last night with irate. Maybe he's rushing to work because he barely afforded the mortgage last month. And if he's late one more time, he's gonna lose his job. Once you start looking at the world like that, your whole relationship to stress changes.

• 1:12:19Speaker 01

  And therefore, your behaviors like sugar and alcohol that were there to manage your stress. Well, once you realize that a lot of your stress is self-generated by the way you choose to respond to the world. Then the whole world opens up to you.

• 1:12:35Dr. Darshan Shah?

  Absolutely.

• 1:12:36Speaker 01

  And the reason I, and I said to you this in the car on the way here, I'm forty seven. I've never felt this good. I honestly, I I feel happy, I feel calm, I feel content in myself. And this has been going on for a few years now. And most of it has come from the stuff I've written about in Make Change at Last. It's that internal stress response.

• 1:12:55Dr. Darshan Shah?

  Right.

• 1:12:56Speaker 01

  I've changed the way I view the world. Think about that third question I ask myself each morning. What quality do I want to showcase to the world today? Right? I choose to show the world patience and compassion. And I promise you, if you choose to show the world things like patience and compassion and integrity. And these qualities each day, you naturally make better decisions. You naturally engage in more helpful behaviors. If you're chronically stressed, if you think you're justified in shouting at that driver because they shouldn't be doing that. Hey, I'm not here to change your mind. You're welcome to respond how you wish to. Just know that that response that you are choosing has a consequence.

• 1:13:40Speaker 01

  And again, and even within the functional medicine world, Darshan, I think one thing that we miss. Is that that emotional stress that you generate by the way you interact with your boss. Or that driver who cut you up on the roads. That emotional stress is not neutral. Right? So if you drive to work and you were feeling calm and the traffic bothers you. And I know the traffic here in L A is a massive thing.

• 1:14:03Dr. Darshan Shah?

  It's a massive thing.

• 1:14:04Speaker 01

  And someone.

• 1:14:04Dr. Darshan Shah?

  Bother's everybody in L A.

• 1:14:06Speaker 01

  Yeah, but the problem is, well, it would be interesting to do a study, wouldn't it? About the behaviors in an environment where there's heavy traffic, compared to the behaviors people make in an area where there isn't heavy traffic. I'm genuine, I'm actually deadly serious.

• 1:14:21Dr. Darshan Shah?

  Right, exactly.

• 1:14:22Speaker 01

  Because, because if you're living in an environment where everyone's stressed out, right? And everyone's getting annoyed at other drivers, well, of course, behaviors are going to be worse. But of course, sugar intake, caffeine intake, alcohol intake, because that emotional stress is not neutral. You have to neutralize it in some way. Now, you can neutralize it by going for a run, or you can neutralize it by eating ice cream.

• 1:14:49Dr. Darshan Shah?

  Uh huh, right, absolutely.

• 1:14:50Speaker 01

  But you will choose something to neutralize it.

• 1:14:53Dr. Darshan Shah?

  Right.

• 1:14:54Speaker 01

  So, and, you know, as we go through our careers, we evolve our thought process, we, we go deeper into the root causes. And yes, I still maintain that food, movement, sleep and relaxation are four key root causes, right? That if you address them, your health is going to be better, for sure.

• 1:15:13Dr. Darshan Shah?

  Yes.

• 1:15:14Speaker 01

  But I think you go even higher than that. I would say that for many of us, our food choices are symptoms in and of themselves. They're symptoms of further upstream problems, the way we're interacting with the world.

• 1:15:29Dr. Darshan Shah?

  Yeah, and I think on the car right over here, you said, you know, this book is probably one of the riskiest books you've ever written, because you're trying to take people into this mindset that your nutrition, your sleep, your, your habits around exercise and movement, all of that really comes from a few levels above of what's, what's happening in your life and the way you're framing these events in your life.

• 1:15:52Speaker 01

  Yeah, I, I, what, what, the reason I say I think it's, it's risky, the right words. I think. I've previously written a book on happiness. Sure. Okay. And I created a model for happiness. And in that model, I basically said that there are three ingredients to happiness. So you don't work on happiness directly. You work on the three ingredients and happiness happens as a side effect. And the three ingredients are contentment, control and alignment. So contentment is about the things that you can do that make you feel calm and content and peaceful. Control is a sense of control. We've already spoken about that. What are the things that you can do regularly that give you a sense of control?

• 1:16:35Speaker 01

  But the third ingredient is alignment. And alignment is when your inner values and your external actions start to match up more and more. When basically the person you are on the inside and the person who you are being on the outside are one and the same. Now, my contention is that one of the reasons I would say I find behavior change quite easy now compared to the past is because I'm not trying to fight this misalignment in who I am. Over the last few years, I've made certain choices in my life with my career, with my family life, with what I say yes to, what I say no to. I've become much more aligned with who I am.

• 1:17:18Speaker 01

  Therefore, I have less of a need now to binge eat, to stuff my face with sugar. I haven't drunk alcohol in five years now. Okay. Again, no ethical or moral judgment. People are entitled to do whatever they want to do with their lives. I genuinely mean that. I just realized that I started drinking alcohol at university to fit in with my friends. Cause everyone was drinking. And I never really questioned as to is that something I want to continue doing? And a few years ago, I realized I don't think I do. And bit by bit, I would reduce it. And then about five years ago or so, I just stopped. I haven't drunk a drop since. Not because I'm trying not to drink and resist something.

• 1:18:01Speaker 01

  I'm not because I'm in alignment with who I am. I naturally make choices now that are in harmony with that. And again, in functional medicine, we talk about root cause. And I'm a huge fan of how functional medicine looks at the human body and health.

• 1:18:19Dr. Darshan Shah?

  Yes.

• 1:18:19Speaker 01

  But I think you can go even more root cause. You can go right to the top. How do you view the world? How do you make decisions? And then I think when you get that right, and that's basically what Make Change at Last is all about. When you get that right, I think behavior naturally follows as a consequence.

• 1:18:36Dr. Darshan Shah?

  Yeah, it's all about getting your behaviors to be in alignment with who you are. And once you do, the good behaviors just kind of come.

• 1:18:45Speaker 01

  Exactly.

• 1:18:46Dr. Darshan Shah?

  You know, one of the other concepts in the book that I want to touch on is this concept of reliances, right? And you talk about minimal reliance, not zero reliance. Can you unpack that for us a little bit?

• 1:18:57Speaker 01

  Yeah, it's hard to summarize that, but it's the kind of, it's a foundational concept behind everything in this book. Okay, and I think it's quite a fresh concept. And it's this idea that many of us are overly reliant on things outside of ourselves in order to feel good. We need things to be a certain way. We need there to be no traffic, right? We need our partner to treat us well. We need the kids to put their things away. We need our email inbox to be manageable. All of these externalities need to be just right, and then we can be right. The problem with that, though, is that it means fundamentally our health and well-being is outside our control.

• 1:19:38Speaker 01

  We require things on the outside to all go a certain way in order for us to feel good. That was me a few years ago. And then I realized, how am I ever going to be truly calm and contented if I'm reliant on all these things in the outside world to be right before I can feel good? And I realized it was ridiculous. I can't. So the whole concept of minimal reliance is how do we become less reliant on the things outside of ourselves and more reliant on ourselves? Okay, so each of the nine chapters goes through what I consider a big reliance that many of us have. So we're maximally reliant, not minimally reliant. So I'll give you an example.

• 1:20:23Speaker 01

  One is about our over reliance on experts. And I'm aware that you're a very well qualified doctor. I'm a very well qualified doctor, but I do believe that the population have become overly reliant on expert voices like us. I'm not saying they should ignore what we have to say, but like I said earlier on in this conversation, I think they need to put it through their own filter. They come and see you at Next Health, they come and get the advice. And maybe you give them a diet sheet of the things that they can try. I don't know how you guys operate, right? But then they need to experiment and go, yeah, that's a cool framework, but actually within that framework, I feel better when I'm eating like this.

• 1:21:06Speaker 01

  Right? So they need to become less reliant on us and more reliant on themselves. Okay. Chapter seven is a reliance on busyness.

• 1:21:17Dr. Darshan Shah?

  Yeah.

• 1:21:18Speaker 01

  Right? So we think we have to be busy because that's what the culture says, particularly here in the US. This go, go, go culture, right? Chronically being busy. And I, I make the case in that chat that busyness does not equal success.

• 1:21:32Dr. Darshan Shah?

  Right.

• 1:21:33Speaker 01

  But we think it does as a cultural narrative that if we're busy, we're successful. And I'm saying you can become less reliant on the idea. Now, one way you can do that is by asking yourself that question each day. What's the most important thing you have to do today? It doesn't mean that your emails or your job doesn't, it vanishes and suddenly your life has come numb. But it means that you're becoming less reliant on the idea of being busy all the time and going, actually, no, this one thing is the most important thing I have to do today. Yes, I'm going to stay busy, but I'm going to make sure I do this one thing. And bit by bit, your life will start to change. So that's kind of the idea of minimal reliance. Another one of my favorite chats is this reliance on comfort.

• 1:22:16Dr. Darshan Shah?

  It's a big problem.

• 1:22:17Speaker 01

  It's a huge problem and you can make the case, Tasha, now. I, I never really thought about it till I wrote the chapter. This idea that most of the diseases and symptoms that people come in with these days and that are frankly bankrupting most healthcare systems are diseases of comfort.

• 1:22:34Speaker 01

  Right, type two diabetes is a disease of comfort. You do not get it in a more traditional society where life is inherently uncomfortable. In most traditional societies, you have to go and get your food, hunt it or gather it, then bring it back, start the fire, cook it. Right, that is uncomfortable.

• 1:22:53Dr. Darshan Shah?

  Right.

• 1:22:53Speaker 01

  And humans are hardwired for comfort. Okay, there's nothing wrong with that until about fifty years ago. Until about fifty years ago.

• 1:23:01Dr. Darshan Shah?

  Yeah.

• 1:23:02Speaker 01

  That desire for comfort, yeah, I want a heated home.

• 1:23:05Dr. Darshan Shah?

  Right.

• 1:23:05Speaker 01

  Right, I want to make it easy to get my food in a store, whatever. All these things are great, but we've now got to a point where comfort is killing us. Now, in a modern western nation, you can sit on your sofa in your climate controlled house. You don't have to get any food on your phone. You can not only have groceries delivered, it can be cooked. The most beautiful meal can be delivered to your door without you having to get up off your chair.

• 1:23:33Dr. Darshan Shah?

  Right.

• 1:23:34Speaker 01

  Right, it's remarkable.

• 1:23:35Dr. Darshan Shah?

  Yeah.

• 1:23:35Speaker 01

  Like what we've done with humanity, that are innovation, but that reliance on comfort is now starting to kill us. We know that, I mean, kids today, I don't know if you you've seen this research or not, it's really quite alarming. There was a a study done, I think of twenty eight million kids in twenty five different countries. Okay, on average today, it takes a child ninety seconds longer to run a mile than thirty years ago.

• 1:24:02Dr. Darshan Shah?

  Wow, that's a big difference.

• 1:24:04Speaker 01

  That's a lot, ninety seconds on a mile is huge.

• 1:24:06Dr. Darshan Shah?

  Right.

• 1:24:07Speaker 01

  That just shows you how much weaker.

• 1:24:09Dr. Darshan Shah?

  Yeah.

• 1:24:10Speaker 01

  Our kids are compared to just thirty years ago. And we know that adults are getting weaker as well. So that concept of minimal reliance, when you look at it through the lens of comfort is, I'm not saying let's go back to living in camps in in nature, right, without air conditioning, I'm not saying that at all. No, I like the comforts of the modern world, but in that chapter, I say you have to introduce a little bit of discomfort into your life each day.

• 1:24:37Dr. Darshan Shah?

  Mm hmm.

• 1:24:37Speaker 01

  Now, that could be a little bit of a cold shower at the end of your hot shower each morning. You just go for twenty seconds, you go cold. Okay, it could be that you always take the stairs and you don't take the lift. Right? And in that chat, so I've got this thing about discomfort rules. I say, what rule can you create? So I, I think rules can be really helpful sometimes as a way of automating our behavior. So I have a discomfort rule in my own life that I put in about five years ago. And this rule basically says, I will always take the stairs unless there's a damn good reason not to. Now, why making a rule has been very helpful. It comes back to what we've been talking about throughout this conversation about automating behavior.

• 1:25:20Speaker 01

  So by making that a rule, I'll give you, like, I literally got off an 11 hour flight yesterday. Okay, so I live in near, near Manchester. So I got the plane from Manchester to London, changed London to LA. So been on the plane for a long period of time. I got off at LAX. I think I was the only person I saw from the plane when you come off and you're getting these, there's two big escalators going up.

• 1:25:43Dr. Darshan Shah?

  Stairs in between, yeah.

• 1:25:45Speaker 01

  I take the stairs and I was the only one that I saw take the stairs.

• 1:25:48Dr. Darshan Shah?

  No one takes the stairs when there's an escalator anymore. It's crazy.

• 1:25:51Speaker 01

  No, and I understand it. Like, we shouldn't feel bad about that because we're hardwired to, for comfort, to make things easy. But we've got to a point where comfort is now killing us. So I'm saying, maybe the stairs isn't the right one for everyone. But for me, it is. I've decided no wrong and I'm a capable human. I'm not going to outsource my movement to an electronic device unless I absolutely need to. So I did that. In the hotel I'm staying at at the moment is Santa Monica. You know, I remember checking yesterday and they pointed me to the lift. I said, excuse me, thank you so much. Are there any stairs up to the sixth floor? They said, yeah, there are, but they're over the way, they're around the corner there. I said, okay, no worries. Thank you.

• 1:26:32Speaker 01

  I went to the stairs. Now, I'm not saying I'm anything special, but by making it a rule, I internalize this concept that I'm someone who takes the stairs. Now, I will take the lift occasionally if I've got loads of bags or I'm exhausted or whatever. But my default has become taking the stairs. Now, how does that relate to health? We're talking about minimal reliance and. Comfort. Well, how it relates to health is we know that physical activity

• 1:26:57Dr. Darshan Shah?

  Yeah.

• 1:26:57Speaker 01

  is really important. We know that many people struggle to get even the most basic recommendations done. They say they don't have time. Well, I didn't have to create extra time yesterday, right? I was, I had to go up to my hotel room, right? I just chose to take the stairs. In my local supermarket back in the UK, if we drive there, like if I drive there to get the grocery shopping, where you park is two floors down from the supermarket. So I, when I go and park, I park at the furthest parking spot away. So I have to walk five minutes to the stairs and the lift, and I don't take the lift, I go down the stairs.

• 1:27:36Speaker 01

  And also, my kids now have been doing that with me for years, so I feel I'm also trying to lead by example with my children. Now, I'm not trying to make anyone feel bad who doesn't take the stairs. My whole approach is never to make people feel bad, it's to give them a range of options, and in the book, there are so many options.

• 1:27:53Dr. Darshan Shah?

  Right.

• 1:27:54Speaker 01

  But in essence, my point is that we are overly reliant on comfort. We've got to become less reliant on comfort. And one way you can do that is by having a discomfort rule in your life. That's one of mine. And I also want to be acknowledged that some people have got bad knees. Some people aren't able to do something like that. I totally understand that. In which case, it might be something else that you do.

• 1:28:18Dr. Darshan Shah?

  Sure.

• 1:28:18Speaker 01

  But did that all make sense?

• 1:28:19Dr. Darshan Shah?

  Yeah, absolutely. I mean, I don't think this example of taking the stairs is just one example.

• 1:28:24Speaker 01

  It's just one example.

• 1:28:25Dr. Darshan Shah?

  Another thing you said in your book, I heard you on a podcast, I like, what if you just take five seconds of a cold shower at the end of a shower? That's another form of discomfort.

• 1:28:33Speaker 01

  And the benefits are actually, you can look at the physical benefits of what the cold immersion might do. And there are some benefits there. I think the benefits are primarily psychological.

• 1:28:42Dr. Darshan Shah?

  Exactly.

• 1:28:43Speaker 01

  You're choosing to do something uncomfortable when you don't have to.

• 1:28:47Dr. Darshan Shah?

  Right.

• 1:28:48Speaker 01

  And that's where the goal is. That's when you show yourself, though, I am a capable, resilient human being who can manage. So I think these things are really, really important.

• 1:28:58Dr. Darshan Shah?

  Yeah, they're a game changer in modifying other behaviors, and you might not even realize it. You said a funny story about someone on a train that didn't want to get up to get a bottle of water two cars down because then the app wasn't working, right? And they're getting annoyed at this.

• 1:29:13Speaker 01

  Yeah, in that chat, I wrote about that, where literally. It's about a year and a half ago. So from Manchester to London, there's a high speed train service, okay? It's called the Pendleino train in the UK and it tilts, so it goes fast. And I was travelling with a friend to London in the winter about a year and a half ago. And my friend, who I was sitting opposite me, was trying to use the new app where from the cafe section, which is four cars down, they would deliver you the drink that you want. He was getting really pissed off because the app wasn't working. And I thought, this is utterly ridiculous, right? We're literally travelling at about 150 miles an hour to one of the great cities of the world,

• 1:29:56Speaker 01

  London, and he's generating this internal stress and annoyance because an app isn't working. And the irony of this is, is that 10 years ago, he wouldn't even have needed that because it wasn't even available. Exactly. So we've now become conditioned to this comfort. And when this comfort doesn't work, we get so annoyed. I've had patients start and where they tell me they've got Bluetooth headphones, so they love to go for a walk, listen to music. And they would say, I've got friends like this, when occasionally their Bluetooth is not connecting to their phone, they get really frustrated. And I get it, but we've got to take a step back and go, this is ridiculous. That technology didn't exist 20 years ago.

• 1:30:40Speaker 01

  And now we're self generating annoyance when it doesn't work. This is what I mean about reliance. Right. We've become so reliant on all these things working in order to feel good. This book will help people become less reliant, not zero reliance. And the key point about minimal and not zero is that you can take this concept to an extreme and become so independent that you start to not rely on people around you. No, humans are social beings, we're social animals. A bit of reliance is a good thing. We need others to be able to rely on us and we also need to be able to be someone who others can count on, right? We need to be reliable for other people, right? That's really important. So throughout the whole book, I made the case that actually, no.

• 1:31:26Speaker 01

  We're not chasing zero reliance, we're just chasing minimal reliance. And the final chapter is the gift of reliance, what a beautiful thing it is. When you're there for someone else and someone else is there for you.

• 1:31:37Dr. Darshan Shah?

  Yeah, yeah, I love that. You know, I feel like you've written many books and this is your sixth book.

• 1:31:43Speaker 01

  Sixth book, yeah.

• 1:31:44Dr. Darshan Shah?

  And the first few books you wrote talk a lot about nutrition and movement and sleep, et cetera. But it's almost, you want to start with this book. If someone has not read any of your books, you want to start with this book. Cause this sets the framework for everything else that follows after.

• 1:31:59Speaker 01

  Yeah, I would, you know, you can look at these things, I think you can look at these things in many ways, right? So, yes, if you're looking at ultimate root cause, I think this is the starting point. However, the flip side to that is if you're living a life at the moment where you're exhausted all the time and you're chronically stressed and you're not eating well. The truth is, if you can change your physical behaviours, like if you eat better and you get more sleep. It's actually easier than to take on all the mindset piece as well. Like, the whole supplement thing gets really controversial. I don't know what it's like in America, but in the UK. You know, there's this, there's this movement that supplements aren't a good thing, right? I don't agree with that. I think so many people benefit from supplements, right?

• 1:32:41Speaker 01

  With the food that we eat today is not the same as food we ate 50 years ago. We know the soil quality is worse. We know that, you know, the, the mineral content of the food, like magnesium, is just not what it was 50 years ago. Alongside, we're chronically stressed, which means we're not even absorbing the nutrients that are there in the food as, as well as we, as we would do if we were not stressed. So people say, well, supplements should be an add-on to a healthy lifestyle. But again, we shouldn't get too fixed in our views because things work both ways. Sure, I would much rather people dialed in their nutrition, their movement, their sleep, their stress. And then if they need to, they use some supplements to sort of plug in the deficiencies. But you can also make the case the other way.

• 1:33:23Speaker 01

  If you're feeling exhausted and stressed out and your B vitamins are low because you're not absorbing any, because, you know, A, your diet, but B, you're so, you know, you, you will test this in next health, but the amount of people who Have suboptimal B12 levels is ridiculous.

• 1:33:39Dr. Darshan Shah?

  Almost everybody.

• 1:33:40Speaker 01

  It's almost everyone. And here's the thing, they're not all vegan.

• 1:33:43Dr. Darshan Shah?

  Right.

• 1:33:43Speaker 01

  Right. So some people are eating animal products, which are rich in B vitamins. But they've still got low levels. And there's a number of reasons. One of the reasons is that we're chronically stressed. We need a good quality digestion. We need good amounts of stomach acid, all sorts of things to combine with the intrinsic factors to absorb the B12. So many of us, even if we're eating the right stuff, we're not absorbing it. So I found with many patients that, yeah, I want them to change their lifestyle. I want to help them with that. But in the short term, using some supplements can be really beneficial because it helps them feel good. Then they can start implementing the behaviors.

• 1:34:22Speaker 01

  So again, going back to where I think this all gets really confusing for the public is online, people are fighting. They see clinicians fighting online about, you know, supplements are a waste of money, or, you know, it should be lifestyle first and supplements second. And I just take a much more nuanced approach and go, yeah, sure, but it depends on who.

• 1:34:41Dr. Darshan Shah?

  Exactly.

• 1:34:42Speaker 01

  Depends on who. Who is that person? What are they struggling with? You don't know the right approach for them. Like, you know, the right approach for you. Every single person is different.

• 1:34:52Dr. Darshan Shah?

  Absolutely. And this is why I think it's really important, the work that you're doing, that I'm doing, is we understand that. We see a lot of patients and people fall somewhere on that bell shaped curve. And some people, you're right, they don't need supplements at all. You measure them and all their vitamins, everything is perfect. That's fantastic. They don't need to take supplements, but most people, they do. And some people want to take many supplements, like they'll look up like, what is Brian Johnson taking and Mark Hyman? And they create a list of every supplement that they could possibly take. And other people only want to take one or two things, right? And so you have to meet patients where they're at. Not just physiologically, but also their psychology and understand the nuance behind all of these.

• 1:35:35Dr. Darshan Shah?

  And if, you know, someone asked me the other day, I was on stage and someone asked me, how do you know what information is right? Like, you know, they're talking specifically about carnivore diet versus vegan diet. And I said, well, the one way to know it's wrong is if someone is shouting something from the rooftop as it being the only way.

• 1:35:52Speaker 01

  Yeah.

• 1:35:53Dr. Darshan Shah?

  And then you know, probably that's someone that you might not want to spend a lot of time listening to, right?

• 1:35:58Speaker 01

  Yeah, what you just said there about that question, it's also really interesting because as we we all know, the diets wars online can be pretty vicious.

• 1:36:08Dr. Darshan Shah?

  Vicious, exactly.

• 1:36:09Speaker 01

  But I look at them now with this detachment and go a lot of the time they're missing a fundamental point for me, which is that they can all be right for different people.

• 1:36:20Dr. Darshan Shah?

  Right, exactly.

• 1:36:22Speaker 01

  That's the irony. And a lot of people, when they criticize things like the carnivore diet, okay, then for people who don't know, the carnivore diet, you know, there's many interpretations, but it's a very meat heavy diet. Some people, it's only meat. Other people call it a carnivore diet if it's mostly meat and they've got a few other things in it. But in essence, and you'll know this, Darshan, as a clinician, if you've been sick for years, if you've had joint pain and fatigue, and you've been round the houses with different doctors and the medications are not working and you can't figure out a way to get better. And then you read something about the carnivore diet and then you try it. And then if all your joint pain goes and your gut symptoms go, you feel good, your energy's up. I get why people would do that. Like, I understand it.

• 1:37:07Speaker 01

  And when people criticize it, I just, I just feel you guys don't really understand what's going on. That individual has suffered for years. They've now found something that's helping them. Now, whether it's the right move in the long term, okay, we can have that conversation. But you have to understand at that moment in time, for some people, that is a game changing diet. Right? For some people. And yes, you could argue it's the ultimate elimination diet, where you're cutting out all the common things that generally can cause problems in people. You know, and generally I would agree with that. I think that is one of the reasons why it works so well for some people. Now, some people can then use that diet as a starting point.

• 1:37:52Speaker 01

  They then make other changes. They then repair their guts. And over time, they can often start introducing other foods, but sometimes they can't. Or sometimes, you know, again, it hasn't been around for that long in this sort of popular amount. So I think we're gonna learn things over the years. But I understand why people are pursuing it. I really do. Do you know, do you know what I mean?

• 1:38:12Dr. Darshan Shah?

  Yeah, exactly. It's a great intervention.

• 1:38:14Speaker 01

  Yeah.

• 1:38:15Dr. Darshan Shah?

  Someone that's struggling and they haven't been able to figure out a dietary change that's gonna work. We don't know, for most, actually, sticking to that type of diet is very difficult, right?

• 1:38:26Speaker 01

  Yeah.

• 1:38:26Dr. Darshan Shah?

  Just living in this world. So it's hard to stick to and if, and some, for some people, if they stick to it, they're gonna be fine. And they might feel great, but once again, it's not for everybody.

• 1:38:35Speaker 01

  Yeah. And again, it comes back to where we started this conversation.

• 1:38:38Dr. Darshan Shah?

  Yeah.

• 1:38:39Speaker 01

  Which is pay attention.

• 1:38:41Dr. Darshan Shah?

  Right.

• 1:38:41Speaker 01

  Right? Ask yourself, how am I feeling when I'm eating this way? But then also, I've, you know, I said, tap into your own inner expertise, but then you can also tap into external expertise and go, okay, well, I'm feeling really good eating this way. Let me go and see someone like Dr. Shah. And get my bloods checked.

• 1:38:59Dr. Darshan Shah?

  Right.

• 1:39:00Speaker 01

  And see what's going on inside my body. Right? These things work both ways.

• 1:39:04Dr. Darshan Shah?

  Yeah.

• 1:39:05Speaker 01

  Yes, you want some external expertise, but you also want your own internal expertise. And that's the point I'm trying to make.

• 1:39:12Dr. Darshan Shah?

  Absolutely, absolutely. And it's, I think, like you said, you know, parallel paths of taking the time and giving yourself some space to understand what's going inside and what you're feeling. But there's also the parallel path. You know, you're, you measure a lot of blood work, just like I do, to look underneath the hood

• 1:39:28Speaker 01

  Yeah.

• 1:39:29Dr. Darshan Shah?

  of your health and understand what these interventions are doing for you. And it might be different for you than it is from somebody else too, even in your blood work. Some people might get higher cholesterol with having a carnivore only diet. Some people, I've actually seen people's cholesterol go down, believe it or not.

• 1:39:44Speaker 01

  Wow.

• 1:39:44Dr. Darshan Shah?

  With having a carnivore diet. So it's a, it's a rage here in LA right now to be trying, to try the carnivore diet.

• 1:39:50Speaker 01

  Right.

• 1:39:51Dr. Darshan Shah?

  And so I see a lot of people coming in, maybe one or two a week, actually, that are doing it.

• 1:39:55Speaker 01

  You've seen some go down.

• 1:39:56Dr. Darshan Shah?

  Yeah.

• 1:39:56Speaker 01

  The cholesterol. That's really interesting.

• 1:39:58Dr. Darshan Shah?

  It's really interesting.

• 1:39:58Speaker 01

  What, LDL or?

• 1:39:59Dr. Darshan Shah?

  Yeah, LDL, uh huh, LDL and even total cholesterol goes down. ApoB goes down on very, on few people. I've seen this like two or three times already.

• 1:40:08Speaker 01

  And that, for me, that just speaks to how unique we all are.

• 1:40:11Dr. Darshan Shah?

  Exactly, yeah. And we don't know that our microbiome is unique. We don't know what our microbiome is going to react and do. It's a whole other organism.

• 1:40:20Speaker 01

  Again, this is where I think half of these dietary wars are pointless.

• 1:40:25Dr. Darshan Shah?

  Pointless.

• 1:40:26Speaker 01

  Because, and again, going back to the way we measure things in Western medicine with these randomized controlled trials. When you really look at it, we've all got different gut microbiomes, right? We all do. That's the gut microbiome you were born with, but then there's the, what's it, a natural birth, was it cesarean? How many antibiotics did you have? How many drugs are you on? What has happened in your life that may have impacted it? How much pollution is going on? How stressed are you? All those things contribute to the health or the lack of health in your gut microbiome.

• 1:40:58Dr. Darshan Shah?

  Exactly.

• 1:40:58Speaker 01

  And then depending on the status of your gut microbiome, that will massively influence how you deal with, process and digest food.

• 1:41:06Dr. Darshan Shah?

  Absolutely.

• 1:41:07Speaker 01

  So these trials, whilst they're helpful to look at what might be going on, as you say, ultimately, we're all unequal ones.

• 1:41:15Dr. Darshan Shah?

  Exactly.

• 1:41:16Speaker 01

  We really are.

• 1:41:17Dr. Darshan Shah?

  We really are.

• 1:41:17Speaker 01

  And more and more, as we see more and more suggestions of, so quite unethical practices in research. You know, we know that depending on who pays for the research can massively influence the outcome. And it's very hard to know what to do with that because then you can go, well, which research can I actually trust? Right? I've got like that. I don't know if you have.

• 1:41:38Dr. Darshan Shah?

  I have, absolutely.

• 1:41:40Speaker 01

  And so then I tend to go with what I've seen for 23 years. What have I seen with real people work? Right? That for me has been the best evidence. It's like, okay, I love reading research papers. I love seeing what the science shows. But I became a doctor to help people, right? A scientific study is fantastic if it translates and helps my patient. If it doesn't, well, the value is limited for that individual patient. So my favorite thing as a doctor is to help my patient understand what's going on and make changes to improve their health. That's why I became a doctor.

• 1:42:17Dr. Darshan Shah?

  Exactly.

• 1:42:18Speaker 01

  And the research doesn't always tell you what you need to be doing.

• 1:42:21Dr. Darshan Shah?

  No, not at all. You know, I noticed you're wearing a continuous glucose monitor. That's one of my favorite devices right now because it really underscores this whole thought that we're talking about, which is an N of one. Because I can tell you, every single patient that I have on a continuous glucose monitor has different reactions to different kinds of foods. And it's, it's very surprising to almost everyone that wears one. I don't know about you, but when I wore mine, I was very surprised at things that could cause my glucose to bump.

• 1:42:52Speaker 01

  Hundred percent. And again, I don't know if it's what it's like here, but in the UK, there's quite a lot of controversy over CGMs, continuous glucose monitors. And, you know, there was a, I would say there's a school of thoughts where only type two diabetics should be wearing this. I just disagree with that.

• 1:43:07Dr. Darshan Shah?

  I completely disagree.

• 1:43:08Speaker 01

  You know, now, do I think it's for everyone? Not necessarily, because I think health anxiety is real. I think some people can get overly obsessed and stressed out by the data.

• 1:43:21Dr. Darshan Shah?

  For sure.

• 1:43:21Speaker 01

  And I'm not someone like that. I can stay quite detached from it. So I don't wear it all the time. I would say I probably at the moment, wear it every three months. So they'll last for two weeks. And I think every three months or so, I'll put it on for two weeks. Because I've done it quite a bit. So I've now understood what's going on. And by doing it every three months, for me, it stops me becoming, you know, obsessed and and like overly reliant on it. But it just keeps me in check and it's a nice reminder.

• 1:43:51Dr. Darshan Shah?

  Yeah.

• 1:43:52Speaker 01

  And I think all of us have to find what works for us.

• 1:43:55Dr. Darshan Shah?

  Exactly.

• 1:43:56Speaker 01

  Do you know what I mean? This, I find it a very helpful tool. And people say, well, it's not everything. Yeah, you're right. It's not everything.

• 1:44:02Dr. Darshan Shah?

  No.

• 1:44:02Speaker 01

  But nothing is.

• 1:44:03Dr. Darshan Shah?

  Nothing is everything.

• 1:44:04Speaker 01

  But they use that as a reason to say, no one should have one. It's like, no, no, hold on a minute.

• 1:44:09Speaker 01

  Your blood glucose is a very powerful root cause indicator of multiple downstream problems.

• 1:44:17Dr. Darshan Shah?

  Exactly.

• 1:44:18Speaker 01

  If you can learn about yourself, if you can learn, for example, that, like, one of the things I learned when I first started using it, we, we as a family would often have sweet potato wedges in the evening.

• 1:44:28Dr. Darshan Shah?

  Yeah.

• 1:44:29Speaker 01

  Okay. And again, nothing wrong with sweet potato wedges, but for me. If I was having the amounts that I used to have, my sugar would rise quite high. And I thought, hmm, if this is happening five times a week, week after week for a few years, and given that HbA1c, which is the average measure of blood sugar, which is how we diagnose type two diabetes, if I'm consistently having more elevated blood sugar readings on this CGM, well, of course, that's going to over time increase my chances of prediabetes and type two diabetes. So with that information, I'm empowered. I can do what I want with that information, but for me, I've massively reduced how much I would have that.

• 1:45:11Speaker 01

  I've also learned from wearing a CGM that quantity makes a massive difference.

• 1:45:15Dr. Darshan Shah?

  Yes, absolutely.

• 1:45:16Speaker 01

  Right? So I can still have it, but if I have a small amount instead of what I was having before, my blood sugar's fine. So that's very useful. Now, I may not, I don't need to wear it continuously for that. I've learned that and I apply that. I don't see why that's not a helpful thing for people.

• 1:45:34Dr. Darshan Shah?

  Exactly.

• 1:45:34Speaker 01

  I mean, so I don't know, do you get pushed back care on CGMs?

• 1:45:37Dr. Darshan Shah?

  You know, not, not as much, but I do talk to other physicians about the CGM, what is a game changer in my practice. And even physicians are of the mindset that not everyone should have it. And they kind of give me a lot of grief for putting my patients on it, even temporarily when I'm, some, some doctors that I talk to. And they're like, you know, what are people going to do with that information? And you're giving people, you know, a feeling that they're getting sick and they're diabetic. I'm like, no, I'm not. I'm actually trying to turn them away from diabetes. I'm actually getting them to understand.

• 1:46:12Speaker 01

  Well, let's flip it the other way. Okay, let's, let's just, let's just play devil's advocate there and go, okay. So let's say they're right.

• 1:46:19Dr. Darshan Shah?

  Right.

• 1:46:19Speaker 01

  Right. Let's say those colleagues of yours are right. And so, Sean, what are you doing giving patients a CGM? You're just making them worry and about this. Well, okay, let's look at the state of the US population health at the moment. It's not as if we're doing a fantastic job with the current methods around type two diabetes and prediabetes, right?

• 1:46:38Dr. Darshan Shah?

  Maybe we should be worried about this.

• 1:46:39Speaker 01

  Exactly. Like, and again, I'm not saying we're any better in the UK. You know, you'll be familiar with the research that is suggesting that eighty eight percent or even ninety percent of the US adult population have some degree of metabolic dysfunction.

• 1:46:52Dr. Darshan Shah?

  Exactly.

• 1:46:53Speaker 01

  Okay, so let's take a step back and go, we're saying that maybe ninety percent of the US population have an issue here. Are we really saying that a CGM has no role in some of those ninety percent?

• 1:47:07Dr. Darshan Shah?

  Exactly.

• 1:47:08Speaker 01

  It is utterly ridiculous.

• 1:47:10Dr. Darshan Shah?

  It's ridiculous.

• 1:47:11Speaker 01

  I'm not saying it's for everyone, but there's many people, like, I would say, since I started practicing twenty three years ago, I have very rarely seen something that has the ability to change someone's behavior for the better more than a CGM.

• 1:47:27Dr. Darshan Shah?

  Exactly.

• 1:47:27Speaker 01

  It's, it's because it's no longer generic nutrition advice anymore.

• 1:47:32Dr. Darshan Shah?

  Right, right.

• 1:47:33Speaker 01

  It's like, oh, when I eat this, that's what's happening to my blood sugar, I'm going into the diabetic range. That's empowering information, right? Just mean, maybe you'll never eat that again, but instead of having it two times a week, you might go, I'll have that once a month now. Whatever it might be for that patient. And also, if a patient is getting stressed out by it, we as physicians can help guide them and we might say, hey, listen, maybe you're better off without that actually. But having this blanket rule that, oh, we're gonna stress people out, I just don't know where anyone gets this idea from.

• 1:48:07Dr. Darshan Shah?

  Yeah.

• 1:48:07Speaker 01

  Like, it's just not been my experience.

• 1:48:10Dr. Darshan Shah?

  Yeah, you know, this brings up a story for me that actually kind of hurt my feelings because I put a patient on the continuous glucose monitor. The next day, she walked into their primary care doctor and said, why are you wearing that? Take that thing off. And she said, well, my Dr. Shaw told me to do it. And the doctor's response was, that doctor doesn't know what he's doing with those things. You shouldn't be wearing one. I'm an endocrinologist. I'm telling you, don't wear it.

• 1:48:34Speaker 01

  Yeah, so.

• 1:48:35Dr. Darshan Shah?

  And it's, you know, it's like that old mentality that we went to school, you know, we went to school that thinking, you and I both in Western medicine, thinking that all these devices, all this stuff is really only there for disease care. That's like a major mindset problem.

• 1:48:52Speaker 01

  Yeah, there's, there's two things there for me, Dr. Darshan. First of all, I'm sorry that happened to you. That kind of thing is one of the things that frustrates me the most about the way we practice medicine, if I'm being completely honest. I really don't like talking down about other clinicians.

• 1:49:08Dr. Darshan Shah?

  Right.

• 1:49:09Speaker 01

  I just don't like it. I don't think it's professional. And it's a very paternalistic sort of mindset. I know best for you. That doctor knows nothing. I'll let, I'm gonna tell you what's best for you. I just, I've never liked that about medicine, right? I've never felt that way. I've always given my patients the utmost respect to think, well, actually, you know more about your life than I do. Let's do this together. Okay, so that's one thing. But the second thing there is, one of the major problems with the way we were taught to practice medicine is that we're pretty much taught that blood tests are either normal or abnormal.

• 1:49:44Dr. Darshan Shah?

  Right.

• 1:49:45Speaker 01

  So it, it's actually so ridiculous and laughable when you actually understand it. But, so in the UK, we have slightly different parameters from here in the US. So in the UK, your HbA1c, which I'm sure your audience know, but it's that two to three month average blood sugar, if you do it as a blood test, and it gives you an average reading of what your blood sugar will have been for the past two to three months. Okay. And it's one of the ways that we can diagnose type two diabetes. So in the UK, if it is six point zero to six point four, we call that prediabetes. So in the US, it's five point seven.

• 1:50:20Dr. Darshan Shah?

  Five point seven.

• 1:50:20Speaker 01

  But in the UK, it isn't.

• 1:50:21Dr. Darshan Shah?

  Six.

• 1:50:22Speaker 01

  Right. Which just shows you how arbitrary these figures are, right? We call it prediabetes at six, and type two diabetes is the same as you at six point five. In the UK today, there are many clinicians who, if your A1c comes back at five point nine, it's reported as normal. In the US, that would be prediabetes. But in the UK, we call that normal. It is not normal.

• 1:50:45Dr. Darshan Shah?

  Right.

• 1:50:46Speaker 01

  It may not be prediabetes, it may not be type 2 diabetes, but it is anything but normal. And I think there's this real lack of understanding across society that these chronic diseases build up over time. When you get a diagnosis of type 2 diabetes, that didn't happen in the past week. That was probably building up for 10 years before you finally crossed the threshold. When you get Alzheimer's at 65, that didn't start when you were 60. That started 20 to 30 years ago. It was building up, building up, building up to the point where you now have symptoms. So the way we interpret blood tests in modern Western medicine is flawed.

• 1:51:27Dr. Darshan Shah?

  Right.

• 1:51:27Speaker 01

  It's fundamentally flawed. You know, we need to be saying an A1C of 5.5. I mean, there's really good data, depending on where you look, suggesting that anything above 5.2, and there's some studies even showing above 5, right? But they're showing that even above 5.2, if you go to 5.3, your risk of cardiovascular problem starts to go up.

• 1:51:48Dr. Darshan Shah?

  Sure.

• 1:51:48Speaker 01

  And other issues as well. So going back to what the endocrinologist was saying, or what the patient said that they said. I don't know what it is in medicine, but we have this, people get quite possessive over, like, this is my condition and I'll tell you what to do when at this stage. I never really get it. It's like, I'm perfectly willing to accept that for some people, a CGM may not be useful in the sense that it may stress them out. Cause I have seen that.

• 1:52:16Dr. Darshan Shah?

  But that's a minority of the people.

• 1:52:17Speaker 01

  It is a minority. For many people, they're like, oh my God.

• 1:52:21Dr. Darshan Shah?

  I'm glad I wore it.

• 1:52:22Speaker 01

  I'm so glad I wore that. Now I understand. Now, can some of you take it to an extreme and wear it all the time, 52 weeks a year? Yeah, some people can. And again, I'm not to say whether that's good or bad for that individual. As I say, for me, going back to how I started this conversation with you, I've paid attention. And for me, at this stage in my life, I wear one like every season.

• 1:52:46Speaker 01

  Right, so four times a year. That works for me.

• 1:52:49Dr. Darshan Shah?

  That works for you. What works for me is I wear, I wore it for three months. I figured out a bunch of stuff.

• 1:52:55Speaker 01

  Yep.

• 1:52:55Dr. Darshan Shah?

  It completely changed my hemoglobin A1C. I was at five point four. Now I'm close to five and.

• 1:53:01Speaker 01

  That's amazing.

• 1:53:02Dr. Darshan Shah?

  It was amazing, right? And so now I wear it when I feel like I'm not eating well, you know? As kind of a reminder to me, as kind of like a check on me, and that's what works for me. So if my diet is off point, maybe I've been traveling a lot and I come back from a big vacation and I know that I need to get back into the swing of things. I use it as a checkpoint for me and that's the only time I wear it again.

• 1:53:25Speaker 01

  Exactly, exactly.

• 1:53:26Dr. Darshan Shah?

  But that's just my, my thing.

• 1:53:27Speaker 01

  And the, one of the other things people will learn if they wear one is how much stress impacts their blood sugar.

• 1:53:34Dr. Darshan Shah?

  Right.

• 1:53:35Speaker 01

  And I think again, remember when I explained the stress response a little while ago?

• 1:53:39Dr. Darshan Shah?

  Right.

• 1:53:39Speaker 01

  What was the first thing I said?

• 1:53:41Dr. Darshan Shah?

  Your blood sugar goes up.

• 1:53:41Speaker 01

  Your blood sugar goes up. That's fine if you're in a spinning class. It's fine if you're running away from a tiger, but if that's happening to your email inbox and the state of your life day in, day out, that's a problem. Interestingly enough, the reason I put this on last week is because I was coming to LA. I thought I'm traveling, I'm on the road. I am interested to see how jet lag, how air travel affects us. And let me tell you what happened on the plane yesterday. Cause I, I, I haven't worn one before on a plane, on a long haul flight. I ate really well yesterday. I mostly fasted on the plane, but I had some low carb snacks with me.

• 1:54:19Speaker 01

  Long story, why? But in essence, I wasn't eating anything on the plane that would typically spike my blood sugar. Yet my blood sugar was, was like, it was nearly seven on my CGM yesterday, uh, points during the flights.

• 1:54:37Speaker 01

  I thought, hmm, this is interesting. What is this? Is this chronic stress? Is this the cabin pressure? Again, this is just purely on an interesting academic point for me. I thought this is fascinating. These foods at ground level.

• 1:54:51Dr. Darshan Shah?

  Yeah.

• 1:54:52Speaker 01

  Are not doing this. So it's really interesting for me as I learn more about myself. Well, what was going on? Have you experienced that before?

• 1:55:00Dr. Darshan Shah?

  No, but you know what it brings up for me is that when you drink alcohol on a plane, you get drunk faster, right?

• 1:55:07Speaker 01

  Yeah.

• 1:55:08Dr. Darshan Shah?

  And so I think there is something about being in that high-stress environment that's causing these reactions.

• 1:55:14Speaker 01

  It's the stress on the body. We don't think about that. We see that the crisp packets are getting inflated. They're puffing out, right? But of course, that must be happening inside our bodies as well. There's going to be fluid shifts and fluid changes. So again, I'm not beating myself up.

• 1:55:29Dr. Darshan Shah?

  No, but it's interesting.

• 1:55:30Speaker 01

  But it was fascinating. I go, wow, had I not warned that, I wouldn't have known that. And so for me, on a personal level, as a doctor who wants to learn about my body and learn how to help my patients, it was just a really interesting insight.

• 1:55:44Dr. Darshan Shah?

  Yeah. I had a conversation with one of the manufacturers, the CEO of the company, actually. And they were telling me that this sensor, they're going to be packing into it the ability to measure ketones, to measure lactate, and also blood alcohol levels.

• 1:55:59Speaker 01

  Wow.

• 1:55:59Dr. Darshan Shah?

  I mean, what a game changer that will be for humanity to know these numbers consistently.

• 1:56:06Speaker 01

  Yeah. Why I think they're so useful for the people who find them useful is because it takes you away from the randomized controlled study that was done with a different population and a different part of the world, and instead you're getting data on you.

• 1:56:21Dr. Darshan Shah?

  Exactly.

• 1:56:22Speaker 01

  You're going, oh, wow, when I eat this food, this is what happens.

• 1:56:27Dr. Darshan Shah?

  Right.

• 1:56:27Speaker 01

  When I eat that food, this is what happens. And there's nothing that's as powerful as that because you know, oh, this is how it's affecting me.

• 1:56:34Dr. Darshan Shah?

  Right now in real time.

• 1:56:36Speaker 01

  Exactly.

• 1:56:36Dr. Darshan Shah?

  It's so powerful. And like you said, for your example of eating these foods on the plane, your blood sugar level was higher. You know, to do a randomized controlled trial on what. Food does to your blood sugar on a plane on, you know, a thousand individuals. It's just never gonna happen. No one's gonna do that because there's no it's gonna be very difficult to do, but who cares? Now you know how it worked on you.

• 1:56:58Speaker 01

  Yeah. And then again, you know, I don't do long haul travel very often. I haven't been to America for several years now. But next time I do it, I'll probably wear a CGM because I wanna know. And again, I think, you know, with travel, we don't realize that simply getting on a plane is a stressor on the body. I had a stark reminder yesterday by wearing this thought, wow, there is an impact on your body from doing this travel. Again, I understand it's a part of the modern world for many people, but at least we know that's another stressor coming in.

• 1:57:29Dr. Darshan Shah?

  Yeah.

• 1:57:29Speaker 01

  And we know that we see that if people monitor their HRV, their heart rate variability, for example, they'll often know that the day after traveling, their HRV is often lower.

• 1:57:39Dr. Darshan Shah?

  Yeah.

• 1:57:40Speaker 01

  Right? Because their body is having to also deal. Yeah, no, you could say that's because of time zones. You could say it's because there's poor food that's around when you're traveling. Sure, but I was eating good foods.

• 1:57:52Dr. Darshan Shah?

  Yeah.

• 1:57:52Speaker 01

  Okay, I wasn't drinking alcohol. So it was like, I'm pretty sure that it was the travel and maybe being on the plane that was doing that.

• 1:58:00Dr. Darshan Shah?

  Yeah, absolutely. I noticed you're wearing a whoop band as well. I have my Oura ring. I'm also a big believer in having some sort of wearable device for people that don't have health anxiety. Because, you know, I feel that a lot of people feel that they're healthy and they're getting good sleep. But when you really look at the data, they're not, right? And so like, just because you're sleeping seven hours doesn't mean you're getting good sleep during that time. You know, I think also like with movement, a lot of people feel like they're maybe moving enough. And then you look at their data and they moved an average of 2,000 steps a day for the last month.

• 1:58:32Speaker 01

  Yeah, I mean, I've, I've evolved my view on these wearables over the years and even in the last few months. Okay, so it took me a while to get into them. I bought an Oura ring maybe five years ago and I wore it for a few months. And then I stopped. Back then, I'll tell you why I stopped back then. I stopped then because I thought I've kind of learnt. I've learnt loads, but I don't feel I need it as a constant reminder now. Like, for example, back then, or maybe it was it was longer than five years ago, actually, I think. Whenever it came out, I got one. You would see what even one glass of alcohol did to the quality of your sleep. You go, well, that's interesting. Or for me, I learned that eating late, not even that late, eating within two hours of bed would affect my sleep quality.

• 1:59:16Speaker 01

  I thought, this is interesting. I don't really need it anymore. I've understood it. And I I never wanted to get reliant and obsessed with it. But I feel like I'm a different person now. I've only been wearing this swoop band for two months. I thought, okay, I'm gonna give it a go now. I feel like a different person. And one of the things I like about it is that there's no screen.

• 1:59:36Dr. Darshan Shah?

  Right.

• 1:59:36Speaker 01

  So I think that's really cool.

• 1:59:38Dr. Darshan Shah?

  That is cool.

• 1:59:39Speaker 01

  And I don't have it constantly wired to my phone, so I I've got the connection off. And once a day, or maybe once every forty hours, I'll go on and download the data. So I feel I've got a nice relationship with it, where it's not it's not stressing me out or getting me obsessed. But it's allowing me to learn about myself. And I'll be honest, I have actually learned a lot about myself from it. And again, if you'd asked me six months ago, I probably would have said, I'm just not sure I need one. And I don't need one, but I feel it's helping me. And the truth is, Darshan, you know, I'm forty seven now. Now, I I look after myself. I'm in good health. But I know that this is the kind of age where men start to get sick.

• 2:00:20Dr. Darshan Shah?

  Right.

• 2:00:21Speaker 01

  Right?

• 2:00:22Dr. Darshan Shah?

  Right.

• 2:00:22Speaker 01

  Men get heart attacks and China, autoimmune disease, all kinds of things. And, you know, I want to be around, not to live forever, you know, that's not my desire. But I want to be around for my kids, right? I I want to be around for many years to come, and I've got lots I still want to do in the world. And I believe in this kind of two-month experiment that I've been running so far. I think this is a net positive for me. But again, like, I'm I believe we have to keep asking ourselves these questions regularly. There may be a time in the future where it isn't a net positive. Maybe there'll be a point in the future where I'm getting more obsessed. And I think, actually, this is not a good thing. I don't think that will happen. But I think maybe five years ago, I wasn't in.

• 2:01:06Speaker 01

  The right place to use that without it obsessing me. Do you know what I mean?

• 2:01:11Dr. Darshan Shah?

  Absolutely.

• 2:01:11Speaker 01

  So I think these things can change.

• 2:01:13Dr. Darshan Shah?

  It changes.

• 2:01:14Speaker 01

  Nothing is either good or bad. It depends for who and in what context.

• 2:01:18Dr. Darshan Shah?

  Yeah. And in what part of your life you're in at that moment as well. Right. Exactly. Yeah, maybe you're having a very stressful few months because of multiple things at work. And this is one more thing that stresses you out. Just.

• 2:01:29Speaker 01

  Yeah.

• 2:01:30Dr. Darshan Shah?

  Take it off.

• 2:01:30Speaker 01

  But I guess one thing I have been doing, I'm significantly increasing how much I move over the last few months. Okay, that's something I'm realizing as I get older, I want to ramp up how much I'm moving.

• 2:01:42Dr. Darshan Shah?

  Yeah.

• 2:01:42Speaker 01

  So I know I mentioned five minute strength workouts every morning. I still do those. But I also now, on most days, I'm trying to get one hour of either walking or running.

• 2:01:53Dr. Darshan Shah?

  Yeah.

• 2:01:53Speaker 01

  Okay. Because I've realized that as I get older, I need to break the cultural narrative that we move less and go, no, you need to move more.

• 2:02:00Dr. Darshan Shah?

  Absolutely.

• 2:02:01Speaker 01

  And so what I'm finding really helpful about the Whoop Band is that I'm learning the impact of, you know, the running as a stressor on the body and how much recovery one might need.

• 2:02:13Dr. Darshan Shah?

  Exactly.

• 2:02:14Speaker 01

  And I, I'm just finding it truly fascinating.

• 2:02:16Dr. Darshan Shah?

  It's fascinating. Right. Exactly. Yeah. And I think also as we age, you know, I grew up in a time period where you calories in, calories out. So if you spend an hour on the treadmill every single day, you will maintain a healthy body weight is what I was taught. I know that's not the truth, you know, especially for me, because it actually makes me hungrier. But what I've found is as I get older, it takes me longer to recover from these longer runs. So I used to, you know, try to get in a good two or three mile run every week or two, every week. And now I've deprioritized that because it takes me two or three days for my HRV to recover from that.

• 2:02:52Speaker 01

  Yeah, there you go.

• 2:02:53Dr. Darshan Shah?

  Yeah.

• 2:02:53Speaker 01

  So you're, you're developing that self-knowledge.

• 2:02:56Dr. Darshan Shah?

  Exactly.

• 2:02:57Speaker 01

  So sort of put it all together in terms of what we've been talking about throughout this episode of your podcast, Ash. And is this, this kind of self-awareness piece that I feel has been missing. I believe that these wearables, if they're not stressing you out, and I recognize that for some people they do, right? And there's actually some, I don't know if you've seen these studies, there's some data showing that, that I think, I can't remember where the study was done, but essentially there was two groups of people, one sat for five hours, one sat for eight hours. And they were wearing wearables. But if, in essence, if the five hour group were told that they had sat for eight hours, they did really well. And their physiology responded as well.

• 2:03:40Speaker 01

  And if the eight hour group were told they only sat for five hours, you could also see a negative response later, right? And that also plays into how important our mindset is, right? It's really, really important. So I think we have to be careful. Who are we? What is our personality? Can we stay a bit detached from the data? Like, it doesn't bother me now, that readiness score, whether it's good or bad, it doesn't affect me. And sometimes I don't even look in the morning. Sometimes I look later to go, ah, interesting. So again, we're all different. We all have to figure out what works for us.

• 2:04:17Dr. Darshan Shah?

  Yeah, absolutely.

• 2:04:23Dr. Darshan Shah?

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• 2:05:03Dr. Darshan Shah?

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• 2:05:47Dr. Darshan Shah?

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• 2:06:02Dr. Darshan Shah?

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• 2:06:46Dr. Darshan Shah?

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• 2:06:56Dr. Darshan Shah?

  You know, you are a leader and a pioneer in our space of proactive and functional and root cause medicine, and you've been talking about it publicly for such a long time. Do you see the overall perception of this type of medicine changing in the community of health and Western medicine? Because one of the things I run up into is still, when I ask in a room of people, raise your hand if you've seen a functional medicine doctor. There's about maybe 5 to 10% of people that raise their hand. And then some people actually say, my doctor says that's all quackery, and it's something that I don't need, I shouldn't be doing. It's just a bunch of tests and supplements that they're trying

• 2:07:39Dr. Darshan Shah?

  to sell you. And so this is a perception that I run into quite often, I would say. At least once a month, I hear this narrative about root cause medicine. I'm wondering what your, from your vantage point, what you're seeing.

• 2:07:51Speaker 01

  It's a great question. And I think because we live in different countries, our experiences may be subtly different. Okay, so the model in the UK of healthcare is very different from the US. So we have something called the National Health Service. People think it's free. It's not free. We're all paying with our taxes. But it feels free because at the point of care, whatever it is, you don't have to sign anything, you don't have to give a card, like, you don't have to give insurance, nothing. Okay, so it feels free. When I started talking about this kind of stuff to the public, it was probably about 2014. I had at the time, a BBC primetime documentary series called Doctor in the House.

• 2:08:32Dr. Darshan Shah?

  I remember it.

• 2:08:33Speaker 01

  And I basically went to live alongside family for four to six weeks. They all had health problems. They were all already under doctors and specialists. They were all on drugs. And it's still one of the proudest things I've ever done in my career. I helped a lady reverse type 2 diabetes in 30 days, panic attacks down by 80% in six weeks, fibromyalgia pains that had been there for 10 years, gone in six weeks, and a whole host of other things. Menopausal symptoms almost completely eliminated without the use of hormones. Just with nutrition and lifestyle. And that went out to five million people each week in the UK. It went to 70 countries around the world. So I was very proud to be able to showcase what is possible. Now, let's take one example from that first series.

• 2:09:18Speaker 01

  I helped a lady put her type 2 diabetes into remission in 30 days. Back in 2015, that was deemed controversial. Okay, I remember what was going on at Twitter and some of the establishment in the UK were sort of saying that's not possible and all this kind of stuff. Now it's an accepted part of practice in the UK. You can actually code it within the NHS and primary care. Type 2 diabetes into remission. So I took some heat online back in 2015, which I didn't find easy back then. That's the truth. I've had it really difficult to deal with back then. I didn't understand how I could help all these patients get better without using any drugs. And there'd be any criticism. Now, to be fair, 99% was all positive, but you know, there was a pretty vocal group online.

• 2:10:03Speaker 01

  Who were pretty savage and I wasn't emotionally equipped back then to deal with it. So I found it hard and my wife found it hard. But 10 years on, it's now accepted that this is possible. I do believe things are changing. Now, in the UK, even though plenty of people train in functional medicine, they're often practicing that model within NHS general practice. It's tricky too, but they're trying to implement it in that way. And so I created a course called Prescribing Lifestyle Medicine with the, that's been fully accredited by the Royal College of GPs in London. And since COVID, we put it online and we've trained thousands of clinicians around the world on the principles, many of the principles that we've been talking about today, right?

• 2:10:47Speaker 01

  I do believe that if you say functional medicine to many doctors in the UK, they wouldn't know what you're talking about. And I don't love the term functional medicine. Like, I love what functional medicine teaches, but really, this is just good quality medicine for me. Exactly. Ultimately, we have to call it something to differentiate it from the standard. I believe that the doctors who are calling it quackery, frankly, for me, it's ignorance. Honestly, I wouldn't have had the courage to say that five years ago, but now I can say hand on heart, it's pure ignorance. Because if they knew the benefits that people get, they would be totally on board. If your goal as a doctor is really to help people and not cling

• 2:11:31Speaker 01

  to your identity that what I learnt and what my career is now, and I have to protect it all. If your goal is to help people, then there's nothing to be afraid of with functional medicine, right? Now, is it expensive for some people? Yeah, that is true. And unfortunately, that's because the model that is currently exists is set up in a different way. The fact that it's expensive is not the doctors or the clinics who are offering it. It's not their fault. Like, we were saying in the car, you were saying that many patients say to you, why does insurance not cover this? Well, I would say that's not your job to answer that question. You're not the insurance company. You didn't set up the model of care. Your job as a doctor is to help people. You realise that there's a method here that's going to help so many people. It's a method you

• 2:12:12Speaker 01

  use to heal yourself. So, yes, I do believe that we have to deal with that negativity sometimes. And that's why me, in my public facing work, I'm very careful with language and have been for years. Now, even in that BBC documentary series, the term functional medicine never came up, because I realised I didn't need to use that term. If you just deal with dealing with the root cause, and you help people get better by dealing with the root cause, that's all that everyone wants. Do you understand what I'm getting at? Absolutely. I've had, the reason I believe that I've managed to make such a big impact in the UK and across the world, is because it's not, it's not through dishonesty. It's by being

• 2:12:55Speaker 01

  careful with the language that I use. I don't need to use certain language if I don't, you know, you don't, for me, it's all about how you communicate the ideas. I think communicating the idea that actually eighty to ninety percent of the problems we see are in some way related to our collective modern lifestyles, I think that's very palatable. And by helping patients change their nutrition, their movement habits, their sleep habits, their stress habits, we can make a huge impact on multiple conditions. I think that's very palatable. So that's the kind of messaging I've always tried to use with the public. And I think that's why it's got traction.

• 2:13:35Dr. Darshan Shah?

  Yeah, I think one of the biggest problems that we have in the United States, which is not a problem for the UK, is that there is this trillion dollar system that basically has misaligned incentives to treat disease and to diagnose people with diseases and put them on a subscription program of medications that you're on forever, right? And so it's immensely profitable for pharmaceutical companies, even hospital systems, et cetera, to have people in a disease state, right? And even though doctors and hospitals and people that work there don't want to see people in disease states, at the end of the day, people are making a lot of money off of this, right? And so.

• 2:14:16Speaker 01

  I genuinely, I was thinking about this on the plane over yesterday. I genuinely do not believe that the general public know how little we are taught in medical school about the creation of health.

• 2:14:28Dr. Darshan Shah?

  Yeah, exactly.

• 2:14:29Speaker 01

  I honestly think they would be shocked if they understood that. Our medical school training is exceptionally good for certain things. It really is, but it ain't good for everything. And that's the key. Why can't we as a profession go, yeah, you know what? We're really good at acute disease. But actually, when we try and apply those principles to chronic disease, which is multifactorial, that's where we really struggle. But we don't seem to be able to say that as a profession. I think it comes from a fragile identity where it has to all be good. Well, why does it all have to be good? The health landscape has changed over 50 years, right? Maybe 50 years ago, it was mostly acute illness. You come in, you got a productive cough, doctor sees you, goes, yeah, this is a chest infection,

• 2:15:14Speaker 01

  maybe pneumonia, right? Let me give you a treatment. Seven days later, you take that treatment, your disease is gone. Great.

• 2:15:21Dr. Darshan Shah?

  Yeah.

• 2:15:21Speaker 01

  The model of care, the way the healthcare system is set up is very. Very good for that.

• 2:15:27Dr. Darshan Shah?

  Right.

• 2:15:28Speaker 01

  But when you come in with a condition that's been brewing for ten years. And there are multiple inputs. There's your genetics. Sure, that plays a role, but it ain't your destiny, right? There's your genetics and how that has then interplayed with your environment and your food choices and your stress and your sleep and your movement. And the amount of pollution in your environment and all that kind of stuff. And those things together have led to your current state of health. Well, a quick fifty minute appointment ain't gonna cut it anymore.

• 2:15:56Dr. Darshan Shah?

  There's no way.

• 2:15:57Speaker 01

  Right. But the model we're taught is not suitable for these chronic multifactorial conditions.

• 2:16:03Dr. Darshan Shah?

  Absolutely.

• 2:16:03Speaker 01

  That's all I'm saying.

• 2:16:05Dr. Darshan Shah?

  Right.

• 2:16:05Speaker 01

  And so the reason I created that prescribing lifestyle medicine course is to help be an add-on to the medical school training, not in place of it.

• 2:16:13Dr. Darshan Shah?

  Right.

• 2:16:13Speaker 01

  Say, yeah, if you've got a dis- do you know what I mean? It's it's the subtlety that we don't have there.

• 2:16:18Dr. Darshan Shah?

  Right, exactly. And I think, um, you know, the, are you familiar with the Flexner report? Okay, so this was a report that was commissioned by a very wealthy American family. Many years ago, when we first started the medical education system in the United States. And it basically said that all types of alternative medicine should not be taught in medical school. The only medicine that we teach our medical students is something that's based on scientific, rigorous scientific evidence. So randomized controlled trials and, you know, science that's discovered in a laboratory through scientific principle. And so when that happened, basically, everything that was taught in medical school from that point forward

• 2:17:01Dr. Darshan Shah?

  was along the lines of diagnosing disease and what pharmaceutical you can prescribe for it. Or how do you do surgeries to treat those diseases? It's very difficult to do studies on nutrition, sleep, exercise, especially back then, no one really did those studies at scale. And so they just stopped teaching those things, unfortunately.

• 2:17:19Speaker 01

  Not only is it difficult to do those studies, but another big difference is if you have got a chronic illness.

• 2:17:25Dr. Darshan Shah?

  Yeah.

• 2:17:26Speaker 01

  It's never just down to one thing.

• 2:17:28Dr. Darshan Shah?

  Yes.

• 2:17:29Speaker 01

  Right. So the nature of science is to be reductionist.

• 2:17:32Dr. Darshan Shah?

  Right.

• 2:17:33Speaker 01

  Right? That's how we study. What is, what is it here? Is it this factor or that factor? Let's reduce it right down. But the problem is, is if you've got a patient who's struggling, it's very rarely, in my experience, just one thing. You have to tackle it from multiple different angles.

• 2:17:49Dr. Darshan Shah?

  Exactly.

• 2:17:50Speaker 01

  And so maybe. You know, the patient's health issue, maybe 20% of it is from nutrition, maybe 30% of it is from chronic stress, maybe 15% is from their lack of movement, et cetera, et cetera. So you need to do multiple things, whereas the scientific studies generally tend to be

• 2:18:08Dr. Darshan Shah?

  One thing.

• 2:18:09Speaker 01

  One thing. And again, that's very good for certain things. I'm not saying a randomized control trial isn't an exceptionally good piece of data to collect. It is for certain things.

• 2:18:19Dr. Darshan Shah?

  Yeah.

• 2:18:20Speaker 01

  But not for everything.

• 2:18:21Dr. Darshan Shah?

  Yeah, I agree. So you've already done so much to change the way medicine is practiced with the course that you created and your podcast and your six books now. What do you think is the future of medicine and health? And what direction do you think is headed? And how can, how are you going to help continue to move things in the right direction?

• 2:18:44Speaker 01

  I believe that change is starting to happen.

• 2:18:47Dr. Darshan Shah?

  I agree with you.

• 2:18:48Speaker 01

  But I don't believe it's coming from the top. I believe it's bottom up rather than top down. Because the, the truth of it is, who are the doctors who end up seeking a different way of looking at this? Well, there's many reasons, but often it's doctors who've had their own health problems. And then they're faced with their specialist telling them, you have to take this drug every day for the rest of your life. And suddenly, when it's them having to do it and not their patient, they're like, oh, I'm only 40 and have to take this now for the rest of my life. And I know all the side effects. Unfortunately, that's often what it takes. But when that does happen, and we're, we're a sick society, so of course, who are doctors?

• 2:19:30Speaker 01

  Doctors are just part of society. They're getting sick, you know, at the same rates as anyone else, maybe even higher rates due to the chronic rates of stress and insomnia in that role. They're starting to change, right? We've had thousands of doctors now do our prescribing lifetime medicine course all over the world. But the problem still remains that the people who are doing it are choosing to do it. And thankfully, there's a few medical schools in the UK who are in touch with us now. I was recently made a professor at Chester Medical School in the UK.

• 2:19:59Dr. Darshan Shah?

  Congratulations.

• 2:20:00Speaker 01

  And You know, I'm trying to implement these principles when students are getting educated. But here's the other reality for me, Darshan, is that a lot of the things I try and teach the public through my books, through my podcast, through coming on podcasts like yours, is about empowering those individuals. I believe there's a lot we can do ourselves. I really do. And a few years ago, I made the decision that I wasn't going to get involved with all these boards and committees, not because they don't play a role, that's not my strength. I'm not good in these big committee meetings. Like, I sort of feel a bit timid in those environments, you know, with the big professors there. Do you know what I mean?

• 2:20:44Dr. Darshan Shah?

  Absolutely.

• 2:20:45Speaker 01

  Maybe it's a hangover from my medical school training. Like, I don't know what it is. I just thought, you know what? Let people who like being in committees do all that. Let me, on an individual level now, just try and spread helpful, uplifting information for people. And you know, my podcast has just passed, almost passed seven years.

• 2:21:04Dr. Darshan Shah?

  Yeah.

• 2:21:04Speaker 01

  We've had a quarter of a million listens and downloads since we started, right? Two hundred fifty million. I never thought that when I started at seven years ago. This is my sixth book, you know, over, I think the first five have sold over a million now across the world. Like, I could give you grand plans of what I have, about a big five or ten year plan. I don't have that. I'm just gonna keep doing what I'm doing. It's gonna take more than one voice. It's gonna take everyone doing their bit. You're doing your bit with your patients, on your podcast, in your community. I'm doing my bit. We've all got friends in this field who are doing their bit. Many of these people have been on your show. It's gonna take all these voices together, because the more of us out there who are talking about this, the more we normalize this.

• 2:21:48Speaker 01

  The more it isn't this fringe thing in the corner. It's like, all these doctors with this incredible training. I mean, what did I read about you? Were you one of the youngest surgeons in the US?

• 2:21:58Dr. Darshan Shah?

  Yeah, I graduated medical school when I was twenty one years old.

• 2:22:01Speaker 01

  Right, okay. So without knowing any more than that, you must be exceptionally bright to have graduated from medic school at twenty one.

• 2:22:11Dr. Darshan Shah?

  Thank you.

• 2:22:11Speaker 01

  Right. So if you now are talking about the power of this kind of medicine, there's a reason why. It's not as if you've just fallen out of the car one day and thought, you know, yeah, I wanna, I'm just gonna try something different. No, no, you've got a powerful reason.

• 2:22:27Dr. Darshan Shah?

  Right.

• 2:22:27Speaker 01

  There's a lot of very well-educated physicians like you, like me, who are saying, no, no, we've got something wrong in medicine. There is another way of helping people. So I'm very optimistic, right? I don't know if I quite answered your question, right? My, my own personal goal is to keep doing what I'm doing.

• 2:22:44Dr. Darshan Shah?

  Yes.

• 2:22:44Speaker 01

  And what I've always done in, with my public voice is I never talk down about other people. And I always try and do and spread messages in a positive and compassionate way. Because I believe that we have to be the change that we want to see in the world. So if I start to get combative with other people online, I start to be rude and arrogant towards them, which is not who I am anyway, I don't believe that's the way to make change. Even if what you're saying is correct, I don't believe that's the way to make change. Because I want, why, why do we want a healthier world?

• 2:23:16Dr. Darshan Shah?

  No.

• 2:23:16Speaker 01

  I ask myself this. Why do you want a healthier world? Is it about health? I don't think it is. What do we want as human beings, right? We wanna be happy. I really believe that. So we know from the research that healthier people are happier. But it goes beyond that for me. I don't like seeing a divided world. I want my kids to grow up in a compassionate world where people are good to each other. I believe that's who we are as humans. I believe we can be kind and compassionate and show empathy to people. But we don't appear to be doing that at the moment. And my goal with the stuff that I can do at least, and I'm very lucky now to have a very big global platform. I think, well, Ron, if you can deliver helpful information, but in a very positive and uplifting way,

• 2:23:57Speaker 01

  well, you then contribute to creating a world that is also healthy and happy and compassionate. And I can't change everyone, right? We all have a circle of influence. You do and I do. For some of us, our circle of influence is bigger than for others, but we all have a circle of influence. And I love that phrase, I think is attributed to Gandhi, be the change you wanna see in the world. I wanna be the person that I want to see in the world. So I spend a lot of time working on my inner world so I can be calm and positive and compassionate and uplifting.

• 2:24:29Dr. Darshan Shah?

  You ask yourself the question every morning.

• 2:24:31Speaker 01

  I do.

• 2:24:32Dr. Darshan Shah?

  Yeah, it's a very powerful way to affect the world with a simple habit every morning. And you're the embodiment of it. So I really, I really appreciate you spreading the knowledge that you do.

• 2:24:44Speaker 01

  And I believe also, what people say, would you get into politics? And I've had multiple offers to get involved in various ways or to talk to the former prime minister. And without going into too much detail, but it's never felt right. Like, I don't particularly have that much confidence in politicians, if I'm honest.

• 2:25:05Dr. Darshan Shah?

  Right.

• 2:25:05Speaker 01

  You know, I'm sure some of them are in it for the right reasons. But I believe that many of them are not. I believe many of them, when I see them, haven't done the inner work. So they're not these calm, present individuals. So therefore, how can what they do and what they give out to the world be calm and present and intentional? They can't be. So I'm not ruling out at some point getting involved at those levels. But as of yet, I've never seen that doing so actually makes any difference. And so I just try. And anyone who interacts with me and my online presence, whether on Instagram or my email list

• 2:25:44Speaker 01

  or my podcasts or my books, I want to make sure I'm positively impacting them. And then they're going to positively impact the people around them and their circle of influence. And that's how I've decided I want to make change in the world.

• 2:25:58Dr. Darshan Shah?

  Yeah, that's fantastic. Well, thank you so much for joining me today, Rangan. It's been an absolute pleasure to have you. And I learned so much from you today. And I can't wait to write down my three questions tomorrow morning.

• 2:26:11Speaker 01

  Fantastic.

• 2:26:12Dr. Darshan Shah?

  And also, I can't wait to read the book. Make Change That Lasts is coming out December of this year, is that correct?

• 2:26:18Speaker 01

  Yeah, December 31st.

• 2:26:19Dr. Darshan Shah?

  Okay, I've already put my preorder in on Amazon. And I look forward to getting this podcast out there so everyone knows who you are. From my audience, I mean, I'm sure everybody already knows who you are. But at least they can get the book. I saw our buddy Jay Shetty wrote a nice little quote on there for you. Jay Shetty says, Rangan. Most insightful, inspiring and transformative book yet. That's awesome, coming from Jay, who we just saw a few minutes ago, actually.

• 2:26:47Speaker 01

  Yeah, and actually, look, I just want to say you've created a phenomenal center downstairs. I get to see quite a few things, you know, people show me all the time what they're, what they're doing in the world of health and wellness. That was really impressive. I haven't seen anything like it. It was so wonderful to see. So you are clearly making a massive impact with what you're doing in that cell. So, so keep up the great work.

• 2:27:08Dr. Darshan Shah?

  Thank you so much. Yeah, our whole goal, I saw, you know, 20 years ago, uh, sorry, 10 years ago, when I went through my own health struggle, you were basically describing me. That's what I, that's why I decided to change my career from surgery to this world of, you know, functional root cause medicine was because I went through my own health struggle and I saw it really did work and I was wanting my patients to feel better. And yeah, I took a massive pay cut going into this, you know, I was a very successful surgeon, but this is the kind of medicine I want to practice. And you were transformative in my journey as well, because just hearing you speak and, and you being a doctor, speaking about these things, I was like, oh, I can be a doctor

• 2:27:47Dr. Darshan Shah?

  and talk about nutrition and lifestyle and mental health and emotional health. They, they do go together. They do actually, this actually works to make people healthier.

• 2:27:55Speaker 01

  And funnily enough, doctors always have until very recently.

• 2:27:59Dr. Darshan Shah?

  Oh, yeah.

• 2:28:00Speaker 01

  Like, we need a bit more humility, I feel, in modern society. We feel that we've suddenly got all the answers with all our fancy tech. But the truth is, if you look at the way traditional Indian medicine and traditional Chinese medicine practiced, there is so much evidence now that we're getting that is supporting so many elements of what they did, particularly for chronic illness. There really is.

• 2:28:26Dr. Darshan Shah?

  Right.

• 2:28:26Speaker 01

  You know, stuff that we might have poo-pooed in the West for many years, we're now seeing all kinds of data supporting it. You know, traditional Chinese medicine for years has said that different organ systems have different parts of the day where they're most active.

• 2:28:40Dr. Darshan Shah?

  Uh huh, right.

• 2:28:41Speaker 01

  And I remember seeing a headline in the Guardian newspaper in the UK about five years ago, there was some chronobiology scientific research showing that different organ systems have different levels of genetic expression and activity at different parts of the day. And the conclusion was, so that means we can give, you know, we can change when we give our drugs. Like, we can give a liver drug, maybe at a time when the liver's more active and, you know, et cetera, et cetera. But I, what I thought when I read it, I thought, oh, it's interesting that that's what traditional Chinese medicine has been saying for 3,000 years. So my point is, what you were saying is that traditionally, doctors have always spoken about all these things together, because you can't separate your physical health from your mental health, from your emotional health. It's all part

• 2:29:26Speaker 01

  of the same thing. And I would argue that one of the ways, one of the places that modern medicine has gone off track is by separating it all out. It has benefits for some things, for sure, but for many things, that separation has proved highly problematic.

• 2:29:42Dr. Darshan Shah?

  Yeah, I agree with you. I agree with you. And also, you know, doctors don't have the time anymore because of this profit-centric system. Doctors are getting paid less and less. And so they don't have the time, in the United States at least, to spend more than 15, 20 minutes for, you know, what they get paid. And so I think, I think that's another massive struggle. And so at Next Health, we, because we're outside of the insurance system, we can spend time with people to discuss everything from their emotional well-being, their stress levels, et cetera. And I just think we just have to practice medicine a different way. And, and I think, you know, people like yourself and myself, we're, we're making that happen. And I think others can find functional medicine doctors, root cause med, doc, good doctors in communities where they live as well. And so just got to look for it.

• 2:30:27Speaker 01

  Yeah.

• 2:30:28Dr. Darshan Shah?

  Yeah, awesome. Well, thank you so much. Once again, for people who don't know where to find you, how can they find you?

• 2:30:35Speaker 01

  I mean, I'm pretty available online, but I'd probably say my website, drchattery.com, my Instagram, which is at drchattery, D R C H A T T E R J double E.

• 2:30:47Dr. Darshan Shah?

  Thank you so much, Dr. Chatter.

• 2:30:48Speaker 01

  Thanks for having me.

• 2:30:55Dr. Darshan Shah?

  That was an awesome conversation with Dr. Chatterjee. I really feel like he and I connected on so many levels. Here are my top 10 takeaways from that episode with Dr. Chatterjee. Takeaway number one, you can be really surprised at what can spike your glucose levels. Even healthy food choices like sweet potatoes, for example, can actually cause significant glucose spikes for some people. Wearable devices can reveal that portion sizes and timing of food intake can dramatically affect your metabolic response. My takeaway number two is that stress mimics blood sugar spikes from food and chronic stress from daily life, just like things like reading emails or even traveling, can cause glucose spikes similar to consuming sugary foods. This highlights the profound physiological impact of unmanaged stress.

• 2:31:39Dr. Darshan Shah?

  Takeaway number three, airplane travel alters glucose levels. Long haul flights can actually spike glucose levels even with a controlled diet. Cabin pressure and environmental stressors may actually play a larger role than previously understood. Takeaway number four, hemoglobin A1 thresholds are actually different from country to country. So I didn't know this, but the UK and the US define prediabetes differently. The hemoglobin cutoff of 6.0 versus 5.7 are different in each country. This arbitrary distinction highlights and influences global diagnosis and treatments are approached globally differently. Everyone, in my opinion, should aim for a hemoglobin A1C as close to 5.2 or below that if possible.

• 2:32:23Dr. Darshan Shah?

  Takeaway number five, chronic disease begins decades before diagnosis. Conditions like type 2 diabetes and Alzheimer's often develop 10 to 20 years before clinical symptoms appear. Early intervention with lifestyle changes can prevent these outcomes. Takeaway number six, food timing impacts recovery. Eating even small meals close to bedtimes can disrupt recovery metrics like heart rate variability. This indicates the importance of aligning meals with your circadian rhythms. Takeaway number seven. Even one wearable can transform behavior. Many patients experience profound lifestyle changes after even a brief exposure to a wearable device like an Oura Ring or a continuous glucose monitor.

• 2:33:07Dr. Darshan Shah?

  Seeing real-time health data leads to better adherence and to healthier habits. Takeaway number eight. Health myths persist among physicians. Some physicians actually discourage CGM use, fearing that it will stress people with too much data. The studies show that most users find the data actually empowering. This actually reveals a disconnect between traditional and functional medicine and something that every patient needs to be aware of. Takeaway number nine. Wearables can reflect emotional states. Emotional stress directly impacts measures like glucose and HRV, demonstrating there's a tight link between mental and physical health. This makes stress management as crucial

• 2:33:50Dr. Darshan Shah?

  as diet and exercise in achieving your health goals. And finally, takeaway number 10. Lifestyle medicine still faces resistance. Despite growing evidence, many healthcare systems and professionals remain skeptical of lifestyle medicine's benefits. This resistance slows widespread adoption of preventative approaches. We need to do more to expose more practitioners and patients to lifestyle medicine, to unburden the disease care system from the trillions and trillions of dollars of cost that are incurred by diagnosing diseases too late.

• 2:34:27Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.