Feel Better, Live More with Dr Rangan Chatterjee - #287 The Secret To Radically Improving Your Health (That Nobody’s Talking About!) with James Maskell

Episode Date: June 28, 2022

Are the people around you supportive of your health goals? If you were to embark on a new routine, would your friends be a help or hindrance? For today’s episode, I was delighted to welcome my good friend James Maskell for a conversation around friendship, community and the concept of ‘group medicine’. James is a health entrepreneur, author and community builder. He studied health economics and it’s now his mission to curb rising healthcare costs across the globe with a model that puts people first. His latest book, The Community Cure, looks at how helping groups of people with common health concerns come together can solve the very problems they share – an idea similar to Alcoholics Anonymous. He runs virtual health coaching groups in the US, which have been successful for everything from autoimmune disease to depression, chronic pain to digestive disorders. And he believes there are few conditions that couldn’t be helped by a collective mentality.   We discuss a 2006 NHS version of this concept, which famously saw patients work together to reverse their type 2 diabetes through diet. It saved one practice £70,000 a year in drug costs, which would have equated to £270 million if rolled out across the UK. But it’s not just health-focused communities that can feel the benefit of coming together in groups and James and I discuss the profound benefits of men’s groups. When people share their experience, solutions and support each other to live well, amazing things can happen. I hope this conversation encourages you to reach out, find your tribe, and see what you can do for each other.  Thanks to our sponsors: https://www.athleticgreens.com/livemore https://www.vivobarefoot.com/livemore Order Dr Chatterjee's new book Happy Mind, Happy Life: UK version: https://amzn.to/304opgJ, US & Canada version: https://amzn.to/3DRxjgp Show notes available at https://drchatterjee.com/287 DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified health care provider with any questions you have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

There's this one resource that's inexhaustible and it's ridiculously powerful and it's being used to zero percent of its potential and I believe that it's a critical part of the future of reversing chronic illness. Hi, my name is Rangan Chastji. Welcome to Feel Better Live More. Are the people around you supportive of your health goals? If you were to embark on a new routine, would your friends be a help or a hindrance? Well, for today's episode, I was delighted to welcome a really good friend of mine, James Maskell, for a conversation around friendship, community, and the concept of group medicine. Now, I've known James for a few years now, having first met him in America at lifestyle medicine

conferences we were both attending. And probably the best way to describe James is as a health entrepreneur and community builder. But James is not a doctor, but he knows a lot about how we and other healthcare professionals work and could work better. He studied health economics and is the CEO and founder of an incredible company called Heal Community. He's now on a mission to reduce rising healthcare costs across the globe with a model that puts people first. His latest book, The Community Cure, looks at how helping groups of people with common health concerns come together can solve the very problems they share. In our conversation, James explains that an easy way to understand this model that has health coaching at its heart is to think of Alcoholics Anonymous. You see,

AA does not try to cure alcoholism with drugs. Rather, it's a mutual support system where people who have found sobriety can help or sponsor others to do the same. This is the same approach that James has taken with the virtual health coaching groups that he and his company run in America, which have been successful at managing all kinds of conditions, including autoimmune disease, depression, chronic pain, and digestive disorders. There isn't a doctor telling people what to do. There are simply like-minded, non-medical professionals sharing what has worked for them. Now, in this model, doctors can prescribe patients to attend a group in the first place and intervene to adjust medications as symptoms

hopefully improve. But the rest of the time, the doctors stay out of it. In our conversation today, James shares exactly how this works. Now, it's not just health-focused communities that can feel the benefit of coming together in groups. I was fortunate enough to catch up with James and a couple of our mutual friends over dinner the night before this recording, and it really was such a nourishing evening that got me reflecting on the value of male friendship and how important it is to belong to a close community outside of your immediate family. In fact, in this conversation, James shares how attending a men's group for three hours a week in his hometown has done wonders for his emotional health, his relationship with his wife, and his general well-being. The truth is that many of us, perhaps even most of us, are starved of close,

nourishing connection and are crying out for more community in our lives. And while we get it, as we discuss in this episode, all kinds of problems can be solved. This is an inspiring conversation. It's powerful. It's uplifting, it's hopeful. I hope you enjoy listening. And now, me in conversation with James Maskell. James, good to see you, mate. Mate, great to be here. Obviously, we had a great dinner last night. here. We had a great dinner last night. And over dinner, you said to me that for a lot of people,

their friends are getting in the way of them being healthy. They've either got to choose their friends or their health. Yeah. What do you mean by that? Yeah, so, you know, we've been running group medicine for the last two years all online. So getting groups of people together and taking them through a lifestyle enhancement process. And in the first month, we asked the question, who out of all of your friends and your family is going to be supportive of this transformation, right? And what we found is that very few people had friendships that actually reinforced healthy behaviors. And in fact, a lot of friendships were built on really unhealthy behaviors. In England, going to the pub, in America, tailgating, you know, there's all these different things that are built around these really unhealthy behaviors. And so when people

are faced with the fact like, do I want to have, do I want to reject these friendships, right? And loneliness is the biggest driver of all-cause mortality. A targeted rejection from a social group can increase your chances of depression by 20 times. So that's one path, right? Leaving that group behind. And on the other side, you know, if you've got an autoimmune disease and you're going to pizza and beer night every Friday, it's very difficult, you know, if you've got an autoimmune disease and you're going to pizza and beer night every Friday, it's very difficult, you know, to get improvement in an autoimmune disease with that consistent diet. And so many people who are at the beginning of thinking, can I actually reverse my chronic illness, which is sort of the journey that they're starting with, are faced with this really, really impossible choice.

starting with are faced with this really, really impossible choice. This is just so powerful. And I'm pretty sure, James, that every single person listening to this or watching this right now, if you really think about that question, who in your life is going to be supportive of these changes? I kind of feel that will bring up a whole load of emotions for different people because as a doctor, that's something I've seen time and time again is that, you know, often it's in January when they've got the motivation, they can, you know, follow the plan for a few weeks and they're feeling better, but the life around them, the environment around them, the people around them are not swimming in the same direction so

that change becomes almost impossible to turn into like a long-term transformation yeah and other people could actually almost actively sabotage it because they have their own shame and guilt about not making those changes and so it's's like, come on, have another drink or whatever that is, because they wanna feel better about themselves too. And there's these subtle psychological things that are happening inside friendships. And ultimately what we've seen is that

when people can build new healthy relationships that support these new healthy behaviors, it's not only transformational to people's sort of mental state but actually it gives them the right sort of accountability and support structures to make really profound changes in their health that as you know turn into really profound changes in their diagnosis health status it's something i've been pondering a lot over the last few years is this idea that you know are we fundamentally getting something wrong as doctors? Not intentionally,

but as a result of the way that we practice, which is that we're fundamentally, if we go from the starting point that 80 to 90% of what we're seeing now as medical doctors is in some way related to our collective modern lifestyles. Okay, again, I'm not putting blame on people, I get it that life's tough and it's difficult for people. But if that's the starting point, then the next step is that a lot of what we're asking our patients to do is make changes to their lifestyle. Right?

And our patients want help in making changes to their lifestyle. But a lot of what we do, the way the system is set up is to see an individual by themselves, talk to them about their health, and actually ask them to make changes in isolation. And this is, of course, why things like Parkrun are proving so transformative because, you know, Parkrun park run you know these kind of events where people do a 5k walking or running or walk running whatever and people whether they're attending or they're volunteering or having their lives transformed because it's the power of the

group and the community now you mentioned a term group medicine yeah i reckon a lot of people listening at the moment would not be familiar with that term. So what do you mean when you say the term group medicine? Well, the reason why they're unfamiliar with it is because it hasn't really existed, right? This is a new area that I've been working in and pioneering in trying to really understand. You know, something that most people will be familiar with

is Alcoholics Anonymous, right? Where if you went back 100 years and you asked the average doctor, is alcoholism treatable, reversible? They would say, absolutely not. You can't reverse it. That's because doctors and drugs can't reverse it. But a supportive community of mentorship, support, and accountability is actually very effective at getting people to no longer be addicted to alcohol. And as I looked at these chronic illnesses, like type 2 diabetes, heart disease, Alzheimer's, mental health issues, like the big chronic illnesses that affect the majority of the population, even things like chronic pain, they're actually a lot more similar to alcoholism than they are to being hit by a car.

And yet we sort of use the medicine of, we use acute style medicine with these chronic illnesses. And essentially that was the beginning of a thinking process of like, could we take some of the ideas from Alcoholics Anonymous? Like the most obvious one is knowing someone who got sober, right? So if you have a chronic illness, maybe the most important person that you need, not a doctor, is actually knowing someone

who reversed that chronic illness. And what if we could introduce those people to each other in a supportive container where other people, where it was just a norm and all these people had made progress on it, what would happen if we did that? And as we've innovated in that,

both in person before the pandemic and now online since the pandemic, what we've seen is that that person is really missing in healthcare, that mentor, that support, that sponsor. And I believe that it's a critical part of the future of reversing chronic illness. It's a beautiful analogy that it really is that we use this acute care model that works very well for the car crash and the heart attack to in that moment treat it and help someone get out of that emergency state or that acute illness, whatever it might be. One of the things I've said many times on this podcast, and you've been talking about for years in America, is this idea that that acute medical model that works well for acute conditions

is not translating very well to chronic illness, you know, anxiety, depression, chronic pain, type 2 diabetes, obesity, even things like gut problems, and even low libido I'd put in this category. These are all these kind of chronic conditions that are bothering us and affecting us. But we still see these things as medical issues. And I think that's what's really interesting about your work to me. Are these medical issues, or are they actually social issues? Yeah. Well, it's really interesting. As I started researching my book and I did a TEDx talk on this topic,

I started to really see that many things that are now medicalized were actually just a part of community, right? Before technology, you know, if you look at technology through the Industrial Revolution, and then now into the information technology revolution, all that, so many of the things that used to happen as part of community are now sort of outsourced to the medical system. So, you know, grandma had a lot of knowledge about how to keep you healthy. Grandma had a lot of knowledge about how to keep you healthy. You had, you know, people in your life like what we now are like babysitters and grief counselors.

Like this was just things that were provided because a group of people knew each other and supported each other through those kind of things. And as technology has dissipated community, there's this sort of missing layer. And everyone's just on their own, me against the world. And ultimately, the need for all these services just goes up and up and up and up. And ultimately, you know, community is something that is such an elegant solution to so many of those things, but it's been lost. And ultimately, you know, my thesis is essentially that we need to recreate that community. Now that can happen in many different ways. But ultimately, if the issue is chronic illness, and people are coming into the medical system, because that's where lonely, sick people end up, then the medical system is the place to re-energize community. Yeah. I don't think it's an over-exaggeration to say that you are someone who is transforming healthcare in America.

What you're doing, yes, with your books, but more in terms of the stuff you're doing now in terms of helping clinics, doctors, healthcare systems utilize group medicine in a way that's effective and working and improving health and reducing costs is transformative, right? I want to get to that. But I think you just made a really powerful point that the lack of community that we have now is ending up as medical problems. There never were medical problems. You know, I remember chatting to Tim Spector on the show a few months ago. And I think I said to Tim, one of the big problems I think around the nutrition topic

is that we need nutrition experts. Fundamentally, I think that is problematic, that we need a guru, we need an expert to tell us what we should be eating. When have we ever had that before? We would have learnt it from our parents and our tribe. This is what you eat, this is what you avoid, this is the kind of things you eat, this is the time in which you eat.

Yeah, absolutely. And we now need books and podcasts and all kinds of things to teach people what their community would have given. But this goes beyond health, doesn't it? Because one of the reasons I think so many relationships, marriages are struggling is because, again, we don't have that community. We've moved away from our homes, our friends, our tribe, basically, for work, for better opportunity. And I appreciate everyone has

lots of different ways of bringing up kids. But let's say there's a romantic couple, everyone has lots of different ways of bringing up kids, but let's say there's a romantic couple who've got kids. Usually now, it's not unusual for them to be hundreds of miles away from their parents, from their childhood friends, from whatever. And there can be pros of that for sure. But it means then that they wonder so many relationships are under strain

because they're expecting their other half or their partner to be everything. The grief counselor, the lover, the supportive friend, whatever it might be. Someone from an immigrant family, I've been thinking, I wonder what you think about this, but I think a lot of immigrants, let's say an Indian immigrant, let's say, let's take them up, my family, my parents, friends, they left India in search of a better life. Yeah. But then the question is, what does a better life mean? Yeah. Because they literally leave all their family, all their friends, all their community, all their culture to go to somewhere completely different. Yes, on paper, they may be earning more money. But I've really come to the conclusion that I think

many families now are actually regretting the trade that they made. They got more money, more material wealth, but I think they lost a whole lot more in that process. but I think they lost a whole lot more in that process. A hundred percent, man. I mean, I'm living proof of that too. So, you know, I've lived in America for 17 years. I grew up here in the UK. I had the American passport.

So 17 years, I moved away, met a girl, got married, had kids. My first daughter was born in New York, extremely isolating. The first year we were there was snowmageddon. You couldn't go outside for four months, right? And no one else I knew had kids because we were 32 when we have kids. People in New York have kids when they're 45, right? So then we moved to LA, really good weather, but, you know, better for bringing up the kids, but still isolated in the fact that we didn't really know anyone else when we moved there and who had kids. And eventually in 2018, we actually ended up moving back to the Sacramento area where my wife's family's from because ultimately we realized like,

am I really gonna entrust, what proportion of my kid's life do I wanna entrust to a random babysitter that's trying to be an actress, right? I would hear my daughter say things and I was like, where did you hear that? And I was like, it's the babysitters. So then there was a real moment where I was like, hang on a minute. It's really important to have

family around. My wife's family is from Sacramento area. And so it was really important to me to, you know, give my daughter and our two daughters the opportunity to be around people who genuinely cared for them for reasons of, you know, altruistic and real love, right? So that was the first thing. for reasons of altruistic and real love, right? So that was the first thing. And I will say, I could visibly see that my daughter's nervous system shift when we moved there and she kind of realized that she knew and trusted everyone around her

and that there was no sort of random new characters coming into her life every day. That there was a serious moment of like, that I saw, okay, we've done the right thing. Beyond that, you know, when I moved there, I realized like, I don't know anyone here. You know, so who's going to be my new friends? And how am I going to, as someone who's interested in community, what sort of community do I want? And, you know, ultimately one of the best decisions that I ever made in my life, in the last three years, I've been part of a men's group. So every week, for three hours a week, there's a group of anywhere between, you know,

four and nine of us. There's nine of us in the group, but not everyone can make it every week. Sit in circle for three hours and get into it, right? Get into what's going on in our lives, get into really understanding each other and supporting each other through the ups and downs of life and and i realized until i had that group i was kind of dumping all of that on my wife right and it's very difficult to have um a nourishing relationship when you know being an entrepreneur being a dad um you know, just being in the world, you know, there's something really powerful to be able to have a group of emotionally mature men to spend time with so that not all of that stuff

is just being sort of dumped on your significant others. It's been really transformative for me. You said to me last night that these men's groups have had a massive impact not only only on you, but also your marriage. Yeah. Yeah, absolutely. I mean, I'm grounded. I'm in integrity with my word. I show up as a much better father. better father. I don't bring the frustration of whatever's going on in my day, you know, to my wife unless there's something that we need to connect about. If there are things that I need to connect about with my wife, I have other emotionally mature men in that group. Part of

the men's group is actually building a capacity to feel, right? What I realized is my capacity to feel, feel emotions had been blunted somehow. Drinking, whatever other things that, you know, I've done there, that was, it was, I realized like I had a sort of a, sort of a deadness inside and that I couldn't feel the emotions that I could see that other people felt. And through this process, you know, the process that I'm in, the group that I'm in has a number of different factors to it. But each week, the first thing we do after we sort of share, okay, what's going on in our lives and what do we need to get out in order to be really fully present for the group is about just sitting there and thinking like, how am I feeling,

right? And how am I feeling today, right now in the present? And ultimately, like that's a practice. And if you do it every week for three years, you start to realize like, actually I'm feeling a little bit of tension or I am feeling, you know, I feel it in different parts of my body. I'm feeling, you know, joyful or anxious

or whatever that might be, but it's a practice so it sounds like having a community around you this men's group not only is it great because it enables you to bounce things around with other people who have committed to saying yeah we're here to support you but it also strikes me as though you're getting to know yourself better through this tight community. Because I guess before that, because without the structure, it's too easy for you to get caught up in emails and work and booze or whatever it might be. So you never have to ask yourself the question, how am I actually feeling? It's something so simple, James, to me, yet it feels totally profound because I genuinely feel that one of the big problems these days for many people is that

they're not in touch with their innermost feelings. One of the big reasons for that is that they're constantly distracting with other things. It's never been easier to distract ourselves. Yeah, so it isn't just the community is helping you with that community, it's impacting your relationship with your wife. It's also impacting your relationship with yourself. 100%. Yeah, I mean, there's that. The next round that we go through after feeling is really about accountability. And i realized like i was very professionally accountable right where i had employees and team and mentors and i'd be like have i done my work this week and you know i was accountable in that way but i wasn't really personally accountable i'm an only child right so i think part of it was like i could just get away

with whatever i want because it's only in here and And if no one else saw it, then it didn't happen. But it resided in here. And it was blocking that feeling. And ultimately, you know, being in integrity with my word, right, and being accountable to my word. If I say I'm going to do it, then I do it. That has been transformational for me. I mean, I don't drink anymore.

You know, I, and, you know, I would, when I was younger, I would sort of laugh at people who had made that kind of transition. But ultimately, the way that that's showing up for myself, you know, for my business, for my family, for my kids, you know, these are the most important things. This is why I'm here. I'm here for the mission. I'm here for my family.

Everything else, you know, can just fade away a little bit. What I'm hearing is it's very much about waking up to a more intentional life, about a life where in the past maybe you're reacting, you're living on autopilot. You're just doing things because people around you do them and you think that's what you're meant to do, but actually, for a variety of reasons,

through the power of community, the accountability that you have to have for these guys, you're making much more intentional choices. You're not giving up alcohol because someone's told you you should do it or, oh, it's good for my health if I do it. Actually, from what I can tell, you're giving it up, at least for the time being, because you've realized it's not actually helping you be the person you want to be. That's very, very different. And again, coming back to one of

the things I think about in terms of healthcare, a lot of time people are trying to follow someone else's plan. Okay, what should I do? Okay, how long do I do that for? What benefits am I going to get? The doctor's plan. The doctor's plan, exactly. And as I wrote in the conclusion in my last book on,

so my fourth book on sustainable weight loss, I put at some point, this plan has to stop being my plan. Yeah. Has to become your plan. 100%. Because you're the architects of your health and happiness. You understand what works and what doesn't. So. The locus of control has to shift from the doctor to the patient. That's the key thing of the transformation of healthcare. Is the doctor in charge or is the patient in charge? And the group is the structure by which that locus can be transferred and the patient can actually participate. So let's get into that. People currently think medicine is,

I have a problem with my health. Whatever country you live in, then it could well be I phone to make an appointment with a healthcare professional, maybe a doctor, maybe someone else, because then I can tell that person about my problems, and they, with their training and expertise, can actually tell me what's wrong and what I need to do. And the benefits of that for me are, or the sold benefits are, I'm going to get expert advice from a professional. My healthcare is private. I don't have to share it with anyone. This is a private thing. I've got a one-on-one consultation. Yet what you're doing with groups is showing that this model that we're used to, that all healthcare systems that I'm aware of are currently set up around, are fundamentally problematic for many of the conditions that we see. Yeah. Let me give you my favorite example.

Yeah, please. It's actually here in the UK. So Dr. David Unwin, 2016 NHS Innovator of the Year. What is he doing in his practice? So the first thing he works out is that type 2 diabetes is reversible with diet. And you know this better than anyone because you did it on the TV show like four times, right? So he realizes that. But it's quite like labor intensive to do that in a one-on-one GP visit when you've got a million other things to do. So Dr. David Unwin starts these type 2 diabetes groups, which is essentially community support plus a low-carb diet. That's pretty much what it is. So he implements it into his GP clinic. And over the next five years, reverses type 2 diabetes in the majority of the patients who have type 2 diabetes

in his clinic. The savings on medication alone from doing that is almost 70,000 pounds in that clinic. And they've shown that, and this was in the BMJ, that if you extrapolated that out to the whole NHS, that would save 270 million pounds, a quarter of a billion pounds. One chronic condition, right, just being done a little bit differently in a group supported in that way. So, you know, if we're here, if we want to talk about the transformation of the NHS, and you're looking at, you know, what sort of examples do we need to lead out of the pandemic to the future, look at that and say, look, is there an example? Is that a good example

of what we look? Lower cost, more access, more love, more accountability, more support, more professional satisfaction patients getting better as well it's getting better and not reliant on the healthcare system i mean that's incredible and you think those savings should have anyone in any healthcare system their ears should be pricking up going okay how do we do that and you obviously know how to because you're doing it right and i'm very hopeful that what you're doing in America, you're going to be able to bring to the UK very, very soon because you're figuring out what the obstacles are, what the problems are. We'll come to that, right? But what is it about a group then, right? What is

it? You said earlier, the most powerful thing for someone who struggles with their alcohol intake and, you know, wants to reduce it and ultimately get off it is to know another alcoholic who no longer drinks. Absolutely. What is the magic in the group

that they're not getting from the experts? Yeah. There's a key person that I would sort of, the term that I would use is a health coach, right? And that's the term that we use in America. And essentially the health coach, it's not a health professional. It's not a dietician. It's not a nutritionist.

It's really sort of this, it's the equivalent, in my estimation, it's the equivalent of the mentor in Alcoholics Anonymous, the sponsor. It's someone who's overcome a chronic illness, has learned a ridiculous amount through that process. They have the lived experience of the disease. They have the lived experience of the reversal. And now they can be this sort of peer leader where you now know someone, you know, you're able to essentially hold space for someone else to come to their own conclusion, right? To support people in coming to that. So in the groups that we run, we have this health coach. In Dr. Unwin's model, what he realized is the first couple of people that he helped reverse their type 2 diabetes in

the clinic put them in the group, right? So it's not just Unwin saying, "'Hey, the science says this. "'This is the most optimal thing. "'Look at the science.'" It's like, here's Jane and Jane did it. Jane, tell us about your experience. You know, when we run these groups,

I'll tell you something else. So now we're doing it virtually, you'll love this. Think about when you come on the first Zoom with a bunch of people you've never met. Most people have their camera off on the Zoom because what is this? I don't even know what I'm getting onto, you know, getting into and doing that. So what is the first, what is the coach who hosts these groups? Well, the first thing they do, they share their story of their own chronic illness, how painful it was, how traumatic it was, the effect on their whole family,

then finding this new operating system of care, lifestyle medicine, starting to take care of themselves, learning, and then their journey back to being, not having the chronic illness, right, that journey. Bing, bing, bing. It just, the Zoom cameras turn on because people feel safe to be seen because they're like, that's me.

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whether it's in person or on DMs, on social media, is I don't feel seen and heard by my doctor. You know, I don't feel they got me. They didn't really take it seriously. I don't feel they really cared. Now, let me just defend the medical profession for a moment. I understand that the system makes it very hard sometimes. You know, if you are working in a model where there's 10-minute consultations, but even if you can do that as a doctor, it's not as good as someone who

has had the same experience as you've had, is it? And I can just see how that would be so powerful where suddenly that person is like, yeah, I get it. It's hard. I get it. It has an impact on your relationship. Sometimes you don't want to get out of bed. Your kids need taking to school. You've got no energy. That's what connects you to someone else. Now, suddenly, that has more resonance. It's more like, oh, and you know those struggles.

You know what that feels like. And you've got through them onto the other side. Okay, tell me more. I'm really engaged now. Rather than the more distant,'m really engaged now. Rather than the more distant, the less engaged approach it might be in a more conventional sort of appointment system, one-on-one with a doctor. Yeah. I mean, the question I would just ask anyone who's listening to this is like, if you have a chronic condition, how many other people do you know who had that

chronic condition and reversed it? And if the answer answer is zero you need to find those people and they're out there they have their own podcasts and books and other kind of things in almost every condition right but ultimately there's something super critical to learn from someone who's been in your shoes and most people who have a chronic illness feel extremely isolated because they don't know anyone else that's going through the same thing if you're addicted to psychotropic medication or pain medication you don't know anyone else that's going through the same thing. If you're addicted to psychotropic medication or pain medication, you don't know anyone that is. And ultimately, those relationships may not be empowering. And ultimately, what we've seen is that if you can find other people that have gone on the journey that you're trying to go through, there's a shared resonance.

There's a shared experience. People feel safe, right? That's the big, it sends, community sends the signal of safety, right? You're safe here. This is a safe environment where you're able to share because I'm starting off by sharing my experience and now it's safe for you to share.

And look, some people feel safe straight away. They're like, oh great, I've been waiting to tell my story. But other people, it takes weeks or months. And that's why the episodes of care that we've made is a six-month group, right? Because- What does that mean, episode of care? So like, you know, when in our model, when a doctor prescribes you into the group, the group is six months long. And the goal is each month, we focus on one of the pillars of health. So the first pillar is community and connection. The first month is really about, can I create trust in this collective, right? Hence the first

question, which of your friends, which of your community, which of your family are going to support you in this change, right? So that all feeds into this first pillar, community. Other things that we do in that first month, smart goals, right? Everyone who's ever made any sort of changes in business or otherwise in coaching, you know, the smart goals, right? So what is your goal for this next six months? You've got enough time to do something really transformational. What do you want to do? And for it to come from you. It's no longer the doctor saying, you should reverse your chronic disease in the next six months. It's like, I'm going to reverse my chronic disease in the six months. That's what I'm going to do. And that's like an internal motivation that's coming from them. The other thing is, how did I get here? How did I end up with a chronic illness? One of the

things that I think people hate this the most is that in their mind, the doctor's kind of telling them it was like healthy, healthy, healthy, healthy, healthy lupus. It didn't go down like that. The body was breaking down over time that eventually leads one marker to be at a point where you have lupus, but it was a slow, you know, dysfunction, right? Over time, you got more and more dysfunctional. And then at a certain time, your hemoglobin A1c goes over seven, and you've got type two diabetes, but you had something was going on before you weren't just healthy, it didn't just happen, right?

So really understanding sort of like where the illness came from. So that's like month one. And then also we pair people with what we call a progress partner. When we started out, it was an accountability buddy. Turns out accountability's not that sexy and people don't want it.

But you just call it a progress partner and everyone's like, oh, I want progress, that's cool. So it's the same thing, but just rebranded it to be something so then um month two what do we do in month two what is the what is the one thing that you can do that will make the biggest shift in your potential for chronic disease what's the answer change your diet food right so in that month the goal of this program with each month is, can I make one permanent change to what I eat? Now, the reason why you need a month is because you need time to fail, right?

To try, do something, fail, come back into the collective, share why it didn't work for you, and then sort of reshift the plan. Whatever the plan was, why it didn't work for you, and then sort of re-shift that, you know, the plan. Whatever the plan was, if it didn't work, why didn't it work? Deal with that, and then come up with something that's going to be real. And that's why we have challenges. And the challenges are really simple. In week three of each month, the challenge is like, eat a few new vegetables, I guess, as an example. What is the impact of someone eating a few new vegetables on their physiology, right?

If then you do it for the next five months, it can be transformational, right? So there's that. So that's, you know, month two. Month three, stress, right? How do you deal with stress? How do you, you know, what are your, what are the ways that you deal with stress? Can you try some new stress reduction techniques? Month four, sleep.

You know, I've heard you say a million times that a good night's sleep starts in the morning, so we really focus on what is your morning routine? The sunlight, having good sleep hygiene, not having the phone in the room. You know, we've had some people who come through the group who are doing all of these perfectly, but their smart goal is, I wanna change my relationship with social media, right?

It could be that kind of thing. Like, people have their own goals, and that's the whole point. It's not like the doctor is saying, you need to do this. It's like people are coming up with their own one. The fifth month is all-around movement. It's like creating regular movement and structures where you can move every day. Then the sixth one is your environment.

What you see, if you make one permanent change in each of those things, you are a dramatically different person by the end. And the outcomes prove it out. So anxiety, depression, pain, fatigue, sleep struggles. In our groups, the vast majority of everyone who has those issues in the groups have a remarkable transformation in that six months, a clinically significant reduction in those areas. It's just, you know, like a lot of the best ideas,

they're just so simple at their core. Yeah. You know, it makes so much sense. I'm sure everyone gets that straight away. If you're doing this with people, other people who are trying to do it at the same time, you've got the support. Hey, I tried to do that, guys.

I fell off the wagon. You know, this happened. Someone else is like, you know, I get it. I did that. But this is what I've tried. This is what I helped. And the fact that you have a month on each pillar and the request is you just make one permanent change

in that month, it makes it very manageable. You know, it reminded me, before March 2020, this podcast was having lots of podcast clubs around the world. Certainly in the UK, there were, I think, at least 60 or 70 in the UK around the country where people were getting together. They were getting together with other Feel Better Live More listeners and going for walks together and discussing what changes they were making from the last episode. Actually, I was about to attend one near to my house. They invited me. I thought, I'd love to go. So whoever that was, if you get back in touch again, I would love to start coming. But again, I think it's, even if you take a podcast, right?

Even if you take a podcast, right, people listen to the podcast often while going out for a walk. Or they're going for a drive somewhere by themselves. Yeah. And they might get inspired by the conversation, think about their lives differently, go, yeah, I want to make that change. Yeah. But then they have to go back into their regular life with their friends and their community. life with their friends and their community. And often it's a life that the reason they've ended up with a health problem in the first place, their life actually, in some ways, is not supporting that health outcome they want. It's actually supporting the health outcome they've currently got. I know it's so obvious when you say it like that, but then the onus is very much on

how do I make this change? How do I make this change myself? And it is this power of the group. I think I want to come back to your example in just a minute, but if you take it outside medicine for a minute, think about practices people like to do, let's say yoga. A lot of people like to practice yoga. And because of busyness in life and how many things people feel that they have to do these days, it clearly saves you time if you do a yoga class online or from a YouTube video. You don't have to go, you don't have to travel to it, you don't have to find a parking space or whatever you might do. So yes, it may be more efficient time-wise to do it at home. But actually, again, we miss out a big piece. There's something if you are in person

with another 20 people who also want to practice yoga and the interactions you get beforehand, the struggles other people may have, and then you see what the teacher says to them. You go, oh, you know, maybe that's what I'm, you know, there's something about being together. Of course, it's not either or, but I often say to my patients, if you like doing this at home,

you do 10, 15 minutes a day on Zoom or on a YouTube thing. If you can, go to a real life club as well or a class where you're surrounded by the humans. And it really is transformative, isn't it? When we engage with these groups. Yeah, super transformative. There's another amazing example from the UK that I'd love to share. I guess the question might have people like, what does this look like at scale? Like, could this really be a transformative agent for the world? Like if it was done? And right in the UK, there's another great example, actually quite near where I grew up, and it's a town called Froome.

You've actually had… Julian Abel. Yeah, on the podcast here. A couple of years ago. You know, their thesis was exactly this. People are lonely, and that's driving, you know, these health outcomes. So in Froome, which is 115,000 people, what they thought is, could we solve loneliness? Could we cure loneliness in the town of Froome? And how are we going to do that? There's five medical practices.

So they hired a coach for each of these practices. The coaches spend half their time in the clinic speaking to people and half the time in what they call these talking cafes, right? Where people, they sit in cafes and actually just meet with people but the key thing that they did is they they took an inventory of every group that was happening not just health groups but all kinds of groups church groups sports groups men's groups they took a whole imagery there were 2,000 groups they whittled it down to I thought 400 that were regular anyone could join had a you know constant location, consistent location. And so essentially, this was a website where you could see, and essentially, what people would do if they came in and they saw that these people were lonely, especially older people,

they would sit with the coach, and the coach would say, what do you like doing? What do you want to be part of? And then say, hey, look, here are the different options, which one do you go? It meets this time per week at this location go get him The other thing that happened is they recruited 1500 just people in the community that walk around with this green lanyard right to let them know that they're a community Connector and they would just send people to the website They had no role apart from say hey, here's the website go to it find something for yourself

So in a time where you know know, the healthcare costs and, you know, everything was going up in Somerset, which is in the town, emergency room admissions went down, recidivism on drugs went down, and loneliness was essentially solved by one small town in the UK. So on one end, you have the David Unwin example of reversing chronic illness in small groups. David Unwin example of reversing chronic illness in small groups. On the other end, you have sort of like a societal shift driven by medicine again. And ultimately, you know, the solution, in my estimation, to the super elegant solution to so much of healthcare is sort of at the nexus of those two things. And Julian has said it himself, since I've had a chance to know him, is that he realized the first thing was to get people in these groups but if you can potentiate that that connection with some sort of other healthy behavior it's sort of almost exponentially more healthy so like you

know it like you said going to yoga and doing a yoga class um so rather than just meeting and sitting around uh what if we spend our time doing a mindfulness exercise, or we actually do movement together, or we actually eat as a community? So this goes back to the first question you guys ask people in the groups. Who in your life is going to support this transformation? It's a critical question. Because for many people, of course, in their current life, there is no one. Because for many people, of course, in their current life, there is no one. But by having these groups, suddenly you now, you're part of a new community, a new tribe, where actually these people will support it.

And I think this also, I wonder what the experience has been for people who've gone through these six-month groups, what it's done to their friendships, because it's not necessarily either or, like, you know, I'm going to become healthy now, so my current friends no longer serve my life, because that can be very scary for people. I don't think it has to be that extreme. It's be, you know, these friends can still serve me.

I can still enjoy hanging out with them. But actually, it speaks down to, it speaks to this idea about relationships, right? It takes a village, right? We can't expect our partner to be everything. And therefore, maybe our romantic partner plays certain roles in our life. Maybe our friends play certain roles in our life. And maybe our health goals might be done by another group. It depends on who you are, of course. A lot of people have got friends they

like to go walking with or yoga with or whatever. Do you know what I mean? It doesn't have to be one formula for everyone. It's like different people in your life are going to help you with different needs. But have you actually intentionally thought about it? Have you thought about who is helping these needs that I have? Yeah. And you know, you need time to work all that out. Yeah. Right. You need time and space and a proven process that does that. My men's group did that for me. And honestly, being in the men's group and being a guy that's making a group medicine business and trying to get the whole world to do group medicine has actually been extremely instructive because the men's group is not a health group, right? The men's group is really

an emotional maturity group. There's many different things that it is, but ultimately, in my group, I've seen people give up drinking, give up smoking, transform the relationship with their significant others. I've seen business success, all of that. This is the key thing, James, to me, right? I'm sorry to keep hammering home this point, but I think this is the key thing, James, to me, right? I'm sorry to kind of keep

hammering home this point, but I think this is the key point for me as I hear what you're saying. This is not a health group, right? It's not a health group. Yeah. Yet people are having health outcomes. They're having amazing health outcomes, giving up smoking, giving up alcohol, whatever, business success, improving their relationships, right? It's not a health outcomes, giving up smoking, giving up alcohol, whatever, business success, improving their relationships, right? It's not a health group, yet they're having health benefits. And this speaks to this wider idea that a lot of the problems we're now seeing, we talk about them being lifestyle related, and of course, they are to a certain degree, but maybe actually, as as you say going upstream even more they're a consequence of the lack of community that we all have or many of us have in

our lives. A couple things I want to say about these men's groups. They've had a transformative effect on you. A really really close mate of mine joined one about three years ago and said, you know, he raves about it. He says it's completely changed his life, his relationship, his ability to be a good father, his ability to be a good husband, his work, all sorts of things. Now, I've heard that. I've heard it from him. I've just heard it from you. I'm not a part of a men's group. Okay. And honestly, you know, I spend a lot of time with my wife and my kids. I spend a lot of time working.

I love my work. But I have often thought that, you know what, you don't really have really good quality, close friends talking to myself near where I live. Yeah. You know, I don't. And I've got really good friends from uni that I speak to a lot, but they're all hundreds of miles away. And last night was a really great example for me. So I'm in London, right? Meet you for dinner. Ian comes along, Rupi comes along, we're having a laugh.

And I knew in my head, part of me was like, I'm not going to stay long, get back to the hotel room, do a bit more prep for the podcast tomorrow with the guests. I had a chap called Sachin Panda beforehand. But I realised as I was there, man, this is awesome. I am able to really be myself and just, you know, I'm not Dr. Chatterjee

with you, with Ayn, with Rupi. I'm just me. Do you know what I mean? And I know it's, of course, it is me who shows up as Dr. Chastity on the podcast more and more than it ever has done. But still, there's something about just being open and honest, sharing the things you're struggling with, sharing the things that are going well. And I realize actually, for me at this moment in time, I'd rather spend another two hours with these guys, even if it means I get less sleep tonight, that is going to nourish my soul much more than sleep will nourish my physical

body tonight. Do you know what I mean? Absolutely. Yeah, I mean, to think that I would give, as an entrepreneur and a father and whatever, give three hours of my week to be with a group of strangers, like at the beginning, it doesn't seem like that's a good use of time because there's millions of other things I could be doing. And I could justify it a lot of different ways. But it really adds quality to everything else in a very interesting way. And it's nourishing and it creates like safety and nourishment in a way that other things just can't.

Why are men's groups on the rise so much? And why, or in your view, why do we not hear as much about female groups? Is there something fundamentally different in how we're wired? Is there something to do with society? Have you seen any gender differences in this, I guess, wider across society, but then also within the groups that you're doing for chronic disease? Well, in our chronic disease groups, the vast majority of people that sign up are women, which is interesting. So, you know, I think they, you know, I don't feel that I know enough about those dynamics to like really understand it. But I would say, in general, the kind of the people that show up for lifestyle medicine are majority women,

the numbers, you know, the doctors that practice it are, you know, it's a lot of women too, because I think they understand that a sort of a fundamental level, nourishment and empowerment support, it's just, you know, something that's, you know, part of, you know, part of them. I think men are needing it more and more because I think a lot of men realize that the sort of like competitive side of men and the sort of like emotionally dysfunctional part of men that is sort of celebrated in society in a weird way ends up being quite detrimental to their relationships, their ability to lead, manage people, work with people,

have good long-term relationships with people. And I think that there's just sort of a new generation of men who realize, like, you know, if I want to be able to feel feelings and have a truly human experience on my time here, it's going to take work. And I don't know what to do. So I want to go and find some people who do. Yeah. Right. The average, you know, the other people in my men's group, there's a guy who's 65, there's a guy who's 60, you know, that I'm one of the younger people in the group. And these are people in some cases for 20 years have been doing this work. They still have their own stuff, but they're working through it. But their advice is so

powerful. And it's the same energy of what we're talking about with the health coach. It's just like a kind of an unpaid life coach. You know, the whole thing's free, right? There's no cost for me to be in the main group. It's just the only cost is that we meet in this random room at a church and we pay them, you know, a tiny amount to be part of it. Like you said last night, room at a church and we pay them you know a tiny amount to be part of it like you said last night people helping people yeah is the only inexhaustible resource we have 100 like i couldn't stop thinking about that last night yeah i mean look if you look at say we want to save the nhs and then it's like well there's not enough resources there's this one resource that's inexhaustible and it ridiculously powerful and is being used to

zero percent of its potential we need to that's what to build around yeah just speaking to men and women and again these aren't gross generalizations but you know one thing i've noticed when i go for walks around my neighbourhood, is you often see women walking with other women. I don't know, look, you live in Sacramento, I live in the northwest of England, right? I've observed, if this is not a scientific experiment, this is just my observation, where I live, what I've seen. Well, you know, I'll take my wife. My wife will often go for her walk with her friends. They arrange to meet. I never do that. My walk is always by myself. Always. Whereas hers, I would say 80% of the time is with someone else. So you'll catch up with someone, connect with them, and you'll walk together. I see that around me. So I find that quite interesting. And there could be a whole variety of societal reasons

why that is, of course, but whatever. That's what I've observed. We talk about loneliness and how harmful that is for our health. I'm really at the stage, James, where I actually genuinely believe that not having a tribe around us feeling lonely and correcting that is possibly more important than the food that you eat. Yeah. I mean, it is. There's science to show that it is. And that's huge because when we think about loneliness, a lot of people think about the elderly stuck by themselves or in homes. Yes, that's a big issue. In the UK, and I suspect it's the same in America, the loneliest group in society, I think,

are men between the age of 30 and 50. And that is a group where there is a very, very high rate of suicide. This is massive. And again, so that's really interesting. I mean, you talk about these groups that you are helping set up in America. Can I just say one thing onto that? Please. Because I've actually seen research saying that younger people are infinitely more affected by this than everyone because of the society that's been created. Social media, where you can connect. I saw research saying that one in four British teenagers didn't have one friend.

Right? And you know there's an epidemic of mental illness in the teens, right? Think about how these teens connect. Like, if your friendship group is in a chat in Fortnite, that is not a healthy behavior. That is not a supportive community. That is people, you know, that's a chat stream inside a video game that is unhealthy in its own right. Like, where are kids getting together to be with each other and not be on their technology? There's sport. There used to be with each other and not be on their technology? There's sport. There used to be church.

There's no church. You know, it's like there's these structures that used to exist where kids would come together and play. And ultimately, you know, we are creating a seriously mentally ill, you know, younger population. I'm seriously concerned about it. And yet, it's pretty exciting to see, you know, what's going on with kids when they get access to these kind of tools, like in the work that we're doing now. You know, we're selling our program to pediatricians because the pediatricians are dealing with 13 to 18-year-old kids who, the highest ever rates of mental illness.

And those kids, because grandma isn't around in the community, are not getting the training that we once got on how to be healthy, right? The community is not reinforcing healthy behaviors. So you need to go through a six-month program to learn healthy behaviors, how to deal with stress. You need to be in a community where other people are doing it. So I actually feel this is sort of just like a fundamental training in how to be a human that is missing from society that is only reasonable that we need to put back in. And the only place where there's like budget assigned to do it

is in the medical system. And so that's why it has to come from there, even though it should just be a societal gift. The paediatric thing is interesting. Ian said last night, of course, over dinner, that, and for people who don't know, Ian's been on the show a few times. He's a brilliant NHS GP.

And he knows, because we run a course together, as you know, called Prescribing Lifestyle Medicine, and we've trained thousands of healthcare professionals and doctors all over the globe now in terms of some of these principles. And a lot of these people we train are very interested in group medicine. They get it, they can see it, but they don't know how to do it. Like the system is not set up, which is where I

think you can come in. But Ian said some really good friend of his has used an element of this group medicine with pediatric respiratory patients. Yeah, that was amazing. Right. And he shared actually their admission rate to hospital and how many times I happened to go to A&E now, I think it was with asthma, he said, gone right down because these families and kids and their mum and their dad are helping each other. So what's interesting to me,

a lot of these doctors we train up, they want to do this, but they don't know how. Yeah. Right. So what is it you've learned? Because you are, as I say, you're transforming healthcare in America. You're putting this into practice. What do people try and do? What do they get wrong when they try and do this? What do they not get? What are some of these key things that you've learned? Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make

meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life. And I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour. I can't wait to see you there. forward slash tour, and I can't wait to see you there. This episode is also brought to you by the Three Question Journal,

the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision-making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal and as with most things, it's important that you find the method that works best for you. One method that you may want to consider

is the one that I outline in the three-question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how

much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. One, doctors should definitely not be doing it. That's the key thing. Why?

Because the doctor is an expert and the doctor has spent their last, however long their career is, probably since they were 10 years old, being validated for their expertise their retention of knowledge their ability to regurgitate that knowledge and ultimately when you're in a group and someone asks a question the most important thing to do is not answer the question the most important thing to do is to let someone else in the group answer the question because then you're building trust in the collective and all the doctors that i know that are amazing at this,

and I know the best ones, because I interviewed them for my book and I spent time with them, they actually had to go through a deconstruction of their own ego to be able to actually hold a group, because it's so tempting to answer the question because they're an expert. And we're moving out of this era,

like there's definitely room for experts, 100%, we need experts, but not in group medicine. We need peers, we need 100%. We need experts, but not in group medicine. We need peers. We need support. We need mentorship. And that is not being done by a doctor. When we first started running these virtual groups, we had some doctors say, oh, I've done a weekend in coaching.

I can do it. I'll run the groups. It was a disaster. There's also still this, like, there's this thing where the doctor has the white coat, right? And there's this inbuilt relationship that sort of patients have with what they assume doctors are going to be like. And that can be actually, you know, that can be unhelpful in creating trust in a group. So the first thing is, you know, look, we've worked together for a long time. I think getting doctors trained in lifestyle medicine, getting trained in this sort of like lifestyle first root cause approach to health is amazing.

And I did it for 10 years and I'm still involved in it. But what I've come to see is that the quickest way to facilitate the transformation is for the doctor to prescribe it. Because there's something about the prescription, like patients still will follow the prescription of the doctor. So I prescribe that group for you. You prescribe, you're going into this group, but then the doctor doesn't run the group, right?

The only reason why you need the doctor in the group is to deprescribe the medication. That's what we're seeing in America right now. The most exciting is chronic pain, right? Before COVID came along, opiates was the biggest issue in America, right? You know, overuse of opiates, chronic pain. So in our groups, the doctor actually comes in once a month

and their only reason why they're there, well, there's many reasons for them to be there, but the biggest thing that they're hopefully doing is allowing patients, telling patients, yeah, you could probably come down a little bit on your prescription now. Deprescribing, the doctor has to be there because there's a lot of factors

and the doctors have to know it. But ultimately, the first thing we see is that doctors shouldn't be running the groups. The coach, this peer piece is a part of it. That's empowering on two levels. Even the doctors who want to see group medicine implemented, who've seen some of the research, this course makes sense. You know, AM last night, What are you saying? I'd love to see it. I just don't have time. Yeah. Right?

So doctors are overworked anyway. So actually, it helps that because they're not having to do one more thing. And I love that, that actually I can totally see why ego and the way that fundamentally to be at medical school, there is a certain type of personality, right? And I can say this,

and you know, this is not in a derogatory way, but a lot of people are super competitive. And, you know, a lot of people have been validated for that. A lot of them get their self-worth. This used to be me. Get your self-worth from success or external validation. Now, you know, how I've got rid of those things and why I feel happier and more content is something I've spoken about a lot recently, but that's a separate issue. The point is that I can totally see how doctors would not be the right person. And actually, their expertise and knowledge can be downright harmful in this setting. So I think that's really,

really powerful. You mentioned chronic pain. Why do you think this is so powerful for chronic pain? Because chronic pain is a big issue. And the medical profession are not doing that well at dealing with it. Number one, lonely people have higher pain scores. The science on chronic pain shows that it is, and this is a big word that I'm going to use here, it's a biopsychosocial disease. There are biological parts of it.

There's, you know, the physical body is dysfunctioning that's causing to it. There are psychological parts of it, right? And then there's also social parts. And so you can't solve a biopsychosocial problem with a biological input, a drug. It's not a match. So lonely people have higher pain scores. The structure of actually now working to improve your physiology

is what leads to the, you know, that you wouldn't need the medication anymore. You've got to change your physiology. If your current physiology is causing ongoing chronic pain, you've got to change your physiology. And that's what the power of the group can do and the lifestyle medicine. And then, you know, ultimately, to have it then be prescribed by a doctor gives the validation of the medical piece. So the doctors, it's important for them to prescribe it. But ultimately, the action is happening with the group. Okay, so first thing we get wrong, we think the doctors need to run it. So they don't.

Okay, great. What's that next hurdle that we fall at when trying to implement this? I mean, most of the rest of it comes down to like the boring, annoying details of rejigging a health system to do group medicine. So like one of those is, you know, we've had doctors that tried to run this

and they do it in person, right? Because getting in a group together in person is better than being online. But like if your clinic only has four parking spots and there's 20 people coming to the group, you can't run it. If there's no room where people can sit around together, you can't run it. You know, and so what we found, even though there might be more value in having the group meeting in person with a completely virtual experience, like what are the reasons why people love telemedicine? Why do people love telemedicine? One, it respects your time, right? You can come in from wherever you are. You can use your phone.

You can chat to the doctor directly. You don't have to wait in the waiting room. You don't have to deal with your kids, all those other things. It's very respectful of patient's time, and that's why they like it. So you get to come in from wherever you are. In America, there's a big conversation

about the social determinants of health. How do you get to the office, right? Who's car? The doctor's office. How are you getting there? And if you have to go there every week, then that can be tricky. But here's the biggest thing.

Health is happening outside of those sessions. That's where health is actually happening. That's when you're making the decision of what you're going to eat tonight or whether you're going to go for a walk after dinner or what your movement for the day is going to be or whether you're going to have the morning routine that you want. To be connected to the other people in the group at that moment is the critical moment. That's high touch care.

You're able to touch with your people all the time. People know what this is like, because most people have had the experience of being in a Facebook group, right? Where you see that there's like asynchronous communication. Not everyone's there at the same time, right? So I can put something in and say, hey, I really struggled with this today. But, you know, I something in and say, hey, I really struggled with this today, but I did this and I did that, put it in, and then you go off to work and then you see a minute later,

someone said, oh, I had that same experience. Or they said, this thing really helped me. Here's an episode of Dr. Chatterjee's podcast. That kind of communication is happening the whole time and people are helping each other in the time that they're not in the office. And that's what we found to be the most valuable. And look, I think everyone would aspire that wouldn't it be great if every patient could have that kind of access to their doctor?

It's just the resources don't add up. I'm an economist, first and foremost. I'm a health economist. And so I come to this problem from a resource constraint, you know, perspective. I'm not a doctor. But what I recognize is like this is the path that people have to go to. And I spent the last 17 years trying to work out what is a way that can do it in a way that is using the right resources in the right way to create the right transformation.

And ultimately, you can see in that process that allowing people who are inside, they already have an agreement of what they're doing together. They've set their SMART goals. They've set their collective intention. Another thing that we do at the beginning is help them to sort of define as a group what this group is, like what the name of it is, what it's going to be about for them. So they're like bought into it. And then they're just supporting each other throughout the process. And ideally, forever. I mean, in the book, I spoke about some of the original group visits. It starts off as a type 2 diabetes reversal group. But what do you do once everyone's reversed their diabetes?

You know, in this case, it became a salsa dancing club and a gardening club. Salsa dancing in the winter because it was rainy in Massachusetts and they can't go outside. So they meet once a week for salsa dancing. And in the summer, it was a gardening club. Both really healthy behaviors when done as a gardening club both really healthy behaviors when done as a group even healthier and some of these groups have gone on for 20 years yeah that facebook group example i think is i think a lot of people will will get that straight away um i've got my own kind of um facebook group i think it's called Dr. Chachi's Four Pillar Tribe.

And, you know, I rarely go on it. But what's interesting, as you say, people are helping each other in there. It's just something I've created, right? But I'm not in there to answer questions. It's people in there who are helping. People post things like, oh, I'm really struggling with this and my health, you know.

And then everyone's jumping on to help people. And it's really wonderful because also for that person who's helping someone else, that is a real kind of boost to feel good into their arm, and that helps their health. And it's kind of who we are. You know, you mentioned men before and competition. I've been reading a lot recently on tribes. And there was something I was reading recently, and they were talking about running in tribes and how running in a lot of modern hunter-gatherer tribes is not competitive. People aren't racing with each other. It's really interesting that running is a group thing. It's often to hunt. It's not about who's the fastest runner, which is quite interesting in itself.

There's also, I was reading about some other tribes whereby if anyone's ego is getting a bit too elevated or they think they're better than the people around them, there are certain practices that happen to sort of bring them back down to size. And more and more, I think, oh, actually, being competitive is not who we are. It's who we become as a way,

as a consequence of the way we're living life. And structure, I think, particularly with a lot of men, we end up thinking the way we are, being competitive, you know, trying to do more, be more, is kind of, it's the male way to do things. We're realizing more and more it's leaving a lot of us incredibly isolated, lonely, we're drawn to what I call junk happiness habits, like booze, gambling, whatever it might be. And actually, that's why these men's groups I think are being so effective for so many people.

James, in terms of what you're doing for healthcare, so far in the group medicines clinics, or not, sorry, not clinics, the clinics you've helped, you've brought in this infrastructure of group medicine, you've said to them, God, you don't have to do anything. We'll do all that stuff for you, all the boring stuff, which I think is powerful because then they're like, okay, really? So I know you've done a very clever model in America, which has really, really helped. Be really specific. What conditions have you done it with so far? The first one was in a primary care clinic. So it was a range of conditions. It was the summer of 2020. Immune health was hot for some reason. I can't remember why.

But that was like a range of immune issues. So digestive issues, autoimmune kind of conditions, that was the first group. We've run metabolic groups, which is like type 2 diabetes, heart disease, metabolic syndrome, those groups. We've done chronic pain groups. We've done mental health groups. We've done, you know, really neat niche stuff like urinary incontinence groups. You know, there's no drug for urinary incontinence. So how are you going to do? What are you going to do? You're going to get women together and work together. There's history of incredible success in actually all areas of group medicine, even pregnancy. You know, what the most successful group program in America pre-pandemic is called Centering Pregnancy. It's literally just getting

women who are pregnant, putting them in a cohort. I know this happens actually in the NHS because some of my friends who still live here, you know, had that. But in America, Centering Pregnancy leads to a 35% reduction in preterm birth only by getting women into a circle. There's no other thing, you know, it's just them connecting over a period of time. So yeah, we've focused on, you know, we've seen success in all of those areas. Fatigue, anxiety, depression, you know, chronic pain, digestive disorders are really well helped. If you've got a food-first approach, obviously, digestive disorders can be really helped with food. You see that yourself.

So I actually think there's really no limit to where this can be applied. And part of what we've been doing for the last year is working out where are all the places where this can be deployed. And it's taken us some pretty you know weird and wonderful corners of medicine i mean i think you're doing just just incredible work that that really has the potential to transform healthcare globally i really believe that um a lot of people james who are very influential in healthcare listen to this show i know in the uk certainly influential health leaders in the nhs in politics listen listen, because I've got it on good authority. I've heard people have got in touch. What you're doing, you are showing cost savings, resource savings, you're showing huge benefits for patients. That is literally the tick-tick

for everyone. Patients are getting better, costs coming down, yet it's not being implemented. You've mentioned in the UK, we've got some science. David Unwin's work has been absolutely incredible in what it's doing. Just for that one condition, if we have those savings across every GP practice, the savings are just staggering amounts of money, yet it's not happening. You, with your company, with the framework that you've developed, literally have the potential to help the NHS with immediate effects.

Yeah. Right? So if someone in those influential places is listening or watching right now, and it's like, okay, James Maskell, I'm hearing you. I'm interested. What should they do? Get in touch.

Healcommunity.com. That's the name of the business. I'm coming more and more back to the UK. This is like a pet project of mine because I left 17 years ago to go to America and try and work out what was going on with chronic disease. My degree was in health economics. I saw that in our lifetime, we were going to bankrupt ourselves with going on with chronic disease. Like my degree was in health economics. I saw that in our lifetime,

you know, we were gonna bankrupt ourselves with the cost of chronic disease. And it's been 17 years to try and work out, first, is chronic disease reversible? And then second, how can we do it in a resource efficient manner so that it could be deployed? And then how can we scale the deployment? So yeah, healcommunity.com is the name of the business.

And I would love to find a way that it could create a more equitable, sustainable, healthful, and human NHS because living in America, I want the NHS to survive and thrive. It took great care of my mother for years, right? And that's why I'm really committed to it. But coming to America, you realize what a shambles is going on over there.

There's something really beautiful about the social contract to take care of each other through medicine. And my concern is that that contract is breaking down as we speak. And I would love that my efforts would reinforce that social contract. Yeah, I hope so. I think it is going to, mate. I really do. Of course, in our prescribing lifestyle medicine course,

we talk about you, your work. We're going to showcase more and more what this is doing because, again, the people who are coming on are already thinking differently. They're already going, there's something not working with the current system. That's another piece I just want to mention here, because one thing we find when doctors from all around the world do our prescribing lifestyle medicine course, which is online

now, so they don't need to fly anymore to London to do it, is they get more enjoyment out of their job. There's less burnouts. They re-fall in love with medicine. And for many physicians, it's something that over time, they're just like, man, it's just a slog, this job. Is that something you're also seeing? Yeah, 100%. I mean, you know, even just now in the pandemic, right, you see a 400% increase in demand for mental health services. There's no more doctors, there's no more providers,

there's no more therapists, right? That's an equation that just doesn't add up. And so what that ends up doing is putting way more pressure on the doctors and they feel that pressure because the pain of transformation of the patients, the pain of the patients sits squarely on their shoulders. The beauty of this is it takes that pressure and it redistributes it

over a group of 20 people. And so if doctors know that that group can take care of that, they can really focus on spending time with the people that they can really help. And just to give you an example of this whole thing working. So at the Cleveland Clinic Center for Functional Medicine in America, everyone goes through this kind of group structure first, right? Half the people, this was in the BMJ, half the people get better without any doctor because all they really needed was support, accountability, and working together in groups. And that means that half the people are better. They don't need the doctor. That gives the doctor, you know, can either see twice as many people or can spend more time with them. The army of doctors that you've created is

necessary, but it's not sufficient to solve the problem. And that's why I think the work that you've done, you know, we've been friends for eight years now. You know, we're all tackling our own little bit of it. And we're all here to try and, you know, create something that's more healthful, more equitable, and more effective. And I'm super excited for the future. something that's more healthful, more equitable, and more effective. And I'm super excited for the future. Taking it away from healthcare systems for a minute, just to finish off, this podcast is called Feel Better, Live More.

When we feel better, we get more out of our lives. You've given us the big picture. You've shown us how healthcare across the world can be transformed with a relatively simple intervention. Right. But for that individual who's not involved with healthcare systems, who's not involved with healthcare, who listens to this show,

watches the show to help them with their own life, given what we've just spoken about, what would you say to them? Find your healthy community. It might take a little bit of effort up front, but there's so many new tools with the internet to be able to identify people in your local community who have similar ideas, goals than you do. And I think you're already seeing those kind of things pop up.

But the value of those relationships to you over a lifetime, it's the key to long-lasting transformational health. Yeah, love it. James, you're doing incredible work. Thank you for coming on the show, mate. It's good to have dinner last night. Good to see you. Catch us more on the podcast.

Thank you. Really hope you enjoyed that conversation. Please do let James and I know what you thought on social media. Thank you so much for listening. Have a wonderful week. Always remember, you are the architect of your own health. Making lifestyle changes always worth it. Because when you feel better, you live more.