Dhru Purohit Show - Top Gastroenterologist Explains The Connection Between Belly Fat, Inflammation, and Heart Disease and Why Your Diet Is Destroying Your Gut With Dr. Pal

Episode Date: June 10, 2024

This episode is brought to you by LMNT, Lifeforce, and AquaTru. Cardiovascular disease is increasingly prevalent among South Asians, particularly Indian immigrants. The rise of this health issue, especially among younger Indian Americans, is attributed not only to lifestyle factors but also to cultural beliefs surrounding success and a lack of emphasis on prioritizing health. Today’s guest joins us in dissecting these nuances and encouraging individuals to focus on longevity. Today on The Dhru Purohit Show, Dhru sits down with Dr. Manickam Palaniappan (Dr. Pal) to discuss the dangers of belly fat and visceral fat, particularly among the South Asian population. Dr. Pal explains why South Asians should be cautious even if they have a "normal" lipid profile but aren't considered obese by traditional standards. He also shares his personal journey, which led to a deeper understanding of true health and the challenges immigrants face in achieving success. Dr. Pal provides top tips on optimal fiber and protein intake and identifies the risk factors for heart disease. Dr. Manickam Palaniappan is a renowned gastroenterologist recognized for his expertise in digestive health and innovative treatment approaches. Currently serving as a leading gastroenterologist at a major medical center, Dr. Palaniappan is highly respected for his skill in managing complex gastrointestinal disorders, including inflammatory bowel disease, liver diseases, and colorectal cancer. His commitment to patient care is matched by his involvement in cutting-edge research, contributing to numerous peer-reviewed publications that have advanced the field of gastroenterology. In this episode, Dhru and Dr. Pal dive into (audio version / Apple Subscriber version): Why belly fat is dangerous (00:00:02 / 00:00:02) Dr. Pal’s journey in discovering why visceral fat was dangerous (3:22 / 3:22) What is visceral fat (12:15 / 8:54) Genetics versus environment (17: 20 / 14:00)  The importance of gut health in reclaiming your health (21:20 / 17:00) The role of excess insulin, flours, and seed oils (28:51 / 24:00) Risk Factors that impact heart disease (44:50 / 40:00) Fiber and optimal amounts (49:00 / 44:16) Prioritizing protein (51:50 / 47:00)  Body composition test (54:00 / 49:50) Five points of Gut Man challenge (1:00:00 / 54:30) Tracking your calorie intake as an assessment tool (1:04:00 / 58:00) Top mistakes people make in their journey (1:16 50 / 1:12:00) Final Thoughts (1:22:00 / 1:1:17:00)  Also mentioned in this episode: Study on the increase in skeletal muscle index amounts to a reduction in insulin resistance and risk of type 2 diabetes risk For more on Dr. Pal, follow him on YouTube, Instagram, TikTok, Twitter, or his website.  Right now, LMNT is offering my listeners a free sample pack with any purchase. Head over to DrinkLMNT.com/dhru today. Right now, you can save $250 on your first diagnostic and get personalized suggestions. Optimize your longevity and track your progress; go to mylifeforce.com/dhru!  AquaTru is a countertop reverse osmosis purifier with a four-stage filtration system that removes 15x more contaminants than the bestselling water filters out there. Go to dhrupurohit.com/filter/ and get $100 off when you try AquaTru for yourself. Learn more about your ad choices. Visit megaphone.fm/adchoices

Why is belly fat so dangerous to our overall health? If your waist circumference is more than 102 centimeters in men, and if your waist circumference is more than 88 centimeters in women, you are at increased risk of heart disease. So people who are listening to this podcast, they can do this a simple test by themselves in the morning. They can just measure the waist circumference around their belly button. If it is more than 100 to 102 centimeters in men,

then it is a wake-up call for you. It is an indication that the adipose tissue overflow is happening. It's happening. And adipose tissue is not bad. You need adipose tissue. Okay, adipose tissue releases a hormone called adiponectin. And what this does is, similar to what we talked about in starvation, it releases a lot of hormonal regulations

where all the fat tissues are getting broken down into energy. you can use them for when you are not having enough foot, similar to our ancestors during fasting and hunting time. But what is happening is, and that adipose tissue, adiponectin hormone regulation happens very well if it is subcutaneous fat. When it is flowing into visceral fat, the adiponectin goes down. And when adiponectin goes down, the transmembrane fatty acid reflex is the problem with this metabolic profile that I talked about with increased triglycerides and increase LDL and decrease HDL. And when that goes up, and that is where the underlying problem of your, you know, plaque

formation and the blood vessels are playing the heart and that increases the risk of, you know, hypertension and heart disease and everything. So it is bottom line, it is very clear that visceral fat increases the risk of heart disease. This is what I explain to all my patients on the clinical level. But I go a step beyond that. And then I say that, yes, it's good that, you know, we found your diabetes, we found your hypertension. Now you know that visceral fat is at increased risk of heart disease. And now we can treat you from diabetes to developing into heart attack.

Okay. But I am more interested in how a normal person don't develop diabetes or hypertension to start with. Okay, so that is a normal person, subclinical level, clinical level, and the outcome. Okay? So clinical level is your diagnose of diabetes, hypertension, obesity and everything. So I think the key, which is the most important thing in the world, is to target preventive medicine right at the subclinical level where everything is happening before the disease happens. Right.

We're going to go into the top drivers and the mistakes that are there in the traditional Indian diet. both in India and also that we've brought with us, you know, here into America, along with and other places, England, Australia. I know you have a big NRI population that follows you. So we've brought some of the things from the Indian diet that are good, a lot of the things that are not that good, and we've combined it with ultra-processed foods and other mistakes. We're going to talk about those that are driving belly fat. Actually, I didn't know about this as a medical doctor myself until there was a healthcare to me

person. So I think I'll just tell me you my journey. Please. And then I can say how I learned about all this. So similar to all Indian immigrant, we're all hardworking and we work so hard to settle in our career. And we build our career so much to a point that we forgot to build our muscle during the young days. And so I was into medical school in 2000. And then 2000 and 2006 was my Mbibious and I came here. I did my MPH Masters in Public Health, MD General Medicine, D.M. Gastro, AB, Gastro, Advanced as well.

So from 2000 to 2015, if you look at it, it says Dr. Palineap and Manicum, MBB is MD, A, B, gastro. There were like eight letters right after my name. But the same time, there was eight inches of belly hanging around my belly button. Right? So I was similar to every hardworking person out there. I abuse my body as well.

in the name of settling down and my career was more important than my health. So I had a scare while I was seeing a patient in my office in my gastronology office after being an attending where I suddenly had a palpitation, dizziness, and chest pain. And then they found out that I had an angina and then, you know, treatment was done. And while I was sitting in that hospital bed. And that was the time where I was actually looking at what am I doing to my body. And that opened up so many mistakes that is happening to every immigrant, not only in India, every immigrant who comes to the United States for better life, better financial status, and better work profile and all those things.

At the same time, and everybody can relate to this, that we are the last person in the list to focus on our health, and we are the first person in our list to focus on our education and career. and statistics says that Indian immigrants are the most successful immigrant population over here in U.S. Yeah, they have the highest average income per capita of any ethnic minority. And along with that, they have the highest risk of heart disease amongst any ethnic group in here in America. Of course, of course. And in the hospital, if you look at it, all the patients in the, you know, IC unit with the cardiovascular disease,

we are seeing so many young people, you know, like 35 to 45 years old, working so hard in the software industry, I come from near Bay Area, and it is pretty common. It is very common. And they say all these big names, you know, all these giant tech companies where on paper it looks great. But when they're admitted as a patient, that's where they are realizing that, okay, you know, we are going too far. I think it is high time that we dial back down and then see what happened to me, where I was, I was pretty normal. I was not obese. And I just recently had a physical exam just before the attack and my body mass index was 24.7. But that is where the problem started. I think that, you know, I went to a primary care physician here in US and then, you know, BMI is good. Your LDL was slightly

high and, you know, HDL was slightly low, triglycerates was slightly high. Okay. So I want audience to focus on three parameters, high triglycerides, low HDL, and increased LDL. That's exactly what happened to me. And there was exactly one week prior to this heart attack that I had. And this is a very common lipid profile among all Indian immigrants, especially Indians in India as well. And if you look at me, my BMI was normal at 24.7 according to the U.S. standards. But that is not the problem for the Asians and Indian, South Asians mainly. South Asians mainly. So, I didn't realize that BMI should be 23 and not 24.9 for South Asians because all the studies were done in Caucasian population. That's number one.

Number two, if you look at me, I look very skinny. I look very skinny when you look from the front. But the moment I turn to the side, that's where the belly fat comes into play. Yeah, you were thin on the outside, fat on the inside. Correct. Toffee. Toffee. Toffee.

And I still remember I wear this T-shirt based Mission Impossible. Okay? Mission Impossible would be... When you look at straight, it'll be perfect. When you learn on the side, mission will be here. Impossible will be over here.

I still remember that T-shirt. So then I realized that my base circumference, which is the measurement around your belly button when you take an inch tape, was one-zero-one centimeters. Okay?

And I have read in multiple studies that way circumference more than 100 centimeters puts you over an increased risk of our disease. I didn't know. I didn't realize the importance of that at that time and now I realized that, okay, maybe that is what is happening and that is where I belong to this category of skinny fat. After realizing this, I kind of looked around all my friends and family and everything. Everybody had this, most of them, most of them had this problem of skinny fat. they look skinny from out, fat from inside, and mainly they have this tendency to form along the truncle area.

Yeah. So that is also a lot of visceral fat. Can you take a moment to just explain visceral fat to the audience if they're just not familiar with it? Yes. So when we eat more, right? When we eat more than what we need, the energy is getting converted into fat,

thinking that we will need that energy sometime later in the future, when we don't have food. But unfortunately, that situation never happens because when I put a video on intermittent fasting, the ad comes for Uber Eats in between. So we are in a situation where there is no problem with the food availability. So when there is excess of calories that you can convert into fat,

usually what happens is just beneath the skin, there is a fat accumulation called subcutaneous. fat. And beneath the subcutaneous fat is your muscle. And beneath your muscle is your fat deposition around the organs that includes your liver, pancreas, retropratonial space and the momentum. These are all like fancy terms, but basically, bottom line is the fat is getting accumulated behind the muscle inside your body, which you are not able to see right away. And that is what is called visceral fat. Being a gastroenterologist, I see a lot of patients with fatty liver, and the number one reason is visceral fat being deposited around the liver. So you combine the visceral

fat along with the blood profile that you're talking about, which is essentially you're talking about high triglycerides, low HDL, and elevated LDL, all signs, and if you add maybe some fasting insulin in there, or fasting glucose, a sign of a metabolically unhealthy individual. Exactly. And a lot of Indians, immigrants, South Asians, many people that went from eating a more traditional diet and that are now maybe immigrated somewhere and are eating more of a processed food diet are now suffering and are in that profile range, which makes them at risk for a whole host of diseases, including a lot of belly fat around their waist. Of course. And on the top of it, we are genetically predisposed as well because of this theory called

called adiposite overflow hypothesis. What that means is, you know, there is some school of thought where it says that we talked about the subcutaneous fat just beneath the skin and there's a muscle and the fat beneath the muscle around the organs, visceral fat. When there is no space to accumulate in the subcutaneous fat, that's where the adipose tissue overflows into the visceral fat. And there a school of thought saying that among Indians and South Asians mainly, the compartment of the subcutaneous fat is significantly smaller compared to the Western counterparts. So what happens is, let's say it's a box, okay, and you can fill like, you know, 100 lipid particles inside the box of the subcutaneous fat in a Caucasian counterpart. Unfortunately, we can only

fill 50 lipid particles in that subcutaneous fat in a South Asian counterpart. So what happens for the remaining 50, it spills over into the visceral fat. And this hypothesis is very visible, even babies. And it is, you could track down how babies are being formed, right? So, I'm sorry, how the fat is being formed with the babies. So there is this thing called thin fat Indian baby hypothesis. Thin fat Indian baby. What does mean, what that means is, let's say you take two babies. One is a Caucasian baby and the other one is an Indian baby. So Indian babies are thinner, lighter and shorter compared to the Caucasian counterparts. That is a pretty known fact. But the unknown fact is the subcutaneous fat is almost equal compared to the Caucasian counterpart

even at birth. So if you look at the, there is something called a sub-scapular fat. It is a marker of a central fat where you measure the fat just beneath the shoulder bone. And that was pretty high or equal in the Indian babies even though they are normal weight. And that is even more predominant in low birth weight babies. Let's say the baby has low weight, birth weight. Even in low birth weight babies, they don't have lean muscle mass. Every other area, the mass is lower. except for the truncle fat.

And this is absolutely mind-blowing that even in low birth weight babies, Indian babies, they have this fat sparing capacity of just localizing storage of adipose tissue right around the trunkal area in the belly buttocks and the thigh area. So this is what is fascinating is they studied this in a longer population. All right. In antherosclerotic vascular disease study in UK where they took like, okay,

4,50,000 of European patients and 8,500 patients of Indian immigrants, South Asians. They followed them up for 11 years. They followed them for 11 years. At the end of 11 years, they found out that there was a 8% increase in risk of heart attack in the South Asian people

compared to only 4% increased risk of heart attack in the European counterparts. How much do you think, and the idea that it's genetically driven, is it fair to say that that's a little bit debated, that how much of it that is the lifestyle of the individuals, like a lot of Indian population, they tend to be eating less protein, they're less active,

we're going to get into a lot of these things here in a minute, and how much of it is pure genetic? Is it fair to say that it could be a little bit of both? No, I think the, I'm not saying, at all that genetic is the main reason. That is not the point. Major point is people think that you are healthy. Indians, if you are healthy, doesn't mean that you are completely healthy. You need to be on top of your health. Yeah, you have to be more on top. More on the top of your health. Given the genetic problem, that is what the point that I always tell my patients is that,

yes, you're doing great. Your LDL is only slightly high. Your triglycerate is only slightly high. Your HDL is only slightly low, but that's slightly low, significant. hired to you compared to a Caucasian patient that I have. So I drilled that point every time to my patient when they walk into my office and I said that unfortunately, you know, when you play cricket, you know that we as Indians and South Asians, we start the innings with the wicket down. You need to put more effort to be healthy compared to a Caucasian counterp. On the top of it, unfortunately, we are the, as we talked about initially, we are the, we are

the last community to focus on health on the top of this genetic problem. Yeah, because all the emphasis goes into education, career, for all good reasons. Yes, of course. And that's led to a lot of return on investment, right? Indians, if you look at like a lot of the top companies in Silicon Valley, the CEOs, how well they've done as a, you know, a society here, being in an incredible country like America and some of these other countries that they've immigrated to and being able to to take advantage of capitalism.

Yes. Right? For a long time in India, like capitalism wasn't capitalism. It was more like nepotism. You couldn't get a job unless you knew somebody. So it's great to be able to be in these countries that you can flourish. And I think people are waking up and saying that we have a big problem. Even though we come from this country of turmeric and all these incredible health trends and

yoga and breathing, we're actually dying earlier. and we're living sicker longer than many other parts of the world. And that's a big problem. We need health for everybody, but we need health in particular for the society that's completely ignored it. Yes, yes. You are a gastroenterologist by training. And a lot of how you help people set up the conversation of preventative health

and stepping into our best health ever, which is the goal of today's podcast, is to give people inspiration and an idea that that is possible. you start with the gut. Tell us why is it so important that we understand how to get our gut health back? So remember we talked about

the subclinical level and the subclinical level what I was mentioning is your gut health. So in my, I always tell my patients is that if you have a strong gut, I will not have a job. No doctors will have a job.

No doctors will have a job because, you know, as you know, there is like 100 trillion bacteria in our gut and we were exposed to it when right from the mother's womb and it has multiple studies have shown that. You know, a lot of babies born through vaginal canal has been exposed to the maternal microbes and they start off with a very good gut microbiome compared to babies born with a cesarean section.

And it bonds, it starts right there at your birth and all these bacteria are like fighting for real estate. it's almost here in LA, there is no space at all. Fighting for real estate and they see this new baby that is being born out of the virginic colon, they just come and then occupy. And so we are being occupied with all these gut microbiomes right from the start, from the oral cavity all the way up to the anal orifice, but majority is being focused in the large intestine, which is your colon.

And I want the, I want to go deep into this and explain to our audience in terms of why this gut health is the main problem. So people should understand that. When we say gut, it is not only the stomach, it is right from the oral cavity all the way to the anal orifice. But our focus should be on the large intestine that is where the 90% of the gut bacteria is there. And it is being lined up so closely as the houses here in LA.

There is no space at all. It is completely packed. And there is a reason to it. because the lining of the intestinal cells is where your immune cells are, is where your connections to the brain starts, and that's where your brain get access all starts. So all these bacteria, which is a good gut bacteria, is on the lining, always starts to look for, okay, so whether this food is good, okay, let's take it.

This food is bad, okay, let's just discard it. And this happens only when the connection between the two cells are strong and close together. This is an extremely important point for the audience to understand. Extremely important point. The problem happens when this barrier breaks. And we call this a musin barrier. Musin is a slimy mucus layer being secreted by a cell called goblet cells in the intestine. They keep on secreting musin, musin, musin, and the lining of the intestine is so thick that nothing can break through.

Yeah, we want that. We want a good amount of musin. in the body, in the gut, especially in the gut. So then nothing can break through. And this goblet cells need this enzyme called buterate. Buterate is a short-chain fatty acids in the intestine that stimulates the goblet cells to secrete mucin so that the lining is very strong and thick.

The problem is we are not supplying enough butrate. Okay, it's very important to understand, enough butyrate. So because of all the lifestyle changes we'll talk about, The bottom line is this enzyme is not there. When the enzyme is not there, the mucin is not being produced properly. And because of the alteration of the gut bacteria with more bad gut bacteria. And all this foods that we are eating when we talk about is they are not feeding the bad gut bacteria. Because there's nothing left when it comes into the colon.

It's all being absorbed in the small intestine itself. So this bad gut bacteria starts eating up the mucin, which was a strong lining, strong lining. And it causes a mucosal break in the barrier. Once you have that small hole, then that is the entry of bad gut bacteria into the circulatory system. And how do we know that? There is a gram-negative bacteria. And on the outer wall of the gran negative bacteria is something called LPS, lipopolysacrides LPS,

which is surrounding the outer membrane of the gram-negative bacteria. So when there is a opening, this gram-negative bacteria seeps into the opening, gets into the blood vessel, okay, in the circulation. And our body is so smart.

So they know that, okay, something is wrong. Something which is not supposed to be in the blood is there. The border has opened up. Border has opened up. And there's a bunch of invaders that are coming in.

Correct. Correct. Correct. So it is time to attack it, right? So that is where our innate immune system acts. There are two kinds of immune systems. The innate immune system is something called the cells will include macrophages, natural killer cells, where it starts attacking. So what happens is after seeing this endotoxin, I mean, these are all endotoxins

within the body. After seeing this LPS and endotoxin, innate immune system gets activated. And all this natural killer cells and macrophages, stimulates these inflammatory mediators called IL-12, interleukin-12 and TN-F alpha. And these are all good things. We need them to fight against bad stuff, but not through this bad stuff. So while they are creating this inflammation, the lot of inflammatory mediators disturbs the hormonal signaling. And this is where you talk about in your channel all the time, the insulin resistance is the start of all this.

where the insulin is trying to get into the cell by attaching the cell to the receptor and getting all the glucose into the cells so that the cells can convert the glucose into energy. Just a crude picture is that imagine that all these inflammatory mediators of TNF, alpha and IL12 is like flowing around in circulation. The insulin is not finding its way into the receptor.

So the body thinks that there is no insulin. So then the body is so smart that the brain is stimulating the pancreas to secrete even more insulin. So that is why when you check fasting insulin levels, it is sky high, but at the same time,

the diabetes glucose level is also high. You think that that's a bigger driver than people having excess sugar and carbohydrates for driving fasting insulin way up. It's more of the gut barrier opening. So this is a,

the bottom line. The bottom line. It starts there. It starts right there. On the top of it, everything they talk about, right? You know, similar to how you said, you know, excess sugar. Of course, when already there is a little bit of more insulin resistant to start with. Of course, you're feeding more sugar.

Then, again, the same problem is that more insulin is being secreted and it is not being attached. But the problem with excess sugar is that that sugar, especially high, refined sugars in Indian immigrants, South Asians mainly. Sure. We call us Maida in India. We hear, we call it as all-purpose flour. Basically, white flour.

And it has been shown to disrupt this barrier. Yeah. And that is the key. So everything, every life child that we are going to talk about is going to target this mucosal barrier. And the whole gets widened up. More bacteria, more endotoxin gets through. More inflammation starts.

and there is no stoppage. So that's the first takeaway for everybody. Again, if you're an Indian immigrant, if you're wherever you're from, whether you're even native-born, it doesn't matter. First things first is that if you are looking to protect your gut health, there has to be an understanding that a diet

that is rich in all-purpose flour, white flour, refined flour, essentially, which is the byproduct of many ultra-processed foods, breads, bagels, pasta, pizza, pizza, pizza, etc., the modern ultra-processed diet that's out there in the world. If your diet is rich in those things, which many people it is, then you're going to be destroying your gut.

You're going to be eating away at that musin layer, which is actually something we don't want to do. And on top of that, you're going to be creating these endotoxins, this leakage into the blood. And on top of that, you're going to be also just adding high variability in blood glucose, which is also going to make the fasting insulin problem even worse. So number one recommendation, greatly minimize and reduce the reliance on white, all-purpose

flour that typically is not just in the food that you make at home, but is in these processed foods that you're eating on a regular basis. Is that accurate? Yes, yes, of course. on the top of it I can add one more thing is that you know UPF ultra processed food is everywhere is everywhere correct and one main thing is you know people were not having this much amount of heart disease like 15 20 years ago what has changed now is the easy availability of UPF before 20 years ago when I grew up

it's usually minimally processed right you know not processed or processed and minimally processed for this UPF ultra processed foods were available only in the last like a couple of decades. So what do they do in addition to the white-purpose, all-purpose flour, or white refined whole wheat flour, I'm sorry, refined wheat flour, as they also add, you know,

emulsifiers to extend the half-life and shelf life so that, you know, it could be a good, sustainable business model for them as well. So studies have shown that there is a connection between this emulsifiers and the gut mucin barrier. So most common emulsifiers are polysorbid 80 and CWC, CMC, carbaccymetalsals are loose, and, you know, Carrigan. Carragian.

Carragian, yeah. And these are all emulsifiers and just for the audience's awareness, these are stabilizers. They're added to food to make sure it last long. But in a way, they're really micro-pesticides because they're getting rid of bacteria. How do you make sure a food lasts longer? You have to kill the bacteria that's there.

So these emulsifiers are used to stabilize, which means get rid of the bacteria, which prolongs the shelf life. So, yes, maybe these things don't break down and you can keep them in your closet, your pantry for years and years and years and years and eat them during a global apocalypse one day in the future. But they're extremely harmful to your gut mucin and your gut bacteria. Of course, of course. And, you know, it doesn't happen like, you know, okay, so let's say one bag of potato chips, will that going to cause this huge museum barrier break? Absolutely not, right? But if this happens repeatedly on a, you know, weekly basis, monthly basis,

on a multiple levels of accumulated problems, I think that is where the problem is. And this PAT, CMC and this carry gun, they've shown to directly disrupt the gut barrier. And these are the emilsophase added in, you know, multiple vegetable oils as well. And, you know, in India, we always, we grew up with, you know, canola oil, sunflower oil, all these are, yes, there's a huge, you know, backlash against seed oils these days. My take is that, you know, that is not the only problem. There's a lot of problems. There's a lot of problems. Yeah.

So, you know, just saying that, oh, seed oil is very bad. Or don't use seed oils at all. you know, you are eating, not eating seed oils, okay, not eating seed oils, but you're not worried about other white refined grains, then white refined flour, then that doesn't matter. Yeah, that's a problem. Your sort of view from looking at a lot of your content is that, hey, listen, I want people to minimize seed oils only because they tend to be associated with a lot of ultra-processed foods. And if you cut ultra-processed foods, you're naturally going to cut back on seed oils.

And then at home, you know, the more you eat at home, the more you can control the diet, the better the quality can be, et cetera. You can control the calories, and you can make sure you get good fiber fat. You know, there's plenty of alternatives that are not too costly. You know, avocado oil, olive oil, those are all fats.

Those all have calories that are there, but we don't have to necessarily rely on seed oils. But the main reason to minimize seed oil exposure, it's because it's really tied with ultra-process foods. Yes. And also the emulsifiers are also being used in the vegetable oil as well. Again, the emulsifiers are targeting the gut barrier function. That's great. I didn't know that they were adding emulsifiers of seed oils, but that makes sense.

To extend the same thing. It's in the half-life as well. So, for example, the only oil, to be honest, I didn't know about oil and everything until, you know, my situation happened. But looking back, all I knew was cannola oil. Okay. Canola, I think when you do some research about it, it says that it's in Canadian oil, low an acid. And that's where it's called canola. Canadian and low-n acid canola. And, you know, it's coming from rapesee. Yeah. Okay, and it is a cultivar of rapesee, and that's why it's called a vegetable oil or not a seed oil directly. And as you know, you know, seed oil seeds has this toxic substance.

So you don't want to have the people eat the plant, and that's why the plant wants to grow. So when you process it, you have this polyunsaturated fatty acid thing, which is liquid at room temperatures. But when you heat it at 120 degree Fahrenheit with a nickel catalyst, that's where it becomes like the solid thing that you see on the stores. And when you heat it, it becomes liquid again. So with this ultra-processing and emulsifier, I'm looking at it. Okay, so all the deep-fried foods that I ate, you know, samosas, pucas, and all those things, on multiple levels of dosage exposure. Not only one or two, let's say you take samosa once a month.

Probably that's not going to make the gap barrier week. But let's say in America, I'm sure you know this. That's where every South Asian immigrant family, they meet weekend for potluck. and the potluck, the competition is whose food is tasty. And the taste comes from, of course, deep red oil, especially for Indian snacks and desserts and everything, correct? Yeah. So I'm not saying that, you know, seed oil is bad, Indian snacks are bad, Indian desserts,

but it is the amount and it is a dosage. And it is the, it is a very clear that all these emulsifies, ultra-process, what we're talking about, it's a dose-response relationship into the mucin. barrier of the gut that we talked about. Yeah, day by day, month by month, year by year, you can completely destroy your gut health and that can have all sorts of consequences. It's not just, you know, oh, you're at a higher risk of diabetes, which is a major issue, definitely amongst Indians in the South Asian population immigrants as well, but you are

increasing your oxidative stress inside of the body, right, which has a whole bunch of consequences, and you're actually making it easier for you to gain weight as well, too, because if your gut health is not integrity and these foods being so addictive, it's going to lead to a situation where you are going to end up overeating on other ultra-processed foods. Of course. Which is going to contribute to the excess calories you have, and it's going to increase your likelihood of gaining weight and having your belly fat expand. And on the top of it, we talked about the genetic makeup as well. We shouldn't forget that because at the bottom line we are at a disadvantage.

And there was one beautiful study, and it was a basic science study that they did on Thailand, Thailand and Burma immigrants. There is two ethnic groups called Karen and Monk. And they are very big in Minneapolis. So what this investigators did was, you know, they took the first generation people living in Thailand for the Karen population. and they took stool samples from them and then they immigrated to US and they followed them for six to nine months

and they checked the stool samples after nine months to one year. You will not believe about the decrease in diversity of the get bacteria that they had when they were in Thailand and Burma area compared to over here in Minneapolis, over here in US. And the conclusion of the study was an immigrant from a non-Western country

coming into the Western country has a decrease in the diversity of the gut bacteria as early as 6 to 9 months. Wow. And they followed them up for their second generation immigrants. The obesity rate was significantly higher in both this population compared to people over there. And that is why risk of non-communicable diseases death due to NCD, non-communicable diseases is significantly higher in Western population compared to the risk of communicable disease death in a South Asian population before.

But it's changing. So that is one of the most important factor that has to be discussed in a South Asian population here outside, here in US mainly. And the other thing is there is a group of bacteria called Privatala. And a group of bacteria called bacterioretis. Bacteriitis, we know that it is not that good for the gut.

We know that Privatala is very good for the gut because it has a fiber degrading enzymes. So when they check the stool samples of the current population in Thailand, Burma area, the Privatela was high. When they moved to the Minneapolis, after a year, the pivotala went down, bacteriitis went up. So what do you think that they were doing? What are the things, obviously we know that they're eating a more processed diet

when they came here to America, but what in particular? What were they doing that was destroying the gut? and what were they doing or what were they not doing that helped feed the good gut? Correct, correct. So I think that paper did not, it was a 24-hour dietary recall in terms of what you ate in the last 24 hours. Okay. Of course, there was a decrease in the fiber, which was a major thing among all the participants. And the second thing was adding the ultra-processed foods on the top of the existing food.

culture that they have. So they're not feeding the gut the good things like fiber. Fiber, correct. They're not getting enough buterate. Correct, correct. And then they're also destroying the gut with ultra-processed foods, with all the emulsifiers, and also ultra-processed foods. They tend to be concentrated in a plant.

There is some thoughts, limited studies that are out there, but some thoughts that can also lead to an increase in concentration of pesticides that are included, just traditional pesticides are out there, glyphosate, et cetera, especially when it comes to things like wheat, glyphosate being used as a desiccant inside of there and other vegetables that would be there. So they're hitting it from both sides. They're both having a bunch of bad things happen and they're not adding in the good things. But from a practical standpoint, let me tell you from my practical experience, right? So I came from Madurai, which is a very small town in southernmost part of India.

So let's say I come from Madurai to you as I came to Boston first. I was there for almost two years. It was a new environment. I didn't know what I was doing. And I have to prove myself. So I'm thinking that a lot of stress was involved during the transition. And this extra pressure of performing, settling down, and the lack of sleep during this initial first to two years

was a major risk factor for me. looking back at my profile. I'm not saying that my, everybody will fit my profile, but I can say that most of the immigrant population follow my template, basically. So there's multiple studies, as you know, that exercise increases the but rate in the intestine. When was the first time I exercised after the heart attack? Yeah. After the attack. And when was the first time that I actually focused on my seven hours of quality sleep after the heart attack? Whenever there's an exam the next day, what I do, the first thing is compromises. I study until 2 a.m.

and I wake up at 5 a.m. in the morning. Right? So hard work is good, but not at the expense of your body. I wish I knew this long time ago so that I'll start respecting my body more. So the point taken here is that, yes, food is one of the main trigger

of all these gut barrier, but there are other factors as well, which is also interfering with this mucin barrier that we talked about. Sedentary lifestyle. Yes. lack of resistance training, which directly goes into making sure we have adequate levels of muscle. We know that a lot of these immigrant populations, especially specifically South Asian, who tends to have also a high percentage of plant-based individuals, nothing wrong with that.

Plant-based, great. If people want to do that, I grew up vegetarian and then I was vegan for a while. I'm not vegetarian or vegan anymore, but I still have a lot of plant food instead of my diet. But there tends to be not a prioritization of protein, both whether people, people eat meat or whether they don't eat meat. There's not a priority as an nutrient protein. So you have people who are both, they're both skinny fat, but they're also like they're undermuscled as part of that. And eating protein is part of it. It's 25%. But then the other part is the resistance training, the working out, doing things, which is the 75% of the factor. You talk

about sleep. And then, of course, it's stressful. It's stressful to be an immigrant and be in medical school like your situation and many other people that are out there, or to be starting a new business and you come here and learn all the new customs of a new country and learn the language and want to fit in and be a good citizen. So all those factors lead into it. If you had to say, though, looking at most people, between sedentary lifestyle, stress, food, and let's say, so stress, food, sedentary lifestyle and sleep, how would you rank them in terms of priority of what's driving

this epidemic of a lot of belly fat in our community, but also more importantly, a super high risk of heart disease. If you had to rank those in order, what would you say? I think the number one, I would say sleep. Number one is sleep. I would say in my opinion, because, you know, there is no research to clearly say, okay, compare this four factors, you know, sleep is a one. But why I'm saying that is multiple research have shown that. that this gut barrier, what we talked about, is very strong if you have a strong brain-gat access. It's absolutely very clear that your gut controls the brain. There is no way out of it, no matter how you spin it.

Their gut-brain axis is being proven multiple times in multiple research studies. So if you have a strong brain-gut axis, then the intestinal wall with the barrier is strong. is strong. So I would say sleep is the number one. And the number two would be diet in my case. So because when coming to diet, I think we can go a little bit deep on the diet thing now. Because people say that, oh, I will go only carnivore diet.

I will not eat any plants at all. And I will go people say, oh, I'll go eat only plant-based. I will not go any carnivore at all, any protein at all. I mean, any animal-based product at all. in my practice, what I tell my patients is that whenever you do anything extreme, it's not going to be sustainable. It's not going to be sustainable. And, you know, multiple studies have shown that high ketogenic diet with just pure fat

has been shown to some cardiovascular disease down the road, you know, 10, 15 years. Again, same thing with pure plant-based diet. It's not inferior to the, I mean, of course, in my opinion, plant-based diet is much more better than the carnivode diet because it provides that fiber that is needed for the gut bacteria. But again, only plant-based diet, then it depends upon you to see whether that is sustainable for you. So what always I say is you don't have to be a vegetarian, you don't have to be a non-vegetarian.

You can be like Dr. Palitarian. What I mean by that is it is very clear that if you eat fruits, vegetables, plant-based, the fiber complex, both soluble and insoluble fibers, that goes from the oral cavity into the stomach, escapes the digestive activity of the stomach and the small intestine, gets into your colon, feeds the good gut bacteria, stimulates the butrate production, stimulates the goblet cell secreting mucin, and your mucin barrier is so strong that the gram negative bacteria doesn't see into the blood. So in that aspect, nobody can be the plant-based diet for sure.

So what I say is there are three meals a day, seven days a week, 21 meals a week. Out of this 21 meals, why don't we try 80% plant-based? Let's say, no, 16-17 meals. The remaining three, four meals, you know, you could take non-vegetarian diet or animal base so that you could add fiber in addition to the animal base. That's what I would recommend for people who are not, who are confused which diet to follow.

But it will all boil down to which diet will actually increase the mucin barrier in the gut. Yeah. I think that, you know, to add a little bit to that, that, you know, having targets of how much we want to be getting from certain macro nutrients to support the end goal of what our body is. And so I'd love to just walk through that. So let's talk about the fiber side of it.

Because what I found is that sometimes you say 80%, you know, people think, okay, is that by volume, is that by calories, et cetera? But if you give people a target number of fiber to hit, then they can look and they can actually are they hitting that target number of fiber? It could be one other indication that's there. So for you, for, you know, male or female, you know, coming from Indian background or any other immigrant background or just any human being in general, what is your target fiber that you have your patients shoot for in a day? So being a gastroenterologist, as soon as you walk into the office, there will be a big chart. It says, did you take your fiber today? Question mark.

If not, come back again. So usually for men need a little bit more fiber than women. So bigger bodies. Bigger bodies, right? So for women, 25 grams of fiber per day, women, men, 35 grams of fiber per day. But when you actually look into how much amount of fiber is there in each and every food, even 25 grams, it's a lot. It's a lot.

It's a lot. People don't realize. Until they sort of track calories, look at the back, you know, use like a chronometer, My Fitness Pal, Carbon App, something to look at actually how much fiber there's. taking. And the tendency is, you know, I grew up vegetarian, but I was not eating except for the meal that my parents would make at home at night, which was a Gujarati-inspired sort of dinner. During the day, just vegetarian meant for me that I'm just not eating meat. So I'm eating twinkies and chips and I'm eating everything.

Gulanchamu, mazur, park. Right. And all those things, just they are vegetarian, but they have no fiber really. There's hardly any fiber. They're fiber devoid. Just like you were talking about telling people to void that all-purpose flour because, again, you've ripped out all the, essentially the sugar, quote unquote, and there's no fiber to slow the uptake of it. So a lot of foods that people are eating, especially in our immigrant populations, we just realize that there's not actually that much fiber inside of it. Even sometimes when I go to India, I haven't been there in five years, five, six years. Sometimes I'm just so astonished at how few raw vegetables or

pure vegetables that people are eating. If I see a vegetable, it's usually deep fried into samosa, right? So that's usually what I see that's out there. I'm sure things are changing. You know, we got... It's not changing as fast as it should. Okay. It's not changing as fast as it should. But slowly. Slowly with your work, you know, how many followers you have now on YouTube, like 3 million followers on YouTube, you know, a few million on TikTok. So you're making a difference, slowly, slowly. But more than 95% of the moment of patients. Yeah, 90% of their patients. They're just rewatching, which is good.

Okay. So that's fiber. another one that we want to talk about. And this is where I do want to have a little bit of an honest conversation around the protein side of things. And, you know, again, people can do it vegetarian. They can do it non-vegetarian. We can do a combination of a little bit of both. But what have you learned about protein? Because I see from your content from the outside, you know, looking in, is you, it feels like you've really started since your incident and especially in the last few years, you've really started to prioritize protein your life. So tell us why. Why did you start doing that? again, I'm emphasizing the fact that being a medical professional myself,

I was not aware of the dietary importance. Undereducated on this. There's no nutritional education. Yeah. So that's very, very important. And I'm very glad that medical community is looking into it. And they're saying that diet is the main treatment option for everything. So food is the medicine.

I think I'm so glad that if you follow any J.M, New England Journal of Medicine, they have this new column of talking about diet and disease. Nutrition 101 starting from last month. So it's a huge change. I'm telling you, it's a huge change. We always talked about the prevention. I mean, I'm so treatment. Let's say a patient had a heart attack.

Okay, we have the state of the art stent. And this tent come back to that stent. And this tent gives you more life. But what will happen to prevent that heart attack? Not many studies and many resources have been allocated. for that. And I'm so glad that has been changing. That was happened to me as well. In my case, I don't know about protein that month. So I know that we need 0.8 gram per kilogram per day for everybody for general maintaining cellular functions. But am I getting it? Then I started noticing

about what I'm eating, how much protein is there in each and every food. Then I came to know that non-vegetarians have an easier option of getting protein intake compared to vegetarians. And you need to actually be more mindful, more conscious, more plant to get the the same amount of protein if you are a vegetarian source. So that's why I propose as a combination of both vegetarian and non-veacherian so that you can meet your protein goals. And it is very clear that the DNA of our cells needs protein. And every cell is being died down and then being repaired and then new cells are being formed

and you need protein for that. And that is one of the most important thing that we should learn as, you know, South Asians, Our food is rich in carbs. Whether you like it or not, it's absolutely, absolutely delicious. Absolutely delicious. But what I am asking my patients and also your followers as well as that, why don't we get the best of both worlds? We are very good in education. We are good in career.

We are, why don't we just focus a little bit more on the diet? We're not saying that no complete to the carbs, decrease the carbs, increase the carbs, increase the protein. you can definitely find a good harmonious way to proceed. Yeah, no, that's great. I think the other thing about protein that a lot of people who are new to consuming the appropriate amount of protein and a lot of the recommendation of people who come on this podcast and top protein researchers, they'll say, okay, for your ideal body weight of where your target body weight is, let's say if you are overweight individual, it's a little tricky with people

who are, you know, toffee. They still usually want to lose a few pounds, but it's really more they want to lose fat. because it's their body composition. If many of, many Indians go to get, you know, as you mentioned before, BMI is not helpful because your doctor will tell you, hey, look, you look healthy and, oh, you're vegetarian. Okay, great. You're doing good.

But if they went and did a body composition test, you can get a Dexas scan. Sure, there's a little bit of radiation with that tiny bit. You can do an in-body scan. That's another way. Many places, you know, you can Google it and you can, many doctors offices have it. And if you get a body composition, many Indians and immigrants are in South Asians. They're so surprised as I was right before I turned 40. I went in for my first body composition.

And I came in as one of those individuals. I was thin on the outside, fat on the inside. I came in at, I had just come back from a month in Italy. So I had overcarved it up. Probably a little bit of alcohol is in there as well too. I came back and I think I measured it at 25% body fat. And somebody who would look at me, who's somebody who's naturally slender and skinny growing up,

they would think, no way that you were that way. And that really, because before that I got serious, there's a friend of mine, her name is Dr. Gabriel Lyon. She has a whole approach called muscle-centric medicine. And her sort of argument is that for you, it's not that you're over fat, you're under-muscled. And she really helped me understand the importance of really focusing on adding more lean muscle mass.

So I got serious about it. I started tracking my calories, you know, to really do an audit of my lifestyle. And I started prioritizing protein. And when you start prioritizing protein, you realize that, okay, great, if you want to lose fat and you want to add muscle, which is something you talk about a lot, in many instances, in addition to most importantly, working out and having resistance training, you're going to need about a gram of protein for your ideal body weight that's there. So I was eating, you know, 155 grams of protein a day.

which prior to that, I think my average was probably about like 80. 80. And I saw the transformation in my body over about nine months, 10 months. I have the records, but I don't know exactly offhand. I added almost 10 pounds of lean muscle mass. And I reduced my body fat. And I got into a 15% body composition place, working with the trainer, working out regularly. And that was at the age of, you know, 40.

Right. And so I didn't even know as being somebody, you know, so we're all just learning, right? We're all on that education journey that's there. And the other beautiful thing is protein is so satiating. When you have it, you don't feel as hungry for eating other things. Of course. So that's another benefit of having protein instead of diet. Exactly what you said. I did this three months ago. Yes. I've been watching your journey. And you've been sharing your workout videos with people. It's fantastic. Exactly. The reason is, yes, I was pretty big before. I was 200 pounds before. Okay.

And then after all this, I came down to 175. And I'd followed this Dr. Satchin Panta's time-restricted feeding circadian rhythm. And I respected very well. And then I started losing weight. And I promote not eating late at night as well to all my followers and my patients as well. So but in the meantime, I didn't know that I lost my muscle mass as well while I was losing all this weight. So I didn't know about at that time. So now I'm telling my followers and my patients is that,

hey, look at my dexascan. My boss, people would be surprised similar to you. You know, people think that I'm very healthy and very skinny, but I showed them that my body fat percentage was 29. And my muscle mass was only 59 pounds. Muscle mass was 59 pounds. And then I showed the dexas scan and I said that, you know, this is going to take a lot of time, dedication and commitment.

The initial weight loss is easy. The actually building muscle will take a lot of time and coming up. It's a slow process. And even a lot of accountability. I am going to be accountable for my 3 million followers on YouTube. I am going to tell you what I'm going to do every day. And I know that everything is tied down to the gut. And that's why I started this gutman challenge

where you have this five different points to stimulate the gut barrier that will help you build muscle in addition to the resistance training that you're doing. So I'm in my 60th day. Today is my 60th day. That's amazing. And you said there's five points of the challenge? Five points in the challenge. You want to review those points?

Yes, of course. Yeah. Number one, building muscle needs resistance training. There's no other way. So I said, you know, daily one hour of training, including active recovery. So rest is very important for muscle. So even if you're giving rest for two days, active recovery is like mile walking, mile jogging, even stretching is an active recovery.

And the second point is you need to include at least five plant points a day. Plant points. Plant points. Yeah. It could be vegetable, seeds, nuts. you know, fruits, any, but it should be different variety. If you have two apples, that doesn't count. It counts as only one.

So it needs to have a different variety. And then number three is avoiding ultra-processed food. And the number four is meditation, minimum of 10 minutes a day. And I have a, I strongly believe that, again, coming back to the brain get access, you need to take care of the brain get access in whatever way that is possible. Sleep is one of them. And meditation will help you. sleep better and that will strengthen the brain get access as well.

That's great. I love that. Also, too, the ton of research showing that when you don't sleep well because you're using your devices at night or maybe you're stressed out or increasingly we're learning more that not keeping a cool environment if it's too hot or if the temperature variability is not what you like that creates a lot of disruptive sleep. So when you don't sleep well, you crave more calories the next day. Right?

We know that. So it becomes a vicious cycle. When I ask you to list the top drivers of increasing belly fat and also increasing our risk of heart disease, you listed sleep as number one and you listed food as number two. And there's a vicious relationship between those. When you don't sleep well, you crave more high carb, high fat foods, and then you don't sleep as well. And then it's a cycle that continues and continues. And one thing I should tell the audience is that what I'm doing right now is a very clear example of how

difficult this is. Being a very busy professional, everybody is busy. Being a busy professional, unless you prioritize this, it's not going to happen. It is not going to happen. You need to prioritize it. And what I have learned in the last 60 days is I'm 40 now. As your age advances, the recovery and the outcome is slower, much slower. And, you know, I did a XA scan on day 30 to see how the progress, 30 or 40, I don't remember. But I, you gained three pounds of muscle mass. That's great. But my body fat percentage didn't change a bunch, didn't budge at all,

maybe like 0.5% down. Then I realized that the amount, I thought I was doing so much effort. And that's the most important thing I want to convey to the audience is that you think that you are put in so much effort, you didn't see the results, you get disappointed, and you go back to your previous routine, your body needs a little bit more. So don't focus on the,

the outcome. Just blindly do the process. Trust the process. The outcome will come. You enjoy the process. It is going to be a long challenge. And that's why I did that for 100 days and not for like quick fix or like 50, 60 days. Yeah. Yeah. No, that's great. It's also too, it's difficult for a lot of people. I didn't notice this until I started doing this until you track your calories, not forever. That's very difficult for a lot of people. But if you don't track your calories for at least two weeks. You actually have no idea how much you're eating. And for example, I'm a huge fan of this dressing. It's called Primal Kitchen.

It was started by Marxists and they sell it in stores and stuff. And it's made with avocado oil. It doesn't have seed oils, other stuff. And I would do sometimes, I didn't realize it, but a big pour is like two and a half tablespoons. Right? If I did a big pour on my dressing, I just thought, okay, this is all healthy.

ingredients. Exactly. Right? The amount of fat in two and a half servings and calories compared to one serving. I always thought, oh, this is just one serving, but it was a heavy pour. And we do that with a lot of things that are there. And all that adds up to your total. And I realize, oh, just by dialing in a little bit of even the healthy fats, you can gain weight from healthy foods. You can gain weight from healthy foods. It's not just ultraproseless foods that makes you gain weight. So if you don't do an audit, you know, we tend to significantly underestimate the calories that we're eating, especially from fat, not that everything is about calories, but if you're trying to lose weight, you're going to have to get a handle on those calories in addition to, you know, having an

active lifestyle that's there. And until I measured it and saw, okay, I'm going to be a little bit more stricter. And we all typically eat the same foods on a weekly basis anyway, with some variety. So you don't have to track your calories forever necessarily. You just have to audit them enough and see, wow, when I make this salad, even something healthy this way, and I add a lot of dressing, that might be, you know, 650 calories. But if I just dialed in the dressing a little bit,

that would be 400 calories. And all you need to lose, you know, a pound here or there is you just need to have a deficit of about 500 calories every single day, and that's going to add up. I think you said it in one video is that to lose a pound of fat, a pound of fat is how many calories? $3,500 calories. $3,500. So divide that over, you know, a week and a half if you want to, you know, not be too

aggressive. That's the deficit that you have to create with things. And I think my audience, more than anything, needs to hear, you will gain weight if you overeat healthy foods. And a lot of the healthy foods that are whole foods, they're sometimes just as addictive as processed foods. They may not be super ultra-processed, but they're still processed.

So that's why it's important to have a little bit of an audit, even though it's difficult. You will be surprised how many people, including me, I didn't know how to track a calorie at all. You know, biryani is one of the favorite food for all Indian immigrants in it as well. So I didn't know that biryani had this much amount of calories. I used to eat like one full plate.

So I think conscious education, monitoring and then as you said exactly that you don't have to do this forever until you get the habit of seeing a plate of biryani assuming that okay so this is 500 600 calories until then you need to track it down until then you need to track it up so that's I say my GI patients all right because I see a lot of patients fatty liver and the treatment is weight loss and they ask me how do you lose weight the first thing is you need to track your calories the first thing you don't have to do anything don't change foot, just do for one week, just monitor the calories in terms of what you're taking on every

day. That's it. Just the concept of, you'll be surprised that that concept has not been caught up in South Asians yet, at least in India. Maybe here it's slowly getting better. Yeah. And as you mentioned, long term, and as I mentioned too, long term calorie tracking is very difficult for people, right? It's very difficult for people. It's tough to do and, you know, doing every single thing like that. And that's why I think that you're a huge fan of also, and also I'm a huge fan of this, is that people shifting their diet as much as possible to a whole food diet. Because a whole food diet creates satiety inside of the body and ultra-processed foods, even if you can eat them in moderation, I do want to say the thing that's there for people

is that those foods are just designed for you to overeat. Yes. So I don't want to ever completely. tell people to move away from them. But I do want people to know, you know, moderation is such a tricky word because if you go to here at Hollywood Boulevard and you tell one person, hey, do you eat healthy? That person says, yes, I eat healthy. And their definition of healthy is that they only have two Coca-Cola's a day. And then you ask the other person, do you eat healthy? And they say, yeah, I eat healthy. And their definition of healthy is that, you know, they only drink,

they only eat, you know, fast food, you know, one meal a day, right? So everybody has a different definition of moderation. And that's why I think that I'm a huge fan of having a little bit of a palate cleanse. That's why I like your challenge. In your challenge that you're doing right now, what's it called the gut? Gutman. The gutman challenge. I have a huge following of 10 to 14 years old. Yes. Kids. So I just want to target them. Yes. I used to get like letters of having like Spider-Man, Superman, they have a gutman. So you're gutman. Got it. So you're the gut man. We need to make you a cape. Yeah, cape. We need to make you a cape. Oh, the other thing is they said moderation. is key for which we have lost the key.

Yes, that's true. So what I love about your challenge, the gutman challenge, and we'll link to your social media and I encourage everybody to follow you to follow along. A lot of your followers are participating in this challenge. Is it until you have a little bit of a palate cleanse?

And as part of that challenge, if I understood correctly, you're not eating any prox, like ultra-process foods. No ultra-positive. And I think that that's super important. You don't know how good you feel until you remove something completely, at least for a short period of time. Then if you want to add back in truly in quote unquote moderation a little bit here and there,

that's a lot easier. It's hard, though, when your diet is a lot of ultra-processed foods. And then you're saying, okay, I'm just going to do it in moderation, but you don't know the difference of not having it in. And the reason for 100 days is it takes 90 to 100 days for the gut bacteria to change. The craving. For example, let's say that you crave for the chips, potato chips, and the reason that you're craving is not you.

It's the bad gut bacteria in your body. And that secretes chemicals, neurochemicals similar to dopamine. And that dopamine is controlling the appetite center in the brain by traveling through the brain get access and making you to order the chips again. And this process takes three months. Can we change it? Yes, of course we can change it, right?

but not in one month or two months. We need to keep giving, let's say, cucumber, for example. You keep giving cucumber for every day for three months, three to four months. Then the same gut bacteria, good gut bacteria, also have the exact same power as bad gut bacteria. It will secrete the same neurochemicals and will make you crave for cucumber. It's absolutely amazing. We are born with this wonderful 100 trillion bacteria.

It is up to us how to mold them because they are very malleable. And another example that I can give you is in my GI patients. Every patient comes in with abdominal, bloating, constipation, diarrhea, pain, post-pranorial fullness. And the bottom line is they're not able to tolerate certain kind of diet. You might have heard this FODMAP diet. The first thing that we say is, oh, you go low on FodMap diet. For our audience, I'll explain, FODMAPS stands for fermentable, oligo, disaccharates, monosaccharates, and polyols. What does it contain?

It contains whole grains, seeds, nuts, fruits, vegetables, and good healthy fats. Why is that patient is not able to tolerate all this VATMap diet? Because the bad gut bacteria is overpopulated. And that is why we call it, have the term called Cibo, small intestinal bacterial overgrowth, where there is bad gut bacteria overpopulating the good gut bacteria and making you crave for all the things that is not good for the gut. So what we say, go low on the FortMab diet. That is not what we want because that is not good for you, but we can have. We don't have an option because you are not able to tolerate this diet because you don't have the gut bacteria to have the fiber and degrading enzymes.

So you go on low Fodmab diet, fermentable example of a Farnemortmab diet is apple. Apple, will you say apple is bad? No, apple contains pectin. Pectin is so good for you. But the problem is these patients have, because of multiple lifestyle factors we discussed, don't have the gut bacteria to digest that pectin in the apple. So what do you say? You don't eat apples.

Okay. And you give rest to your body for a couple of months. And then you slowly reintroduce it later so that you can repopulate the good gut bacteria again. It's an elimination diet. Yeah. Similar to a similar elimination rate, but not completely. Not completely. Not completely.

So based on what I learned. from my IBS patients, irritable bowel syndrome patients, the best thing to do is to give Fottmap diet to our kids and young age so that you don't develop any other GI symptoms so that your gut barrier function is so good. You want them to be eating a lot of those diversity of foods from early age, a lot of fiber, a lot of different fruits and vegetables, and also making sure that they sort of,

by doing that crowd out a lot of the ultra-processed fruits. Yes. It's not the base of their diet. They want to have it. Kids are always going to eat it. I mean a little bit of this, a little bit of that. But it's not the base of their diet. And hopefully, knock on wood, they never end up in that position in the first place.

Exactly. So people say, oh, we cannot have bananas for diabetes, right? Because bananas increases the risk of glycemic index. But what if you give the banana at the younger age, let's say like, you know, 5 to 15 years of age, where the gut bacteria is the most malleable thing? So then you give the phantom diet. diet, then your gut is so strong, then it'll come down to the same barrier thing,

decreasing the gram-negative, metabolic endotoxemia, insulin resistance, will not happen to start with. Yeah, yeah. How much of it do you think is introducing these good foods from a young age and how much of it is avoiding the ultra-process foods? If you have to say, you know, percentage-wise. I would say giving the good food. I would say 75%.

75%. Make sure they have good food. When you have good food, you have a lot. of leeway to have ultra-process food a little bit more. Yeah. You know, the other thing about that is that when you have muscle, you have more leeway to have more amounts of sugar and carbs in the diet. When I added, when I went on my journey and I worked out with a team here based in Los Angeles,

but they have a bunch of locations all around the world. It's called ultimate performance. And they're very methodical about everything. They have a coach. They track it, et cetera. They're looking at your protein. You're working out in the gym with them three to four days. week. The biggest thing that I saw is that even though I was eating more carbs and I was on a super low

carb diet before, I actually saw that my fasting insulin improved because I added more muscle mass. And your muscle is so metabolically active. And we even wrote a study about this. We'll put in the show notes. We featured a study last week in my newsletter. We were talking about for every pound of increased muscle mass, I think that there's like an 11% improvement in insulin sensitivity that's there. Wow. Don't quote me, but we'll link to that study below. It's something like that.

And it just shows you how important it is that, yes, diet is super key and especially from a young age, but having an active lifestyle and especially for the Indian population and especially as they age, my parents, right now, the main focus for them. that me, my sisters, my brother-in-law, Neil, are doing for them is making sure they get some resistance training and that they also have kept up with their protein to increase their muscle mass even at the age of, you know, 70 years old, right? It's a slow process, but it's still super important. And, you know, we didn't touch on this, is that muscles also extremely skeletal muscle is extremely protective if you fall. It's going to protect you from breaking your hip.

you know, a little bit more protection than if you didn't have that muscle mass that's there. So there's so many reasons to prioritize muscle. And you know, it's funny for the Indian community because we watch all these Bollywood movies and all the stars there have so much muscle. And all the women look incredibly toned. And there's rhythmic erosion everywhere. Right. It's inspired to be at least a little bit in that direction, right?

Right. This is true for women mainly because you will not believe how many hip fractures and femur fractures happens in post-menopausal women. Yes, of course, because of the hormonal imbalances that are increased risk of bone mineral density being decreased to start with. On the top of it, if you don't have the muscles to support the bones, the fracture risk is significantly high.

My colleague in India, he is extremely busy replacing hips, mainly in women after like 50, 55 years of age. Wow. And, I mean, as a man itself, for me itself, you know, I didn't know about resistance training and everything. Translating that into women is something that we really need to work on, especially for South Asian Committee.

When people finally decide that this is something they want to prioritize in their life, what are the things that you see from your patients, your social media followers that trip them up on the journey? It's natural, you know, we'll fall off the wagon sometimes and we have to get back on. It's a journey. But what are the top things and mistakes that people make? when they decide finally that I'm going to prioritize this. I'm going to do this, right?

Because what I see sometimes is that people have a little hiccup and they say they throw up their hands and they say, I'm not going to do this, right? What are some of those mistakes that you see people making? First of all, I tell my patients as well as that, number one, you should not do this for weight loss. That's number one. I always tell them that weight loss is not your goal.

It's not your outcome. Weight loss is a byproduct of the process. Incredible. And the weight loss is directly proportional to the amount of damage that you have done to your body prior to the intervention. I am 40. I have been abusing my body for the last 20 years. And I can't expect rizzles in 40 days. The problem didn't happen overnight.

It's not going to be fixed overnight. Fixed overnight. So that is number one. So I always tell my patient in fatty liver is that, okay, weight loss is the treatment. You know that. But the first thing I want you to do is to wrap up your weighing scale. and put it on the top of your shelf for six weeks. The biggest problem is people step on it every day.

Oh, I lost 500 milligrams. They go to the mind and when they go up a little bit and they just lose the motivation. They decide how they feel on the day based on their weight fluctuation, but your weight fluctuates all the time. All the time. That's not the thing that we want to be. And also, you remember that talked about the mucin barrier that on the gut.

the reason I'm bringing back to the gut is once this mucin barrier is so strong, you can decrease the inflammation in your body and the weight loss will happen slowly. So when you decrease the inflammation, it takes time. It takes time and nothing will be shown outside. There's so many things that is happening inside. So I always tell my patients, be patient not to become a patient. Okay, so that's the first one, is that don't obsess about the scale. Do you still recommend to people just so that they have it and have some benchmark,

do you recommend if your patient can to get a Dexas scan, to get an in-body scan so that they understand their body fat percentage and they can track their lean muscle mass? Correct. So Dexas scan two problems. One is it is not being covered by insurance for general muscle mass evaluation. And the second is, of course, you know, it is widely available now, but, you know, the Avanus is still not there in India yet. So what I usually tell my patients is if your waist circumference is more than 100 centimeters

around the belly button, you don't need a excess scan. Yeah, so you can just do a tape measure. Tape measure. Or the second thing is you should do a waist to hip ratio, WHHR, where you measure your waist first, you measure your hip first, second, then you do a ratio of it and it should be less than 0.9 in males and less than 0.85 in females. For example, let's say my waist was 100 centimeters. my hip was 90 centimeters 100 ever by 90 is 1.1.

So I am an increased risk of heart disease. I know that there is visceral fat inside. Dexas scan. I'm not going to waste my money on that. I will better do it or donate that money to my charity. So how do you measure progress? Exactly the same thing. If your waist goes down, your progress is getting better.

But again, it has to be slower and then you need to be understanding that, okay, it's going to be slow. So waist to hip ratio and waist circumference. And all this is very important in South Asian community. And that is why all the numbers are much, much different. Body mass index 23 in South Asian's. Blood pressure, 140 over 19, a Caucasian counterpart, 130 over 85 in our South Asian counterpart. So everything is different for us.

So we cannot go by standard numbers. Do you have a cheat sheet that you've published or a video that we can link to where you have your sort of optimal numbers that you want for the South Asian? Asian community? Yes, yes. Yeah, and I started my video with how you can use.

I started my channel in terms of fasting in terms of, I said, how you can lose weight using the sun. Because we follow the sunrace to sunset method of circadian rhythm. Yes, circadian. Right. So in that video, I talk a lot about the circumference weight ratio, blood pressure and everything. And just the bottom line is that, you know, the numbers,

yes, that's well and good, but you should realize whether it is applicable to you or not. Fantastic. Any other things that you see that trip people up that you want to address with our audience here before we go into some concluding thoughts on the episode? The most important thing is, you know, you remember about the, we're tracking down the calories, eating whole grains, eating vegetables and all those things. This requires a lot of effort. You need to understand that it is going to be tedious. And if you are a couple raising a family over here in the US, we know how busy you are. And I have two little kids. I exactly can relate to you. The only thing that you should keep on telling yourself is, yes, there are so many chores to be done, so many things to be done.

But if you have, I mean, one more thing people always say is you only live once so you can eat whatever you want. right yolo concept so i say that you know yolo is okay as long as you are solo if you are kids less than 18 years of age it is your damn responsibility to be alive until they are healthy until they turn 18 and uh it is it is it is something that because you see lots of i'm pretty sure you must have seen as well lots of WhatsApp forward messages that we are getting right now where young software engineer young very well busy professional dropping dad in 40 to 45 years of age. Yeah.

Leaving the, you know, surviving spouse with the kids with a go-fund me page, my heart goes out to them. And I know that the damage didn't happen overnight. The damage happened 10 years ago and most of the diseases are avoidable.

Some are unavoidable. I completely understand. But this is something that you should do for your family, for your kids. So whenever you think that there is no time, just remember that prioritizing your health, you will create time. And that is what is happening with me.

Now with 60 days, able to make this as a habit and not using this as a well-power. That's so great. And you'll also set that example for your kids. Yes. Right? You'll set that example. They'll see that.

Right. If your kids see you studying a lot and working hard to be a doctor or to be a software professional or whatever job somebody has and they see you working hard and studying and making effort towards there and they see you doing a budget and being responsible with money, they're going to be learning those things in the same way. In the same way, if they see you prioritizing weight training, resistance training, eating healthy, they're going to want to aspire to those things too. We don't just need Indians to be the champions in the spelling bee competitions.

We want them to start seeing some gains inside of the gym too. And the other message that I have for parents, especially as somebody who I'm turning 42 this year, my parents, my mom just turned 70, my dad turned 75 this year. and I'm so thankful for my parents for them being open to change some of their ways. And, you know, they immigrated to here to this country from Kenya is where our family's from. And they immigrated this country with all of our different Indian cultures and foods and other things. And they've been doing things a very specific way for the last almost 35 years, 36 years, since they've been here. And it's very difficult to change.

But I know that one of the things that motivates my parents to do this is that we're very lucky to be able to have them live, you know, very close to us. They're in San Diego. They live with my older sister. And, you know, a lot of Indian families, they live in multi-general, you know, and immigrant families. They live in multi-generation homes. And we are realizing increasingly now is that parents, you know, they don't want to be a burden. even if they are living in the same home as their families in these multi-general families, everybody's worried about being a burden.

The number one way to be less of a burden is to prioritize your health. Because if you're healthy and you live, you know, a long age, but it's more about health span, a healthy age, you're going to be in a place and position where you can maximize the amount of quality time that's there with your family. if you spend the last 20 years of your life riddled with diabetes, a hip fracture, these other things, bedridden, you know, that's, I'm just going to be very honest about it. That's taxing on your family. So don't be selfish with your yolo. Priorize your health because it's your kids who ultimately will also be taking care of you as well. Of course, it's for you first, but it's also for your family.

And I think a lot of parents need to kind of hear that honest conversation is if you love your kids, prioritize your health. You're going to feel good along the way. You're going to have less disease, but you're also not going to have as much health challenges, which even if your family loves you, and I hope that they do, and I love my family, they want to take care of you, but they don't want to see you suffer. That's why we need to minimize our risk of, you know, chronic disease that's there. Of course, of course.

I actually hit the point was right. I think, you know, as a, when we grew up, most of the times, you know, we were going to join family and the, you know, the connectivity was there. And the emotional connection, I think it's being slowly lost. It's being lost. It's unfortunate. I think, you know, any kind of connection, I will always bring it back to the brain cut connection. Yeah.

Any kind of connection wherever you see, I think remember that. It is always good for your brain gut connection. emotional connect with your friends, families, prioritize, and prioritize your family time more than anything else. No phones, no screen time, playing with your kids while you are working on the laptop, playing with your, you know, talking to your wife while you are doing something else. All those small, small things, I know that it has to be done multitasking is good in this busy environment, but all those small, small things are disturbing the brain get can access. So, again, when we, when somebody's prioritizing, it's.

authorizing their health, they know exactly what is wrong. Yeah, it's well said. Dr. Powell, this has been fantastic. Thank you so much for coming down here and sharing your wisdom. You know, I want to just acknowledge you for a second. You've done an incredible job of communicating these things that are so multilayered, especially when it comes to things like gut health and diet. I'm so excited for the launch of your, you know, podcast, your channel, everything.

And the best part about it is you take this thing that is so serious, which is our health, right? You know, we already shared it, that South Asians, Indians in particular, that the highest risk of heart disease here in the United States. And growingly in India, India is one of the fastest rates of diabetes that's there. And that's very unfortunate, but you're tackling this very serious subject, but you're doing it with humor. I feel like in another universe and another dimension out there somewhere, you're a full-time comedian.

And I'm so grateful that you'll be able to bring your humor and your medicine and your education and to be able to translate it, especially for a population, that this is very new to. And I know a lot of my family has watched your videos, and they just find you incredibly funny and how you shout out all your different friends, you know, who are, you know, you're this Kumar and that Kumar who are doing this or that. And, you know, that takes real talent. And it also takes courage. You know, it also takes courage. There's not a lot of, you know, South Asian doctors that are doing what you're doing. And I hope that many more of them see you. And they do decide to go into medicine, but they bring in this humor component because ultimately all those things lead

to change. Thank you. Thank you. Thank you very much. I coined this new journal called Metcom, medical comedy. So I do a 90-minute English stand-up comedy show. Oh, really? It's like a metcom. So I engage people. We talk about all this thing that we talked about in a much humorous way, interaction in person. This is in person. I've been touring. I've been touring in India. Oh my gosh. I've been touring in U.S. as well. Oh, that's great. I went to Raleigh, Boston and everything. So I'm not sure where it takes, but I'm just doing it for fun. But I love interacting with people. That's great.

But the humor also makes a big change in the brain connection as well. But one thing I will let your audience take away from the whole podcast is, I think if you just follow this one rule that I always tell my patients. So I'm going to tell to everybody as well. As I say, follow this rule of three to one. And remember that bottom line is your gut brain axis and your gut connection. is three. Three is you need to include three vegetables every day, different varieties. Two fruits, different varieties. If you are diabetic, low glycemic fruits like berries. One, fermented food every day. Three, two, one. If you follow this, all the gastroenterologists will say, one, two,

three, go. We don't have a job. How can our audience keep in touch with you if you just shout out where they can follow you and you're most active? Yes, you know, very active in YouTube. I have close three million followers. Dr. Pal is the handle. And Instagram is Dr. Palmanicam, close to 1.4 million followers. So we would love to keep in touch. And we also run a holistic weight loss program. Actually, gut health program.

I shouldn't say weight loss. It's a small thing that we're doing. It's called New Me. New Me. So the concept is that, okay, old you is gone. New me is coming in, but with a newer vision about your health, not just focusing on weightless or so. Amazing.

Well, thank you for coming on the podcast today and showing all of us how we can step into the new version of us, the new me, that we have the potential for. I appreciate you. Thank you, so much having me through. Hi, everyone, Drew here. Two quick things.

Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share with a friend, share with a friend who would benefit from listening. Number two, before I go,

I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset, to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com.

That's D-H-R-U-P-U-R-H-I-T dot com and click on the tab that says, try this.