Dr Mike: The Hidden Side Effects Of Vaping! The Dark Side Of Being A Doctor! We Need To Stop Medical Misinformation!

He might be known as the ‘Sexiest Doctor Alive’ but his true talent is fighting against the ugly side of medical misinformation. Doctor Mike is a family medicine doctor and YouTube’s #1 Doctor. He has over 25 million followers on social media and is also the host of ‘The Checkup with Doctor Mike’ podcast. In this conversation, Doctor Mike and Steven discuss topics such as, the errors in the biggest online health trends, which popular diets are destroying your health, the real truth about calorie counting, and the one thing that helped Dr Mike cure his depression. Here is a link to an article discussing the inefficiency of the anti-depression drug, Paxil: https://bit.ly/3X867q2 Follow Doctor Mike: Instagram - https://bit.ly/3V4pJsy Twitter - https://bit.ly/4bVeidJ YouTube - https://bit.ly/3yPtKcQ Watch the episodes on Youtube - https://g2ul0.app.link/3kxINCANKsb My new book! 'The 33 Laws Of Business & Life' is out now - https://smarturl.it/DOACbook Follow me: https://beacons.ai/diaryofaceo Learn more about your ad choices. Visit megaphone.fm/adchoices

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

• 0:00Steven Bartlett?

  As a founder building a business when I was in my early twenties, I think I always had a deep sense of imposter syndrome because there was something that I wasn't good at, and that thing was finances. Finance and understanding your financial position as a small business is the great enabler of all of your dreams. I was running from it until I discovered a platform called Zero. Zero is an accounting and financial management platform specifically for small businesses, and it brings accounting, payments, payroll and analytics all into one place, even for people that don't love doing finances. Zero wants to do the financial work for you, but its core ambition is to go beyond keeping the financial record because Zero wants to help you understand what's happening in your business and increasingly, and this is maybe the most important thing, is help you make decisions.

• 0:45Steven Bartlett?

  Finally, we have a partner who can enable us in a simple way for those people that are both left brain or right brain and enable our dreams. You can learn more about Zero by going to zero.com. Thank you to Zero. Thank you for sponsoring this podcast, but also thank you for helping me to scale my business as somebody that, quite frankly, has never loved finances that much.

• 1:06Steven Bartlett?

  Running a small business can feel a lot like being alone at sea, and too often, you're not steering the ship yourself. You're getting dragged underneath all of the admin, things like offer letters, onboarding, wages, payroll, filing taxes and health insurance.

• 1:22Steven Bartlett?

  And that's where our sponsor Gusto helps. They help you break free of all of this clutter and all of this admin work and all of this headache. Gusto is an online payroll and benefits software built for small businesses, just like some of you. It's an all-in-one, remote-friendly and incredibly easy-to-use platform so that you can pay, hire, onboard and support your team from anywhere in the world. That way, you can channel all of your energy into growing your business rather than just keeping your head above water, which is a feeling I know very, very well. Try Gusto today at gusto.com/diary and get three months free when you run your first payroll through Gusto. That's three months of free payroll at gusto.com/diary. That's gusto.com/diary. Your mission at the moment is to myth-bust and call out disinformation as it relates to healthcare.

• 2:07Steven Bartlett?

  Let's get into that.

• 2:08Steven Bartlett?

  Okay.

• 2:10Speaker 02

  He's the actively practicing medicine doctor with over 25 million followers.

• 2:15Steven Bartlett?

  Who's created one of the largest health education platforms in the world. Dr. Mike, what's the key to finding a diet that's gonna stick?

• 2:23Speaker 03

  There's two real things that you need to think about. One, calories in and calories out is true. Second, and this is important, you need to have.

• 2:31Steven Bartlett?

  What about the prevailing narrative that if you want to lose weight, you've got to get on a running machine?

• 2:34Speaker 03

  Nutrition, that's where the majority of the change will come from.

• 2:38Steven Bartlett?

  What's the medical advantage if I go to the gym every day?

• 2:40Speaker 03

  Literally everything else.

• 2:42Steven Bartlett?

  Is vaping dangerous?

• 2:43Speaker 03

  Yes, and no one knows this, by the way, this is why I do what I do. But the more dangerous part of it is.

• 2:47Steven Bartlett?

  What's your POV on supplements?

• 2:49Speaker 03

  They will make you skip on doing things that are healthy for you. And supplements have side effects. You have too many of them, we notice that they [BLEEP]. But no one talks about that because you can't really sell that.

• 2:59Steven Bartlett?

  And then, considering you care so much about your health, why would a doctor choose boxing?

• 3:03Speaker 03

  Because I unfortunately lost my mom to cancer. To ask the doctors to stop doing chest compressions on your mom, that is not something that I wish on anyone. And I got into a very unhealthy mental state. So boxing chose me instead of me choosing boxing.

• 3:19Steven Bartlett?

  In the circumstances that you lost your mother, where she was given the all clear?

• 3:24Speaker 03

  Yeah.

• 3:24Steven Bartlett?

  Did that experience change your perspective of the medical industry in any way?

• 3:38Steven Bartlett?

  Dr. Mike, considering everything you do, from your podcast to all of the content you produce across your channels, to the stuff you do in TV, everything, social media, all of it.

• 3:52Steven Bartlett?

  How do you summarize the overarching mission that you're on in this phase of your life?

• 3:58Speaker 03

  The mission is largely to make sure that in the sea of misinformation, my patients, my viewers are getting the most honest, transparent and engaging information so that hopefully they can make the best decisions healthcare wise for themselves and their family members.

• 4:20Steven Bartlett?

  Why do you care?

• 4:22Speaker 03

  When I was a medical student, I would go into rooms with patients and they would be being seen by some of the top doctors in the world. I mean, experts upon experts, credentials, published work. And the second the doctor would walk out after presenting all this accurate, evidence-based information, the patient would look at me as the med student and say, "What did he say?" Or "What did she say?" And I realized that the message wasn't hitting home. And I realized we need to do a better job as communicators in the healthcare space. And then I said, "Well, TV must be the answer. Media training must be the answer." And then as I became a practicing physician in my residency program, I started seeing

• 5:05Speaker 03

  people being influenced by those TV physicians in the wrong ways. They would be promising miracle solutions to any problem. They would be having snake oil being sold to them. They would think that they can skip out on taking their medications, or going for treatments, or making lifestyle changes because of a solution proposed to them for three easy payments of $19.99. And I said, "Oh, man, not only are we not great communicators, but we're being outed by people who are trying to make a profit in this healthcare space." And I viewed it as a mega problem. I remember in 2017, I wrote a blog post for the American Academy of Family Physicians,

• 5:48Speaker 03

  and I said, "The lack of evidence-based physicians online is going to create a world of a difference in our patients' lives. It's going to allow misinformation to come in, especially in this section I call the gray zone, where modern science doesn't yet have an answer to certain medical problems, to certain medical conditions. And they're going to come in and promise you solutions, and they're going to be quite successful at it." What happened three years later? COVID-19 pandemic, misinformation pandemic, people confused, not knowing who to seek out for information. And for some very strange reason, a doctor with only five years of experience after

• 6:29Speaker 03

  residency was the number-one channel on YouTube being watched and giving the answers when people were not watching the CDC, they weren't listening to true experts, instead they were falling for misinformation online, and I had to be there to set the record straight. I couldn't believe that that happened.

• 6:46Steven Bartlett?

  For people that might not know who you're referring to when you cite that doctor, that is you, you reach a lot of people every month. You have 12 million subscribers on YouTube now. You have other channels with millions of people following you across the board, and that's happened in quite a short space of time. What is it about you that you think has been so resonant with so many people as it relates to sort of medical information and spotting disinformation?

• 7:14Speaker 03

  I think it's not one thing. Much like in healthcare, this would be a multifactorial situation. I think when I first started, the reason why I got popularity was because I was an early adopter of Instagram, and I would share my medical journey of being a med student, mostly because I wanted to show people that you can have a life, a social life, a family life, a sports life, and still go through medical school because I felt like there existed this stigma. You have to give up everything to study medicine. And while I was doing that, I got some followers on Instagram. And at that point, having 10,000 followers was a huge win because it was so new. And being a broke medical student to go to a club and say, oh, my God, I have 10,000 followers. Let me in without paying

• 7:57Speaker 03

  the admission. That was a win. Then fast forward just a couple of years later, I'm in my residency program. BuzzFeed writes an article, and they didn't write an article about me being the youngest doctor in my hospital. They didn't write an article about the fact that I did some medical research. They didn't write about the fact that I was passionate about putting out accurate info. The title of the article was, you got to check out this sexy doctor and his awesome dog. And I'm like, oh, that's silly. No one's going to read this. I thought it was cute. I'd send it to some friends. And then boom, that was the moment everyone was going viral, and it seemed like every outlet in the world was reaching out. And when I say in the world, I'm not exaggerating, like outlets from the UK, from

• 8:44Speaker 03

  Budapest, from Asia, from every possible outlet here in the United States, was calling for an interview. And I very vividly remember all the talk show hosts were reaching out. And I had no idea about this world, that there existed so much competition. Where I remember the Ellen DeGeneres Show folks reached out and they said, "If you do our show, you can't do the Steve Harvey Show." And Steve Harvey reached out and said, "You know, if you do our show, you can't do their show." I talked to some friends, I'm like, "All right, I'll do the Ellen DeGeneres Show. I think that'll be a cool opportunity." And they do the pre-interviews, I meet with the producers, I tell them about what I'm passionate about. And the day before filming, they call and they say, "Hey, we have some news. Hillary Clinton is announcing her bid for the presidency of the United States,

• 9:29Speaker 03

  and she's doing our daytime talk show as the first talk show." And like, the other guests were like Pink and Jimmy Kimmel, so you're the one getting kicked off. And I said, "No biggie, I'll go on Steve Harvey." So I called Steve Harvey's people back and they said, "Oh no, that was two weeks ago, we're not interested anymore." And it was such a wake-up call where the 15 minutes of fame statement was true. You were hot for a second, people were interested about this unique story, and then they move on. But I said, "No way, I still have to push this." Because I viewed it as an opportunity to get people to care about the information, but drawing their attention to something else first.

• 10:10Speaker 03

  If you look at who's successful in media 20 years ago in the healthcare space, it would be, unfortunately, people who corrupted the health information for the viewership. And it feels like you oftentimes have to corrupt something to get views. And I felt that if I could corrupt and have people come for the scandal of Sexy Doctor, but when they come for that, I instead give them some accurate information, or maybe have them come for some comedy and give them some health information. That was a way to get people interested. Because if we're being honest... Healthcare information, textbooks, science, it can be boring if you're not passionate about it. But if you can present it in a way, like some of the amazing teachers that I've had over the years,

• 10:54Speaker 03

  in a way where it's fun, it's engaging, they make it almost like a journey that you're going on. Suddenly you pay attention, you have a few takeaways. And then from those takeaways, you're better equipped to handle some of the things I can come up with during life. And I really took that to heart in the beginning. And over the last five years, I've really studied what marketers have done so well in the commercial space. Or what those snake oil salesmen have done so well in pitching their misinformation. And take those same principles, but bring them to evidence-based medicine. Allow people to have fun while they're learning.

• 11:31Steven Bartlett?

  There's a lot of information out there as it relates to health. What is your sort of framework for deciding what you share and how you share it? When there's so many, a lot of these studies as well, the methodology of the studies is often hard to trust because of the way that they're, you know, certain studies where they look at kind of, they don't isolate one variable. So you look, you look at the study and it could be anything. They say, you know, they, you hear these studies about like veganism, for example, where they say veganism is healthier. But that doesn't remove out all the other factors in that person's lifestyle. Maybe, okay, maybe they're, they're eating less meat, but it's processed meat that they're having with fries and hamburgers, et cetera. So how do you, what's your framework for deciding if something is true in a sea of information?

• 12:17Speaker 03

  Every time I look at some new research, I treat it differently than most people would in the media space. And I also treat it differently than an individual would treat it. So if you're a news outlet and a breakthrough study comes out, they treat it like it's the answer to people's problems, like it's the new and best. I take that research and I apply it to the existing data and knowledge that I've gotten over the years through my medical education and position it.

• 12:51Speaker 03

  In where it belongs. So some research comes out. It might make me lean in saying we need to move closer to a plant focused diet. It doesn't mean that everyone needs to be on it. It doesn't mean we need to eliminate everything because in medicine extremes are rarely right. Even when we're talking about optimization, you'll hear oftentimes people say, oh, you can boost your immune system, you could hyper optimize this. No, no, no. Hyper optimization is extreme. Whenever you're going to those extremes, you start creating problems because that's how the human body works. It works in homeostasis. It wants to be balanced and the enemy of balance is bad, but also perfect.

• 13:33Steven Bartlett?

  So what do you make of this optimization, longevity, anti aging, live forever? Culture that's emerged in the last couple of years?

• 13:40Speaker 03

  I understand where it's coming from. We've made a lot of scientific progress. We believe that we should have the answers to the one problem that is facing all of us and that's that life is not forever. But I feel like the field has been corrupted and it's actually the way that healthcare has been corrupted across the board. So when we talk about health insurance, the pharma industry, anti aging industry, a lot of it has been corrupted with capitalism. And I take and I say that as someone who's actually pro capitalism, but I believe healthcare is a commodity that cannot be Uberized. I love Uber. I love Lyft. I love the idea of being able to call something on demand.

• 14:25Speaker 03

  Doesn't quite work for healthcare. Demanding what you want for your body when you're not the expert, doesn't always yield the best results. We've seen that time and time again. I see it with my patients when they come in and it's very clear that they have a viral illness, but they demand antibiotics or they demand a medication that's going to help them live longer.

• 14:47Speaker 03

  Doesn't exist. We don't have yet the evidence to sell these things to people, to explain them to people. But there will always be a person who will take some new information, some preliminary data, data from an animal model, from a Petri dish, and sell it as the next great thing. This happened with the Fountain of Youth. This happened with literally snake oil hundreds of years ago. And now it's happening, but with the power of social media. And the fact that this misinformation, a lot of times, is insidious. You don't realize that it's so bad and so problematic. Because what it's doing is it's actually tricking people into not understanding how science works. How when we put out a hypothesis, an idea of what we think could happen,

• 15:32Speaker 03

  we actually strive to disprove our hypothesis. So if I say this glass of water here will help you live longer, I will actually, as a scientist, want to set out to prove that it doesn't. And I will think of every way, and I would bring on people to disagree with me, and find ways that we could test that this doesn't work. But right now, on social media, what you see is a lot of people just supporting what agrees with them.

• 15:58Steven Bartlett?

  What are some of those ideas that have proliferated across social media that irritate you the most and you think are most harmful?

• 16:05Speaker 03

  I think the ones that create certainty in an uncertain world. And I think that could apply to pretty much any field. I talked about the gray zone earlier, and I think the gray zone has changed. Thirty years ago, the gray zone was weight loss. And if you put on any TV channel, especially late at night, there would be a fat burner, there'd be some grapefruit diet, or some next great thing that someone came up with. But everyone forgets about all that. People used to sell you nonsense to try and help you lose weight. And all of it didn't work. It was not healthy. Even if it made you lose weight, it was in an unhealthy way. It ended up creating and fueling this almost eating disorder-like cycle for most folks.

• 16:50Speaker 03

  And then came out some medications, like Ozempic. And people started actually losing weight with an FDA approved medicine that had real results. Now you see less of those fat burner ads, but you see more of a new gray zone, anti-aging. Science doesn't have an answer to stop us from aging. We don't have the answers perfectly to our genetic code. But boy, there will be a genetic test for sale that will tell you exactly what you need to avoid. But the reality is, we just don't know. And it's not sexy to say, I don't know. But I've been passionate about encouraging folks to celebrate those experts who come

• 17:32Speaker 03

  in and say, here's what we don't know, but here's how we're working to get to those answers. Because that's what gets me excited. There's so many breakthroughs being made in medicine, and we don't talk about those honest breakthroughs because they're not always exciting. But if we could pair it with something cultural, if we could pair it with some comedy, with some fun, I think we can get in front of a lot of eyes.

• 17:54Steven Bartlett?

  One of the first things you said there was about weight loss and a Zempec. And it's this incredibly relevant and widely discussed subject at the moment, a Zempec. I listened to the research on a Zempec, and I am someone that typically has a bias towards not taking medications if I can and pursuing a natural route.

• 18:16Speaker 03

  And that is what we do, too.

• 18:18Steven Bartlett?

  Yeah.

• 18:19Speaker 03

  Which is understated in most circles.

• 18:21Steven Bartlett?

  As doctors?

• 18:23Speaker 03

  Yeah. So our training, for example, if you look at our, we have a reference called, let's say, Up to Date. It's a medical platform where we could go and get guidance on any medical condition, and it could tell us what the epidemiology is, who gets sick with it, what is the diagnosis that we should do to try and make it, like what laboratory testing, what imaging we should do, what treatments work, first line, second line, third line, et cetera. If we look at pretty much any chronic disease treatment, whether it's high blood pressure, sugar management from like diabetes.

• 18:58Speaker 03

  All of the first steps is lifestyle modifications. That's what we're taught.

• 19:04Steven Bartlett?

  Is that because of the type of training you had as a doctor? You became, or is that all medical doctors?

• 19:08Speaker 03

  That is all medical doctors. But what ends up happening is twofold. One, patients love a shortcut.

• 19:19Speaker 03

  They love having a medication, potentially do the work that they may not be able to or don't want to. You know, it's difficult to generalize here because some patients truly have difficult lives. They have three jobs. They're a single parent. They're having a mental health crisis. So they may not be able to do those lifestyle changes. But then there's a portion of us who could do it, but prefer to take the shortcut. And that's pretty human of us. We would like to get the shortcut. We would like to take the edge.

• 19:50Steven Bartlett?

  Is there such a thing as a shortcut?

• 19:53Speaker 03

  In healthcare, no. And I heard you actually say it on your last podcast covering Ozempic, that there is no shortcut. There are side effects and trade offs to everything, and you're absolutely right in that. There is no such thing as just something that is all good. Hydration, you can't live without it. Over drink, you'll throw off your electrolytes, you could damage your brain, you could lose your life. Carrots, healthy food, I would say. Eat enough, you'll turn orange. Same thing goes for medications. And that's why when people go and villainize treatments, medications, supplements, it just depends and there needs to be nuance. It's too hard to paint medicine with a broad brush, but social media makes that really

• 20:38Speaker 03

  tempting.

• 20:40Steven Bartlett?

  That, that non Ozempic path, if I'm not going to take the, the new sort of fat burning magic pills or the appetite, I guess, I guess they suppress appetite, magic pills.

• 20:52Steven Bartlett?

  That becomes another, still is a bit of a gray area in many respects because we, on the drug side of things, people now have an option that's FDA approved. But if they don't want to pursue that path, there's still all of this other information around, okay, I want to lose weight. And there's lots of opportunity for a lot of people to present them with solutions. There's a roaring debate around calories, which seems to just be never ending. And I wanted to get your take on that. If someone was, in your training, when you've been advised to suggest lifestyle changes first and foremost. If I'm trying to lose a bit of weight, I'm at risk of being diabetic or something. What would you say to me as your patient?

• 21:30Speaker 03

  It would be hard to generalize it because it really depends on what preexisting conditions exist, what have you tried thus far, what works, what do you have time for? What do you have budget for?

• 21:43Steven Bartlett?

  On that point of tried thus far, why does that matter so much?

• 21:48Speaker 03

  If I have a patient who's tried dieting and failed, and I don't ask that question, and I recommend dieting, they may not take the advice, they may nod because they want to be a quote unquote, "good patient" and leave and say, "not doing it." But if I ask that question, they can say they tried and failed. Then that gives me an opportunity to ask, what exactly did they try? Did they try some really restrictive diet that's out there, carnivore, keto, what have you? And that set them up for failure, something that wasn't able to be sustainable? Whereas now I can explain that, hey, the thing you tried actually set you up for failure. And here's a more reasonable recommendation that we can try.

• 22:33Speaker 03

  And now I can actually be a doctor that recommends a dietary modification that could help them.

• 22:39Steven Bartlett?

  What's the key to finding a diet that is successful from your experience? What are the foundational factors of that diet that's going to typically make it stick?

• 22:48Speaker 03

  There's two real things that you need to think about when it comes to dieting. One is its impact on your weight. Because calories in and calories out, as nonsexy as it sounds, as clinical and cold and heartless as it sounds, is true. Second, you also need to think about the nutrients in your food. Because if we just take one of those parts and ignore the other, we can get into a really bad place. I can even see those grapefruit diets that people say like, eat three grapefruits a day and you'll lose weight. Yeah, you will, because you're under consuming calories. But is that healthy from a nutrition side? Absolutely not. On the other side is, you can get enough protein, enough nutrients, but if you're

• 23:32Speaker 03

  overeating calories, you can get into a metabolic problem where now you're carrying excess weight and increasing your risks of all sorts of conditions. So the goal is to get you in a place where it's balanced in both a caloric, weight management standpoint, but also in ideally, a healthy nutritional balance as well. And what that means person to person is going to vary. It's going to vary based on the medical condition they have. Some patients who are anemic may need certain nutrients that someone who's not anemic doesn't need. Someone who's prone to kidney stones may need a slightly different diet than someone who is IBS prone. So we need to always take into account that generalized advice isn't great when it comes

• 24:14Speaker 03

  to healthcare, especially when it's very easy to create buzzy statements from truth in healthcare. Like I said on a podcast not too long ago, that exercise for weight loss almost doesn't matter. And that's a buzzy statement, because on one hand, it's true, but you also need to pair it with some nuance and say, exercise has so many benefits outside of weight loss, of why it's important to participate in exercise. And the idea of weight loss needs to come from nutrition. That's where the majority of the change will come from.

• 24:52Steven Bartlett?

  Super interesting, because I've sat here with so many people that have said that to me. They've said that when you look at a lot of the studies, exercise as a, if you prescribe someone exercise to lose weight, they probably won't lose weight. But I would definitely say that in culture, people see exercise as the, many would see, I reckon, the primary way you lose weight. They think you have to go for a run to lose weight. And again, you've expressed the nuance there, but I've even I've struggled with understanding that because over here, people say, exercise isn't super useful for weight loss in the studies. But then the prevailing narrative in society is that if you want to lose weight, you've got to get on a running machine.

• 25:35Speaker 03

  That's because they're equating in their minds, health with a magazine cover. And health is not a magazine cover. They think that you need to have big muscles to be considered healthy. And while you can have big muscles and be healthy, you can have big muscles and be tremendously unhealthy. So just looking at someone's appearance doesn't give you the full picture. Just like looking at someone's weight doesn't give you the full picture. You need to know more. And when it comes to exercise and weight loss, let's just take for a very simple example. I used to go to the movies when I was a kid. I loved it. I did it all the time. It is not unusual to eat a tub of popcorn, a little

• 26:18Speaker 03

  candy bar and a soda, well over a thousand calories. Do you know how hard it is through exercise to burn off a thousand extra calories? Most of us are not physically even equipped to burn a thousand calories during an exercise session. So it's just about the science of not being able to out exercise a bad diet.

• 26:40Steven Bartlett?

  What if I just eat loads of salads? I think I've been in that mindset before. I thought, well, it's just really, I could have, well, I've been in periods of my life where I've just eaten more and more and more good stuff, quote unquote, good stuff.

• 26:54Speaker 03

  Yep.

• 26:54Steven Bartlett?

  Things that I thought were good. But I also didn't lose weight.

• 26:59Speaker 03

  You were, you're a really smart person. You're a person that wants to be as effective as you can in your podcast, in your communication style, and you're amazing at it. You want to do the same thing with your diet. And the hacks and tricks that you use in your business mind, in your communication mind, don't work for healthcare. You cannot find the shortcut of the salad that's going to fix everything that bothers you, of the probiotic miracle supplement, it's not going to be there. That's why some of the minds that actually end up falling for the most simplest forms of misinformation are those who are really good at business. Because the things that work very well in the business world,

• 27:44Speaker 03

  in the communication space, don't work in healthcare. Because healthcare is not a commodity. Healthcare does not work well with extremes. You cannot do something so good all the time without it having negative repercussions. You want to be good, not perfect, when it comes to healthcare. And the more you try and chase perfect, number one, you're going to get the negative response. But also, number two, you're going to create anxieties, worries that are also toxic to your body. So you have to be very careful. So perfect is not only just an illusion, it's a toxic illusion.

• 28:22Steven Bartlett?

  I saw someone talking recently about the calories in, calories out thing. And the first comment was a lady who I think had a preexisting condition, basically saying, because of my preexisting condition, the calories in, calories out thing does not work for me. I've tried it. And then the health influencer responded and said, it works for everybody.

• 28:42Speaker 03

  Both statements are true.

• 28:44Steven Bartlett?

  Okay.

• 28:45Speaker 03

  Dialectics are common in healthcare, where two opposing ideas can both be true. Someone can try and do calories in, calories out, which through science works, but the application of it can fail.

• 29:03Steven Bartlett?

  Well, I'm thinking not about the application and like the science of it. Is it regardless of whether I have a preexisting condition?

• 29:10Speaker 03

  Not regardless. Preexisting conditions is part of the application. The individual is part of the application.

• 29:18Steven Bartlett?

  I think she was making the case that because of that preexisting condition, that the maths of it don't apply to her. Like, it doesn't actually work on her body.

• 29:26Speaker 03

  It shifts.

• 29:26Steven Bartlett?

  Versus the applica-- okay.

• 29:28Speaker 03

  It absolutely shifts. And that's the truth for most medicine. Like, when I try and get my patients into a healthy blood pressure range, because we know that having a resting blood pressure above a certain number predisposes you to having risks of heart attacks, stroke, all these cardiovascular conditions. When I treat them with a medication after lifestyle changes either didn't work or they weren't able to go down that route, we have this really unique knowledge. Public health wise, we know that controlling the blood pressure on a large scale will lower deaths significantly, will lower heart attacks significantly.

• 30:11Speaker 03

  But by me medicating this one patient, I have no idea if it's going to help this individual exactly. But that's because all we're doing in medicine is doing our best with the.

• 30:23Steven Bartlett?

  Running a small business can feel a lot like being alone at sea. And too often, you're not steering the ship yourself. You're getting dragged underneath all of the admin, things like offer letters, onboarding, wages, payroll, filing taxes and health insurance.

• 30:39Steven Bartlett?

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• 31:19Speaker 04

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• 31:48Speaker 03

  Limited information that we have on hand.

• 31:52Steven Bartlett?

  Closing off on that point about exercise. So if we shouldn't be thinking about exercise as a way to lose weight, what is the sort of medical advantage, the physiological advantage for me if I go to the gym every day and I'm active?

• 32:04Speaker 03

  Literally everything else. If I could bottle the effects of exercise and sell it, richest person on earth. Happiness, mood, social connections, strength, ability to decrease cancer risk, decrease, increase ability to fight off cancer, increase longevity. Literally everything else is the benefit of exercise. And I say that as someone who's been very exercise focused. But over the last few months, I've kind of fallen off. I've gained some weight. I haven't been exercising as much as I want because sometimes life gets hard. Life gets in the way. Things become problematic. Mental health sometimes takes a struggle.

• 32:49Speaker 03

  And we need to be aware that that can happen. The idea that we need to make every person perfect, or if they're not perfect, they're failure. That's such a dangerous rabbit hole to go into.

• 33:02Steven Bartlett?

  How much exercise?

• 33:04Speaker 03

  Going to vary person to person. General guidelines, say 150 minutes of moderate intensity exercise per week, which isn't a lot, two and a half hours. Moderate intensity, meaning that you shouldn't be able to speak full sentences, maybe one sentence at a time until you're out of breath, is a simple way to put it.

• 33:24Steven Bartlett?

  When you have such a broad view on medicine. Well, I noticed that in your content. I was like, this guy really knows. He really has a real, much more broad view than the neuroscientist I spoke to yesterday, who's really focused on, you know, maybe one part of the body. With that broad view, what are you concerned about in terms of macro social trends? The direction of travel that we're going in with our health? We talked about misinformation and disinformation, but but actual realities of the Western healthcare condition.

• 33:55Speaker 03

  First of all, I think it's important that we have both individuals participating and having a seat at the table. The broad view primary care physician and the single point expert neuroscientist like you had on your podcast before me. We need both. In fact, where I'm able to gather my information from is from all those researchers that are putting in those hours at the bench, making sure that they're checking their biases, showing the flaws of their own research. Without them, I am nothing. Right? Like, where did I get my knowledge from? From them? So we absolutely need to do this in a teamwork approach. I think the big problem that we face today is two things. One, the loss of trust in our healthcare world.

• 34:40Speaker 03

  That's huge. People don't trust healthcare advice. They don't trust our agencies. Frankly, the loss of trust of doctors has been rather shocking over the last decade. And then second is it's more of a philosophical issue that I raise, because I don't know where it's going to go, where we've created this world of processed foods, unhealthy foods, foods that it causes to eat more and more and more and feel not satiated, and then we've come up with a medication to solve that. We've created apps that pull our attention spans, that allow us to focus 10, 15 seconds at a time before we swipe to the next thing.

• 35:22Speaker 03

  Now, a lot of people are requesting prescriptions for ADHD medications. There's people who want to stay out all night and party and still maintain their physical gains. They get on testosterone early when they don't need to. How hyper-medicated are we going to get as a society to a point of actually harming us? And I don't know the answer to it. I'm not smart enough to know the answer to that. But I think it's a good philosophical question to ask ourselves.

• 35:54Steven Bartlett?

  Are you scared about what would happen if we had a pandemic that is 10 times more deadly than the previous pandemic breakout now? Are you scared because of that loss of trust?

• 36:04Speaker 03

  The more deadly the pandemic, a lot of times, the less problematic it is. Isn't that weird?

• 36:11Steven Bartlett?

  Oh, okay.

• 36:12Speaker 03

  So, initial SARS virus was significantly more deadly than SARS-CoV-2, which is the virus that causes COVID-19. So initially, when the reports came out about the lethality rate of SARS-CoV-2, COVID-19, we said, oh, well, it's not as bad as SARS. We'll be okay, because most people with SARS got really sick. They lost their lives. But because asymptomatic spread was a thing with COVID, meaning that you could feel fine or maybe just have a sniffles and spread it, it killed millions more people. And that's what that brings me back to that point of when I said insidious misinformation can be more problematic than true disinformation.

• 36:54Speaker 03

  Because when something doesn't seem so bad, that can, we can allow it to go much further and cause much more harm.

• 37:02Steven Bartlett?

  Complacency can foster...

• 37:03Speaker 03

  Complacency and feelings of safety, like, oh, well, this one's not as lethal. We're good. I feel fine. We're good. But when you look at it and you zoom out macro, oh my God, it's wreaking havoc across the world. And I've actually equated this to vaping. Vaping is not as harmful as cigarettes on paper. But because the odor is not as offensive, it's easier to hide, you could do it much quicker and get a bigger dose, because it feels like it's not as harmful, many more people can get hooked on it.

• 37:42Steven Bartlett?

  Is vaping dangerous?

• 37:45Speaker 03

  Yes.

• 37:47Steven Bartlett?

  Why and how? So many of my friends vape. I think three, three out of my six best friends, they're just like, they're like, they're just absolutely addicted and they never smoked, interestingly.

• 37:56Speaker 03

  That's the issue of it, that it gets people who maybe would have been turned off by smoking to try. And the chemicals found inside are really rewarding to the brain, nicotine being a prime example of it. And the more dangerous part of it is with kids who have a developing frontal lobe, meaning that the part of their brain that is responsible for complex decision making is not yet fully formed. So they're incredibly susceptible to anything that can build a tolerance, a dependence, an addiction to. And it could change the chemistry of their brain moving forward. So we don't want to make it easier for them to start smoking. Vaping should be used as a tool, as a way of getting you off of cigarettes, not as a

• 38:40Speaker 03

  way of introducing you to cigarettes or nicotine at all.

• 38:44Steven Bartlett?

  Is it dangerous for adults as well?

• 38:47Speaker 03

  If you're coming off cigarettes, no, it's a good choice.

• 38:49Steven Bartlett?

  But if you would never, all my friends that vape never smoked.

• 38:52Speaker 03

  Yep, it's not, it's not something that carries value health-wise and can only potentially harm.

• 38:57Steven Bartlett?

  Have they, have they done any, I guess it's super difficult to do studies on these kinds of things, but have, is there any studies that have been done around vaping?

• 39:04Speaker 03

  Yeah, there's been vaping-related lung injury, where that's its own diagnosis code now. There's been children that have been hospitalized with it. There's been even technical problems of the devices blowing up in people's faces. So it's not the fact that I'm trying to fear monger here and say vaping is the devil. I'm here trying to explain that vaping can be problematic because on the surface, it may not look as harmful by comparison.

• 39:35Steven Bartlett?

  Everything is trade-offs.

• 39:36Speaker 03

  Everything is trade-offs.

• 39:37Steven Bartlett?

  It's so interesting. It's like, when I see all my friends vaping, they're all in, we're all in Dubai a couple of, about a year ago. And I thought, pass me, because they will have these little like disposable vape things now. So let me try it. I tried it and it was really nice. And I thought, oh God, I could get into this. And if it's not unhealthy, because we all know that smoking is unhealthy, I thought, you know, you had to think, oh, what's the harm? I could have so easily got into it. Luckily, I just, I'm always skeptical when I don't know the side effect. I would rather accept the side effects.

• 40:06Steven Bartlett?

  And be super clear than someone say to me, there's no side effects. When someone says there's no side effects, I always.

• 40:12Speaker 03

  Well, that's like the whole nature fallacy when someone's like, oh, but this is natural. First of all, what does that mean? Because like they say vitamins are natural, but they're made in a lab. I don't know how that's considered natural. And also just because something natural doesn't mean it's safe. Arsenic, cyanide, natural, but deadly.

• 40:32Steven Bartlett?

  The ADHD point you mentioned.

• 40:34Speaker 03

  Yep.

• 40:35Steven Bartlett?

  What are you seeing as a doctor? You know, over the last couple of years, the term ADHD neurodiversity has seems to have become more and more prevalent. Everywhere I look, it feels like I'm hearing a conversation around ADHD. Now, is that because there's been a social sort of heightened awareness to the subject? And now people are getting diagnosed more. Are we creating more ADHD somehow? Or is it somewhere in between?

• 40:57Speaker 03

  Yeah, I assume it's something in between. I don't have a clear answer to it. I do know that neurodivergence needs to be talked about more. And that's not just from the ADHD perspective. It's also from autism spectrum disorder situation as well. Where it's folks are going to be different. And some people want treatment for a condition, others don't. And we have to respect people's autonomy, even when we talk about something like vaping. If an adult wants to vape, as long as I can convey to them as their doctor, the risks. Everyone's free to make their own decisions. No one lives a life where they say, I'm going to take no risks. Everyone has a different risk tolerance level. Everyone is comfortable with a different level of care in life.

• 41:41Speaker 03

  Some people want more care, some people want less care. Even at the end of life, I have discussions with my patients for end of life care often. And a lot of times they're shocked by it. They're like, wait, do you think something's wrong with me? I'm 30 years old, why are you talking? This is the time to talk about it. When you're healthy, when you aren't facing a decision that you have to make right now. That's when you're going to be able to spend some time and think about what kind of medical care you want. You know, I'm a doctor here that became a professional boxer a couple of years ago. That is not healthy. I do not recommend it. It increases all sorts of risks for head injury, chronic traumatic encephalopathy. All of that is true. It's a risk that I was willing to accept because I studied the risks. I accepted the risks.

• 42:25Speaker 03

  I don't doubt the risks, but it's something that I'm passionate about and I wanted to go down that route.

• 42:30Steven Bartlett?

  Enjoying it?

• 42:31Speaker 03

  Very much so. It's a great outlet for me.

• 42:34Steven Bartlett?

  Why did you choose boxing? Despite the risks.

• 42:37Speaker 03

  Yeah, I would say that boxing probably chose me instead of me choosing boxing. I did Taekwondo growing up, so I was in martial arts for eight, nine years. And then when I was in medical school, I unfortunately lost my mom to cancer. And that was a really strong wake up call for me, being in the medical field, knowing what it's like to be in the room to ask the doctors to stop doing chest compressions on your mom. I mean, that is not something that I wish on anyone. That's the worst thing you can experience, especially when my father was there, also a doctor, who was saying, no, keep going. But I knew it was futile. I knew we were causing more harm.

• 43:19Speaker 03

  And in going through that journey, I got into a very unhealthy mental state. I didn't leave my house, except to go to class. I came home, I was socially isolated. And after a period of three, four months where that was going on, I said, I need to get out of this. I need to take my own advice that I give to people and take the advice that you need to have action before you get motivation. And the action that I took was to go on Guilt City. Do you remember that app? It's like a Groupon-esque app where you can get a coupon to a class. And I got a coupon for a boxing class. And I went and did this boxing session.

• 44:01Speaker 03

  And then I ended up boxing for 10 years after that session. Fell in love with the sport. And then a couple of years ago, I ended up fighting on Showtime pay-per-view in front of an audience of 15,000 people. And it's been a unique journey. So while it's easy to vilify boxing and say that it's problematic, for some people, if the trade-off is right, it might be something that they could participate in and it could be very healthy for them.

• 44:35Steven Bartlett?

  Losing your mother for anybody, I think, is just something that is unimaginably, unimaginably painful. But in the circumstances that you lost your mother, where, from what I understood, she was given the all clear at one point with her...

• 44:51Speaker 03

  Yeah. So she had this unique form of cancer called CLL. And this is usually a cancer of old age, where you get diagnosed with it and you end up dying of something else, other than that cancer. But she had a unique, more aggressive form of CLL, where they needed to really ramp up treatment. And her treatment took a toll on her body. Like, she did not look the same post-treatment, she did not feel the same. But it was all in the hopes of curing this cancer. And I remember very vividly, I was going to Memorial Sloan-Kettering Hospital to pick her up one day. And she actually fell waiting for me

• 45:36Speaker 03

  at the waiting area. So the doctor came down and talked to me and said, maybe we should keep her observation for a day or so. But overall, she's doing great. She's just very weak from the treatment. And he shook my hand in that moment and said, she's cured. There's no more cancer in her body. Now we just got to get her to recover from all these treatments. And that's the greatest news anyone can hear. Your hopes, 10 out of 10. And just a few short days later, her weakness got so severe that she got a very unique type of bacteria called Gram negative in her blood, causing Gram negative sepsis, spread throughout her body. She required the use of pressor medication to artificially raise

• 46:17Speaker 03

  her blood pressure to prevent her organs from dying. And it didn't work. And unfortunately, she lost her life. And one of the hardest moments there was watching my father go through this, who, with my mom, sacrificed their lives to bring us to the United States as immigrants, gave up their lives. He went to medical school for a second time in his life. She went to university after having a PhD in Russia to learn English and be able to teach students math here in the States. It was painful to watch my dad go through it. So I think for the first few months, my focus was more on him than it was even on myself.

• 46:58Steven Bartlett?

  Did that experience change your perspective of medicine and the medical industry in any way? Because in that moment, a doctor turned to you and said, "Your mother is cured." And it wasn't the, it sounds like it wasn't the cancer itself that did the harm. It was the treatment for the cancer that did the harm.

• 47:17Speaker 03

  I never was mad at the doctor for saying that. It would have been easy to in a situation like that where you thought you were good, but then it wasn't. It taught me a lesson about how life can be cruel and take things away from you very quickly after just receiving good news. I remember sharing a meme on my Instagram that it had like, "You: I'm actually happy right now." And then "life: Hang on a second." And that's kind of how life is. So it taught me to be able to bounce back from adversity and realize that you have to put one foot in front of the other while still being able to feel.

• 47:59Speaker 03

  Because repressing emotions in the short term is a valuable tool. You know, if you're unable to function in terms of high stress in that moment, you could lose your life. You could make a really bad decision. You could harm others. You might not be able to successfully hold down a job. But if you do that for a really long period of time, even that as an acute coping strategy can become toxic. And I was getting into that point where it was becoming chronic and I was blocking my feelings of not mourning my mom, not having the proper process. And for everyone, that process will be different.

• 48:39Steven Bartlett?

  You moved in with your father after that?

• 48:40Speaker 03

  Yep.

• 48:42Steven Bartlett?

  If I was a fly on the wall in that household at that time, what would I have observed?

• 48:49Speaker 03

  Two gentlemen trying to raise a dog very poorly.

• 48:55Speaker 03

  That's probably not what you expected, but I, um, in trying to always find some kind of way to help, I thought by helping my dad redirect his feelings towards something else, I got a Siberian Husky for him in that moment, which we always wanted a dog. Even my mom wanted the dog. And he took some time to travel to mourn my mother's passing. And while he was doing that, I raised a dog a little bit for a few weeks, got her at least potty trained. And then when he came home, she was there. He was typical Soviet father yelling at me and telling me why this is a bad idea, crying, which I never saw in my father before, obviously, until the loss of my mom.

• 49:41Speaker 03

  And, um,

• 49:44Speaker 03

  then he started being happy. He started saying what should we call her? His focus shifted. His focus shifted to going for walks with her, which allowed him to think about my mom, to not be locked into the house as so many people are when they're going through a rough time. So while I think it was chaotic of us trying to raise this puppy together, it gave us something to bond around in a moment of tough times.

• 50:10Steven Bartlett?

  There will be a lot of people listening right now that are maybe in the throes of that grief or the throes of their own sadness or depression for whatever reason.

• 50:17Speaker 03

  Right.

• 50:18Steven Bartlett?

  And it's, um, when you're in the midst of the storm, when it's, it's hard to see any way out. And you said something super interesting, which is, you said you realized that like action comes before motivation.

• 50:29Speaker 03

  Yep.

• 50:30Steven Bartlett?

  If I, if I'm someone that's in that situation right now and I'm listening, what would you say to that person?

• 50:34Speaker 03

  Put on your shoes.

• 50:40Speaker 03

  They'll, you'll go somewhere. Doesn't matter where you'll go. Gym, not gym, walk, dog park. You can go to a dog park without a dog.

• 50:51Speaker 03

  It's therapy. The biggest therapy that I think I've ever had, and I've gone through traditional therapy, was going to a dog park with my dog after my mom passed away.

• 51:01Speaker 03

  It's such a weird thing, but animal therapy is real.

• 51:07Speaker 03

  And you know who actually gave me that advice, speaking of dragons then? Barbara Corcoran.

• 51:12Steven Bartlett?

  Oh, really?

• 51:12Speaker 03

  She said that the way that she gets herself to exercise, because she doesn't like to, she hates it, she's very vocal about it. But she says, next to her bed are her shoes, her athletic shoes, that if she puts them on, she's like, alright, well, since I have them on, I may as well go exercise. And that one little step creates that cascade. Look, will it work for everybody? Is this the miracle solution? No, but it's one step. And even if you just do that one step and nothing else, the next time, it'll be easier to put on the shoes and maybe try for the second one.

• 51:42Steven Bartlett?

  Putting on the shoes is hard as well, when you're in that, in...

• 51:46Speaker 03

  Showering is hard, grooming is hard. The basics of all basics is hard. That's why when I hear advice like, "Go make some friends online when you're feeling down," oh, boy, that's tough advice. That's not easy. So, the putting on the shoes thing is simple, in the sense of, doesn't require others to be around you to judge you, doesn't have any steps after that, just to put on the shoes. And if you're at that point, seeking help from a medical professional is of utmost importance. Because we've put this stigma where, if you go for mental health treatment, you're somehow

• 52:28Speaker 03

  weak, but if you go for treatment for a broken bone, you're not weak. That stigma doesn't exist for it. And that's strange, because both things can have problems arise with it, especially from a mental health standpoint, especially with the society we find ourselves in. Currently, society is the most unnatural it's ever been for humans.

• 52:52Steven Bartlett?

  How would you describe the journey you've been on with your own mental health?

• 52:57Speaker 03

  I don't know how I would describe the journey. I would say, just like most people, it's had ups and downs.

• 53:06Speaker 03

  I would say the thing that's really thrown me for a loop is the social media world of it all because of how unnatural that that is. But I feel like a lot of people are working through that without even having a social media platform. Because at the end of the day, these days, everyone's a content creator, right? Like, when you make a video and it gets millions of views, you kind of know what to expect. Being a content creator, you have experience. But Johnny, Rebecca, someone else putting out a video on their social media at 16 years old, that too can get a million views. And they're not ready for what comes with a million views. In fact, so many people, even in the medical community, reach out

• 53:49Speaker 03

  and say, how do I go viral? I'm like, do you want to go viral?

• 53:56Steven Bartlett?

  That's throwing your mental through a bit of a loop.

• 53:58Speaker 03

  Yeah, I was obsessed with it, checking it all the time. And I wasn't obsessed for the reason most people think. I was obsessed with it from a place of growth. I was like, even if they're 99% BS, there's some kind of truth, there's a kernel of truth there that I could take away and make myself better. And you know, there is truth to that. I did learn a lot of things. I did prevent some mistakes. I've improved my content as a result of listening to negative feedback and criticism. But I've had to, in working with my therapist, carve out moments where I'm not in a place where that's acceptable for me right now. Where you just have to say, I'm not in a healthy mindset to look.

• 54:40Steven Bartlett?

  What was the symptom of the impact it was having on you?

• 54:47Speaker 03

  Tremendous anxiety, where you're just worried at all times, and you're almost addicted to checking it, because you want to be ahead of it. You want to be safe. You want to be able to think of a response. And when you get to that point, you're never letting your mind rest. You're always in fight or flight. And when you're in fight or flight, you're not resting, you're not repairing, you're not getting good quality sleep, even. So I know how important that is. I talk about it all the time. But as I said, you know, we're all not perfect. Doctors are probably the biggest hypocrites when it comes to their own health. I guarantee you, some of the people that have come on your podcast that talk about sleep or talk about this.

• 55:29Speaker 03

  They struggle with sleep. They don't do those things, just like how some advice that I give, I don't follow to the T. My job is just to present the evidence. So I know certain things that I should be doing better, but just because I know doesn't mean that I'm going to be 100% following it all the time.

• 55:44Steven Bartlett?

  There's this interesting thing that I was just thinking about as you're saying that, that at like a philosophical level, I think we're all kind of just passing our anxiety on to someone else.

• 55:53Speaker 03

  Like it's like energy cannot be destroyed and must be transferred.

• 55:57Steven Bartlett?

  I noticed this because on my podcast, I have multiple guests that often disagree with each other. And if I was to do a map of how those people are feeling, they're all suffering.

• 56:08Speaker 03

  Well, that's just humanity as a whole.

• 56:10Steven Bartlett?

  They're all like really suffering. And sometimes those people are suffering because of someone else who's suffering and then because of someone else's suffering. It's almost like this, this chain of suffering because of misunderstanding, a variety of different reasons. But I think, as you said, it's humanity as a whole. The person that's leaving those messages or, you know, attacking you is probably also suffering in their own way.

• 56:29Speaker 03

  Of course.

• 56:30Steven Bartlett?

  It's a real shame, but I can't see any way out of that.

• 56:32Speaker 03

  It's a, like the, the circle of anxiety is an artistic way to put it for sure. But I think there's, there's some truth to it, you know, even from trauma, the odds are that if you've experienced a traumatic childhood, that you will also potentially cause trauma to others goes up. That risk does go up. And that's also pretty common sense, even if you're not looking at the medical research. You could just say that if you've been hurt, odds are you can hurt people. What do they say? Hurt people, hurt people too. Right? I think that that's like that common sense logic that does get it right.

• 57:08Steven Bartlett?

  What's the, um, did your therapist give you any advice that's proven to be useful?

• 57:13Speaker 03

  Well, the advice that you put perfectly in, in place of logging off, not looking at certain things at certain times of the day. Like literally, I had to completely shut off my phone at certain times of the day because otherwise what happens is I would get into the cycle of, okay, I just finished in the hospital. I just filmed my video for the day. Now it's sleep time. And just before going into bed, let's check my phone one last time and search the social media sites, what people are saying. And it's like, why? That's ultimately what I think probably got me healthier. Like not looking at it was very good in moments of despair. Because during those moments, I was just so fragile and it would not be a good time to look.

• 57:55Speaker 03

  But really where it got me is, what got me is, don't look unless there's something valuable you're getting from looking at it. So now if I'm in a healthy place and I feel like I'm looking and I'm doing some kind of preventive task, I'm learning from it. I'm like, okay, I'm looking at it, but I'm looking at it with some kind of intention. And that's actually true for all of social media. I think he was on your show as well, Dr. Robert Waldinger, who ran the largest, the longest running study at Harvard of happiness, talked about the different usages of social media. How if you use social media passively and you just look and consume, it can be rather disheartening and make you unhappy.

• 58:38Speaker 03

  But if you use it to form a community, to learn from it, to better yourself, suddenly the social media may not have as bad of a health impact and can actually have a positive mental health impact. So if I'm looking at the negative comments, I'd have to do that check in with myself. Am I doing this because I'm actually benefiting from it or is it destructive in nature?

• 58:58Steven Bartlett?

  Have you ever wondered if there's something about you that makes you more likely to look at that stuff or to care about that stuff? I've often wondered about that myself.

• 59:11Speaker 03

  Yeah, I feel like I have. I think it's a, it's a pretty natural thing. I think most people look. I think for me, I derive so much value in the work that I do on social media because this was never meant to be a financial venture. This was not some grand ideology that I had to make myself successful. This was solely because of my frustration as a practicing doctor, which the first question ever anyone ever asked me when I got into social media is like, now that you're doing so well, you must want to quit medicine, right? Like you're probably out earning it. Yeah, but that's not why I do medicine. I work at a community health center.

• 59:53Speaker 03

  Most doctors that do really well on social media either leave medicine or maybe do concierge practice or, you know, celebrity practice or something. I work at a community health center where 50% of people don't have insurance. So that's been my goal and social media is just a tool to help me with that goal. And when I see negative comments, I view it as a threat to that goal.

• 1:00:15Steven Bartlett?

  Have you ever considered quitting social media?

• 1:00:19Steven Bartlett?

  Seriously?

• 1:00:20Speaker 03

  I pondered what life would be like.

• 1:00:24Speaker 03

  But I just viewed it as a negative all around, not just for me. I just view a social media as such an opportunity to help people. It's like me saying quitting medicine. I don't want to quit medicine. I want to be there for people. I want to be valuable and useful. I, in fact, I think about myself as like a more practical, useful person. And every strength that everyone has can also be their weakness. So sometimes I'm too practical and that impacts you as a friend, as a partner, as a family member. So sometimes being too practical is problematic, but because of my practical nature, I want to be useful to my patients.

• 1:01:02Steven Bartlett?

  So let's continue with this, um, this health related stuff. Supplements and vitamins. I wanted to get your take on that. There's a lot of, you've mentioned supplements and a few times in this conversation. Is that part of the gray area? Is that snake oil? What's your POV on supplements?

• 1:01:21Speaker 03

  I want to say like one sentence that is all encompassing and answers all those questions. But it's really hard because there's just so much nuance with it.

• 1:01:30Speaker 03

  Vitamins. We can't live without them. We need them. Supplements, supplemental vitamins are not necessarily the huge majority of the time and are often sold by people who are preying on insecurities, promising shortcuts.

• 1:01:49Speaker 03

  And honestly, people trying to get wealthy.

• 1:01:52Speaker 03

  The evidence for almost all supplements, unless you have a very specific reason for needing to take them, is missing. And what I've learned at, through my 10 years of being a physician and

• 1:02:08Speaker 03

  The hundreds of years of practice of medicine, unless we're certain of some benefit, introducing new things, distracting people from things that work, is not a good solution.

• 1:02:22Steven Bartlett?

  Is the harm of supplements that they don't actually work? Again, with supplements is a broad word.

• 1:02:27Speaker 03

  Of course.

• 1:02:27Steven Bartlett?

  Probably have to be. Is it the harm that they don't work? Or is, are you saying that we should be getting all of the things that we're supplementing from our natural diet anyway? Or are you saying both?

• 1:02:37Speaker 03

  Yes, and you can get all of your nutrients, again, unless you have a specific medical condition from foods. Two, they will make you skip out on doing things that are healthy for you because you think you can take a shortcut. Three, you're spending your limited healthcare budget that many people have a very limited healthcare budget on things that are very expensive, making a lot of promises. And the thing that I'm most worried about is when we enter the space of people saying you need supplements and not true medical treatments for conditions that bother them or that affect them.

• 1:03:16Steven Bartlett?

  If I'm someone that maybe, I'm not talking about myself here, but if I'm someone that has a very, very limited diet just because of my lifestyle choices, whatever.

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• 1:03:52Steven Bartlett?

  Would you recommend that individual to take a multivitamin supplement?

• 1:03:55Speaker 03

  I probably wouldn't. But if they did, I wouldn't discourage them.

• 1:04:00Steven Bartlett?

  Do they work? That's what I'm trying to figure out.

• 1:04:01Speaker 03

  And then the other point that I didn't mention is that there's harm. Like you said, everything has trade offs. There's no such thing as no side effects. So supplements have side effects. They have interactions with medications. They can create health conditions. The term antioxidants. Antioxidants are generally healthy. You know, B vitamins are traditionally labeled as healthy. You have too many of them. We notice that they become pro-inflammatory.

• 1:04:31Speaker 03

  But no one talks about that because you can't really sell that. So what instead gets talked about is the promise of what they could do. But there's harms that come from taking supplements, especially in our world where, you know, consumer labs and consumer ports goes and pulls supplements off the shelves to find out that they don't have the ingredients that are listed in them because they're not regulated by the Food and Drug Administration. They have some ingredients at five to 10x what's on the label, like vitamin A, which is a fat soluble vitamin, and can actually be really harmful. So they're not regulated. They can cause potential harm. Their benefit, unless very clearly indicated, is in the air and not proven. Why recommend them? Why sell them?

• 1:05:18Speaker 03

  And I say this as someone who can make a fortune.

• 1:05:22Speaker 03

  I mean, you said yourself, 12 million subscribers. You know, I take a little boxing selfie fit and say, the reason I'm this fit is because I take whatever thing I bottled up in my house, put into those pills, whatever powder I want. No one checks it, and I could sell it and become a multimillionaire. Is that true that no one checks it? No one checks it. No one checks this? No one checks it. These supplements? No.

• 1:05:49Speaker 03

  Like, right now, we could bottle up on the table our miracle formula. We can call it a miracle formula. Yeah. As long as we don't make a claim that it treats a specific medical condition that requires the treatment of a medical doctor. Okay. And I just put buzzwords on it. So instead of saying, "This helps your depression," I just say, "depression, immunity, support." Just buzzwords. Feel good. Feel good. Happy. Happy, natural, simple, from the earth. We could sell it. How much? We don't have to get anything cleared by anybody. How much you think we'd make?

• 1:06:25Speaker 03

  Too much money. And that's why it's like, man, I understand why people do it. And there is the notion that they could potentially work. There's always like a little bit of evidence coming out that something is there. We're just gonna cut to an ad break for Miracle Mood, which is on.

• 1:06:42Speaker 03

  It's so tempting. I get it. And I get, there's also, I don't want to label everyone with a broad brush and say they're evil and just trying to make money. Some people do believe that they work. They want the belief that this is what ails us as a society. And I wish that was true. I wish it was as simple as giving people some supplements or that eating eight almonds a day will extend your life by 10 years. I wish that was the case.

• 1:07:08Steven Bartlett?

  The subject around gut microbiome is something that I've talked about a lot on this podcast because I've just had a lot of experts talking to me about the subject. And something that I didn't even know existed three years ago. I didn't realize there was loads of bugs in my belly.

• 1:07:20Steven Bartlett?

  There are prebiotics, probiotics, all of these things coming out now for, to enhance the, what do they call it? It's not gut flora, is it?

• 1:07:27Speaker 03

  Microbiota encompasses all of it.

• 1:07:29Steven Bartlett?

  Is there truth that prebiotics and probiotics are useful for?

• 1:07:32Speaker 03

  Well, there's truth in the fact that we have all of these living organisms inside of us. There is a very strong interconnectedness between how we feel, disease conditions, and what species of those bugs exist in us, the counts by which they exist. That people who generally eat specific foods that are rich in them may have better health outcomes than those who don't. But manipulating those bugs has not been proven or clear in the majority of ways that people promise they do. Like, we know consuming fiber correlates with better health, less negative health outcomes.

• 1:08:15Speaker 03

  Do we know that taking a prebiotic supplement does the same? We don't know. Do we know that having specific bacteria in the gut gets destroyed if you have a health condition? We do know that. But does that mean reestablishing it by taking it in a pill will fix that condition? We don't know that. But people will make that jump and say, no big deal, we're trying to help. But to me, it's a big deal because we're promising something that we're uncertain of without even some good evidence for it. There's very few conditions that probiotics can actually help with.

• 1:08:50Steven Bartlett?

  What advice would you give someone that comes into your practice and you identify that they have some kind of gut-related, gut-microbiome-related issue? Is there anything that you would recommend that they do to improve their gut microbiome?

• 1:09:01Speaker 03

  Well, it would be focusing on foods that are considered healthy for the microbiome, so foods that are rich in fiber, plants essentially, avoiding bad habits, poor-quality sleep, over-drinking alcohol, smoking, all those things are unhealthy. The thing that makes health advice so boring is that the things that grandma told us still is what I say in my office. And it's not sexy and it puts people to sleep, but it's true. That's what we know works. We don't have a perfect answer as to why. And right now, there's like tests on the market to check your microbiome, to know what food, too preliminary to recommend.

• 1:09:42Speaker 03

  We don't know what to do with the information. The promises that they make don't hold up when we look at it long-term. Genetic tests, potential is there for a lot of value. Most of them are very preliminary unless you're working with a geneticist on a very specific condition. So I think the hype oftentimes speeds up the selling of the products before the evidence is there. It outpaces the evidence. And in some instances, medicine does that too, like traditional medicine, but it does that with some thought in mind. For example, if we create an emergency use authorization, or if we allow someone to have a treatment

• 1:10:24Speaker 03

  exemption for something that is not proven, for a disease that's already lethal, that they're gonna lose their life anyway, or if we don't act now, we're gonna lose so many lives in the moment, then yeah, there might be instances where we can speed up the process of certain things. We can create some shortcuts because we're taking that trade-off that's thought about. But with a lot of these products, they come and go, and there's just so much misinformation around them. You know, like one of the big individuals that does this in this space, and hate to single out, but it's just been such a voice in this community, is Gary Brekka. You know, I talked about him on my show.

• 1:11:07Steven Bartlett?

  Have you spoke to him?

• 1:11:08Speaker 03

  No, and seems like a really good person. Seems very passionate about what he's talking about.

• 1:11:16Speaker 03

  But the promises that are being made are not proven. And the intention may be good. And good intentions can have bad outcomes. But if the information is not accurate, no matter how passionate you are about the subject, long term, it's going to have negative outcomes.

• 1:11:35Steven Bartlett?

  When you use the word proven there, do you mean that there's not a significant or a reliable sort of basis of research that's been done yet to validate the hypotheses or the statements? Or you're not saying that it's been disproven? It just hasn't been proven?

• 1:11:55Speaker 03

  Yeah, so that's a good point to bring up. The things that I say that are inaccurate largely have not been disproven. Because if I say the juice inside this cup will help you live forever, would you say that's true or not?

• 1:12:13Steven Bartlett?

  My theory would be that that's not true.

• 1:12:14Speaker 03

  Right, but can you disprove it?

• 1:12:16Steven Bartlett?

  No.

• 1:12:16Speaker 03

  You would have to run a study to disprove it.

• 1:12:18Steven Bartlett?

  Yeah.

• 1:12:19Speaker 03

  And that's how I function as a doctor. So I can't disprove what he's saying because then I would have to run my own study. But based on what we do know, based on, remember how I said at the beginning, when a new study comes out, I try and bring it to the established information that we have. It doesn't vibe with what we know to be true. If you want to go against public health standards from what we've established as science, you better have a good reason for doing it. And if you do, I'm all ears. I'm excited for that kind of stuff. If you have some breakthrough of why you disagree with the CDC, with the WHO, with Harvard Health, please tell me why you disagree. But if you disagree because you said so, that's where things get problematic.

• 1:13:04Speaker 03

  Like, I'll give you the simplest of examples. There's a very famous clip that I reacted to on my podcast where Gary Brekka says, if you have headaches, it's because you're low on pink Himalayan sea salt.

• 1:13:19Speaker 03

  How many reasons do you think people get headaches?

• 1:13:23Steven Bartlett?

  Many reasons.

• 1:13:24Speaker 03

  You're not even, you're not even a doctor, right?

• 1:13:26Steven Bartlett?

  No, I know, because my brother has, my brother has had chronic headaches since he was, since he was a kid.

• 1:13:29Speaker 03

  But just, you got a concussion, you have stress, you have a hormone issue, you have a tumor.

• 1:13:35Steven Bartlett?

  Yeah.

• 1:13:36Speaker 03

  There's so many. You have migraines, you have a neck cramp. The possibilities are endless, right? To have the confidence to say this is what you're missing.

• 1:13:50Speaker 03

  Everything else almost doesn't matter. The confidence is the misinformation. Like, notice every time you asked me a question today, it was either, I don't know, it depends, nuance, for who? It's almost annoying because I can never give a clear answer. But that's what science is. And that's actually why people have lost trust in science. Because we're not as confident as Gary Brekka when he talks about salt for headaches.

• 1:14:19Steven Bartlett?

  Sometimes you've been wrong, right?

• 1:14:20Speaker 03

  Of course.

• 1:14:21Steven Bartlett?

  And sometimes you've, I remember reading something where you said, I admit that I, I change. I've changed my mindset when presented with new information and I've explained why. I think when we, we think about doctors, this is the part I think that some people struggle with. Is if you look over the course of sort of 10, 20, 30, 40 years, some of the things we were told were healthy back then are no longer healthy. And new information comes about. I'm well aware that this is the scientific model, but I'm, I'm trying to present a counter, trying to present a counter argument.

• 1:14:47Speaker 03

  Put yourself in that shoe, in that seat, yeah.

• 1:14:49Steven Bartlett?

  How do we know who to trust when doctors say that they've been wrong and they've changed their mind on really critical things before? And even, you know, when we think about vaccine disinformation.

• 1:14:59Speaker 03

  Right.

• 1:15:00Steven Bartlett?

  A lot of the arguments you'll get from the right are that you said this and now look what happened, so we'll never trust you again. How do we navigate and know who to believe, even doctors, when doctors will say, information I gave you in the past was actually no longer true?

• 1:15:15Speaker 03

  You have to take. The hard route and do the work to find out why they said what they said then and why they're changing their mind now.

• 1:15:25Steven Bartlett?

  So I'll give you an example.

• 1:15:26Speaker 03

  Yep.

• 1:15:26Steven Bartlett?

  Actually, maybe this isn't a doctor, this is studies. I remember having a guest on my podcast that talked about, I think there was a bit of a crisis with depression drugs in the early years where they'd, because of the way that the tests had been done by the big pharmaceutical companies, the CEO of the pharmaceutical company knew that the depression drug did not work and had all of these side effects, but they pushed it through, even though the vast majority of the studies hadn't shown that the drug worked, they found one study that had, they pushed it through, got to market, loads of kids used it, and then I think a decade later, again, I'm paraphrasing here, I'll link what I'm talking about below, it was discovered that the CEO of that company knew it didn't work, but there was a study and research that got it to market and people started using it, and I think Johann Hari, who's been on my podcast before, he was the

• 1:16:09Steven Bartlett?

  Zempec episode we released, he was one of the people as a young man that started taking that depression drug, only to find out that five, six years, seven, eight years later, it didn't work, and the CEO knew that it wasn't really working. So that was the, that was trust in the medical system, that was trust in research, that was trust in Big Pharma. Much of the counter movement we're seeing now is we think Big Pharma is corrupt, and we think they're meddling with doctors to get drugs into market that maybe don't work.

• 1:16:43Speaker 03

  There's a lot of drugs on the market, agree?

• 1:16:46Steven Bartlett?

  Yeah.

• 1:16:49Speaker 03

  If science is so problematic and we shouldn't trust for all those reasons, why is it the one example that we're stretching to find of the mistake that was happened or the fraud that happened with this one drug? We're talking about something that happened decades ago. It does happen, fraud happens. It happens in healthcare, it happens with policing, it happens with politicians, there is fraud. But pointing to that one episode and saying we should throw the whole field away is going to cause a loss for us. And there are issues with pharma, there's huge issues with pharma. I frequently talk about, even from like the pricing standpoint of pharma, how problematic they are.

• 1:17:32Speaker 03

  We've seen the issues with the opioid epidemic, how that was driven largely by pharma.

• 1:17:39Speaker 03

  But we're calling them out. The beauty of Western medicine of what we do here is that we are the best at calling ourselves out on our failures. But actually, the more we call ourselves out on our failures, the more trust we've lost. And in fact, when someone owes up to their failures and seeks to learn from them and seeks to make change, that's the person you want to follow. The person who is not confident, who is open to be transparent, who explains why these things are happening without 100% confidence, that's the people that are giving you advice that's true.

• 1:18:19Speaker 03

  The same way that we said earlier that everything was all natural does not mean it's all good. Everything for profit is not necessarily evil. My YouTube channel is for profit. I make a very healthy living doing what I'm doing. Doesn't mean it's evil. So while it's easy to make shortcuts and overgeneralize, we have to talk about specific instances and call balls and strikes as they are. Umpires make mistakes. Healthcare industry has made mistakes. There's been vaccine incidents in the past that have hurt people. We've learned from them. We called it out. We've studied it. We are... There are doctors constantly studying where we need to do better. This is ongoing at all times.

• 1:19:04Speaker 03

  And the ironic part is, most people have no idea that it's happening because we only find out about it on issues we're passionate about. I recently did a video, or I was on a podcast, where I was asked about birth control. I gave a very simple answer. It was non-motivated in any way. It was just kind of presenting the information as it was. And there were a lot of very mean comments in that information about how birth control can potentially be harming people, that I don't believe the negative side effects that can come with it, all these statements that were being made. And I found them to not be true. I had to do like a little soul searching to see if they were true because I do that with all the negative comments. And I said, no, birth control can have side effects, just like with any medication.

• 1:19:50Speaker 03

  The reason why birth control maybe is being brought up is because this is a topic people are very passionate about. This is a topic where doctors have discriminated in the past about. So it's a bit more triggering to the emotional part of our brains. But if we look at what's leading hospitalizations from a drug in the United States, Tylenol. You don't see anyone uproar making YouTube videos that Tylenol is problematic.

• 1:20:17Steven Bartlett?

  What is Tylenol?

• 1:20:18Speaker 03

  Acetamidafin, paracetamol for you.

• 1:20:19Steven Bartlett?

  Oh, paracetamol, yeah.

• 1:20:22Speaker 03

  The amount of hospitalizations for Tylenol-induced liver failure is sky high. I'm sure we could pop up the statistics on screen. But no one gets upset about Tylenol because it's not emotionally triggering. And that is true for all of healthcare. There are side effects to taking medications. So it's easy to only focus on one part of that equation and say, well, doctors used to say this. What about this? Why did doctors say it? What got them to say it there? And the idea of us getting it perfect? Never going to be true. We're always working with incomplete information. All of medicine is just our best guess.

• 1:21:01Steven Bartlett?

  What about these animal studies? A lot of the research that's presented from experts is from animal studies, rats and things like that.

• 1:21:06Speaker 03

  Yes, that's where people like to skip steps. The amount, so pharma is out for money, right? That's fair to say. That's their job. They're trying to create a return for their stockholders. They try and pick research to do that hopefully will drive the best profits. 99% of the stuff that they start researching on from the initial promise of animal studies, 99% of it fails. And they're only picking the top. Then you go one step further. Once it works in animal studies in petri dishes and then it goes into human trials, another 99% of it fails. So the idea that something has mechanistic value, then works in a petri dish, then it works in an animal model, for it to make all those steps

• 1:21:50Speaker 03

  is so astronomically rare that it ends up working for the general population. The fact is that we shouldn't jump to from animal model to human because 99% of that is going to fail.

• 1:22:05Steven Bartlett?

  So what are we saying then? Do we have to go back to just living like our ancestors lived? And because you said earlier on that the world we live in has never been more unnatural. So is the antidote for all of this stuff we're talking about, is it to go back to being human and like we always say our ancestors were?

• 1:22:23Speaker 03

  Well, I think what we need to look at is the evolution of humans and the anthropology aspect of it, because we can then better understand ourselves now and why we're having problems with this unnatural world, right? So if you look at why anxiety was a survival benefit to us back then versus how it could be very problematic to us now in a safer world, studying prehistoric caveman humans would be beneficial. But drawing conclusions from their diets and potentially what they ate, oh man, you're going to get into so many fallacies and biases that the information is not going to be great and not very applicable.

• 1:23:04Steven Bartlett?

  If you could redesign society in such a way that it would be, in your mind, more healthier, more healthier for the average human, you had to start from zero. So you're president of the United States, Trump doesn't get it, Biden doesn't get it, Dr. Mike gets it. And you could really rewire society. What are some of the sort of macro top line changes you would make? Okay, I'm taking, I'm going to keep everything on the table.

• 1:23:28Speaker 03

  The first thing that I would do, and this is echoing one of the authors and experts I really enjoy listening to, and he's actually coming on my podcast soon, Jonathan Haidt, I would get phones out of schools. I think that, much in the same way that we regulate addictive substances like cigarettes, like vaping, like alcohol, to those of age, we need to start thinking about that for social media.

• 1:23:58Speaker 03

  And that's an unpopular thing to say. But I think if you really look at it, there's a lot of problems that can come from it. Very limited benefit for someone who's 13 to be looking at those images. So I think some major changes need to be made in schools.

• 1:24:17Steven Bartlett?

  You were voted in 2015.

• 1:24:19Speaker 03

  That's a long time ago. 10 years ago.

• 1:24:24Steven Bartlett?

  In 2015, you were named People Magazine's Sexiest Doctor Alive.

• 1:24:28Speaker 03

  I don't think I was voted. I think they just nominated me.

• 1:24:32Steven Bartlett?

  Well, it is something, right?

• 1:24:33Speaker 03

  Yeah.

• 1:24:34Steven Bartlett?

  It is what it is. Your relationships. What's your relationship status, if you're able to share it?

• 1:24:41Speaker 03

  Relationships have been really tricky. As a medical provider, you have to carry yourself with an air of professionalism. You have to make people feel comfortable in talking to you about very sensitive subjects. So I've been very careful to balance the world of showing my personal life to some degree and showing people and reminding them that I'm human. I too have relationships. I too play sports. I have a family. I have dogs. But also not do it so much that it actually can cause harm in my clinical interactions. So initially, when I started social media, I was very open about my relationships,

• 1:25:25Speaker 03

  who I was dating, what my relationship status was. And I thought that, I was under the firm belief that there is no way this could be detrimental. And much in the same way that I thought that reading every negative comment can only be helpful, boy, was I proven wrong. Not only does it cause harm to potentially the clinical interactions, it can cause harm with my audience online. Not dating patients, that's not what I mean.

• 1:25:49Steven Bartlett?

  No, no, just the clinical interactions piece.

• 1:25:51Speaker 03

  Well, like, you know, if a patient is wondering who you're dating or what you're dating, that's going to derail the conversation away from health.

• 1:25:59Steven Bartlett?

  Okay.

• 1:26:00Speaker 03

  The same way that it would derail the conversation from social media, from people listening to medical talking points to then talking about personal life. So before, while I was being very open with it, now I've kind of said my personal life to some degrees, my personal life. When I begin sharing, everyone will know about it because it'll be everywhere. But now I tend to become a little bit more, I have some things from my personal life, but the majority of it is an open book.

• 1:26:26Steven Bartlett?

  I was curious about your relationship status because as someone who's so busy and a content creator and going through all of the things we described earlier with your mental health and the feedback and all of that.

• 1:26:36Speaker 03

  Sure.

• 1:26:36Steven Bartlett?

  How you manage to be successful in that realm as well?

• 1:26:42Speaker 03

  Yeah, so like in, in doing what I do, I, I feel like I'm very busy because I'm involved in so many different things. But I feel like everyone's busy. You know, you, you make time for what you're passionate about. So there was a period of time I was single for a few years, then I got into relationships, I got out of relationships. And it really is, if you meet the right person and you want to dedicate your time to them, you'll sacrifice something. You know, before I used to be all about watching sports. Like that was my nighttime routine. Now I can't even tell you the last time I watched a sporting event. I've just been so busy, like maybe the Ryan Garcia fight, boxing match. But I don't, I don't have the time for it because I've made sacrifices to do other things I'm

• 1:27:23Speaker 03

  passionate about. And I think if your partner consistently, I think there's something I said before, that if your partner consistently says they don't have time, no matter how busy they are, you need to do a little evaluation and see is, is that something that they truly want? Or at least bring up that conversation.

• 1:27:41Steven Bartlett?

  You're someone that strikes me as being quite philosophical and deep thinking in their downtime and probably spends a lot of time thinking about bigger questions about life, meaning, purpose, and all of those things. Is that A, accurate? And B?

• 1:27:58Steven Bartlett?

  What are those big things that you're considering in your mind?

• 1:28:03Speaker 03

  It's accurate, but not big picture, big philosophical questions. It's more, I'm deep thinking from an introspective standpoint of running back every day. What could I have done better? What can I improve on? What should I think about for the future? How can I grow from today? So I spend a lot of time doing that. And that's not something I taught myself to do when I was a kid. I remember this very vividly in high school, age 13, being very awkward freshman year of high school, talking to girls in my class and then coming home and sleeping in my bed. And I'm going to sleep thinking, oh, my God, what should I have said to look cool?

• 1:28:46Speaker 03

  Maybe I should have just stayed quiet like those cool guys in the movies and playing back those scenarios throughout the day. And while that was silly when I was 13, now, as a doctor, I play back my patient encounters and think about what I could do better in that communication sense. I play back my podcast interviews in my head and think about what I could do better. So I'm constantly thinking about that. And again, not by choice, it's just kind of happening in my mind.

• 1:29:13Steven Bartlett?

  And that's where the anxiety stems from, I guess.

• 1:29:16Speaker 03

  The anxiety can creep up there if you feel like you're not improving or your progress is stagnating. Like the idea that I told you I wasn't exercising a lot, I start ruminating and thinking, oh, my God, you haven't been exercising in so long. Now you're gonna not be healthy. What if people online start thinking that, oh, that's not a healthy thing to do? And you could start catastrophizing very easy. This is what our human minds do. And that's why CBT, cognitive behavioral therapy, one of the more popular forms of evidence-based therapy, is taking those cognitive distortions, those catastrophized, black or white labeling thoughts, and just talking back to them, saying, how true is that? That if you had all As on your tests and then you got one C, that you're a failure?

• 1:30:01Speaker 03

  How true is it that if you don't exercise for three months, that means you're an out of shape slob? And you have to talk back to them. So doctors are not immune to cognitive distortions.

• 1:30:11Steven Bartlett?

  I always wondered with doctors, when you're dealing with like people's health and their outcomes, which sometimes are positive and are sometimes not positive, how that can... Sit on your shoulders and how you can take that home with you because you must deal with a lot of people that are no longer here.

• 1:30:26Speaker 03

  Yeah, for sure. Especially when I would be a resident working in the ICU where an intensive care unit, patients are the sickest, so more likely for them to lose their lives. You're having conversations with family members about discontinuing CPR, about signing certain papers to say that we're not going to give more medical care. We're only going to focus on comfort as opposed to treatment. And those conversations are not easy conversations. And the way that I have approached them is with unbiased truth. Just here's what I know. I want you to know what I know. I'm explaining to you why I think what I think. Now you tell me what you'd like to do. And ultimately, it gives patients

• 1:31:10Speaker 03

  a sense of responsibility in a good way, where it empowers them or empowers their family members to make the right choice. And the right choice is not clear. Two people can make different choices and they both be right choices. Same thing with healthcare, like healthcare is as much art as it is a science. So two doctors can see the same patient and recommend two different treatments and not be wrong.

• 1:31:34Steven Bartlett?

  Was there a hardest day? When you think back over your medical career, was there a hardest day in your practice?

• 1:31:42Speaker 03

  No, nothing that specifically jumps out. I think it's how it wears on you from a perspective of just length of the amount of administrative work you have to do, the amount of time you want to spend with the patient versus what you're given. The ability of helplessness, where you can't fully help a patient, no matter how much you want to. When you know if a patient does a specific treatment, you know they'll get better, but they're not interested in it or are being deceived or influenced in a way where they're not going down the right path. Those really, really drain me because I think about those at night of how can I be more effective so I can help my patient come to the right conclusion?

• 1:32:27Speaker 03

  Or at least help them make a decision that is actively not detrimental to their health?

• 1:32:32Steven Bartlett?

  Your mission at the moment to really help to myth bust and call out disinformation as it relates to health care and advice, is that driven in part because as a doctor, you're seeing the consequences firsthand of information your patients are bringing to you that is patently false or untrue or isn't quote unquote proven? And then you're basically arguing with them about that or something? Is that where it comes from?

• 1:32:57Speaker 03

  Yeah, that's why I started social media, because I was having a very similar conversation with the 30 patients that I saw in a day. And I was like, wow, I gotta tell the world this so they can all know this information so that they all don't fall victim to these scams where they think, doctor, I had a hundred dollars this month to spend on my health and I bought this thing. I bought these two smoothies and I thought this is the answer. This is gonna help me, right? This says it helps with cancer and it's, that's not the answer. And in having those conversations over and over again, it's what drove the passion to being on social media. And now I think about medicine differently than I did when I first started. I used to think medicine is doctor and patient.

• 1:33:38Speaker 03

  Now I view it more in a public health sense where my impact on social media goes so much further than patient interactions or viewer interactions, where now I can influence policy. Had a medical emergency on a flight and they made that call, is there a doctor on board? And I was faced with the moment like, okay, do I volunteer? Do I just stay quiet? I don't know what to do, but I volunteered. And it turned out after some investigation that a young gentleman was going into anaphylactic shock. His throat was closing up due to an allergy. And I wasn't worried. I said, where's your EpiPen? And he said, I don't have one. I didn't even know I had this allergy. So I asked the pilot, can we land? Pilot says, well, it's an hour and a half back to Canada and an hour to Portugal, some island in Portugal. That's not enough time. His throat's closing.

• 1:34:23Speaker 03

  He's gonna die in five minutes. So I'm like, what can I do? So I opened the plane's emergency kit, thinking there's going to be some epinephrine in there or an EpiPen, and there's no EpiPen. And I'm like, okay, what do I do now? There's no internet when you're over the Atlantic Ocean, so there's nothing to Google. But I'm finding that there is epinephrine, which is the same medicine that is found in an EpiPen, in a different formulation, in a different dosage for a cardiac arrest. So when someone's heart stops, we also give the same medicine, if they're flatlined, if they have a specific rhythm, to try and restart the heart. So it's a much thicker needle, much longer, not those cute little EpiPen needles that just go into the side of your thigh. And I said, okay, well, I need to do some rough calculations here and just guesstimate here, because otherwise, he's going to lose his

• 1:35:08Speaker 03

  life. And right there in the first-class cabin, we take off his pants, we inject them with this huge needle, he's screaming, there's like a little bit of blood coming out, I inject the medicine, I'm praying that it's working. And fast forward that story, I stayed with him for eight hours for the rest of that flight until he landed, we didn't need to divert, I checked his blood pressure and pulse every 15 to 30 minutes, and we saved his life. And you think that would be the end of it? You're like, look at that, I did my doctor job, and that's it. But I went and told that story on YouTube, got almost 10 million views, if not more now, I don't know what it's at. And the Senate Majority Leader Chuck Schumer calls from his office, or his office calls, and says, hey, I'd like

• 1:35:53Speaker 03

  to get EpiPens on planes. Can you stand with us and tell us your story to the media? Yes. We tell the story, we call on the FAA to make these changes. And now, 70% of planes, I don't know what the exact number is, but something like 70% of planes have EpiPens on board, where that will never have to happen again.

• 1:36:13Steven Bartlett?

  That's incredible.

• 1:36:14Speaker 03

  And that's the power of social media that people don't talk about. That's public health. That's helping people that aren't even needing to help yet. So that's the kind of medicine I like to think about now.

• 1:36:25Steven Bartlett?

  Well, you have a half a body lying over there in the corner. So in the sake of helping people using social media, I asked you if you could bring a, I don't even know what to call that, it looks like a half a mannequin or something.

• 1:36:37Speaker 03

  Yeah, it's a mannequin, yeah.

• 1:36:37Steven Bartlett?

  It's a mannequin. Because early in my life, I got told that learning the skill of CPR Is one of the sort of simplest, potentially lifesaving things that I could learn.

• 1:36:47Speaker 03

  Yeah.

• 1:36:48Steven Bartlett?

  Because you never know.

• 1:36:49Speaker 03

  Yeah.

• 1:36:49Steven Bartlett?

  And I've got people in my family that die of various cardiovascular related conditions, heart attacks and things like that. And so I would love to learn. Again, this is probably not official certification.

• 1:37:01Speaker 03

  This is not official certification.

• 1:37:02Steven Bartlett?

  To learn the basics of CPR.

• 1:37:04Speaker 03

  Yeah.

• 1:37:04Steven Bartlett?

  And how to keep someone alive in such a situation. And could Jack, could you bring the, what should we call him? We'll call him Half Mike.

• 1:37:12Speaker 03

  Yeah, we'll call him Baby Mike.

• 1:37:17Speaker 03

  So I'm curious, before we do any kind of instruction on it, what do you know thus far about CPR? And all wrong answers are acceptable here.

• 1:37:26Steven Bartlett?

  You push on the chest, roughly around the top of the rib cage. And then you blow into the mouth and you just do that over and over again until they come back to life.

• 1:37:35Speaker 03

  Okay. Do you know what the reason of doing CPR is?

• 1:37:40Steven Bartlett?

  Hmm, that's a very good question.

• 1:37:41Speaker 03

  And it's not a trick question.

• 1:37:42Steven Bartlett?

  No, no, no.

• 1:37:43Speaker 03

  I'm just genuinely curious because I like to know where we're starting from. And no one knows this, by the way, this is why I do what I do. So this is not.

• 1:37:50Steven Bartlett?

  It's something to do with keeping oxygen flowing around the body through the blood.

• 1:37:54Speaker 03

  You're right on target.

• 1:37:56Steven Bartlett?

  Okay.

• 1:37:56Speaker 03

  So the purpose of CPR is if you find someone who's unconscious, not breathing, is pulseless, that means their heart's not beating. That means clinically, they're dead. So anything you do here can only potentially help, can't hurt, right? Because the person's already dead. So by doing proper CPR, what you're doing is you're compressing the chest, chest compressions, to squeeze the heart, which has some blood in it, to circulate the blood throughout the body that still has some residual oxygen in it, to deliver oxygen to the vital organs. So you're not actually saving someone's life by doing CPR, you're buying them time.

• 1:38:37Speaker 03

  The purpose of doing CPR is to allow time for first responders to arrive to then give advanced cardiac life support.

• 1:38:46Steven Bartlett?

  Oh, okay.

• 1:38:47Speaker 03

  And that's why the first step of doing CPR has nothing to do with the person and has everything to do with calling for help.

• 1:38:56Steven Bartlett?

  Okay, so I called the first responders.

• 1:39:00Speaker 03

  Or, because that would, so ideally, you'd never want to do anything that will distract you from starting chest compressions, because the faster you can get to doing chest compressions, the better your outcomes.

• 1:39:10Steven Bartlett?

  So I tell someone else to call?

• 1:39:12Speaker 03

  Ideally. If you're alone, obviously, that's not happening. But you can't just say out into the open, "Hey, someone call 911." Because what happens, everyone assumes the other person calls, no one calls. This happened with many medical emergencies, and it's terrible when it happens. There's actually criminal cases about that. Someone's screaming for help, and everyone assuming the other neighbor would call, and then no one ends up calling. So you have to say, "Hey, you in the blue shirt, you in the pink hat, you call 911." And they will call 911, and you immediately start pushing hard and fast in the center of the chest, one hand on top of the other.

• 1:39:47Steven Bartlett?

  When you say center of the chest, you mean in between the pecs?

• 1:39:50Speaker 03

  Correct.

• 1:39:51Steven Bartlett?

  Okay, so right in between the pecs, one hand on top of the other.

• 1:39:53Speaker 03

  On top of the other.

• 1:39:54Steven Bartlett?

  And what if I break a rib?

• 1:39:55Speaker 03

  And then full body, doesn't, person's dead.

• 1:39:56Steven Bartlett?

  So I can go as hard as I want to go?

• 1:39:59Speaker 03

  You want to go two inches deep, which means pretty hard, because in order to compress the heart, you need to go two inches deep. And two inches deep is pretty, five centimeters deep. So one hand on top of the other, pushing hard and fast in the center of the chest, in between the pecs, and you're doing that until help arrives. Okay, so you see how you're, much like most people who are in really good shape, you're using your triceps?

• 1:40:24Steven Bartlett?

  Yes.

• 1:40:25Speaker 03

  Try doing that for more than two minutes. You will fade, no matter what good shape you're in. In fact, when we're in the hospitals, the way that we do this is maximum two minutes at a time. And then we tap out and get the next person in because it's so tiring. The way to max, full body weight, correct. And you hear the click, that means you're doing it to the correct depth. And that way you will get less tired and you'll be able to do that for longer periods of time.

• 1:40:52Steven Bartlett?

  So that click means I'm hitting the heart?

• 1:40:54Speaker 03

  For this little device, yes.

• 1:40:56Steven Bartlett?

  I had to go down a long way, I had to go down so far that I would never have naturally done that to somebody. I would have thought that I was going to do more damage.

• 1:41:02Speaker 03

  Correct. And because of that fear that people have, we unfortunately have worse outcomes with people who have cardiac arrest in the field. And in fact, most cardiac arrests, meaning heart stopping, happen not in hospital settings. They happen in community settings, they happen on the street, at dinners with our loved ones. And the important point to remember here, this isn't what you do for someone who's talking and is having a heart attack. This is for cardiac arrest. They're not talking, they're not moving, they're not breathing. Because if they're talking, that means they have a pulse. Because I've seen in some videos online, like someone's trying to talk or moving around and people are doing chest compression. I'm like, no, stop, please do chest compression.

• 1:41:44Speaker 03

  But if they're pulseless, if they're not breathing, they're unconscious, start hands only CPR after calling for help.

• 1:41:49Steven Bartlett?

  I can't, I really want to emphasize how hard I had to push down then. It wasn't just like pushing on the surface. I had to put all my weight and shove down on the chest.

• 1:41:58Speaker 03

  And you know that insecurity about the amount of pressure that you were talking about? There is even worse outcomes for women who have a cardiac arrest because people are afraid of pushing in between breasts.

• 1:42:11Speaker 03

  If the person's life can be saved when first responders arrive because you bought them time, do it. It's not fair that women are less likely to receive CPR from bystanders because of their bodies.

• 1:42:24Steven Bartlett?

  I thought, because I think, again, because I've watched so many movies, that when you start doing the CPR, the person comes back to life.

• 1:42:30Speaker 03

  It can happen.

• 1:42:31Steven Bartlett?

  Okay, because I thought that's what you were doing. I thought you were like bringing them back to life.

• 1:42:35Speaker 03

  That's what, that's the notion that some people have. And that's why I wanted to make sure that you're not actually bringing them back to life. You're buying them time and circulating the residual oxygen so that help can arrive to try and restart the heart.

• 1:42:48Steven Bartlett?

  How long do you have to do, what's the longest you've had to do CPR on someone for and then they've ended up surviving?

• 1:42:55Speaker 03

  I've been in double digits before for young patients. Because young patients, we will, like, if you have a patient who's elderly, who's in the ICU, who's already very sick, when their heart stops, the odds are that you'll bring them back are obviously very low. But even if you will bring them back to life, they're going to be in a worse quality of life than they already were. So many times, we actually have a conversation as the CPR is ongoing with the families, explaining that, and saying that this is not beneficial, that even if we bring them back, they might be in a worse state, and that we don't recommend it. We actually have scores and guidelines that we can discuss with patients about statistics on this.

• 1:43:40Speaker 03

  But when someone's very young, let's say you have a 20-year-old who has an unusual cardiac arrest, we would fight much longer because they have an opportunity to heal once we bring them back. So it's very dependent on a specific situation.

• 1:43:55Steven Bartlett?

  And you had to have that exact same conversation when someone was treating your mother?

• 1:44:01Speaker 03

  Yep, that is the conversation. That was my first interaction with that kind of environment. I actually remember when I was in the room and the alarms were going off and the residents or the doctors were doing CPR, and I called it off. I remember the next time I heard those alarms was during my training in a patient simulation lab. And that was like the first moment I ever had a flashback, where a sound brought back a feeling, where that sound of those alarms brought me back to how I felt and how uncomfortable I felt. I've never felt that before.

• 1:44:42Steven Bartlett?

  You must have heard that sound a lot since then.

• 1:44:44Speaker 03

  Oh, yeah. And I've had some difficult conversations with my fellow colleagues because of it. I remember very vividly when my mom passed away, we were in the waiting room, waiting for documentation forms to sign, and I came out to check and see if they're finishing up. And some of the nurses and doctors, I don't even know what medical professionals they were, they were kind of laughing in their little work area in the back, not where they were patient-facing. But hearing those laughs got me so angry. How could anyone laugh during a time like this? But then I had to remind myself, these are people too. These are people who are losing patience every day. And if they took the loss the way that I'm taking this loss, they wouldn't last.

• 1:45:27Speaker 03

  They wouldn't be able to help my mom or other moms. So I had to remind myself about that. But well, my takeaway from it was when I saw co-residents of mine, maybe writing their notes after someone's family passed away, and I see the family in earshot, and they're talking about their day, or they're laughing, or they're giggling, or saying some kind of joke, not related to the situation. I just, I don't correct them. That's not my place to do. I just share my story of how I felt. And I thought it created a really good learning opportunity.

• 1:46:00Steven Bartlett?

  Dr. Mike, we have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for.

• 1:46:05Speaker 03

  Who?

• 1:46:07Steven Bartlett?

  If you could go back to a pivotal moment in your life and make a different decision, what would that moment be and why?

• 1:46:18Speaker 03

  I think about the social isolation and loneliness that you described, that I felt when I lost my mom, and how I isolated myself from my classmates. To this day, out of 300 students in my class or so, I didn't make a lot of friends, in fact, any friends. And I was not involved. I was fully disconnected from my class. And I think it's because of what I was going through at that time. And I wish that I either reached out for support from the school or created conversations

• 1:47:02Speaker 03

  amongst my classmates, because the friendships that they've created have lasted to now. This is over a decade. People got married in those classes. They've created lifelong friends. And I feel like because I moved away and I was two hours away from the school, I wasn't a part of it. And I feel like that has significantly impacted the number of friendships I carry to this day, that the friends that I do have are my close friends from high school, maybe some from college, but almost none from medical school. And I feel like that's a really, really big missed opportunity.

• 1:47:41Steven Bartlett?

  Do you feel lonely?

• 1:47:43Speaker 03

  Yeah, sometimes, for sure.

• 1:47:47Speaker 03

  But I think that's a byproduct of society these days and my work adds to that as well.

• 1:47:56Steven Bartlett?

  Dr. Mike, thank you so much. Thank you for all of the work you do and the way you do it. You're the, one of the most accessible voices on the internet as it relates to medical information. And I say accessible intently because sometimes doctors can be a little bit exclusive. They're too smart and they don't really let us in. But I think you're both confronting disinformation in a really honest, fair, balanced way. But at the same time, you're providing information in such an accessible way. And you've drawn a tremendous audience to you across YouTube and your podcast and across your socials and everywhere else. And it's, there's no doubt in my mind that you've not just saving the lives in your practice every day, but you're saving hundreds of thousands of lives you'll never meet.

• 1:48:38Steven Bartlett?

  But also you're improving so many lives because you're helping us to navigate towards better information or a better way to think about the information we receive. And I'm on that journey too. I'm doing my very best to try and navigate that. And as someone that sits here with a lot of experts, which is your lowest criteria of like acceptable evidence, experts and medical practitioners, and I'm doing this two, three times a week sometimes, there's often conflicting information.

• 1:49:02Steven Bartlett?

  I always struggle with how to present that information because on one hand, you don't want to censor people because that assumes that I know what's right. But on the other hand, you feel a sense of responsibility that the platform you're creating is, is not doing any harm. And I think that's the first kind of principle of anyone that's trying to produce content is do no harm. So Mike, you're a prime example of someone that I see doing no harm and a lot of good in the world. So thank you so much.

• 1:49:23Speaker 03

  I very much appreciate you saying that. It means a lot. You know, a lot of days, me and my team, my small team will sit in front of the camera and talk and forget the implications and the outcomes that we can make in the world with the content that we make. So that's what continually drives us by reminders like what you just said. So I appreciate you saying that.

• 1:49:41Steven Bartlett?

  Please keep going. I know it's difficult some days and I know people do, are very vicious. I've been on the receiving end of that for much of my life. But I think you know that, I don't have to tell you this, but you know that the net impact of your mission is so unbelievable. It's so, you'll never see it. You'll never meet the people, the families, the father, the mother, the grandfather.

• 1:50:02Steven Bartlett?

  But I just wish you could because I think if you could see the net impact, it would put all of that stuff in perspective where it should be. So, Mike, thank you.

• 1:50:13Steven Bartlett?

  Thank you. Appreciate you having me on.

• 1:50:39Steven Bartlett?

  As a founder building a business when I was in my early twenties, I think I always had a deep sense of imposter syndrome because there was something that I wasn't good at. And that thing was finances. Finance and understanding your financial position as a small business is the great enabler of all of your dreams. I was running from it until I discovered a platform called Xero. Xero is an accounting and financial management platform specifically for small businesses. And it brings accounting, payments, payroll and analytics all into one place, even for people that don't love doing finances. Xero wants to do the financial work for you. But its core ambition is to go beyond keeping the financial record because Xero wants to help you understand what's happening in your business. And increasingly, and this is maybe the most important thing, is help you make decisions.

• 1:51:24Steven Bartlett?

  Finally, we have a partner who can enable us in a simple way for those people that are both left brain or right brain, and enable our dreams. You can learn more about Xero by going to xero.com. Thank you to Xero. Thank you for sponsoring this podcast, but also thank you for helping me to scale my business as somebody that, quite frankly, has never loved finances that much.

• 1:51:45Steven Bartlett?

  Running a small business can feel a lot like being alone at sea. And too often, you're not steering the ship yourself. You're getting dragged into need for all of the admin, things like offer letters, onboarding, wages, payroll, filing taxes and health insurance.

• 1:52:01Steven Bartlett?

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