Fasten your seat belts for an incredibly fast moving, wide-ranging, and deeply impactful show from Dr. Ron. This guy has fought a valiant battle against dated mainstream medical advice and in favor of a comprehensive ancestral approach emphasizing not just healthy, whole foods, but also choosing out of the flawed mindsets and hectic lifestyle behaviors that are on display in Silicon Valley like no other spot in America.

Yes, Dr. Ron works in the most affluent community in America. Tech workers make some bank for sure, but we are talking $1.3 million for a median home price in the Silicon Valley counties. The affluence comes at a cost with a hectic workplace, painful commutes, and consumerism traps. Indeed, Dr. Ron observes numerous associated problems: scarcity mindsets (someone around you always has more); excessive rumination, leading to anxiety and depression; and adults pushing this crappy stuff onto their kids with over pressurized parenting leading to troubled, overstressed teens.  

Dr. Ron works runs the corporate health division of the Palo Alto Medical Foundation. He develops onsite health/wellness services for major Silicon Valley companies like the tech giants you have heard of. He delivers lectures on assorted health topics and also gets to do initial consults with patients that last for an hour — he can really get deep into lifestyle modification tips that will keep them away from the doctor’s office.  

For the past decade, Dr. Ron has gained notoriety for fighting the valiant battle against conventional medical wisdom, particularly the widespread use of statins to address heart disease risk. Dr. Ron has succeeded wildly with dietary and lifestyle modification strategies, and communicated his approach to other physicians to inspire change. Dr. Ron is smiling now, and mainstream medicine has progressed over the last 10 years away from the flawed and dated notions about cholesterol, statins, and the proximate cause of heart disease.  

Years ago, Ron promoted the results of a UCLA metastudy revealing that 80 percent of heart attack victims had LDL cholesterol levels widely considered to be in the “safe” range. As most of us have awakened to by this point, heart disease risk is not as simple as monitoring ones’ total LDL number. If one is concerned about high LDL, it’s important to test for small, dense particles as these are the potentially problematic ones that are small and dense enough to lodge on the walls of your arteries. In contrast, the large, fluffy LDL particles are commonly harmless. Guess what? If you have high triglycerides (over 150), you likely have a small, dense LDL problem. Even if your total LDL is artificially lowered by statin drugs, you can still be at high risk of heart disease. Remember CNN anchor Tim Russert? He passed of a heart attack in his 50s despite a total cholesterol number in the low 100s! 

This is crazy talk if you compare to decades of conventional wisdom boilerplate: “Don’t eat fat or cholesterol, take statins if your total cholesterol is over 200 and then you will be fine.” Ron has bravely gone toe to toe with the establishment to convince other doctors that diet modification can reduce heart disease risk better than statins, and that statins can often compromise health and not address the biggest risk factors of heart disease. He, like Dr. Cate Shanahan and other evolutionary health leaders, favors tracking your triglycerides-to-HDL as the most relevant disease risk marker. It’s urgent to get 3:1 and optimal to get 1:1.  

Dr. Ron shared his strategies for affecting lasting dietary transformation and lifestyle change among his patients. First, patients have to get interested in their health. Ron finds that many are too busy trying to make money or push their kids really hard to excel in competitive modern life. Second, to motivate them accordingly, Dr. Ron finds that educating them about the why’s, and offering incentives and competition with clear metrics is an effective strategy. For example, he might challenge a patient to focus on an important blood value like triglycerides and lower it by 100 points by the next blood test date. Third, and this is pure genius, Ron adopts an Additive approach to diet, focusing on efforts to include healthy foods rather than grind on people to eliminate many of their favorites. Some of Ron’s patients have wailed that, “rice is my drug,” so he tells them to add more nuts and meat to their biryani dishes! Fourth, don’t ruminate! This leads to depression when ruminating about the past and anxiety when ruminating about the future.  

This show can get a little science-y but I urge you to play it slowly, repeat passages, and do whatever you need to do to fully understand the important insights and suggestions from Dr. Ron. The podcast is giving you the opportunity to get an hour-long private consult with one of the leading big picture health guides in the world. I am committed to getting Dr. Ron back on the show in the future, because we hit so many points so quickly that there is plenty of fodder for further focus. We have exchanged long thoughtful emails on the disturbing trend of helicopter parenting and over-pressurized youth experiences, and we get a bit of that going on the show. Hey parents, here is a both-parents-are-doctors family working hard to give their kids a balanced life and a healthy approach to education and sports goals. If they can get over themselves, so can we! 

TIMESTAMPS: 

Brad introduces Dr. Ron Sinha. [03:45] 

Dr. Sinha health of the Silicon Valley employees, as nice a place as it is, a hotbed of stress related illnesses as well as physical.  [07:11] 

The fast pace of life, the sedentary living, the high stress, it’s accelerating aging. [11:36]

So you have a strong genetic predisposition to how much and where you store fat. [14:17] 

You can see major transformations in metabolic health just going back two generations. [17:50] 

Technology has ruined the practice of medicine in so many ways. [20:04] 

The concept of preventative health has been fading, especially from the younger generation. [23:20] 

It affects your bottom line if your employees are healthy. [25:35] 

It’s very important to get REALLY interested in your health. {29:14] 

Motivation improves when patients can simplify their goals. [32:28] 

So many people are not aware of having any health problems.  [33:45] 

The metabolic syndrome is really the cornerstone of insulin resistance and heart disease. [36:54] 

There’s a lot of compelling data now around the fact that insulin resistance can get worse if you’re on a statin for a long enough period of time. [40:36] 

Your dietary changes can improve your numbers. [42:35] 

The ratio of triglycerides to HDL is a prominent indicator of heart health. [47:16]

What lifestyle and dietary changes can we make that has the most impact? [49:38] 

Raising insulin sensitivity is good; insulin resistance is bad. [53:46] 

Waist circumference is an indication that you are developing visceral fat.  [59:56] 

Kids are showing up in doctor’s offices with anxiety, depression. [01:06:52] 

Is your family bathing in screen light instead of sunlight? [01:09:02]

Rumination is kind of like pre anxiety or pre depression because it is a common thought process. [01:11:25] 

Parents send very subtle messages of which they aren’t aware. [01:14:41]

LINKS: 

• South Asian Health Solution 
• Dr. Sinha’s blog 
• The extent of human suffering [in silicon valley] is pretty intense 
• Rumination, depression, anxiety 

LISTEN:

Get Over Yourself Podcast

Brad: 00:00:08 Welcome to the get over yourself podcast. This is author and athlete, Brad Kearns, discovering ways to be healthy, fit and happy in hectic, high-stress, modern life. So let’s slow down and take a deep breath. Take a cold plunge and expertly balanced that competitive intensity with an appreciation of the journey. That’s the theme of the show. Here we go.

Brad: 00:02:30 [00:03:45] What a treat you’ re in for an opportunity to engage with one of the most progressive and forward thinking physicians on the planet. Dr Ron Sinha Huh? We go back a long time. We published his book, the South Asian Health Solution, which is targeting the a South Asian population but wonderful overview of the ancestral health approach for reversing your disease risk factors through diet and lifestyle modification. I love Dr Ron’s comprehensive approach where of course he hits the dietary talking points of the Primal/Paleo, low carb ancestral health approach, but he also brings in these important concepts of mindset. So this show is going to be a fast moving, wide ranging, very thought provoking. You’re going to get a lot of practical insights about how to improve your disease risk factors, your dietary habits, and especially your mindset.

Speaker 4: 00:04:45 Oh my gosh, it’s a wild ride. We talk about the dangers and the health consequences of rumination and over pressurized helicopter parenting experiences. We get into a little bit of science with the disease risk factors, so you’re definitely gonna want to hit that 32nd back button, take some notes and listen to Dr Ron and I go deep. This guy has a very cool job down there in Silicon Valley working for the Palo Alto Medical Foundation where he runs their corporate health division, so he provides or oversees these on site health and wellness services for huge Silicon Valley employers. The big companies you may have heard of, Google, oracle, Cisco, Facebook, exciting, fun, so he gives lectures and webinars. He gets to see initial intake patient appointments that lasts for an hour where he can really get deep into their lifestyle parameters. He’s identified some very disturbing trends in the most affluent population in the country.

Brad: 00:05:45 These silicon valley workers that make a good income and live a good life, but they’re constantly ruminating and experiencing anxiety and depression accordingly. So we get into the nuts and bolts of healthy but also integrating all those other factors for what it means to live a healthy life. I think you’re really going to love the show. Yeah. Push the 32nd back button if you need to take some notes and I think you’re gonna get a lot of great practical tips and insights from Dr Ron. He’s been fighting a fantastic battle against mainstream medical establishment and dated views about dietary and drug use, Staten use to try to address the heart disease problem and he demonstrated great success using dietary modification alone and getting people away from the destructive impact of statens or the lack of impact of statins and then convincingly addressing these issues with other doctors to help them expand their mindsets and their perspective and progress toward healthy eating and healthy dietary recommendations in the medical community. Great stuff. Now finally things are coming around and the tide is turning where people are embracing these crazy ideas that 10 years ago were rejected out of hand. Doctor Sinha riding a wonderful way wave of doing a wonderful service for the community down there in Silicon Valley. And now we get to hear from him directly. So enjoy the show Dr Ron.

Brad: 00:07:11 Okay. Ron Sinha we’re here. Thank you so much for hanging out. It’s awesome reconnecting with you after many years, right? Yeah. We, um, we, I first saw you down the street when I did a little, uh, a seminar for people interested in primal living.

Ron: 00:07:27 Totally.

Brad: 00:07:27 And then I think I flashed a quick slide about don’t use statins. Those are stupid. They don’t, and the like this, this hand came up from the audience. Well, technically speaking and then you just went off. I’m like, dude, what are you all about? And then here is this guy, you’re like the, um, the progressive doc, like fighting the battle in mainstream medicine. I love it. And we’ve followed your work for a long time.

New Speaker: 00:07:45 Yeah.

Brad: 00:07:46 Wrote a beautiful book for primal blueprint publishing. Yeah. The South Asian Health Solution. So I guess we could start, we have many things to discuss. Some of them not too pretty, right? I mean, we’re here in the, in the Silicon Valley. Yes. Um, is it, it’s the number one most affluent area in the country in terms of like whatever medium home price and all that, right?

Ron: 00:08:07 Absolutely.

Brad: 00:08:08 Yeah. But we have major issues here.

Ron: 00:08:10 Yep.

Brad: 00:08:11 So what’s, what’s going on man, with the affluence and the access to fantastic healthcare and, and great food. We’re destroying our health in many ways.

Ron: 00:08:20 And that’s really the big paradox that we’re seeing here is, um, in my role right now, I still have a console practice where I see patients, but my primary role really is to go out to these high tech companies and try to come up with strategies to really help their employees become healthier. And it’s in amazing over the last decade that the number of benefits and services that I’m seeing evolving in these companies, and honestly, Brad. in a lot of cases, it’s really to just take competitive because right now everybody’s trying to recruit the highest quality engineers. So let’s throw this benefit at them. Let’s throw that benefit at them. Yet when we look over a lot of their information from a population health standpoint, we still find that depression, anxiety, diabetes, undiagnosed cancers or a lot of chronic health conditions are still at the top of the list. So despite sharing them with all these benefits, like you said, world-class health care, onsite health care, onsite dentists, everything. Um, we have employees who are still suffering with a lot of mental and physical health maladies. So, so the answer isn’t just to give them more benefits and better access is to really dig deeper into what are the root causes of, you know, you’re living in this incredible area, you know, beautiful climate.

Ron: 00:09:24 Um, you can do anything here, but, um, why are people still suffering? So that Kinda got me going on my journey because really, uh, within, you know, taught to be a counselor, a mental health specialist in medical school. We didn’t realize the role of stress with chronic disease. You were absent that day when they come like that. I called in sick that day or something. But, but it’s really at the root of everything we see here in the clinic at every level.

Brad: 00:09:44 So, uh, we’ll also, the physical, uh, issues I think are not, not just here, but all over the place with the hardworking tech, uh, overstimulated, hyper-connected population. Yup. And so how did those present, when you, when you come see a patient, what’s, what’s going on with the average Joe American person?

Ron: 00:10:04 Yeah, good point.

Ron: 00:10:05 And you’re right, this whole tech addiction, it’s not a Silicon Valley phenomenon. It’s worldwide.

Brad: 00:10:09 We just made this stuff here and yeah, we made it in and out.

Ron: 00:10:12 Exactly right. But, um, I think a lot of it starts with the fact that number one health often is not a priority. You know, the priority for a lot of people is you’re surrounded by people at your company that are doing so well. And often you’re at, you’ll hear about the one guy that may be broke out of your company and they started their own, you know, company, and now they’ve made this much money. So there’s always this comparison effect. This always happening. Even when I get invited to social occasions the topical conversations are basically, Hey, what happened with that one guy with this startup? Hey, did you hear about this? Investment? Conversations are fixated on, you know, financial productivity, who’s really succeeding the most? And it gets real infused in your DNA.

Ron: 00:10:49 So on the one hand it’s very exciting because you think the world is at your hand and you can do all these amazing things and that’s the positive of it. But the negative is when you’re surrounded by people that are such high achievers, you feel inadequate, you know, all the time, and your bar for success just keeps going up. So maybe you broke out of that company, now you’re hanging with C levels, but now you hear about the C levels that are actually achieving even more. So you just keep rising and rising and rising and feeling satisfied. So I think this happens in any environment worldwide, but here I think the bar is just so high that there’s just no end to it. So

Brad: 00:11:19 also the work, a pace is frenetic, maybe more so than I’m sure somewhere in less, less technological economy. Yeah. And so what happens when someone’s overworking like to their, to their, to their physical health when you go in and take their blood, what’s going on?

Ron: 00:11:36 So the types of things that we’re seeing is, you know, we, I’m in our books really focused a lot on insulin resistance in diabetes. And this is something I was trained about in medical school. But typically when we talk about case studies of people developing diabetes or kidney issues, our case studies would involve 60 70 plus year people, you know, and here when I came to silicon valley, that’s sort of what I was expecting. But then all of a sudden I’m seeing heart attacks and people in their thirties you know, early thirties you know, diabetes type two presenting teenage years to early twenties. So everything I was taught about in medical training is present presenting decades earlier. And that was a shock to me in the beginning. I thought maybe these are anomalies, but then what we realized is exactly what you said, that fast pace of life, the sedentary living, the high stress, it’s accelerating aging.

Ron: 00:12:21 And we’ve talked about that a lot in prior posts is accelerating aging through fast lifestyle. We see that based on blood markers and we also see that based on culture. So a lot of the focus of my work is certain ethnic groups react much more strongly to these sorts of effects and others. So people that are immigrating from Asian, India that come from a community where there was more group living, maybe stress levels were lower because of the way they lived. When you introduce them into the western style of living, eating and lifestyle, things are just out of hand, they can become diabetic really quickly. So yeah.

Brad: 00:12:53 Why do you say group living? What’s that benefit or how does that factor in?

Ron: 00:12:57 Well, you know, we talk about the village, you know, so basically if you’re coming from anywhere in the world where you’re surrounded by neighbors, by direct family members, extended family members that live around you and support you, you know that sort of group dynamic, this the face to face social interactions that you’re not deliberately trying to seek out there around you all the time. And that was just a part of daily living. And then all of a sudden you take someone from that environment and you put them in like a two bedroom studio right next to a high tech company where they’ve got no other connections, um, that has an adverse effect emotionally and even on your immune system as well too. So, so often I’ve seen patients where there were followed and they might have some baseline tests that they brought from India or China and I can get some baseline info. And it’s amazing. We think about the freshman 15 when you go to college, I talked about this freshman 15 when you first immigrate to this country, you look at the blood parameters and have the glucose goes up or if I’ve got baseline inflammatory markers, how those ended up getting adversely effected. So, so it’s sort of a, a symbol of, you know, going from that group environment to this individual sort of me, me, me sort of society. What really that can do to your emotional and metabolic health.

Brad: 00:14:01 So are there other genetic predispositions, cause it seemed like the message in your book, a shout out to your peeps, the South Asian Health Solution as you said, you guys are kind of screwed. So you better pay attention and listen to them because they respond even worse than let’s say a control subject to a high carbohydrate diet. For example?

Ron: 00:14:17 Good point. You know the, the thing is with Asian Indians, east Asians, Filipinos, certain ethnic groups, what happens is that carbohydrate threshold is actually much lower. The switch for them turning into a metabolic syndrome, insulin resistant person is much lower. So often, you know, if it might take 300 grams of carbohydrate for you to become diabetic, it might take only 150 to 200 grams in one of my patients. And it’s, it’s interesting cause as I take their baseline carbohydrate information, we realized that my gosh, it’s amazing. Like how low that barrier is. And the other thing is when you look at these individuals, they don’t look like your typical diabetics. You’d think that they’d be 20, 30 pounds overweight, but often their body mass index is 21 or 22, which would be considered under weight. But a lot of that fat is being socked away into the liver. It’s stored as triglycerides in the bloodstream. So it’s that invisible fat. And we all probably know about, you know, skinny fat and these types of things. But it’s an epidemic in this population because they’re slender and then culturally their family members think they need to be fed even more. So the spouses are overfeeding with more carbs and if they don’t have any consciousness around that, the problem just gets out of hand.

Brad: 00:15:21 So you have a strong genetic predisposition to how much and where you store fat. For example, we can all nod our heads and think about, um, the, the, uh, the generations of, of potbellies and males on my side or the thick calves that I, I hate looking at them and my mother has them and so does my grandmother. So we have that genetic predisposition. But then we also have, uh, the, the lucky folks who don’t have that predisposition to, to pack on a bunch of fat.

Ron: 00:15:50 Yeah.

Brad: 00:15:50 But in a way, um, there that, that’s, that’s a problem you’re saying.

Ron: 00:15:55 Exactly. I mean the, the problem is they’re packing on the fat in the wrong area and the

Brad: 00:15:59 on the like around the organs?

Ron: 00:16:01 Around the organs? The visceral fat. Exactly. And if you look at ethnic groups, if you looked at the fat distribution of what say in Asian versus a Caucasian and an African American, the distribution is very different. So for, um, Caucasians, you’ll see moderate amounts of subcutaneous and visceral fat. For African Americans, they have a much larger proportion of subcutaneous and smaller versions of visceral fat actually. So a lot of their heart disease comes from hypertension and less from insulin resistance. But when you look at the Asian distribution, that visceral fat is really large and there’s just a thin room of subcutaneous fat, which is why they’re really much more slender. So, so that predisposition really makes a set up for developing heart disease in these conditions at a lower body weight. And at a lower age as well too.

Brad: 00:16:46 So we’re probably gaining these insights only in recent times.

Ron: 00:16:52 It’s recent times because now we finally have access to more diverse literature is, you probably know a lot of our standard guidelines are based on studies done in Framingham, Massachusetts. So 1950s white people, um, were studies done more domestically. And then what we do is we create guidelines and we sort of apply that to diverse population. But now that we’re really looking at more global literature, when you start looking at those research studies, you start to realize, wow, there’s really differences in the way that we should set weight guidelines, you know, heart risk guidelines, you know, age of onset of disease. So, you know, it’d be wonderful if we could have a one stop solution for everyone. But unless you understand their ethnic background and metabolic, you know, you could be giving the wrong type of advice. For example, the low fat diet for somebody who is much more predisposed to being insulin resistant, that could just be, you know, very devastating to the metabolism.

Brad: 00:17:41 Well, I’d say there’s probably some common ground where you can tell every patient to quit drinking slurpees and you’ll be, you’ll safe.

Ron: 00:17:49 Yeah.

Brad: 00:17:50 But then when we start to look at their particulars, yeah. Um, what about the, um, is this coming from the last a hundred generations of South Asian heritage and the last a hundred? I just did my end history. DNA. I’m 46% Irish and 44%, uh, British western Europe. So I’m like, uh, you know, I’m a pure bread, which I may or may not be good. Uh, but now we can track and see, you know, going pretty far back. Yeah. So where’s that influence that’s making me a skinny fat or predisposed to, to this or that? Is that 10 generations, a hundred?

Ron: 00:18:23 Um, no. The interesting thing is when you look at the data, it looks like it’s more like three generations, probably three to four.

Brad: 00:18:29 Ouch, man. And really gramp. Why didn’t you have more fruit in your diet?

Ron: 00:18:33 That’s it. That’s really, yeah. I mean, if you look at a lot of those sort of, even when I go back to India and you look at a lot of our families, you might see that parents and grandparents, you know, they’re, they’re okay. Um, but basically, you know, I think the major problem has been that with the Diet, even though their carbohydrate diet was a little bit heavier, it was still natural, it was still things like the wheat was made naturally with still homemade, a lot of process chemicals didn’t really enter into the diet. Um, their lifestyles were more physically active as well too. So there were walking more. They’re doing a lot more natural physical activity and that counteracted a lot of their insulin resistant tendencies. They weren’t necessarily, if you looked at my grandparents for example, that lived to be 90 plus, they weren’t sporting six packs. Right? So they still carried a healthy amount of subcutaneous fat. Um, but it still wasn’t enough of the visceral fat to really trigger high triglycerides and metabolic syndromes. So, so, so that’s the interesting thing is with a lot of our patients I ask them, can you remember your last healthy relative?

Ron: 00:19:30 And usually it is kind of like a grandparent, you know, sometimes it goes back to parents if they weren’t sort of exposed to western foods and it’s unbelievable. And I take care of multigenerational patients, I’ll look at their lipids and things. It’s a dramatically different from the current generation. So you can see within just two generations just major, major transformations in metabolic health.

Brad: 00:19:50 So I suppose that’s the lifestyle choices and turning the turning the corner and taking, taking some detours from absolutely rate things that your grandparents did. Like I can totally see that.

Ron: 00:20:03 Yeah. Yeah.

Brad: 00:20:04 Even right now my, I’m really concerned because um, you know, thinking about my, the, the career that our fathers had, let’s say. And my father was a, a physician as well. He was a surgeon. He had a long career as a surgeon and he worked really hard and he got called in the middle of the night and went to call.

Ron: 00:20:22 Just like my Dad,

Brad: 00:20:23 He was not bangin. He wasn’t sending 2000 text messages a month and having that extra layer of just um, you know, nonstop.

Ron: 00:20:31 Uh, you nailed it.

Brad: 00:20:32 Nonstop connectivity. Yeah. I mean, yeah. Is it you,

Ron: 00:20:35 You bring that up? My father was a pulmonary critical care doctor as well too, but you’re absolutely right that even though he worked, got up a long hours when he was done, he was done. And right now if you look at the status of physicians, they are facing unbelievable rates of burnout. Like if you look at most national polls, about 45 to 50% of doctors are completely burned out and they’re ready to leave medicine.

Brad: 00:20:56 It’s huge.

Ron: 00:20:56 Right? And you wonder, I mean, this is what’s going to really break our healthcare system if you don’t figure out a way to make the practice of medicine more meaningful. But when you look at polls of what is the number one factor that’s leading to physician burnout, it’s the electronic health record by far over and over

Brad: 00:21:11 Katie, Are you listening? My sister, she works very hard in the clinic overseeing the residency program and the Central Valley, gets home after a 12 hour day, walks the dogs, of course,

Ron: 00:21:21 walks the dogs

Brad: 00:21:22 and then she’s on the computer and it’s like, what the heck is going on here? But the poor doctors, they’re obligated to stay up with the records.

Ron: 00:21:28 I guess with every, we did a study here and showed for every one hour of patient facing time, you generate about 1.5 to two hours of electronic health record time. That’s just not sustainable. But it exactly, it comes back to the fact that technology has ruined the, you know, the, the, the, the practice of medicine in so many ways and really preventing people from wanting to go into this profession.

Brad: 00:21:48 I mean, I remember it was cool for the patient when I was going through my, my surgeries, I had a pen, appendix and, um, complications after interacting with the urologists about the blood in my urine for 90 days. But it was like, you could email, you get the answer back. It was much easier than waiting on hold.

Ron: 00:22:04 Oh yeah.

Brad: 00:22:05 With the doctor’s office music yet this, this hidden consequence, it doesn’t make sense because, um, it seems like you could have a sidekick doing all that for you. Exactly. Like A, and you had to domain in a corporate setting

Ron: 00:22:17 and you’re right, you’re looking at sort of the new generation of medicine and actually the messaging part of it isn’t really what drains us to most, there’s a lot of compliance requirements, charting requirements. So when you look at her in basket, there’s all these categories of other work that you have to do this not patient related. And you’re right, that’s exactly what we’re dealing with is how do you create more meaningful teams. Like you should be able to have a non doc, you know, addressing these administrative issues. And now we’re looking at AI type technologies to really do more automated sort of chats and chatbots that making, maybe you can respond to this. So it has to go in that direction because otherwise the system is falling apart.

Brad: 00:22:50 So we use Google web MD for all further questions about your strange illness.

Ron: 00:22:55 Exactly. Yeah.

Brad: 00:22:56 Dang, that’s disturbing.

Ron: 00:22:57 Yeah. Yup. Yeah.

Brad: 00:22:59 So you’re in this unique role where you can go into the corporate setting, you know, representing a lot of employees. So the, the employee, there’s a healthcare plan for thousands or whatever of employees. Yep. And you’re a pro. You’re representing the provider and trying to, trying to get people more healthy before they, before they go into the hospital or whatever it may be.

Ron: 00:23:20 So, you know, I think the biggest challenge right now is just getting employees engaged about their health and they’ve got all these benefits surrounding them. But you know, even the concept of getting in a physical exam with a doctor, especially from people that have come from different countries where physical exams don’t exist, just getting them out of their chair and into a clinical environment to really get some sort of care done is really, really challenging. So, and I think with newer generations too, just the whole concept of preventive health has really been fading quite a bit. So you’ve got to find other innovative ways to really engage these employees. And so often it might be a lecture or a talk. And even that talk topics have to be different. So if you go out to company and just give a talk on heart health, nobody’s going to show up. But if it’s about the ketogenic diet, by the way, you know, or if it’s about optimizing body fat or addressing fatigue, if it’s about sexual health, you know, things that are a little bit more sexy and racy.

Ron: 00:24:09 Yeah. Then you get people through the door. And the Nice thing is then you can, in the context of that discussion, you can engage them about healthy living, about nutrition, diet and get them engaged into the system. So you’ve got to be very creative nowadays about how you can get busy employees engaged around their health.

Brad: 00:24:25 That’s scary man. I mean they’re there, they’re working their butts off, making money if they can go buy the Tesla. But you’d also think that health would want to come along for the ride.

Ron: 00:24:33 Yeah.

Brad: 00:24:33 I guess are we looking at only a small sliver of the population that’s cranking it at whole foods and entering the adventure race? Is that what you observe in these large companies? Is it?

Ron: 00:24:45 So I would say that the sliver of people that are becoming disengaged about their health is growing rapidly is what I’d say. And just because the work pressure is around them are growing rapidly as well to their environments becoming much more technologically dependent and and so, so I think the good news is there, depending on the company, some companies are starting to realize that offering a benefit is not enough unless you’ve sort of infused a culture of wellness into the managers, into every part of it. The C levels often in companies will be very disconnected with what HR is doing. So they is kind of down in the basement trying to design the wellness programs and the C levels just care about the bottom line. And that’s unfortunately how a lot of companies run. But if you don’t connect the CEO, so the companies where have the most success with where the C levels care about the health of the employees, and often they will promote some of the events that we’re doing or the health education lectures and things like that.

Ron: 00:25:35 And if they show that they really do care about their employees in these sorts of ways, that has an unbelievable impact on getting employees engaged. So, so if you’re out there ready to start a company, just know that you’re not just in charge of profits, but you sort of become the health and wellness champion for those employees. And just, it’s not just health. I mean it does affect your bottom line. When employees are healthier, they’ll produce more, they’re happier, that they do a lot better. So, so that’s a message we’re really trying to get out to the companies where they’re really, you know, facing a lot of challenges with their employees getting healthy.

Brad: 00:26:04 Shout out to Ryan and Hannah at SVM here in Silicon Valley. They care deeply about the employees health, MartinBrauns. My former boss at Interwoven, when I ran this unique employee wellness program and it was infectious, it caught like wildflower. Everyone considered it a healthy workplace. So yeah, just the vibe and the support from the leadership makes such a huge difference.

Ron: 00:26:26 Agreed.

Brad: 00:26:26 Um, but generally instead what I see is you get a discount on your gym membership. If you work here and this and they rate and it’s just real, it’s, it’s, it’s lip service because maybe on the, on the website it’ll say, you know, we care about a healthy balance workplace and we do this and that’s our employees. Yeah.

Ron: 00:26:44 I mean, a lot of these companies, you’re right, they, they throw in incentives at you. Like you’ll get a $150 Amazon Gift Card if you fill out this health risk assessment form. But here people don’t have any, you know, they have an abundance of money sitting in the bank. So, you know, financial incentives are just not unhelpful. I’ll say you’ve got to basically motivate them with maybe competition in some cases or positive peer support or having the right people come out there to give some sort of presentation, some sort of event that’s really gonna engage the employees and people. It’s an interesting, um, what makes them successful here is they’re intrinsically competitive, right? So, but if you can take that competition to like, um, input in a different context around sort of help. So when companies are doing challenges, you know that around getting more physical activity steps are around perhaps weight. I’m not always a big fan of using weight is sort of the center point of that. But sometimes it is a big motivator in a lot of companies to get employees moving in the right direction. And then they noticed that, hey, by the way, I do happen to feel more energetic, my mood’s better, even though I didn’t lose 30 pounds. But that sort of gets them engaged in different ways. So you’ve got to find different incentives outside of just offering, you know, coupons and discount cards to Jamba juice. Yeah.

Brad: 00:27:49 So you like injecting that uh, level of competition, especially to a high performing, uh, you know, yeah. Information workplace. Yeah, absolutely worked.

Ron: 00:27:57 So, so that works. And the other thing is, even without being that direct is when you take an employee and they’ve lost a lot of weight and you kind of make them a health champion. So we, we, we did one of these programs several years ago at a local high tech company and we basically ran it with a pilot of about 30 employees and they all did really well and certain, you know, certain number of them there were just natural health champions, just very, you know, well-spoken. They were able to really motivate their peers and we decided that why don’t we take these folks and sort of use them with the other employees in the company because when somebody sees it, the guy in the next cubicle who’s doing the same day job on a daily basis, drop 20 pounds, looks younger and now all of a sudden sign up for half marathon while I’m sitting here.

Ron: 00:28:38 That’s way more motivating than me as a doctor telling this person you’ve got to drop 20 pounds. Or If of course if family members or spouse or anybody else’s telling you it’s in one ear and out the other. But getting that peer support, if you can drive your peers as health champions, that’s one of the most powerful things you can do.

Brad: 00:28:54 So maybe we should hire at the big tech companies, like every one or one out of every hundred employees could be some fitness freak. That doesn’t really do anything. They just sit there in their cube and look like they’re a project manager yet. See, I love that innovation. That would be awesome.

Ron: 00:29:08 This is a director of finance who actually doesn’t know anything about money, but it’s got a six back, right? Yeah, let go. I’m going to go off for a workout.

Brad: 00:29:14 I’ll miss the meeting, but give me the notes and oh well we’ll catch up later on our, on our budget projections, right. Oh my gosh. Okay, so you’re on to, I mean, I guess challenge number one is get interested in health. Yeah. Get some motivators and some competitive forces in the workplace so people will get off their butt. This reminds me of a Mike Delanco Primal buddy and he works for a company’s satellite company on the East Coast Scs. Yeah, and he arranged, you know that he got the leadership to buy into a $500 cash reward. If you could complete a hundred miles of walking in a year, something pretty, pretty easy if you added up. Yeah. And like it like 15% of the company did it in the not the rest of them. It was self reported too. So you could’ve even lied like 500 bucks or just fudged or whatever. People wouldn’t even budge for $500. Wow. Yeah. And so, I mean that seems like a nice carrot to support your walking and stuff. Yeah. I’m also thinking of Arianna Huffington and her passage from her book where she would take a nap in the workplace when she was starting and running Huffington Post, uh, with glass windowed office, fancy corner office, and she’d purposely leave the curtains open while she crashed out on the couch and had to do not disturb sign on the shirts that don’t come talk to me. Hey, you napping? Uh, yeah, but she wanted it known that the leader was napping and it’s okay.

Ron: 00:30:34 Yup.

Brad: 00:30:35 And it seems like I’m Luskin you, are we there yet in the corporate workplace or is napping like this ridiculous, um, pathetic disgrace of a person who can’t stay awake during the afternoon conference meeting?

Ron: 00:30:46 I think there is more acceptance around it than there used to be, but not enough where most employees would feel comfortable opening up the windows and napping in public. And I’ll be honest, even for me, those power naps are critical, but often I take, take them in a car, you know, before I give a lecture or something like that. You tell a story or do you tell the truth like, I’m going to go down and uh, go to the ATM four blocks away, you just said, yeah, you’re uncovering the issue that it’s still a stigma. So I don’t say that I’m going to my car to nap. Right. So even though I kinda, you know, come to the lecture with bed hair and stuff like that and people,

Brad: 00:31:17 and then we also have science coming out saying your cognitive function improves by a certain extent when you’re refreshed and that these naps have a distinctive, a measured benefit. Yeah. It just hasn’t caught on.

Ron: 00:31:31 It hasn’t caught on. And you know, there’s so much great I’m in for, you know, even the whole stress card. Right. It took a while for people, technologist tresses a true entity that interferes with cognitive function. And I think now finally, you know, corporate leaders are starting to acknowledge that and realize that we can’t just focus on the weight loss in the physical, physical aspects. But now because

Brad: 00:31:49 I don’t recognize anybody at their car, their house, right. Hey, what’s your name? Hey, what’s your name? Hey, what’s your name? Why are all these New People here? Cause everyone else quit man. Cause you work them too hard. Right, right.

Ron: 00:31:58 Exactly. So, so I think sleep still has a little bit of that stigma too, especially during work hours. But um, hopefully we can evolve towards a better situation for that.

Ron: 00:32:06 You know,

Brad: 00:32:06 So you’re in favor and napping. Doctor Ron says, go ahead.

Ron: 00:32:08 Yes. Oh my God. Naps are a godsend. Yeah, absolutely.

Brad: 00:32:12 Um, so number one is to get the population interested. Yeah. And do you have a number two? Because I’m going to, I’m going to tee you up for one, which is get the right information because we’re still being fed bullshit lines about what’s, what’s healthy and what’s not.

Ron: 00:32:28 Yeah, I mean, I think sort of pigging back on to number one is, you know, especially out here when we talk about the high tech digital world, they’re very numbers and metrics focused. Whether their work, their performance, it’s like they’re looking at percent. You know, we kind of joked about this when we were, um, did the book together about how, you know, your report card sort of stays with you for life. You know, am I getting straight A’s in every part of my life? So if you can methodically identify numbers that are meaningful for people and then sort of attach to some outcomes based on some, uh, performance goals, that can be tremendously motivating. But you got to keep it as simple as possible. So, you know, often in our patients who are diabetic, if it’s just one number, like your fasting sugar, your triglyceride, your waist circumference, if you can just stick to one number and metric and then you give them very simple things to do so they can hit it out of the park. So just like you said with that one example, let’s set that mileage goal for the year really low. So 90% of people can achieve that. Man. If you can get that win in place, then they want more as like, what’s the next step? What do I need to do to get my triglycerides a brought up from 300 to 200 how to get it to one 50 so if you can identity and for each person that’s gonna be a little bit different. But if you can sort of find ways to identify that goal that keeps them motivated and then we can sort of go onto further, further from, you know, goals that we can accomplish together.

Brad: 00:33:45 So what would you say is the most urgent thing? Not, not that we have a patient in front of us to talk about, but generally speaking, what is the, what is the, what is the biggest, uh, in the triage issue with the average worker?

Ron: 00:33:57 So I would say, um, my focus is really on metabolic health and insulin resistance. So I’m kind of laser focused on that. So number one, when I first see them, when they walk in the office, you can tell by looking a lot of these patients, whether they’re showing signs of insulin resistance even without drawing blood. So if they’ve got elevated waist circumference, and one of the things that we see in a lot of our Asian patients is they’ve got elevated waist circumference along with very slender limbs. So when I see that in my head, I’m thinking, okay, visceral fat plus very low storage space for carbohydrates because of their body’s anatomy. And that’s kind of different than a lot of our western obese folks where they might have a pot belly, but they’ve filled that pretty large limbs. Their calves are pretty muscular, their arms are muscular. So we know intuitively that they’ve got a little bit more storage space in glucose burning capacity.

Ron: 00:34:43 And we see that in the labs too. They don’t tend to show the sky high triglycerides as often as you would see in somebody with just a little bit of a pot belly and less muscle reserves. So that’s like the initial thing I look at. So already, even before I’ve done the lab, I’m like, this person looks and smells like they got some degree of insulin resistance. And then on top of that you do the basic labs and you know, we can talk for hours about advanced high level labs, but just starting with a metabolic panel where you’re look at their glucose tolerance, I’m looking at their triglycerides, ATO through a standard lipid. Um, maybe some inflammatory markers like the C reactive protein. Just starting with those, we can already make some pretty good guesses in terms of what direction we need to go in.

Brad: 00:35:21 But ,Dr Ron, you didn’t say LDL, right? Wait a second. What about my Statins to where my LDL isn’t that, isn’t that a guarantee of a happy, happy, healthy, long life? Right.

Ron: 00:35:32 So, so with the LDL and the hyperfocus on LTL, we’ve obviously lost a lot of people just by, you know, using that focus. And, and LDL was

Brad: 00:35:39 saying, I lost a lot of people, you know, uh, I mean this, this line that you dispensed, I first heard it from you. Sure. That 80% of heart attack victims may get me if I’m wrong, maybe it was the UCLA Metta study that all these heart attack victims had super low, widely considered to be healthy LDL and they’re still dropping. Yup. Yeah. They’re still dropping f of a heart attack. Right, right, exactly. Yeah. What’s that all about, man?

Ron: 00:36:03 So you know, now that most of our heart disease globally is coming from insulin resistance, the type of lipid profiles were seeing have evolved over time. The old days, yeah. Perhaps it was more related to high LDL levels, but now in the face of insulin resistance, LDL levels tend to look normal or low. And a lot of out of that is pathic mnemonic for insulin resistance because you tend to develop these small LDL particles in on a standard lipid profile that’s going to look low. So that’s involved a lot of training for both patients and doctors. I often tell them that if we make the right changes in the average insulin resistant patients, often their LDL will actually go up because they’re going from small particle to large particle. So before my, you know, referring doctors were getting nervous because it’s the weight, you just took this patient and based on their diet and lifestyle, you took them from an LDL of 90 to 130 so what are you doing? You know, what did you do wrong?

Ron: 00:36:54 But then I’d have to sort of explain to them that that’s sort of expected if you’re going to shift them into a a more healthy LDL patterns. So, so, so understanding the nuances of LDLs are really important for patients and doctors and then focusing on those other metabolic syndrome criteria. Because remember with Metabolic Syndrome, which is really the cornerstone of insulin resistance and heart disease and diabetes risk LDL is not even on the list of criteria. So whenever doctors tell me about the importance of LDL, remind them that it’s actually not one of the metabolic syndrome criteria. Now obviously above a certain threshold, one 61 90 plus et cetera. We’ve got to pay attention to the fact that they might be somewhat saturated fat sensitive. So do we need to modify diet cause it is, you know, just from being one of the pioneers in the Keto movement, some people go a little crazy and become hyper focused on sat fat and might ignore other healthy sources of fat and we can see that translate into major elevations and LDL. So we just have to be a little bit sensitive to that.

Brad: 00:37:46 The bacon and butter diet. Yay. Right. So is that a concern of yours? If you see a person who’s come in and cut their carbs and cut their insulin production, but their saturated fat intake has gone a abundant and their LDL is going up to a certain threshold where even you are going to be concerned?

Ron: 00:38:04 So it is, it’s, it’s not even more because of that LDL number. I still think as much as I’m a fan of saturated fat, it’s a part of my diet. The one thing I would say based on studies is although I don’t think saturated fat is a major player in heart disease, it also is not necessarily been proven to be as heart protective is olive oil and things like that. So you still want to diversify your fats because we clearly have more studies on Mediterranean mono un saturated fats and things where you don’t want to put all bets on sat fat, you want to mix it up between that, some natural three sources, etc.

Ron: 00:38:36 But when I do die, terrain takes on a lot of my patients that have gone low carb, 80 to 90% of their money is basically on sat fat. And there’s very little other sources around that.

Brad: 00:38:44 So, oh yeah, that’s just kind of by default a lack of awareness. They, they end up just eating.

Ron: 00:38:52 It’s the wrong type of is because I think, you know, just like any dietary movement, Brad, um, there is basically what, you know, the educated leaders of the movement are trying to transmit to the public. And then there’s the media messages and you know, the time magazine eat more butter, you know, coconut oil key. So a lot of the cornerstones of that are basically around sat that people aren’t really elevating the importance of olive oil and things. Those are kind of like the old dated fats that we used to know about.

Ron: 00:39:16 So as a result of that media messaging, I am finding that a lot of people, they’re not really diversifying their fat intake. And the interesting thing is a lot of my hyper LDL respond, uh, hyper LDL responders, when they do add even a little bit more monounsaturated or Omega threes, we sometimes see that LDL drop down pretty dramatically. And that makes us, you know, that helps us both sleep better at night. So yeah.

Brad: 00:39:36 How does that conversation go when you’re explaining to the doctor that they’re, uh, they’re, they’re intense focus on LDL though? Narrow focus on LDL is not the whole picture?

Ron: 00:39:47 It’s gone better now than it did 10 years ago. So, cause I think we have a lot more evidence around that. And the other thing I also do is even still, if I see patients that are hyper LDL responders, um, in many of my patients I will get tests like coronary calcium scans will get advanced lipid. So, so often I can come to these doctors armed with data showing, Hey look, these LDL particle numbers, they’re not terrible. They’re got type A LDL. There’s no sign of coronary calcification. You know, the metabolic, you know, numbers are all reversed, you know, body weights fine. So in the context of that why in God’s name, would we put them on a set and medication. So, you know, I don’t always order all those tests to prove my point to the specialist, but sometimes if you can provide that data, it sort of helps educate them. And I’d say now there’s just a lot more great information around this sort of LDO um, you know, paradox or you know, you know, the miseducation around LDL.

Brad: 00:40:36 Now you’re saying this calmly with a smile. We’re chilling here in the conference room, but it’s been 10 years of, I imagine. And I’ve talked to you over time, that it’s been really fighting a battle against the, uh, the, the fixed conventional wisdom that turns out that it was based on flawed assumptions.

Ron: 00:40:53 Yes, it has. In the other thing too is because I am one of these doctors that will take patients off statins or not. I know exactly. Yeah. Don’t report that

Brad: 00:41:04 we pause this podcast for commercial from Dr Ron. If you want to ditch your medications down the toilet, come see him and he’ll feed you some delicious, nutritious vegetables, fruits, nuts and seeds. Yeah, olive oil.

Ron: 00:41:17 Totally. But, but you know, it’s funny cause because I track these numbers so methodically and I can send flow sheets to my referring doctors often I’ll show them that, hey, guess what? This patient where I cut the Stenton despite the diet being exactly the same, the A1C and glucose has actually improved. And there’s a lot of compelling data now around the fact that insulin resistance can get worse if you’re on a statin for a long enough period of time. And that’s just, you know, making worse. The very problem that I’m trying to reverse.

New Speaker: 00:41:42 So, Brian, he’s our audio engineer. There’s your pull quote right there because that’s some scary shit. Yeah, I mean you’re going to go take your statins. And most people, w the people that I’ve talked to, they walk away with a smile. They got their pills and they feel like they’re, they’re in the safe zone now because they’re popping this stuff. It’s in the, in the psychology of the modern humans,

Ron: 00:42:03 they even did a study that showed that individuals that are prescribed statins tend to gain a certain amount of weight after the first couple of months because they feel like they’re bulletproof. I’m, you know, the drug, within three to four weeks, you drop your LDL numbers so dramatically. And they were like, Hey, uh, I can go to town now. I’m fully protected and bulletproof now.

Brad: 00:42:19 So we should do like a spoof commercial about that. You know, like, Hey, want to hot fudge Sundae? Sure. I’ve been on statins now for four weeks. I can indulge. Totally. Uh, imagine you have resistance with patients over time who are scared to go off the statin.

Ron: 00:42:35 So it goes both ways to, so I will say one thing that I definitely see patients that are super high risk, and quite frankly, they’re not gonna follow my dietary guidelines. I get a coronary calcium scan, they’ve got plaque. I’m not going to mess around these patients. There’s definitely a segment of the population that needs to be on statin medications. More people are fearful of statins. So it’s more trying to convince them that you know, you know, the statin are useful in this particular scenario. The other, um, you’re right, the other scenario does exist where people are like, are you sure I should get off the statins and I’ll never twist someone’s arm and forced them to do something that’s uncomfortable. But we do have to present to them the data about risks and really is this truly indicated that indeed in that individual situation.

Brad: 00:43:13 So just to clarify that comment you just made and put it, put a Brad spin on it. Sure. You’re recommending Stanton’s for the lazy asses that won’t make lifestyle modifications. That’s the height you’re identifying a high risk population. Is that what you mean by high risk?

Ron: 00:43:26 That yes. I mean based on a

Brad: 00:43:28 lazy, and maybe I can get a quote in the show to Brian, is high risk really lazy ass, is that our definition?

Ron: 00:43:34 Well, we do have some lazy asses that are genetically gifted and there are a numbers look incredibly well. I’m, they’ve got beautiful triglyceride day show profiles, no signs of insulin resistance. And they’re lucky they don’t have to go on the statin bandwagon

Brad: 00:43:48 Are they eating a good diet or they just lucky as heck no,

Ron: 00:43:51 Um a lot of them are eating a totally unhealthy diet, but they have been gifted with a metabolism where their metabolic numbers look great. And I see this in the clinic quite a bit and I’m jealous because their numbers are better than mine. I mean, they’ve got an HDL of 80 plus, which is, you know, incredible. You know, based on what it’s just, so genes do play a role in some of these cases and on the other hand is, you know, sometimes you will see very elite athletes and people that are doing everything right and their metabolic numbers are through the roof, you know, so you can go sort of either way on those directions.

Brad: 00:44:18 You see that you see someone who’s, who’s trying their hardest and go into whole foods every day or other expensive joints and cooking all the right stuff. And that’s coming in and looking lousy?

Ron: 00:44:27 Yeah, yeah, absolutely do. It’s a small percent. That’s where the LDL number, it can sometimes be really in discord with what their lifestyle is. And that just kind of tells us that, um, LDL is just a very tough nut to crack. You know, based on lifestyle, you can make some lifestyle changes that can clearly have an impact on LDL. But in some cases the genetics of LDLs is so strong the way your liver processes cholesterol, it’s very tough to do anything from a lifestyle perspective to make a dramatic move on. And when genes are playing a strong role.

Brad: 00:44:56 And so what does that mean for them? Are they at high risk of heart disease or can they get their triglycerides down by limiting carbohydrate intake or something?

Ron: 00:45:03 Yeah, so that’s the million dollar question. When you take somebody that let’s say is athletic, everything that you look at in your checklist they’ve met or exceeded in terms of, you know, health goals, but they have an isolated high LDL, what do you do? You know, so if you get the advanced cholesterol profile, you’re checking inflammatory markers, you get a heart scan, there’s no signs of plaque. What do you do with that person? So traditional medical western medicine would say still they need a Statin. You know, I would be leaning towards not doing a Staten, but you do have to have the conversation about the fact that yes, even with an isolated elevated LDL, there is some presumptive risk, you know. So unfortunately there’s, you know, a studies or data to look at everybody in the lipid world bets. Like the one question nobody can definitively answer. So if you talk to all the experts, you know, they’ll probably be a little bit safe and say put them on a stat and get that LDL down to 130, 100, whatever. Um, but a lot of us that are still a bit unsure and our gut check tells us that this just doesn’t look and smell like someone that’s going to have a heart attack in the next five to 10 years. We might sort of have a conversation and hold off on Stantons and sort of go from there.

Brad: 00:46:04 Can you put an individual through like the uh, the stress EKG on the treadmill and get some other indicators besides their blood work that they’re looking good in terms of cardiovascular health.

Ron: 00:46:15 So you can do all these things. So you know, so first of all, if you put them on a stress test, which you’re looking for is do they have a large enough plaque that’s obstructing their arteries during exercise, in which case a lot of them would be having symptoms while they’re exercising. If that stress test is normal, they might still have plaque. And that’s where the coronary calcium scan can be useful because you can pick up on those small plaques, but you’re still looking for calcified plaques, right? So there is still a cohort of patients that can develop noncalcified plaques that you may not see on a standard coronary calcium scan.

Ron: 00:46:44 But the, the, the good news is that the generations of images and scanners are getting much more high fidelity. So we’re pretty much close to a stage now where we can readily have accessible tests with minimal radiation exposure where you can see all types of plaques. So really that that’s going to be the, the real determinant in the near future is even if your LDL is 240, if you have a skin like this that can detect all forms of plaque, um, that’s readily accessible and we see that there’s really no evidence of any impending plaque formation or rupture, then why would you put them on a drug like that? So, uh,

Brad: 00:47:16 do you like the ratio of triglycerides to HDL as a really prominent indicator of your heart health?

Ron: 00:47:21 I love the triglyceride. It’s just a really easily accessible number. It’s not one that’s reported on most lab tests, but that’s just such a great simple indicator of early insulin resistance.

Speaker 5: 00:47:31 So even before your glucose goes up, often the triglyceride de show ratio is a nice lead indicator of whether you’re moving in that direction. So yeah.

Brad: 00:47:40 And when are we shooting for?

Ron: 00:47:41 So less than three, but the lower the better. If we can go for one, wonderful. But that does not always happen for everyone, but definitely dropping it down below three or even 2.5 to one would be great.

Brad: 00:47:51 So we’ve heard about triglycerides under one 50 is kind of an important goal to stay out of the risk zone. Yeah. The red zone. And then we want our HDL oftentimes referred over over 40 is like a, yeah. A minimum objectives. Yeah. And so now you can calculate ,listener, if we’re talking about a triglycerides of one 50 and an HDL of 50 yeah. What’s your grade there for that person?

Ron: 00:48:14 Yeah, I mean I think so. You’re right that the ratio does make sensor. So I think that’d be a good ratio. But I think if you just absolutely looked at the triglyceride, even despite having an elevated HDL, I would prefer the triglycerides to be closer to 100 or below. And these are typically the patients. I just feel like based on their numbers and falling them forward for many years, we see that their A1C’s, glucose, they’re just the most protected against in some resistant in the future. So all my goals with my patients is let’s get that triglycerides to 100 or below. And you know, if it floats up into the low one hundreds or one 50 in the HGL still fine. Yeah. Their additive risk is probably not that great. But I think 100 and below is ideal. And in most people, if you get the triglycerides below a hundred usually see a fairly substantial rise in the HDL over time.

Brad: 00:48:57 Oh, so they’re somewhat associated?

Ron: 00:49:00 Yeah, it’s, it’s almost, it’s an inverse. A, it’s an inverse association in most cases. You get that triglyceride low enough, the HCL goes up over time. So whenever people ask me, how do you get the HDL up, what are the typical things you see on web MD? Right? Drink more red wine, exercise even harder. And these things have modest impact on HDL, but getting the triglycerides down, that’s the number one indicator for getting HDL up.

Brad: 00:49:22 Oh yeah. What else has an impact on HDL? Well then you think about the things that will bring the triglyceride down, right?

Ron: 00:49:28 So lowering the carbohydrate intake, um, you know, making sure obviously you’re getting the right types of exercise, you know, you know, cutting the sugar out of the Diet. Those are the things that are gonna really help bring it down.

Brad: 00:49:38 Okay. So back to the uh, the workplace and getting motivated and concerned about our health. Now I’m concerned the listener’s interested, we’re onto the next stage, which is what are the dietary and lifestyle changes that we can make out of the gate to make the most impact?

Ron: 00:49:54 Yeah, so I’ll tell you I’m, a lot of my thoughts have sort of evolved over time because in the beginning, you know, when I started this movement it was really fixated on let’s get that carbohydrate number down as low as we can or you know, you know, at least to a reasonable threshold. And even though that’s the epicenter of my approach, cause I see so many insulin folks that are consuming loads of carbohydrates now, you know, when I see stressed out people that are in the office that are dealing with the pressures of work, home, et cetera, the last thing you want to tell them is let’s remove something from this diet that you enjoy.

Ron: 00:50:23 Especially if you’re an Asian who likes to eat rice. And I tell them we got to cut back on rice. So that goes okay with some people, with some of the people, they’re like, that’s my comfort food. That’s my package, my pack of cigarettes. You’re taking that away from me, right? I’m not smoking, I’m not drinking alcohol. But you’re taking that away. So then you know, so if someone’s motivated to do that, that’s a no brainer. That’s easy enough to do is to remove those extra carbohydrates. But now I’m really thinking about more of an additive impact on their diet. Like what are the foods that are going to energize you and keep you satiated and satisfied and happy in the context of your chaotic life. And you know, and one of the things we see in a lot of our patients is they’re just not eating enough protein.

Ron: 00:50:59 Like how do we get more diverse, healthy sources of protein into your diet? How do we add back some of the fats? Again, if you’re of Indian origin, you know, things like and coconut oil, which are a huge part of the Paleo primal ketogenic movement. Those were staple foods of Indian ancestry. And you know, based on western science, many people will have thrown out the bottle of coconut oil because they’re like my God, that’s going to contribute to my heart disease. But if I can tell them that, hey, guess what? We can add back some proteins, some of those satiating fats and let’s try a little bit more vegetables. Let’s not over cook the hell out of them, drip them in some curry sauce, but maybe we’ll try to create them in a different way. All of a sudden you’re adding things to the diet to help nourish and energize them.

Ron: 00:51:37 And oh by the way, they’re more satiated, you know? So for example, with Rice, now my technique with Rice is rather than say to cut back on rice, I asked him, do you like Biryani or fried rice? You know Biryani like Indian fried rice where you take a little bit of rice and you mix in nuts and seeds and spices and mixed vegetables. If you eat meat, you can add chicken or shrimp too. It’s like a Asian fried rice. And guess what? If you make it the right way, you can enjoy some of the rice, but you’re getting all these nutrients around it as well. So that’s been more of my sort of gentle approach to diet is how do you take these meals and make them more diverse in add nutrients without telling them, cut out the rice, eat more salads, eat more veggies, and do that.

Brad: 00:52:14 So that is, that’s pure genius man. Cause it’s all positive. Right? Go ahead. I need you to eat more of these, right. Satiating foods. Yeah. Doctor’s orders. Oh my gosh, you’re kidding. I love to eat those foods. And then by default they’re not going to be reaching for the carbohydrate snacks, weight shackling emanate from all sorts of, uh, perhaps bad ideas about cutting the fat out or being the, these low fat options, non fat milk instead of full milk and things like that.

Ron: 00:52:44 And the beauty of that is when you do that, they’ve naturally reduce their carbohydrate load by maybe 30 to 40%. They feel better. And now I can point to that number, that motivating number, the triglyceride or maybe the waist circumference. And they’re like, holy crap. I mean this has gone down just by doing that, what’s next? And then maybe I can sort of look back and say, well, we could probably cut back on these carbs a little bit.

Ron: 00:53:04 And then they’re in, they’re all in cause they feel amazing. Right? So, so again, if you’ve got a motivated person, they might be ready to go down to 30 grams of carbs. Great. Let’s run with it and do it in the best way possible. But you know, I tell people my practice is different. I’m not taking care of elite athletes. I’m taking care of elite sitters in workers and stressaholics. Right? And Arie Nicely said, right? What do you do over there at Google? I’m an elite cubicle performer. Right. And you’re the, the other interesting thing is, you know, I do have some athletes in my practice and for them their goal is their time, right? Or their body composition. But for a lot of my average patients, their goal is to be able to enjoy their traditional foods. Again, their goal is to be able to eat rice again, the way they’d like to, maybe not the way they’d like to, but at least a little bit more.

Ron: 00:53:46 And then the nice thing is, is you know, when you improve their metabolic health and you raise their, um, insulin sensitivity, their carbohydrate tolerance goes up. So once they’re getting more physically active, we’ve added some muscle on to those skinny stick legs. They can handle some more rice in their diet. And then we track the numbers and see that, guess what, you know, your numbers aren’t as bad as they were, you know, a year ago when you had the skinny fat, you know, metabolism and all of that. So, so their goal may not be to break, a world record, but maybe to eat a little bit more rice and that makes them happy. You know, that’s, those are the goals we’re trying to achieve with these patients.

Brad: 00:54:19 So, just a simple, I’m just living a simple life here. I do need to get my Red Tesla when my stock options fast and 90 days. But I also want to eat more rice. Right. That’s wonderful. So when you say raise their insulin sensitivity, just so that we’re doing a little commercial for the layman here. Yeah, that’s a good thing.

New Speaker: 00:54:37 That’s a good thing, right?

New Speaker: 00:54:38 Insulin resistance is bitty bad. Yes, absolutely. Okay.

New Speaker: 00:54:42 Yep.

Brad: 00:54:43 So when, when you say insulin sensitivity, that means the individual is, yeah,

Ron: 00:54:48 Why don’t we, we want their muscles to be able to take in more carbohydrates and use it as a fuel source when they’re insulin resistant, right? Those muscles just don’t want to take that rice and carbs and they’re going to send it towards liver to make triglycerides or storm is fatty liver. They’re going to send them to body fat. So we want to reroute that traffic. So I think one of the things that we did through our book, which has been probably the most meaningful part of the book, was the image of the carbohydrate traffic diagram.

Ron: 00:55:12 So every single patient that comes into my office, I show that image like on a piece of paper and I tell them, here’s the carbohydrate car right now. The car can’t get into the muscle parking lot. So what’s going here or here? You know, and it’s interesting, Brad, cause I see couples a lot too. And it’s interesting to be able to show the couple, and I’m sort of stereotyping, but I can tell them that you know, for the woman often the carbohydrate car’s going more towards fat, but their lipids are okay. So it’s not going as much towards the liver. In a lot of our males, it’s not really going much towards fat because they’re 30 pounds lighter than the wife, but a lot of it’s going to deliver, which is why his triglycerides are high. When you sort of explain it through that simplistic mechanism, it’s really great because now the women realize that, hey, it is an unfair world, but now I understand why this diet is

Ron: 00:55:57 Sort of working in this way for him and it’s not working for them. But really simplifying those concepts. And once you’ve engaged in simplify the concept for them, they understand what foods doing to their body, then it’s an easy sell regarding what changes they need to make. But I think in the past, you know, we, we just tell them what to do, but we don’t tell them why. And these are smart people. You can’t just tell them cut out rice and you’re going to do better. You have to tell them why. What is that rice or that flatbread or that tortilla, what is it really doing your body and this is how it works.

Brad: 00:56:25 So that education part, that’s interesting. I mean that might be the missing link for a lot of people that they’ve just heard the ESP people spouting the information but had never been sat down that, you know, it might be too busy to read a detailed book on your diet or confused because there’s these warring voices that are slamming each other and so they choose out of any awareness level. But when you get educated and know what’s going on,

Ron: 00:56:50 I will tell you after doing years of lectures that all these companies, that is the number one, because you know, I go out to companies like Google and they’ve got people way more famous than me giving talks and lectures on this stuff. But time and time again, it’s my ability to sort of explain science in a very simple way. Like what is this diet doing to your body? I lead with that. So 60, 70% of my talk is all around simplifying the science of what’s happening in your body. And that’s my cell, right? I’m there. Now as a doctor, I realize I’m actually a salesperson. Every day I’m making a sale about lifestyle. So you engage them, you hit them on the front end with the science part of it and how that applies to their body.

Ron: 00:57:25 You tie some emotion into it, you know? So I showed pictures of, you know, grandparents with their bodies look like what their lifestyle was like. Don’t you have an aunt or an uncle that looked like this? This is what’s happening. You tie some emotion to that education and then basically you can introduce the lifestyle principles and it’s much easier that way. And really I think when people come back to me and tell us feedback about the book, and I’ve got to hand it to you and Mark because you guys were so open about really making the book more about storytelling. You know, a lot of people tell me, I remember that case in chapter one. That’s me, you know, or that woman in chapter three, those stories had as much of an impact is my dietary advice of eating 150 carbs or whatever, you know.

Ron: 00:58:01 So. So I think a lot of people listening on the show might be health champions, leaders, coaches, maybe some docs. I think we need to focus more of our energy on making the cell in a emotionally connecting way. And that’s really my passion now. I mean, I can definitely dig into more research and look up more articles and I like doing that. That’s a science part of my head. But there’s another part of my brain that’s more the right brain. How would I create images and stories and messages that will really motivate people so they can make the right changes.

Brad: 00:58:28 Wow. That’s big. And I’m thinking back to some experiences I had with doctors, like when I got my a bone scan and identified that I had a stress fracture and so I couldn’t run in college anymore and the guy came into the room and today you got a, you got a stress factor. See the hotspot right there. Yeah. So you can’t run. All right. See Ya. You know, I mean if he had gone and said, hey, why did you run so much that your, your, your shinbone was in throbbing pain before you started that last run. That really led to the stress fracture and what’s going on here. You know, that that would be like an ideal doctor exchange where the person’s in the position to have you modify your lifestyle habits.

Ron: 00:59:04 Exactly. So we need to build machines in Silicon Valley that can do that for us. Right. So until that happens,

Brad: 00:59:09 well now the machines are doing the surgery. So you could just be like, I know. Right. You know, that’s why you should have Dr Ron podcast. I know people are, you think you’re too busy, but you can just do that all day. No kidding. Yeah. The, the book you’re talking about is the South Asian Health Solution. And if you’re from South Asian heritage, you absolutely have to read it. It’s mandatory. And if you’re not, unfortunately, you know, the title might, might kind of be a niche, niche audience. But yeah, it ha s so much great content in there for everyone to understand. And that car drawings and the graphics were the, the, the um, you know, the, the, the car goes full. They can’t do anything. So then they have to go dig a detour and put it into fat storage. Right. It’s unforgettable. It really, you get what’s going on in your body. Totally. Yep.

Ron: 00:59:54 Yeah. I think anybody can relate to it. Yeah, for sure.

Brad: 00:59:56 So you said, um, that waist circumference is the indication that you’re developing some visceral fat, which is the one of great concern is this for males and females?

Ron: 01:00:06 It is, yeah. Right.

Brad: 01:00:07 And so everything else we see about the different body types. And the, uh, the, the curvy gals versus the, the slender ones. Yeah. All that stuff. Sort of independent of this, um, this concern that you can identify about waist circumference ratio or something.

Ron: 01:00:22 Right. And you know, that one of the challenges with the waist for conference ratios is it’s not something that’s easily measured. It’s not really repeatably measured and in healthcare systems, it’s not something that’s being done because you can just check a weight so much more quickly and calculate a body mass index. But just to keep things simple. I mean, for most people, like when they’ve made changes, one of the main questions I ask them is, are your pants getting loose? Or like, you know, can we sort of be able to tell that there is some reductions in that visceral fat and see some health improvements from that.

Ron: 01:00:49 Um, but it’s not always easy to tell just in the clinic because some of my patients, they visibly look like they don’t have that extra belly fat. But that’s when the metabolic numbers can really tell you that they’re socking some fat away. And that can be the high triglycerides. Often we’ll get liver function tests for anybody that looks and smells like they’ve got insulin resistance. You want to check liver function tests like the AST alt, which are the liver inflammatory markers, and often you will start seeing some mild early elevations in those numbers and sometimes we’ll have to get an ultrasound to document fatty liver. But yeah, it’s just of the body size is an important tool. But I’d still say, Brad, it’s sort of a blunt tool. You know, if we could do body scans obviously more readily in the doctor live or see if it’s coded in yellow.

Ron: 01:01:29 Yeah, right. Totally. And that that is, I mean, as much as we joke, this is a star trek medicine that we’re going to see people walking into a room and they’re already get fully scanned. You know, we get to see their coronary arteries more clearly. We get snapshots of their liver, we got more sensitive blood tests that we’re doing. And that’s really going to be the future where we can more definitively tell you that, yeah, you’re somebody that’s got more of this harmful visceral fat, even though your numbers may not be aligned there. We can catch those things early. So that’s my other messages. How do you find these clues for these chronic health conditions as early as possible? So that’s where you brought up the ratio. The ratio is a great way to, you know, look up, I’m basically diabetes rates. So instead of waiting for glucose, I call the high triglyceride date show ratio. That’s pre prediabetes. Why wait for prediabetes? Right. Wait for it, you know, you know, catch it before the glucose even goes up.

Brad: 01:02:12 So, oh, so then the next stage in the disease process is you’re seeing an elevated fasting glucose.

Ron: 01:02:19 Exactly. Yeah.

Brad: 01:02:20 What are, what are our concerns? What are your numbers that you’re, uh,

Ron: 01:02:22 yeah, I mean, again, if you took a cutoff of a fasting glucose on a standard lab, we’re looking at anything above a hundred, right? So, so ideally we’d like to get that below a hundred. But in our patients that are doing really well, probably more in the eighties you know, below 90 would probably be more ideal. One thing I’ll tell you the, after looking at a lot of fasting blood glucose is over the years is sometimes you can get somebody to do everything right. Their ratios are good, their A1Cs are good, but they just can’t get that darn fasting sugar down to below a hundred.

Ron: 01:02:50 And I see that a ton in my practice. And what I would tell you is I wouldn’t overreact to that. Like that’s just one single data point. Like if you’re in other numbers are great, um, don’t fixate on a one-on-one blood glucose because often that’s just an exaggerated cortisol response that we see a lot because a lot of our folks here out in Silicon Valley, again, and that’s silicon silica anywhere worldwide, there are played at night, they’re looking at digital devices, they’re going to bed in a very high cortisol state and often the liver will respond by pulsing out a little bit of extra sugar. And I’ve seen that in my case, even when I’m in the best of health metabolically, when things are crazy, you know, I’ve worked deadlines, corporate deadlines, whatever I do from a dietary standpoint, I cannot get my glucose below 100 no matter what I do.

Ron: 01:03:32 It’s amazing. I go on vacation sometimes eat more carbs and sometimes I have my meter and my glucose is doing great in the morning.

Brad: 01:03:37 So I’m so, I’m so glad to hear that because when I was doing my ketogenic experiment deep into extreme carb restriction and long fasting periods, yeah I’d prick my finger. Sometimes there’d be like one 31 like WTF, welcome to Facebook. What the heck is that? And then I go, okay, well I haven’t eaten anything in 18 hours. And before that I had an omelet and before that I had a steak. Right. So what’s going on? And I guess my, I was making the glucose I needed, possibly it was post workout or some crazy thing where I’m going, i

Ron: 01:04:10 t’s hats off to our livers cause our liberals will do anything to protect us. So as much as you’re doing great metabolically, your liver is still kind of like a protective grandmother that likes to feed you sugar every now and then. So. So sometimes it’ll like float out a couple of grains of sugar that’s going to show up, especially in the morning when cortisol levels are high. So I’ve learned now because I’ve had patients get so frustrated, I’ve been frustrated. I just sort of let that go now unless we’re seeing trend lines that are really consistently high and we’re seeing other factors. So in some of those patients I might do a glucose tolerance test where they get fed that sugar drink and you measure their glucose and their insulin levels and often that comes back perfectly fine. So if that their A1C and other numbers are fine, I’m not going to overly fixate on that. But it is a great way, Brad, to get people to think about balance and evening routines, you know? So really making sure, can we get off devices? Can we do some mindfulness type things, some gratitude practices because you’re going to bed way too amped up.

Ron: 01:05:02 And sometimes that will translate into better sugar. Sometimes it doesn’t, but it still gets people into the habit of being a little bit more mindful about what their nighttime routine is.

Brad: 01:05:10 Oh, fun. So we can track our morning glucose, uh, with that other level in mind of how well we were. Chill. Yeah. Yeah. Interesting. All right. Um, and we also want to, uh, cover some of the other fun stuff. Now that I’ve gotten through some medical science. Hopefully you’re following along listener. I mean, you did a fantastic job, you know, just getting it tied back into real life circumstances and region, eating more of the, uh, what is it, the Biryani is that where you have all the go and then that center exactly. Just pile the meat on pile the yeah, proteins is speaking of basketball. Yes. I did that with my, my sons, uh, high school players. Cause I know you’ve got kids coming into the hoop scene big time. Um, and the guys would come over and say, hey guys, you want a smoothie? And some popcorn. There was a my to go to things to feed, you know, uh, a mass of, uh, young basketball players. I haven’t thought about popcorn. That’s a good, yeah. But like I’d put it in the smoothie, like giant scoops of coconut oil and so you get this chocolate smoothie that looked like a normal chocolate smoothie, but it had like a thousand calories in one, you know, what is, and then these guys would get full, so they’d just, they have a little popcorn. They wouldn’t go raiding the cupboards and eating all this other crap sugar because they didn’t realize it, but they just had this massive caloric bond and the Smoothie,

Ron: 01:06:20 you send me that recipe, that was an amazing recipe.

Brad: 01:06:23 I remember seeing that, you know, section finalists, second round of the state tournament, man plaster high drinking those coconut oil, the secret coconut oil smoothies. Right. So you have great articles on your blog. Yeah. I get drawn in and it’s, you know, makes you reflect way beyond the, the medicine, the blood tests. So I thought we’d get some of that. Sure. Um, especially, you know, you’re coming from Silicon Valley and seeing maybe the whole thing on steroids. But I think everybody can relate to these concepts like ruminating.

Ron: 01:06:52 Yeah. Well I think, you know, the other area of focus is sort of led to thinking about mental health is, you know, my wife being a pediatrician, we’re are seeing a lot of these chronic health conditions showing up in our kids. You know, when, you know, whenever I talk to my wife during, you know, during her medical training, she didn’t learn to address insulin resistance in young kids and teenagers, you know, anxiety, depression, these types of things.

Brad: 01:07:14 She’s, she’s training in pediatrics, but she’s not covering this stuff.

Ron: 01:07:17 Yeah. Because these are supposed to be adult stuff. This is stuff that Ron should be training and not, you know, a pediatrician who should be seeing more childhood disorders. But, but now we’re really seeing a lot of these adult mental and metabolic health conditions presenting and young kids and teens. So it’s been sort of a passionate thing for me because interestingly, like I told you, often we’ll see spouses in the, in the exam room. Now, often I’ll see the parents and they bring their teenager, their kid into the visit. And when you look at the whole family’s metabolic profile, often you’ll see a lot of similarities and, and we’re starting to understand that, wow, I mean a lot of these conditions, you know it’s really driven by common thought patterns. You know, a lot of motivation.

Ron: 01:07:52 So the same hard driving father or mother has a kid also that feels like they’re not getting the grades so they need to do more extracurricular activities. You know, they got to do more academic enrichment. So these behavioral patterns are leading to similar metabolic manifestations. But it’s scary when you start seeing those signs in a nine year old, right? Versus somebody that’s 40 or 50 and that’s an additional, it’s not, it’s not a type of motivation like to use. But often I have to pull that out if I’ve got the family in the room, I’ve got to tell them that these health behaviors are already manifesting in multiple generations

Brad: 01:08:23 . Teenagers are going, see dad, I told you, leave me alone just cause I got a few Cs.

Ron: 01:08:29 Yeah, right, exactly. You can imagine the conversation there.

Brad: 01:08:32 So we’re passing our, our junk onto our kids as we are.

Ron: 01:08:35 Yeah. Yeah.

Brad: 01:08:36 I mean, it’s okay for you to go be stressed at your, your important job. But like sure we’re, we’re bringing that into the, into the home. Yeah.

Ron: 01:08:43 But Brad, when I was a kid, I don’t know what you were eating, but in my high school, my high school was a block away from McDonald’s. I probably went to McDonald’s three to four days, you know, a week. And I ate all kinds of garbage. My parents were both working. I was a latchkey child, but I also spent a lot of time riding my bike and playing outdoors and doing a lot of things.

Brad: 01:08:59 So, and studying medical texts in his spare time before his parents got home.

Ron: 01:09:02 Right, exactly. But there was a lot of natural activity I was doing as a kid, which today’s generations aren’t doing. So they’re accumulating a lot more of those junk foods into their diet, but they’re just not playing and being outdoors. I tell people through bathing and screen light instead of sunlight. So, right. So, and now we’re seeing really the manifestations of that in young kids and the parents aren’t setting good role models as well. Either they’re on their devices just as much. So, so it’s an opportunity to really think about the whole mental and physical health aspects and you know, sort of track these numbers together as a family. But yeah, I think an eye opener for all of us should be that this is having a major impact on just the next generation below us. The fact that they’re manifesting with these conditions at such an early age. Yeah.

Brad: 01:09:42 As a parent, I have a strict rule when it’s 10 o’clock, I text both my kids and say, get off your devices.

Ron: 01:09:47 Do they listen?

Brad: 01:09:48 How would show I’m sending a text through a house into the closed door bedrooms, but it’s, um, it’s a big concern of mine because we didn’t have that. Just like you said, at least you walk to the McDonald’s, right? What was it, three blocks? Yeah. Well you got a great workout going to get your, your fries and your right, uh, you know, harmful vegetable oils. But today the kids are driving to the McDonald’s, right?

Ron: 01:10:13 Or Door Dash a directly home or something then so

Brad: 01:10:16 I forgot about that. Yeah. Yeah. So how’s that work with the family conversations? How’s that go over?

Ron: 01:10:23 It works well. But you know, when you have a family in the room, you’ve got to set some guidelines before the conversation starts. Because typically what was happening the past, especially with couples, is if I told the husband something the wife would not or hadn’t see, I told you so doctor, and you know, and then that creates a different dynamic. So meal, I have to say that no, the rules are, we can’t be judging each other. This is a positive conversation. We’ve got to be encouraging. And then I’ll sort of go one by one through what each of the different family members can do. So you’ve got to sort of take that approach. But you brought up the word rumination. So again, getting back to the root causes. Yeah, we can address, keep the junk out of the, you know, the pantry. Let’s address a diet. Those things are important, but, but we’re just seeing an epidemic. Uh, in middle school and high school have a lot of um, kids that are just dealing with chronic stress, depression, anxiety. I mean, you know, the, the case of Gunn High School, ironically named Gunn High School in Palo Alto with all the suicides that happen in these affluent families with just really, um, you know, um, just shocking to the entire community. They ain’t even worldwide people responded to that. So, um, you know, we really need to think about what are those root causes.

Ron: 01:11:25 And, and rumination is a very simple way for me to think about that because again, I treat mental health kind of like diabetes. Remember we talked about don’t wait for the sugar to get high, try to identify it as early as possible. For me, rumination is kind of like pre anxiety or pre depression because it is a common thought process. And if you can catch it happening on a regular basis, it is one of the underlying precursors to anxiety or depression. And the simple, beautiful way to sort of think about this is if you tend to ruminate more on past events, that’s really more depression. You know, why did this happen? How did I end up here? You know, if you’re drawing a lot in the past and ruminating on those thoughts, your spectrum is probably more towards depression. If you’re constantly ruminating on future, you know, what’s gonna happen when this happens?

Ron: 01:12:07 You know, when I get this job, what’s gonna Happen to my kids out of the house? Are they going to do okay that that’s normal? Some amount of worry is okay, but rumination is a constant, almost an obsession with those thoughts. And if it’s more future stated, the contents more future thinking, that’s more anxiety basically. And we know it’s not so black and white. There’s a lot of mixtures between depression and anxiety, but often catching it. That stage can really help you acknowledge that thought pattern and then think of specific ways to break that behavior.

Brad: 01:12:35 Well, those go together so frequently. So I suppose you could be someone who is either a lamenting the past or stressing about the future. Alternatively, back and forth, non stop and there’s no mindfulness, there’s no present.

Ron: 01:12:48 That’s, that’s exactly right. Anybody, most of the patients that you see at later stages, most patients don’t just have clear black and white depression, anxiety often it is a combination of both.

Brad: 01:12:57 So, and this is across the age groups. You mentioned the concerns about the teens, but I imagine you seeing adult patients doing the same thing.

Ron: 01:13:04 Oh absolutely. Yeah. Yeah. And then so, so then if you take a step back and think what’s driving those ruminating thoughts? Right. So that’s the bigger question is what, where is that coming from? And you know, all of us are gonna ruminate to some extent, but often it is as an adult, you know, if we were told from an early age that you didn’t achieve this, you didn’t do that, you know, you’re getting straight A’s, you know, that’s not enough that that carries on later into life. It’s a subconscious sort of recording that takes place at, I gotta do more, you know, so it’s all, I’ll tell you my personal anecdote is like, uh, you know, when I grew up, I sort of went to into medicine sort of as a default mechanism cause my brother was supposed to go into it and he didn’t.

Ron: 01:13:39 And I can’t say I was a guy that yeah, I want to go out and save lives, but I was like, I’m good in science. Maybe I’ll go into it, you know? And then my dad being a doctor, he was sort of like, yeah, you’re doing primary care, but why didn’t you think about specializing? And he was very gentle about that, but he was like, it’d be great if you specialize, you became a cardiologist, you’ll make a lot more money, you’ll save a lot more lives. And I wasn’t ready, Brad, to go into three or four more years of training. So I kind of ditched that and I was done. And although I had a very positive parenting environment every now and then that seed’s in the back of my head. And I think that in some ways it drives me because I’m like, I want to go out and do whatever I can, but sometimes it does cause you to ruminate on, okay, what’s next?

Ron: 01:14:12 You know? So it can be very subtle. A lot of us are very positive parents, but we can send very subtle messages or we can behave in a way, um, that your kids are modeling themselves after. If you’re type A, your kid’s probably going to turn out to be type A in some ways. And maybe that’ll lead to success in certain areas, but in other areas, if they’re not satisfied, they’re going to be ruminating on what do I do to make myself better? So, so it’s, it’s kind of a, it’s a, it’s a very fine balance, you know? So we have to be really aware of the messages that we send our kids around these things.

Brad: 01:14:41 I think the type A’s in many cases are afraid to let that go for a brief moment, even to let that type A calm down. And with those voices, their laces tied down, right?

Ron: 01:14:51 Yeah, yeah, yeah.

Brad: 01:14:53 What do you think?

Ron: 01:14:54 Yeah. I think that’s, it’s, it’s hard to turn that sort of thought process off. So, you know, even me a, I would say I’m probably, I don’t know how you’d judge me, but I’d say I’m probably borderline Type A but, but, but often what I have to do with my kids is, you know, I have to show them that even in the midst of all this, that I’m able to disconnect and chill out. And I sort of, I verbalize that with the family. I’m like, you know, even though I’ve got these deadlines, we need to get out, walk the dog and do some of this. Cause otherwise, you know, this is not going to be good for her. So, so were my and my wife and are constantly verbalizing these things in the course of our daily life. So doing this and doing it right

Brad: 01:15:27 and doing it so

Ron: 01:15:27 they’ve gotta be able to see that.

Brad: 01:15:28 I mean, I’ve found that like, there’s like a 10 to one effectiveness ratio of my speeches versus my actions and yeah. Walking my talk and things like that. Right. And that’s not to even, not to discount the speeches. Right, right. Because my kids, I’m telling them to relax when they attend the both in college. Enjoy this, enjoy the learning, enjoy the experience, read the book, don’t stress about tests. And I’ll say that to them over and over. I can’t model that. Yeah. So it is important to, you know, these are, these are values that I harbored that you should have an enjoyable experience studying in college with zero stress about grades or where it’s going to lead. What are you going to do with that degree? Except art history. So what are you going to do with that? Yeah. Oh No, I’m going to go and live my life. And so I want to counter all the cultural forces that are saying, um, yeah. What are you going to do with that?

Ron: 01:16:20 Exactly. It’s hard. It’s built into our DNA so much. But you know, if, if the, if the backside of that is, you know, having somebody that’s graduated from a prestigious university that ends up falling sort of the dream and they ended up depressed, divorced with a chronic health condition. As a parent, is that what you want to see? And in my practice, you know, I see a lot of c level executives and people that on paper or the front of magazines have hit all the bars. They’re on their second marriage or a third marriage or you know, all types of things are happening in and you just realize it for them to get to that point, it’s just they had to make a lot of sacrifices and, and you know, often later in their life they’re like, I wish I spent more time with my kids. I wish, man, I wish I made more basketball games and things like that. Things that they sacrificed, you know, build maybe a better life in some ways. But now they’re reflecting back and having those regrets. I think we just have to think about the consequences of those actions.

Brad: 01:17:10 Jack Welch, my favorite example is, is a line from his book. Yeah. And he was talking about how, you know, the culture of, of working at a GE and everyone came in on Saturday because he went in on Saturday and he now he has regrets and wonders and they sent and started for instance, comma my children. So his children were, for instance, not my children suffered and I didn’t get to know them, but he said, for example, my yard, you know, overcame overgrown with weeds. For instance, I didn’t exercise much. For instance, my kids, they’re , same category.

Ron: 01:17:43 Yeah. That’s, yeah.

Brad: 01:17:45 So if we’re listening, uh, out, shout out to the other parents, get to those basketball games, right. Or read whatever, whatever’s going on. Even if it’s time in the back yard drawing a, I like to do clay sculptures with my daughter. It’s great. We’re not not selling any.

Ron: 01:18:00 Yeah. Right, exactly. Yeah. You’re not trying to build a startup like there. They’re here with the family. That’s the, that’s a family event here with try to build a startup early on and put it on your college application. So, right, so yeah, it’s a,

Brad: 01:18:12 what do you think? Your kids are going to be in those college ages pretty soon and the competitiveness of the application process and all that.

Ron: 01:18:20 I think the whole application, I wish somebody could intervene and just stop the madness with, with the whole college application process because I think it creates so much tension for the entire family. It doesn’t send the right signals. I don’t have a solution for that, but I wish somebody really smart in the innovation world could really help redefine the whole college application process. But we’ve decided to go in and we first of all have not set any goals for schools. For career. It’s exactly what you talked about is just how do we get them to enjoy school as much as possible. I’ve got to say when when I went through school in high school, I don’t really think of it as an enjoyable process. It was just a process basically, but teaching them how to really pick classes that they like, you know how to learn, how to learn. You know, how to like create diagrams, take notes in ways. It’s more interactive discussions today. You know, the the plus side of technology is man, it’s really cool to learn us history when you can watch a short youtube video about the American revolution or something like that.

Ron: 01:19:11 So I think there’s an opportunity to just make school and education a lot more meaningful and memorable. But yeah. The yeah, I got to tell you, I don’t have any solutions on the college application process right now cause it’s a nightmare.

Brad: 01:19:22 I just thought of one tell me, it could just be complete lottery. So as long as you pass all your classes and get a 3.0 you apply to Stanford and you get in just like you get into, um, you know the, the, the Boston marathon that’s overflowed or whatever. Nice. Yeah, just a lottery. And then you show up freshman, freshmen on campus. Who are these guys? I don’t know. I just got in like, it wasn’t that, it wasn’t like the elite maximum. Totally maximum. Swapportunity yeah, I love it. How Fun.

Brad: 01:19:51 Dr Ron. I feel like we have five more shows today from all the little tangents or topics we hit. But it was, it was really fast moving. Yeah. Maybe I’ll inspire you to start your own podcast or at least come back on as we try to, Oh, you know, for ourselves. That’s kind of the theme. And the reason I titled that is like, it seems like a solution to some of these things like ruminating and placing too much importance on the day to day outcome of what you’re doing rather than focusing and enjoying the process.

Ron: 01:20:18 You know, and I gotta give a hats off to you because I think again, coming back to sort of the whole lifestyle, low carb ketogenic movement, what I’ve seen is for some people it’s kind of led to some situations where they’re putting even more pressure on themselves, right? In terms of body Cam, you’ve probably seen this as well. Do I understand her? Right? So often it can take a type A and turn them into a type A in every part of their lay type AAA.

Ron: 01:20:43 But I think your show and a lot of the work you and Mark have done has really tried to put more life balance into this movement. And I think more of the health leaders out there need to really follow suit because, uh, I’ve definitely seen some people develop a lot of frustrations and mental health and anxiety because they’re not hitting those targets.

Brad: 01:20:57 So are they coming to see you and they’re, they’re in good metabolic health, but they’re feeling frustrated. Know those people.

Ron: 01:21:04 I will initially when I was in is mindful of the impact of what, what it would have. They would come back to me, maybe a, you know, maybe a year out instead of six months and say, I was kind of afraid to see you cause I kind of fell off the wagon and I felt like you’d be disappointed in my triglycerides and this and that. So, so after I saw enough of those patients, I’m like, I’ve gotta be much more sort of gentle with the framing of sort of what are our goals here? Right. Is it really to develop a six pack or is it really to make some small changes that you feel more energetics better about yourself? Right. I’m sorry, I’m wrong answer. Okay. Both, all of the above. Right. So, yeah. So, so I think, um, you know, really kind of setting those expectations. You know, that’s something else we talk about in rumination too is what are your expectations for everything you try to accomplish. And maybe we need to be more realistic with what we’re setting.

Brad: 01:21:49 So you’re getting into it with a patient and on this level, cause I thought you only had seven minutes now with the average patient interaction.

Ron: 01:21:54 I know.

Brad: 01:21:55 So is this a, you’re giving a lot of talks. What does your day look like in your role there with the larger point?

Ron: 01:22:00 I do have an unfair advantage because I don’t necessarily, I don’t have a concierge practice, but it’s a, it’s a consult practice. So I get 60 minutes with every new patient. So I do have that advantage of being able to talk through a lot of these situations. So they get the diagram, they get the, you know, the talk on metabolic health, they understand the signs and then it’s not always just the first visit. Maybe I’ll drop in a couple of pearls around stress and goal of lowering, but it might be a followup visit in three months where we started talking a bit more about emotional health and balance and things too. So it’s gotta be layered.

Ron: 01:22:30 That sounds like a nice perk. If I’m working at Google, Facebook, oracle, whoever you’re taking care of, that’s pretty awesome. 60 minutes with Dr Ron, you want to give a shout out to some employers? I mean then then we can like, you know, use this as a recruiting podcast.

Ron: 01:22:42 All of the above, man. Everything you, that’s who you work for you,

Brad: 01:22:45 I mean those guys, one of many. Yeah.

Ron: 01:22:47 So with each of these companies it’s a different type of service. It might be lectures and my peer mobile onsite clinic, which goes out there, it’s an RV where we get primary care doctors at the busy employees. So yeah, you, you, you name an employer. We’re probably working with them in some way.

Brad: 01:23:01 Is there any big place that’s doing a fabulous job going above and beyond to look after their employees? Health and balanced living?

Ron: 01:23:07 I think, I mean, I think that there are a lot of companies now that are evolving in that direction. So, so for example, I think Google does great work in this area because they really have created a culture and an environment that really helps facilitate healthy changes. I think in any environment. You know, a lot of times I think the problem in Silicon Valley is people like to blame the company for everything. Um, but often, you know, the employees can really, you know, take control of their lives and do a lot because many companies that are even trying their best, it always comes back to the employee who’s addicted to work or they just want to keep driving. And sometimes they might turn to the company as being, okay, this is the place that’s really driving these changes. But often it does come back to our own roots. So,

Brad: 01:23:43 Ooh, that reminds me of my podcast with Isaac Rochelle, the NFL defensive end for the La chargers. And we’re talking about how, you know, these organizations don’t really treat the players like the, the multimillion dollar economic assets that they, they are, they’re, they’re, you know, the physical athlete is put back onto the field too soon and they’re not looking after them with longterm interest. They want to get them back and play and inject them with whatever painkiller. And that was acknowledged. And he also said, man, the athlete’s got to take, take responsibility here too. You’re a professional athlete. What you put into your body is utmost important. So I think the knowledge worker the same when you’re working too many hours, these guys are smart. Go look at the research and what happens to your cognitive performance when you’ve gone past that time. Yup. And now, I don’t know. What do you, what do you, what are you doing out there still? Exactly.

Ron: 01:24:33 Yeah. No, you’re right.

Brad: 01:24:34 So where can we find these fabulous blog articles and see what, see what you’re up to. We know about the book South Asian Health Solution.

Ron: 01:24:41 Yeah. I mean it’s got a long URL, but um, my, I blog at culturalhealthsolutions.com and so that’s where you can find a lot information about wellness programs and lectures and any events that are coming out locally or globally as well to a

Brad: 01:24:55 Sassy tweets too. Right?

New Speaker: 01:24:56 Sassy tweets were probably not as often as they should be.

Brad: 01:24:59 Didn’t you say 11 million people are taking the wrong medication? That was one of your tweets I think. Maybe. Yeah. I was like, okay, that’s a lot of people and that’s a lot of wrong medications going out. Yeah. Yeah. All right. Yeah. Dr Ron. Huh? Thank you so much.

Ron: 01:25:12 Hey, it’s been a pleasure. Thanks so much. I’m going to get you back.

Brad: 01:25:15 I’m going to track you down. We’re going to get you back.

Ron: 01:25:16 Hey, you know where to find me.

Brad: 01:25:20 Thank you. Listeners. Thank you for listening to the show. We would love your feedback at getoveryourselfpodcast@gmail.com and we would also love if you could leave a rating and a review on iTunes or wherever you listen to podcasts. I know it’s a hassle. You have to go to desktop, iTunes, click on the tab that says ratings and reviews, and then click to rate the show anywhere from five to five stars, and it really helps spread the word so more people can find the show and get over themselves because they need to. Thanks for doing it.

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