Finding Mastery with Dr. Michael Gervais - Optimize Your Health With Wearables – Insights on the Future of Healthcare | Google’s Senior Medical Lead, Dr. Kapil Parakh

Episode Date: December 6, 2023

Where are wearables leading us? In the dynamic, fast-paced world of health technology, what does the future hold? What possibilities can we unlock? How can we leverage the power of wearables to transcend mere physical tracking and genuinely enhance our psychological well-being?These questions form the perfect springboard for our conversation with Dr. Kapil Parakh, a renowned cardiologist and the Senior Medical Lead at Google. Kapil is more than a doctor, he’s a leader in the wearable movement with keen insight into current trends and future directions.Raised in Zambia and educated at Johns Hopkins, Kapil's diverse background infuses Silicon Valley innovations with the deep empathy of human-centered medicine. His trailblazing work is redefining healthcare and guiding us toward a healthier, more informed future.Kapil's forward-thinking approach spans multiple domains, and his impressive body of work includes the book, Searching for Health: The Smart Way to Find Health Information Online and Put It to Use. It’s a practical guide for navigating the complexities of today's healthcare landscape.At his core, Dr. Kapil Parakh is dedicated to empowering as many people as possible. His initiatives have already impacted over a billion lives, and he's just getting started.Join us in this insightful, forward-looking conversation, where Kapil shares his personal perspectives and insights on the transformative potential of wearable tech. He invites us to look beyond the basic functions of fitness trackers and embrace technology as a partner in achieving optimal health and peak performance.Whether you're a passionate tech enthusiast, a health professional, or simply looking to level up your wellbeing, Kapil's insights promise to elevate your perception of what's possible with wearables, and empower you to make informed decisions that resonate with your body's own unique needs._________________Discount Code for Dr. Kapil Parakh’s Book, Searching for HealthFinding Mastery Podcast listeners may use the discount code HTWN to receive a 30% discount on Searching for Health:The Smart Way to Find Health Information Online and Put It to Use, when purchased through the John’s Hopkins Press website._________________Subscribe to our Youtube Channel for more powerful conversations at the intersection of high performance, leadership, and meaning: https://www.youtube.com/c/FindingMasteryGet exclusive discounts and support our amazing sponsors! Go to: https://findingmastery.com/sponsors/Subscribe to the Finding Mastery newsletter for weekly high performance insights: https://www.findingmastery.com/newsletter Download Dr. Mike's Morning Mindset Routine! https://www.findingmastery.com/morningmindsetFollow us on Instagram, LinkedIn, and X.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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The frontier that we're at now is how to integrate them into the rest of the health system. These are all foundational principles that you need for a fulfilled, wonderful life. And we have access to the tools to get there. Welcome back, or welcome to the Finding Mastery podcast. I'm your host, Dr. Michael Gervais, by trade and training a high-performance psychologist. And I'm thrilled to welcome Dr. Kapil Parakh to the podcast for this week's conversation.

Kapil is a renowned cardiologist and the senior medical lead at Google, which means he's working on some pretty radical stuff. Kapil is more than a doctor. He's a leader in the wearable movement with keen insight into current trends and future directions. And when it comes to wearable health technology, I'm in. You've heard me love slob about Apollo Neuro. And if not, I want to encourage you to check them out. And I think you'll love what they're doing. So the question is, as we integrate more technology into our daily lives and as the world of health technology progresses and evolves rapidly,

what possibilities can they help us unlock? How can they numb us as an instrument? How can we leverage the power of wearables to go beyond mere physical tracking and genuinely enhance our psychological well-being as well? These questions form the springboard for our conversation with Kapil. He was raised in Zambia. He was educated at Johns Hopkins. And his diverse background infuses Silicon Valley innovations with the deep empathy of human-centered medicine. That combination is pretty cool. His trailblazing work is redefining healthcare and guiding us toward a healthier, more informed future. He's also the author of Searching for Health, the smart way to find health information online and put it to use. It's a practical guide for navigating the complexity

of today's healthcare landscape. At his core, he is dedicated to empowering as many people as possible. He's helped launch products that have impacted over a billion lives, and it feels like he's just getting started. Whether you're a passionate tech enthusiast, a health professional,

or more simply looking to level up your game, Kapil's insights promise to elevate your perception of what's possible with wearables, to empower you to make informed decisions that resonate with your body's own unique needs. So with that, let's jump right in today's conversation with Dr. Kapil Parak. Kapil, I am so excited for this conversation. Thank you so much for carving out time in your very full schedule. And you wear so many different hats. Which one are you wearing today? That's a great question. Just me. So this is my personal opinions. What I say is like, you know, I work at Google. I see patients at the VA as a cardiologist. I have affiliations as an adjunct professor at Yale and Georgetown. But today you're just getting me. These are my personal opinions.

Don't buy stock based on anything I say. This is just my personal opinion and nothing more. Okay. So you have this really unique background, this unique vantage point that allows you to see around some corners. And could we maybe get a glimpse of what's coming down the pipeline with health tech? Yeah, absolutely. So I think we're in this super exciting time. And if you think about it, when you look back to when the internet came or when smartphones came around, we knew it was big, but we just didn't know what it would look like. And when Google first launched or Amazon or pets.com, you didn't know which one was going

to be successful and what it would look like. You just knew you were in an exciting time. And I think we're in that same sort of age right now with artificial intelligence. So it's a really exciting time. Okay. I love it. What are you excited about? So when you look at artificial intelligence, what it does... So I have a background in epidemiology. And when you think about mathematical models, in the past, what we could do is do a

regression model where you have some data points, you draw a line through it and say, this is a general direction where things are going. And that gave us things like the Framingham equation, which tells you your risk of heart disease. You put in some numbers, it gives you a risk factor. The next thing that sort of came along was machine learning. So anybody who has a phone knows that it will find pictures that look like your kid or yourself or your spouse or whatever. And you never sat and labeled every photo.

This is my kid. This is me. It just says, hey, these things all kind of look alike. And that's machine learning. It understands these patterns in data, even though it's not ones and zeros in the sense of numerical data, it's image, and it still figures out those trends. Generative AI, which is sort of the latest version of AI, what that does is they've done these things they call foundational models where they map the entire internet, which is just mind-boggling to think about. They map every relationship possible in the internet,

like who's the president, who's the spouse, who's their kids, where they live, and expand that to everything. So you sort of have this computational understanding of the world. And then the programming language is English. You just say, hey, so what does this mean if you say, write me a poem or summarize for me Shakespeare's works?

And it can do these incredible things with this. And my sense is this is going to have important implications for health, just as it will for many other fields. So there's a lot of chatter about AI and there's so many techs that are being built around it, solutions that are being built around it. Where do you see when it comes to health, like it's just a human health standpoint, do you see that there's going to be some, it's going to first interface with the wearables or do you think that it's going to be more meta global awareness about how people are doing in general to be able to map up against them? So reference points. So again, is it a single point solution? Is it a reference point? It's, I know it's yes to both of those and,

or is there something else that is, is getting you excited about the overall booming of wearables? It's yes and, honestly. Yeah, for sure. It's just because there's so many applications of it. So I'll start sort of from the wearables performance side of it and then head over to the health side of the house, as it were. Cool. On the wearable side, I support Fitbit. I've been thinking about wearables for many years.

I've worked on other stuff before that. And one of the – so wearables are fascinating. So it started with 10,000 steps. Great step counters. It was actually – a fun fact is, like, the 10,000 steps number came from the Tokyo Olympics. It just has a great ring in Japanese. It's a marketing term. I don't – we should pause here for a minute.

Sure. Right? Go for it. We should pause here. Both of us are well aware of where that came from. Yes. But it's kind of like the 10,000-hour rule. That doesn't really exist.

Malcolm Gladwell went on a public record saying- And yet it's a useful construct. It's a useful construct. And so it's a useful construct. It's a useful construct. And so it's not a construct of precision necessarily. Exactly. So just open this up a little bit. And I think this will help folks go, oh, so I don't need to get 10,000 in. No, you don't.

Yeah. So although, would you say more is better or would you say less is better? So it really, I'll do the doctor answer. It depends. Oh, yeah. Okay, come on. All right. So, here's what it depends upon.

If you look at the guidelines and there's a 770- page document that summarizes the physical activity recommendations in the United States and a similar one across the world. So if you ever have insomnia, that would be a starting point. Kidding. But it's a dense document that describes all the research that has gone into this space. I can summarize that for you in six words. Move more, huff and puff sometimes. Those are the two main recommendations. Move more is where the step count comes in. So if you take, I think you've said it, we're professional sitters. So if you get people moving, that is good for their health. And depending on which study you quote, some will say benefits start as early as going to like

four or 5,000 steps, but they keep going. And so the most benefit you have with almost any intervention, if you've done any weightlifting, if you've done anything, you see the quickest gains when you go from like a pretty low level to the next level up. And then if you're an elite athlete to get that, squeeze out that next extra percent, it takes an incredible amount of work. So the most health benefits you see are when you get the most energy people moving, not to 10,000 steps, just to five or 6,000, whatever they were a little bit more. If you're a high performer, shoot for 10, shoot for 12, like that will get you more benefits. And at some point, you reach injury levels. So like, you don't want to be like 30,000 steps a day or something ridiculous like that. But 10,000 is actually a pretty

reasonable number for the average, relatively healthy person. And there's good science behind that. And even though it gets mocked a lot with like, it came from the Olympics or the marketing campaign, it just is not grounded in science. Directionally, it is. And so take from that what you will in your own lives and just move more. Okay. Quick pause here to share some of the sponsors of this conversation. Finding Mastery is brought to you by LinkedIn Sales Solutions. In any high-performing environment that I've been part of, from elite teams to executive boardrooms, one thing holds true. Meaningful relationships are at the center of sustained success.

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be the reason that we're running out of these bars so quickly. They're incredible, Mike. I love them. One a day, one a day. What do you mean one a day? There's way more than that happening here. Don't tell. Okay. All right. Look, they're incredibly simple. They're effective. 28 grams of protein, just 150 calories and zero grams of sugar. It's rare to find something that fits so conveniently into a performance-based lifestyle and actually tastes good. Dr. Peter Attia, someone who's been on the show, it's a great episode by the way, is also their chief science officer. So I know they've done their due diligence in that category. My favorite flavor right now is the

chocolate chip cookie dough. And a few of our teammates here at Finding Mastery have been loving the fudge brownie and peanut butter. I know, Stuart, you're still listening here. So getting enough protein matters. And that can't be understated, not just for strength, but for energy and focus, recovery, for longevity. And I love that David is making that easier. So if you're trying to hit your daily protein goals with something seamless, I'd love for you to go check them out. Get a free variety pack, a $25 value and 10% off for life when you head to davidprotein.com slash finding mastery. That's David, D-A-V-I-D, protein, P-R-O-T-E-I-N.com slash finding mastery. And now back to the conversation. That's good. I appreciate that. And I think it is important to know part of origin stories of where these quote unquote standards or rules come from. And they're less precise than we

would like to admit sometimes. So I love that. Okay, cool. And sitting as the new smoking that's been around for a long time, you know, that idea. And so when you say Huff and Puff, you're not talking about vaping no thank you we should be clear right no we should be clear not about that not about sex like this is it could take many different kinds of whoa you just took sex to huffing and what kind of sex are we having somebody told me i i've said this before and somebody's like i mean like my husband would be very happy to hear them oh no no no not not what i meant i'm like okay um all right but but the thing about these kinds of conversations like you say something i feel like we'll remember

those six words because of that um and so the huff and puff is um it's condensed version of moderate to vigorous physical activity so there's three levels of physical activity there's light physical activity which is like taking steps and then there's three levels of physical activity. There's light physical activity, which is like taking steps. And then there's moderate to vigorous physical activity. And so if you get your heart racing a bit and huff and puff, like you get out of breath, that's typically in the moderate to vigorous range. And it could be a moderate level, could even be a brisk walk, a gentle bike ride, something like that. Typically, vigorous is like a run, something a little bit more than that. And what the guidelines recommend is a minimum of 75 minutes a week of vigorous physical activity, 150 minutes of moderate or some

combination thereof. That's hard to even say, let alone wrap your head around. No, no, no. Let's do this again. Sorry to step on. This is really important. What are you recommending for a week? Yeah. Yeah. So do that one more time. So for a week, 75 minutes of vigorous, it's like three 25 minute workouts or 150 minutes of moderate. So like if you do a, you know, 30 minute brisk walk five days a week, that will get you to the goal or some combination. For our folks that are super into it is that is the 75 minutes. Is that zone three,

four and five. So I'm not familiar with the zone numbers, but the way we calculate it. Okay. Oh, go ahead. Tell me about your zones and I'll tell you. Yeah. Zone one to five, like five is like, um, my heart is pounding through my chest. Like

I'm three or four would be moderate and then four or five would be bigger. So my guess is like 150 minutes of three, or, you know, if you're getting to four and five, then 75 minutes. I think, I think it's probably two and three. We should cross-check this. Yeah, heart rate percentages that you're working from, and I can help map which zones those would be in. And I want to give you a fun applied way to think about it too. But are you working, when you say 75 minutes of vigorous, do you have a percentage of heart rate that you're-

Yeah, so 50 to 75 is the moderate, and then above 75 is vigorous. Oh, you're right. Yeah, I think you're right. I think you nailed it then. Okay, perfect. So four and five. So I would go two and three as moderate, and then four and five as vigorous. As vigorous.

It's typically that much. And this is where the 770 pages go in, then they're like well how do you define this and is it like 220 minus age or is it like heart rate reserve and you can really geek out on this stuff and that's why i try and i shrink it down because i'm like yes we should and it's important stuff but but the problem with that is like every fitness magazine is like there's a new thing you should work out at 11 a.m. every day. I'm like, no. The best time to work out is when you can because then you'll do it. If you're convinced that that's the only time that is good for working out,

then you're likely just not going to do it if that's not convenient for you. So let's go. Yes, and. It depends. No, we both used it. Okay. Yes, and. If the only time you can work out, this is where it gets a little tricky, is let's call it used it. Okay. Like, yes. And if, if the only time you can work out,

this is where it gets tricky. A little tricky is, is let's call it 8 PM and you want to fall asleep by 10 30. We're going to have problems in that. Like that effectively that becomes problematic. I've learned as I've gotten older is that fitness, like after 6 p.m., I'm having a hard time. I wish it weren't so, Doc, but like if I drop my last weight or my last rep and I've done some intense work, I'm taking too long not to recover. Like I can get my heart rate down in a functional way just fine, which is a nice indicator of health or fitness, I should say. But like my whole system doesn't. No, you've got adrenaline surging through and you're too wired for that. Okay. So this is a good, okay. Before I get, I nerd out too much further with you is how long

does it take for the average person? I don't know what that really means anymore, but for most people to process adrenaline. So you get a hit of adrenaline, you're about to walk on stage, your rollercoaster moment, somebody says, I love you, and you didn't realize it. That one might take years. So acute adrenaline, how long does it take to process once it's online? You know, I don't have the precise answer for this. The scientist in me wants to research this for you and give you a very precise number, but it's at least a couple hours. Okay, because I usually go to 90 minutes.

I usually say it takes about 45 to 90 minutes to clear. You think it's- That sounds about right. My guess is in one to two hours, and so that sort of falls within 45 to 90, but that's an educated guess, so I could look that up. I think we should both, we owe it to each other a little bit, because I think this is sort of falls within the 45 to 90 but like that's an educated guess so i could look that up i think we should both we owe it to each other a little bit because i think it's a i think this is a good question for well it's one has to do with cardiac health or um yeah um heart health but at the same

time like i just want to frame why i'm interested in that is because um there's this misnomer that once a once you feel butterflies or nervousness or excitement, however you frame the internal activation of, I call it just being switched on. Your sympathetic nervous system, essentially. Yeah, once the sympathetic switches on, there's this idea, well, if I could just breathe and think better, I'll be okay. Yeah, but you still got adrenaline coursing. So yes and, right?

It's an agitating- There are exercises you can do to bring it down, right? Like there are, but it's still in the system. It's like breathing, self-talk, that, that, that, that, that, all of that stuff helps. And so that helps, but that helps you bring it down. So the surge of adrenaline isn't an, isn't a blip, right? It's a wave. And so as you're riding that wave, if you're doing the thing, you can bring the – you can change the trajectory of it. And so it comes down slower rather than the long tail where you're like,

if you did nothing, right, like you got this burst, you went on stage, whatever, and you then went to the bar to hang out some more and blah, blah, blah. By the time you get to bed, you haven't done anything to – that slope, that gradient is still going. Whereas if you finish your presentation, whatever, right, and you know you're still going to go out for dinner, but you take the break to be like do some deep breathing, center yourself, do the things that activate your parasympathetic nervous system,

which is the balance. The rest and digest system. And then, you know, rest and digest. That's right. Sorry, technical term. So you want to go from fight or flight to rest and digest. And so it is this awareness and this sort of understanding the effects on your body of different stimuli that I'll bring it back is

what wearables are incredibly useful for. Yeah. Okay. I like how you brought that back. And I'm going to stay here. I want to stay here one more time. I want to stay here one more time. I know you do. I know. Okay. You round us home on wearables and then I'm going to come back one more time to the heart. Do you want to do your comeback thing and then we'll take it back up? All right, good. All right. So the vigorous activity, 75 minutes over a course of a week. I'm really excited about, there's an emerging research on re-hit. So hit is high intensity interval training and re-hit is reduced exertion, high intensity interval training. And it was first introduced by a technology company, which I love. I'll give them a plug right now. It's called Carol, the Carol bike. And

I wish I had founder stock on this, which I just, I love it. Maybe one day, but like, I really like what they're doing. So they're finding the benefits of a 45 minute run from a cardiovascular health standpoint that they're, they're finding that they can get it in as short as five to seven minutes. And right. I hear the, that's what I did. And so I'll just describe you to, it's like, uh, two minutes walking pace on a bike, 20 seconds flat out, flat out. And it's, it's like at the

right tension. And then there's another kind of two and a half minute, or I I'm taking about one and a half minute break again, walking pace on the bike for 20 seconds as if a wildebeest was chasing you and figured out the right mechanism that your your wheels are spinning but there's the right resistance where it feels really hard like i want to stop after 10 seconds and my heart is pounding out of the chest my wife you know first time she watched me he goes i don't think this is safe it's that type of you know yeah yeah and so And she's super fit, so she's laughing. Have you got your arms around some of the ReHIT data or what I just described in some version? Yeah. So I haven't looked into that specifically. What I'll tell you is the broader sort of

evidence base. And so now we're deep in the weeds and I'm going to hang out here for a little bit longer then. Thank you. Yeah. But the way this breaks down is as follows. So when you look at the literature between science of exercise and cardiovascular outcomes, there's a couple of ways you connect those dots. One is just look at a large group of people and say, hey, look, the ones who do more exercise tend to be healthier. That's association, not causation, as any scientist knows. And so then you're like, well, let's do some causal stuff and see if we can figure out in smaller studies. So like, if you make them work out, look, their cholesterol goes down. And we know cholesterol is associated with bad heart disease. Or look, they are less

likely to get diabetes or their A1c, which is a diabetes mark, comes up. So therefore, you know, that's, that's, therefore, it's probably directionally correct right we haven't yet done the study where you say you take and we have the technology to do this you just haven't done it no one's paid for this yet is you take a hundred thousand people for half of them you give them a you know get your 75 minutes a week at least a vigorous and 150 minutes a week of moderate. And the other half, you say, live your life. And you see if heart attack rates come down or things like that. We don't have that data. We have enough in the other stuff between association and smaller studies that we think

it's all correct. Then when you look at things like the REHIT, they take that a step further. And they're like, well, the thing that seems to be the correlation between exercise and cardiovascular outcomes is cardiovascular fitness. So you look at like VO2 max, things like that, which is like just how much you can get your body to do. So we'll take that as a proxy. And what's the quickest way we can increase your VO2 max, your cardiovascular fitness, and therefore we're improving cardiovascular health. And so, yes, theoretically, these kinds of workouts could improve your cardiovascular fitness,

and therefore that small causation could possibly associate with cardiovascular outcomes. But we obviously haven't done it at that scale to be sure that that's all correct. The risk that these kinds of things, as a cardiologist, where I see most people run into trouble is my mantra for most people that I talk to is start low and go slow, right? If you really push yourself, it's one thing if you're an athlete and you're a professional or a semi-professional athlete, you've done this already, you understand your body, you know how to push yourself. Most people who are sedentary don't. And when they start doing something like this, the risk of injury,

the risk of heart attacks actually goes up. So if you look at the exercise and heart attack data, there is a peak of risk of heart attack when you start exercising. It goes up. And the reason it goes up is because people do crazy things. And so when you look at, take out the people who were sedentary before and did the sudden burst of intense activity, that disappears. So that's the risk with these kinds of programs. Like they take a lot of this sort of causation is likely because of these associations, and they turn into programs, which for the average relatively healthy person they're selling to is fine. But when you start putting that at population scale, you run into real risk. Okay. So you would suggest start slow.

Build your base. Absolutely. Warm up to the intensity that feels right to you. And then for folks that are unfamiliar with what cardiovascular strain feels like, how would you titrate up? I don't even know if that's a phrase. Yeah, no, that's right. So there's something called the Borg scale you may have heard of, right? Which is like self-perceived exertion. So check in with your body. If this just feels too hard,

then stop or slow down. Well, but that's so subjective. Meaning, you know, you're talking about rate of perceived exertion, right? RPE. Yeah. Yep. It's really, that's what I mean.

It's very subjective. And so maybe what we do- That's where wearables can come in. That's where wearables, that's what it's, okay. So perfect. So like you can check your heart rate data, right? And if you're in, as you were calling it, zone five, and you're flat out and you're close to your max heart rate,

slow down, right? There's a whole company, the Orange Theory Fitness, that does the Orange zone based on heart rate. So there's ways to do it where you're in that, objectively in that zone that you need to be at. And I'll close this out with like, part of the reason I'm passionate about this stuff is I was part of, at Google,

we relaunched Google Fit a few years ago as part of that team. And they're like, hey, we need to like revive this app and we're going to do a new version. What I said is you should make it scientific. And so for the first time, we partnered with the World Health Organization and the American Heart Association.

The WHO had never partnered with any tech company before. They're very nervous about the whole thing. We got them to partner. And it was great. So people actually appreciated that we made metrics that mapped to MVPA that it was called Heart Points and Fitbit. We call them active zone minutes. But you just get 150 a week and we'll do the math and all that stuff for you. So it was really a way of like taking this, all this great

data that we have, all this great science that we have. It's not perfect, but pretty good. And now we can reach millions of people in a way that makes sense for them, give them metrics that they can use to tighten it up and get to like the health benefits that, you know, from the available science we know exist. I'm going to pause the conversation here for just a few minutes to talk about our sponsors. Finding Mastery is brought to you by Momentus. When it comes to high performance, whether you're leading a team,

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Clean, clear, no funky color distortion. Just good design, great science. And if you're ready to feel the difference for yourself, Felix Gray is offering all Finding Mastery listeners 20% off. Just head to FelixGray.com and use the code FINDINGMASTERY20 at checkout. Again, that's Felix Gray. You spell it F-E-L-I-X-G-R-A-Y.com and use the code FINDINGMASTERY20 at FelixGray.com for 20% off. And with that, let's jump right back into this conversation. So what are wearables doing well and where are they falling short right now? Yeah. So wearables have come a long way since the 10,000 steps, which is where they started.

They now track your sleep. I know you're wearing an Oura ring, but of many types, right? Like so watches, rings, et cetera. They can check your, not just your sleep, but also like if you have irregular heart rhythm and you're at risk for atrial fibrillation, which is a heart rhythm disorder that increases your risk of stroke fivefold. That's Apple and Fitbit only. But there's a whole bunch of applications and the mental health stuff is super exciting, which I can also go into. But wearables have come a long way from just tracking steps to tracking a whole bunch of variables. I think where we're sort of the frontier that we're at now is how to integrate them into the rest of the health system, right? So many clinicians still

don't understand what I do with this wearable data. Somebody comes in to a cardiologist's office or a primary care doctor's office with a new diagnosis of hypertension. And most people, most doctors and clinicians, that includes nurse practitioners, et cetera, will be like, hey, do some more exercise. Eat better, like a DASH diet or something like that, which stands for Dietary Approach to Stop Hypertension. It's just lower in salt, more in fruits and vegetables, things like that. Good luck. I'll see you in six months. And yet we have these tools where you can be wearable or Fitbit or whatever,

and we'll check in on you. And in a month or so, give them just a call. Like, hey, what are your step counts? What are your active zone minutes doing? And are you meeting the guidelines? And so we're sort of falling short on the entire world is having increasing rates of chronic disease. We have tools, wearables, and not just wearables,

but many digital, even non-digital tools. So we have the solution. What we're having trouble with is integrating those and delivering them in scalable ways. Something I'm passionate about, something I work on at EA, but it's just a huge shortcoming. What is the shortcoming? We're not implementing. We're not scaling.

We're not reaching the people who need it. We're selling the product, but the intervention is not where it needs to be. Is that what you're saying? I think not enough people have these tools and not enough clinicians in the system know how to integrate that. It's so much easier for somebody to write a prescription for high blood pressure pills. Oh, 100 hundred percent. Yeah. So I see where you're going from the point of contact of a physician or a licensed professional that the integration at that level is not rich. And I see where-

It's even beyond that, right? Like if you think about it, if you have high blood pressure and I have to write you a prescription, there's a mechanism for me to write it. There's a mechanism for you to fill it. There's a mechanism for you to fill it. There's a mechanism for you to pay for it. And there's even like pillboxes to make it easy for you to take it home, right? Like every single step of the way has been completely thought through. Whereas for this stuff, they're like, good luck. You know, I love this thought because the switched on physicians will say,

okay, let's talk about say okay let's talk about nutrition or let's talk about your movement or whatever but then they go they they many of them will stop because they're out of scope out of training and they'll make suggestions to lifestyle which okay that it's good but i love the track that you're saying it's not on the right mechanism so much so that in elite sport you couldn't find a coach still can't um or or elite athlete that doesn't say the mental part of the game is important and yet in the flow of business i'm sorry in the flow of sport it's not there's not a segment in the day that says mental training until until the last like say seven years and that's really what I spent a bunch of time trying to, with Coach Carroll, really

mechanizing that training. And if it's not in the rhythm of day, of one's day, and it's left to extra, I think it's too much to ask. It falls off, right? Yeah, it falls off. Like, who's got extra time? No one has extra time. You have to build it in.

You have to make it part of the system. I love that you're saying this. Can you keep going one more layer on what the vision that you're holding for companies, what they could do or organizations could do to help increase the quality of their people's lives? I'll give you two examples of projects that I've been involved in. And it sort of gives you the potential of wearables. And then I can sort of extend it to how this will affect companies and so on. So one is, I'll double down on the mental health, just because you mentioned that example.

So wearables now can, particularly Fitbit, can track things like heart rate variability, which is a sign of stress, but also something called electrodermal activity, which is essentially the sweatiness of your skin. Anyone who's watched a movie with a light detector test, that's what that is. And so when you lie, you have the sympathetic fight or flight response and your skin gets sweaty. Now what Fitbit has is a passive sensor that senses 24-7 this mechanism. My PhD thesis was depression after heart disease. And anytime I had to figure out something about depression as a psychologist, you'd appreciate this. I'd have to either ask a question on a questionnaire or interview the

person, right? It's like, hey, how are you feeling? Are you depressed? How about now? How about now? And it's very frustrating as a subject trying to deal with your own mental health issues to then have this added layer of interrogation. And so having a passive sensor is phenomenal. How do you use that? What good is that, right? So we partnered with a company that works with substance use disorder people. And what they did was they said, if they notice some changes, like a resting heart rate that's high, they'll just pop up a message on the wearable that says, do you want to talk to somebody? Now, it could be somebody like a situation like we're in right now. I'm talking. I'm excited.

My heart rate's up. I'm at rest, but my heart rate's up. I say no. Or it could be I'm sitting here. I'm thinking about using. My heart rate's going up because I'm withdrawing and I'm at rest, but my heart rate's up. I say no. Or it could be I'm sitting here, I'm thinking about using, my heart rate's going up because I'm withdrawing and I'm desperate. And I say yes. And so then I get the opportunity to talk to somebody in my moment of need. And they, on their end, have counselors. But as opposed to like, hey, we'll talk to this guy on Monday and these guys on

Tuesday, they're reaching people at their moment of need, right? So phenomenal way of like, taking a wearable, a huge mental health need and connecting those. That's one example. A second one is going back to like connecting with the health system. So in the UK, in the pandemic, this hospital system was looking to figure out how to connect with patients virtually because they couldn't bring them in for their rehab. So after a heart attack, you do something called cardiac rehab. People come in three times a week, exercise, and gradually increase up. We helped them out, send them some Fitbits. And what they found was that people loved it. They felt connected to the hospital. The nurses could call them up and say, hey, how are your steps? How are you asleep? This mechanism of building a lifestyle as part of it.

And then they started taking their medicines more because they felt cared for. They quit smoking at higher rates. The outcomes from that program were like phenomenally better than what they were doing before, which is in person, which you would think would be better because they actually talk to people one on one. And so these kinds of things, right? Like if you imagine that you can then have that same sort of benefit at a slightly less acuity level with employees or teams where, you know, you can have a incentive. First of all, it's just raise awareness for everybody, like insight into what are my sleep patterns? Like What are my movement patterns like?

And start to understand that because those things affect work performance, right? Like if in the end you want somebody to perform well and they've got social jet lag where they're sleeping in on the weekends and having a normal sleep pattern through the week, Monday morning is going to suck because they've overslept on Saturday and Sunday and their body's like thinking, I'm going to oversleep again. It's Monday, right? So things like that.

If you're an airline, like, you know, and we've done this with truckers, for example, or any kind of shift worker that's working odd hours, things like that, understanding those patterns can be incredibly helpful. But then you can build community. You can create groups of folks that engage with each other, support each other. Like, hey, you know, when I was trying to quit smoking, when I was trying to take more steps, fix my sleep, here's what I did that might work for you. So just employees, like building community, building, you know, understanding awareness

and insight on their own bodies and performance and health so that they can do better at work, but also have better health for themselves. Okay. So let's do a two part on this. One is it's very clear that many of us don't know exactly what to do with the data. So we are getting better at as a community of knowing what the data means. So the community, it's good. And the tech players are doing better with taking data and making it actionable and usable. And so there's a meeting in the middle that's taking place. And there's all types of compromises that need to happen from an organizational standpoint to make something medical grade to commercial. So we got to just remember,

it's not exactly pure. We're still at the beginning stages of commercial data. to do, what data you're most interested in and how you apply it in your life. Part two is, what do you do with data? And I'll double click on that one for a minute. I just need to say it out loud. So for the first part is just use yourself as an example. What data are you most interested in and what are you doing with it? Yeah. So for, you know, we get a, we have a lot of data and wearables are wonderful because they give you a lot of this data. To some extent, it depends on what your goals are and where you're at, right? If you're super athletic and are already pretty physically fit, then that's going to be less interesting to you than maybe your sleep patterns or your stress and so on. So's that component of it so me personally where i i i am very interested in the science of these things so i focus a lot on

physical activity because that has the really great science and so steps and then moderate vigorous physical activity as we've discussed sleep so we partnered with the american academy of sleep medicine theme here about trying to put science into products. And in two of their main recommendations, we've tried to sort of make front and center, which is duration. So at least seven hours, it depends on the person, but 68 hours of sleep. And that's actually become not just the sleep thing,

it's become part of the American Heart Association guidelines too, around heart disease, because we know there's a connection between poor sleep. And so one is duration, the second is consistency. So like trying to avoid the social jet lag, like same time to bed, same time to wake up and things like that. There's a whole bunch of like other things you can do around sleep as in try and wind down better and all of those kinds of things. But just generally speaking, those are the two data points that I, so physical activity, sleep. And then on the mental health thing, what I tend to try and recognize are patterns.

And so if your sensor that does the skin conductance or your heart rate variability are trying to show you that like every Friday at 3 p.m., you get that alert that, hey, you were stressed around this time. And maybe there's a meeting there that is always stressful for you. Then try and do the deep breathing, the exercises that activate your parasympathetic, your rest and digest nervous system to try and either before or after or both to try and like sort of mitigate the mental stress that comes with that context. And so those are in order like my personal set of priorities,

but that doesn't have to be yours, right? It depends what you're working on. When you're interested in heart health and it comes down to your choices like movement, nutrition, psychological practices, sleep, how do you think about organizing priorities there? Yeah. So as a clinician, it tends to be like get people to stop smoking, honestly, is one of the big things. So you get that out of there. What percentage of the US is smoking? It's getting lower, which is great. A lot of the taxes and things like indoor smoking vans and stuff have helped. Still too many. Like I want to say like 20%. And it depends

by age and location. There's a whole bunch of variations, but still too many people. So that's one bit. And then physical activity, nutrition, but nutrition is complicated. The data is even more clear than physical activity and then sleep and psychological. And then it sort of depends on like, hey, if you're hitting some of those and we sort of re-rank. The data for the lower ones is just not as robust because we're not studying it as long. It does mean that they're less important. Here's where I start to how I tend to think about it is I need all of them and I'm not smoking. So check the box. Like that's, that's easy. I do want to get to alcohol.

And cause I know that there's a risk for heart health there. So the way that I think about it is maybe a bit contrarian is that if i've got my right exercise in i'm eating you know uh organic fish and grilled vegetables and i've got sleep consistent and high quality sleep and i'm good there and i wake up in the morning and the first thing i do is i hit the worry button and then i'm agitated and irritated sure and I'm intolerant and I've got a pessimistic framework and I feel anxious and agitated and irritated and I'm pessimistic and something goes a bit sideways and I exponentially a bit more agitated and irritated and then I'm really drained now by 1130. Okay. And then I choose to eat vegetables and organic grilled fish. I think that I'm,

I've just become one of the most inefficient humans. It's like I've stockpiled all this great resource building, um, just a resource, uh, building. And then I've just opened up the valve and let it all flows, which is a problem because my psychology is not sound. So I know I'm saying this and I am a psychologist, but I can't imagine that you, me, because I've lived it. I know this. I've exercised well, eat well, got my sleep right. And I was still anxious. And it was because my psychology was not dialed in right. Oh, no, for sure. I do want to emphasize that just because I ranked it that way, this is sort of an and, not a or, it's not that it's less important. I did a PhD on depression and heart disease because of that connection. So it's something that I think deeply about,

and it is important. It's just that when you look at the physical activity literature and you take somebody who's sedentary and get them moving, the impact on heart health is much easier to track than if you take somebody like yourself and you get from anxious to less anxious and that impact on heart health, partly because you're doing all the other stuff so well that your risk has already gone pretty low. Right. That's super interesting. So, and again, I can make the contrarian argument as well as like, my psychology is great. I'm eating really well. I'm not moving and not sleeping. Yeah. Okay. Like it's, you sort of need it all. Like that's the

bottom line. Like, and it's what I kind of love about your podcast and about like finding mastery, right? Like it's this, you want to not just function. You want to, you want to master in whatever it is you're trying to master. You need the foundation. You need a good sound body. You need a good sound mind. And then you sort of keep working on. And in my mind, mastery doesn't have to be athletic, right? It doesn't have to be CEO of the company. It could be like, hey, I'm working on my marriage. I want to be more present as a dad and take care of my kids. Whatever it is that's meaningful to you, right? Like if becoming a better father was important, but you kind of have to stick around to be

healthy. You kind of have to be nice to them. So make sure your mental state is okay, right? And then you sort of keep working on the edges of like, oh, well, I got irritated here or I didn't, you know. And so you can take that framework and say like, these are all foundational principles that you need for a fulfilled, like wonderful life. And we have access to the tools to get there. And now one final word from our sponsors.

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matters. If you're looking for high quality personal care products that elevate your routine without complicating it, I'd love for you to check them out. Head to calderalab.com slash finding mastery and use the code finding mastery at checkout for 20% off your first order. That's calderalab, C-A-L-D-E-R-L-A-B.com slash finding mastery. Let's jump right back into the conversation. I love that period, full stop. And then when it comes to the wearables and the tech to support it i wanted the second part of that question was what do you do with the data and to be more specific what i mean there is we are incredible instruments the human brain and mind and

internal ecosystem is an i mean it is a tuning fork at, you know, it's the most, it's the, yeah, it's like amazing what we can do. It's like beyond words almost at some level. And I feel like we, I want to get your take on this because the wearable movement in some cases is numbing that tuning fork ability, meaning that we're externalizing our sense of being okay to look at data before we feel and calibrate. So the best practice that I'm doing right now is before you look at your phone, before you look at your watch or whatever it might be, first thing in the morning, before you do that is see if you can guess what your numbers might be. See if you can get a sense of what was

the quality of my sleep and go super simple, red, yellow, green, you know? And so do you have any thoughts about this? Oh, absolutely. So a couple of things there. So one is, have you ever gone for a run and then realized you left your watch at home and feel like that doesn't count because it's gonna throw off my algorithm for the entire year yeah so yes right like because we get validation by looking at your streaks by and we you know designers like think of this hey this would be fun like if we make it a streak then people want to do it more and and get them more physically active so you know yes there is that risk that comes with like you gotta step back and be like okay just because like i didn't track that run like you can either manually enter it or just know that it happened and like it's still good for you like even if it's not in your in your dashboard

um and and the flip side is i love what you said about the check-in first or like guests. There's two components to this. There is the data and there's how you feel. And sometimes the two will align. Like I felt like I slept great. And you look at your thing and it says, you slept great. Amazing. Sometimes they'll disagree.

And you should understand yourself. And this is part of this like understanding yourself well enough to know when to ignore it and when to say hey maybe i should dig deeper here right like i slept great and then it says no you didn't you're like huh and then it says that every night and you're like wait saying hey honey do i snore like and and yes maybe you're asleep at night like who knows right like but you just don't realize it because you the flip side is like the thing tells you like oh you're yeah agitated you're upset or whatever it is like oh man i'm just i was having a fun conversation and i'm not agitated i'm just enjoying myself and so you can ignore that data so like sort of so one is just like not over indexing on it two is that self-awareness and balancing that. The third is where technology comes in which is super exciting is, you know, we talked earlier about

this generative AI and what it's able to do. So one of the things we just recently released is where the model, the artificial intelligence will mine through all your data and then will say, hey, you know, you're trying to improve your runtime. It's actually your sleep. So like sleep a little bit more. And let's try that again in a week. This AI coach, essentially. And we're still at the very beginnings of that, right? And you can imagine applications for everything from the AI coach for running to the AI coach for cardiac rehab to whatever else. And coaching is a wonderful thing. It is so hard to scale. And part of it is because there's a human connection, right? You feel accountable to a coach. You don't feel accountable

to an AI in the same way. And so there's different ways this could scale up some of it is all ai some of it is like human in the loop where they say um not we'll have a human but instead of like you only being able to coach like i work with a personal trainer currently who has like 50 clients like what if you could have 500 clients you know 5 000 clients what does that look like and how can we use ai to take this person's knowledge, your knowledge maybe, and scale that up to not just every footballer in the country, but to everybody in the country? It's an exciting future. If we can get some of this basic stuff right and there's some real humanity stuff, we've got to get right at the time of our recording. You and I are geeking out about this and there's a war that's just broke out and you know there's some we've got yeah you know we've

got some really brutal stuff happening but um okay not to make light of that in any way um no no i mean it's so true like i work so hard like to save people in the hospital or like you know you spend decades training so you could do this or like putting out products that like help people like maybe get a little healthier over time and then like gets blown up overnight it's just it's horrifying and very maddening do you think that there's a wearable that might be able to measure or improve psychological health we're getting closer which is where I mentioned the EDA sensor. And so we're starting to understand the ways to, it's really what you're getting is signals,

physiologic responses from the psychology. So I got a panic attack, a nightmare. So I had this huge surge of adrenaline and you saw that on the EDA sensor. That's where we're at currently. There's some really interesting work. So a good friend of mine has young, but had a stroke and can't speak. And so I was reading this literature around like where they can understand brainwaves and use AI to turn that into speech. And that's super fascinating. And you can imagine a future where that, you know, maybe you don't need it to go all the way from that to speech.

Maybe it's just anxiety, depression, things like that. There's another person that I met with recently who's working on a suicide prevention algorithm. And I could imagine like, you know, the suicidal ideation and thoughts like if you could find a way to codify that as a signal wouldn't that be amazing like so they suffice it to say there's a ton of work happening in all sorts of wearable but like really technologies around the mind and mental health and this whole interface and the covet has just turned up the dial on mental health as you well know yeah so it's it'll be interesting to see what shakes out like there's there's a lot

of promise but I don't overhype anything that's a good position to be in do you see wearables moving to the periphery or do you see them moving into integrated into fabric or are you seeing them is are you seeing it moving into um furniture none of the above i it's weird but like over the last decade we've seen iterations of all of that right like there people have come out with pendants and um even like things that clip into bras or jackets uh google had a project with levis around a smart jacket. And the form factor of the watch just seems to work. And maybe the ring. And ring has some sizing issues and things. But like, there just isn't quite yet a form factor that has replaced the watch and has reached

widespread adoption. It's not from lack of trying. So my guess is, I think the wearables are going to stay pretty much as a watch form factor and maybe a ring. I think what we're going to see is better sensors and newer sensors, more AI, and essentially compute on wearables, leading to more interesting applications. Glasses and earbuds, you're rolling those out? Yeah, so I think definitely earbuds are getting smarter and, and we're finding more and more health applications and then you'll see multimodal. So like earbuds plus watch tell you something, things like that. Google glass was a thing a while ago and, and sort of failed spectacularly.

Facebook has, has its, yeah, you got to you know losses too um facebook has or meta has as i think it's with rayban or as some kind of collaboration with it had a couple of whacks of this as well just it hasn't taken as a form factor it might be different with ai where like you now have like more meaningful information as opposed to again from a health perspective i'm not sure that you'd get more out of glasses other than like as a consumer then you would you know earbuds or watches things like that the ears were interesting there was some stuff we were playing with a while back maybe like 10 years ago on some of the um you know using that for heart rate variability using that for like a haptic device um you could buzz you know your watch can buzz a

little bit too but like yep the hap we're playing around with how to um we're even considering um some of the uh gosh i'm blanking on it now um oh my god what's it called when you measure your brain activity eeg eeg yeah thank you we were yeah we were even using um that as one of the kind of ways to be thinking about eeg data which you know is fun but um i remember early days nike nike actually used the shoe as a place to be yeah gather some feedback so so you're saying wrist, ring, ears, more than glasses. Yeah. I mean, Google even had a smart contact lens. I was going to say, yeah.

Yeah. They used to have that. That kind of faded away. I've seen some really interesting contacts. Not a head-up display. I'm sure that that's happening. But it was more simple. It was using color,

which is an interesting idea for, it's not really a tech. It was no feedback loop. So ignore that actually. Okay, so given all the developments and the advances in wearables, we've been at this for over a decade now. And is it working?

Are we getting healthier as a society? Well, so as a society, we're not getting healthier, right? And I think, if anything, we're exporting chronic disease to the rest of the world. And what used to be mostly a problem in Western Europe and America is now we're seeing it in sub-Saharan Africa and in India and all sorts of things where there are far fewer resources to combat it. If you look at where wearables have been well applied, you can see impact. The problem is the vast majority of people don't have access to those kinds of programs. And structurally, our society is set up to send us down the path of

chronic disease, right? I mean, this is way more, it's just sort of like, structurally, we're really well set up to deliver medicines and pills and vaccines and things like that. So it's a much sort of bigger societal question than truly like our wearables moving the needle. So, okay, so double click. what do you mean here that we're exporting our chronic issues? What, what does that mean? Yeah. So, you know, if, um, so I grew up in Zambia in Southern Africa and the medical school there, um, and in my medical in time, in several years of being clinical in medical school, three years, I saw one person with a heart attack, and it was an immigrant, so not a native Zambian. And now we see, and my friends are still there,

and they'll see routinely, you know, 40, 50, 60-year-old Zambians having heart attacks, strokes, you know, really bad sort of conditions. And a lot of it is because over time, less physical activity, westernization of the diet, things like that. But we know these are all risk factors, but then we see it playing out all the way where not only are they risk factors, but you see the increased incidence of disease in populations pretty much all around the world. Optimist or pessimist? I'm an optimist by nature. Is that by training or?

No, this is who I am. Like it's just literally, like you sort of almost have to be to come out of, Enzyme is a wonderful place, but like I saw a lot of poverty. I saw a lot of suffering. And so that, I'll frame it this way. For me, what that did was it gave me this tremendous responsibility, right? Like through the accident of birth, I have been incredibly fortunate. And I'll give you one foundational memory.

So it's a pathology class. We're doing an autopsy and the medical students get to read the notes as the pathologist is cutting open. So I'm reading the notes, like the woman came in, she had a headache, turns out she had meningitis. We did a spinal tap, the tap showed meningitis, it was confirmed the family was told to go buy some penicillin. They couldn't afford it. She died. And the pathologist at that moment finishes his autopsy, looks up and says, oh, she was pregnant, unbeknownst to the team. So two lives were lost for a dollar's worth of penicillin. And that just shook me like and and so the it sort of to my core like i feel the more people i can help the

more people i can reach improve their health improve their well-being and whether it's you know wearable stuff that we've been talking about or i used to work in google search and the products that we launched reach a billion people i wrote wrote a book about it, but this like obsession with like reaching people at scale and helping them stem from that. Just make sure your book is noted here. It's searching for health, the smart way to find information online and put it to use. Yeah, we'll make sure. And you've also offered a discount code for that. And so for our listeners. And so thank you for that. We'll put a link in the show notes for that. And so to drive awareness to what your findings are and how you're helping folks out here.

So when you were in that experience, do you remember if you felt it and or thought it? Both. It's visceral, right? For you. But you work, yeah. And do you remember what that emotional experience was for you? Like where you felt it, how you processed it? Yeah, no, I mean, it's, you know, part of this is,

and it wasn't the only one, right? Like that's a sad thing. Like I had multiple experiences where I would routinely try and help people. And they, for example, would go back to their villages and compounds and come back with malaria and diarrhea. Or, like, there was somebody who worked for us and their kid had malnutrition. And I literally bought them food to help the kid. And the kid died anyways. in just these incredible experiences that, it wasn't a single one, but it was like accumulation of a lifetime

of decades of experience in Zambia, seeing all of this incredible poverty and suffering, but at the same time, these incredibly resilient people who would still find ways to have joy and live their lives in spite of the challenges that they face. Finding Mastery is brought to you by iRestore.

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mastery for 25% off and then plus an extra $50 on us because quality sleep is just too important to leave to chance. Who were the most influential people in your life? Was it inside your, was it at the dining room table or was it outside? My parents for sure. And then my wife has been just an incredible source of like sort of secret to my success as it were. We're childhood sweethearts. I've known her pretty much all my life and started dating when we're teenagers. And she's really been the one to like, she helped me migrate to the u.s and like everything from like telling you what to wear to interviews to like hey think about we were at a dinner um and and i was trying

to spread the word about a non-profit i was working at hopkins and the the person there was like you know you should think about being a white house home i'm like i don't know my wife like not just me she's like he's interested. Tell us more. Very kind and mentored me. And I got in. But, you know, like little things, big and small like that, like her, my family. Those are sort of some of the fun. And then I have amazing mentors at Hopkins who sort of paved the way to help me get here, as well as folks in Zambia. So if you add up all the good fortune I've had

right like aside from the basic like I'm not one of the poor folks suffering in Zambia like I've also had an incredible amount of support and luck and that only adds to the like opportunity but also the responsibility so like every time I have an opportunity like your podcast or anything else I take it seriously I prep for it and I see how I can use it to, as it were, advance the cause, reach more people and help them. Of all the questions that we have in life, what are the questions that you think about most often? You know, we have a limited time in the world, and it's about how you want to use it. Time is your most precious commodity.

And you have spheres of impact. The most immediate are the people you interact with every day. And so how can I be the best husband, the best father, the best friend and neighbor, right? Coworker, colleague, those kinds of things. And then you have those kinds of things. And then you have larger spheres of impact. So like, who can I teach? You know, who can I mentor?

And because if I mentor that person, they might mentor somebody else and that has impact. What can I build? Who will that reach? Do you think about trying to be your best parent or spouse or are you trying to be the best the best version of myself and when you use that language the best version of myself how do you conceptualize that um it's hard right like you sort of, it's easier to understand your feelings than to understand what's the best version of yourself. And so like, you know, when you're not being a

good dad, and if you can cut down the number of times when you feel like you're not being a good dad, then you're becoming a better version of yourself. But it's hard to say for me right now, that is such a medical model though, that i i hear that and i go you're a doctor jesus you know like wait all the elimination of disease equals health less shitty less disease that's right no absence of disease is not equal health yes okay so disease does not equal health no no no. So if we were to just kind of open this up for a minute. Yeah. Because earnestly, I am absolutely aligned that you are working on being your very best.

And then if we slice that down to a role and let's do as a dad right now, this is not easy. So you had me there 100%. And this is really, I think about this a lot and it does, it does begin to become a little bit of a mind bender trying to put words to this. But the way that I've understood it is like, I need to have, I need to use my imagination and then have that imagination, have some sensory feeling to it. So it's not just intellectual, right. But I can feel it. And those are my two guideposts. What does it look like? And what does it feel like when I'm

at my best? And then from there, I start to back in practices that will help me be that version of me more often. And then I leave full permission to be able to say, that version can change now. So when you use your imagination and there's a felt sense to it, what does that look like for you as a dad and feel like for you as a dad? Yeah. I think for me, the i think of it as like this judo move of like channeling their energy right like tantrum happening a lot of energy a lot of emotion misdirected at like some frustration that they can't how can i carefully acknowledge that and turn that into and and sometimes it's with a joke and a smile and it sort of swings the other way.

And then, you know, like it's this wonderful, warm feeling of like, yes, I helped. I turned this like potentially awful moment into something that was joyous and fun and also showed them a way of coping with adversity with this adversity is wrong word but like when things don't go your way in a way that's graceful right like so that that would be my sort of idealized version of that are you more of a wise human like we'll say wise man right now or are you more of like um a 10th degree judo black belt that is like, are you the Zen master? None of the above. I'm muddling through. I'm just muddling through my day trying to get by.

Oh, that's so good. You asked me to imagine. You didn't ask me what day-to-day looks like. The actual, right? Okay, so let's stay there for a minute. What you've done is amazing over your body of work. It's amazing. So let's stay there for a minute. Like you, like what you've done is amazing over your body. It's amazing. And it's even hard to even track because you've, you wear many hats,

you've got a big motor, um, your forward thinking in so many ways and you're right on the pulse of what's happening now. Do you, did you ever have a thing of like imposter syndrome? Like they're going to find out, they're going to know that I'm going a little faster. I'm a little over my skis, you know, I'm pretending as best as I possibly can. And like, did you ever square with that? Or did you find different? It's, you know, I've read a lot about the imposter syndrome and it's, it's just, it's different, right? Like, so I think for me, it's taking risks, right? I had a path as a cardiologist, as a Johns Hopkins, and I had to sort of leave that step away to go into technology at a time when nobody else was doing it. And then sort of prove my worth that that path is worthwhile.

And that was not a reckless decision that essentially threw away all the investment that people had put in me to become a cardiologist right and now i see patients one day a week instead of every day and instead of being at johns hopkins writing papers on from the one of one of the most illustrious institutions in the world, like make consumer technology products at Google. Like it's a, and is that a sellout? Or is that actually a different way to have impact? And early on, I didn't know, right? I didn't know which way this was going to turn out.

And so there was that, again, that sense of like having to prove that this is actually worthwhile that this is meaningful that this has impact um and when you're sort of busy doing that work it's i didn't have time to stop and think like am i good enough it's just like no i got it i got to get this done do you have a decision tree or a decision framework that you work from when you know certainly in these pivotal transitional types of decisions or even in the small ones like do you have a framework that you use it's something i've been thinking about it um this is not where i was expecting the interview to go

but i'll i'll share would you say that you're unskilled at making decisions uh no i say no no no i'm sorry i'm just i'm just spitballing because i'm like oh gosh like this was not what Would you say that you're unskilled at making decisions? No, I say no. No, no, no. I think you're skilled. I'm just spitballing because I'm like, oh gosh, this is not what I'd expected. You're just buying yourself another moment. No, because you have a humility. It's like it's all there. No, you're very sweet.

Yeah, and you've navigated complicated environments with precision and fidelity. And so like that, I'm buying you more time. No, I appreciate it. There's a construct I've been modeling. It's literally, I've been processing this for the last few. I end up with a lot of giving people career advice, right? People are like, I want to be you, or I want to, I'm thinking about a career that's outside of medicine.

That's something crazy. You've done a crazy thing. How does that work out? Right? And I do those talks at least. I'm flattered that you want to be me. I'm flattered. Yeah.

Right. It's, but it's every. Listen, I'm just. No, you're fine. You're responsible. Totally fine. Keep going. That was fun.

I do. No, no. Man, dude, if I could like. No, I know what you meant. That people walk into your office and say, I wish I could be Kapil. So, okay. Um, part of that career advice is this construct of linear and non-linear sort of opportunities. Go to medical school, become a doctor linear, right? go to Google and like reach a billion people or not nonlinear right and how do you go from doctor at Hopkins to Google nonlinear like there is just

no way to map that clearly and then once you figure out that you're in a linear path or nonlinear it's different return on investment so I'll just try that afresh just so that you have it so thanks that's alinear, it's different return on investment. So I'll just try that afresh just so that you have it. So thanks. That's a great question. It's something I think about a lot in terms of decision making, because people ask me, you know, about careers and things like that. So in my mind, there's two ways of thinking about these kinds of decisions. There's linear and there's nonlinear. So linear thing is something like you go to medical school, you'll become a doctor. And there the thing is something like you go to medical school, you'll become a doctor.

And there the process is relatively straightforward. It's not easy, but it's straightforward. It's like if I take the MCATs, if I study, if I do these courses, pass these exams, I will become a doctor. And there's a pretty straight path to follow.

But then there's non-linear sort of decisions, opportunities, things like that. So for example, my own life, it was from Google, from being a doctor to going to work for Google. And that path is, there is no direct way to say that if I do these things, I will end up as a doctor at Google. And I think it's important to recognize that there are things that can position you for a greater chance of these nonlinear and to be more successful with these nonlinear things. And these nonlinear things have much greater upside. But it takes a certain amount of privilege to even have access to those.

And then the courage to take that leap. And so the privilege is to be in the right circles, talking to the right people. They're like, hey, you might be useful here. Maybe we should talk about a job. And then the courage to say, I'm going to leave my cardiology career at Johns Hopkins to go work at Google. And so not everybody has access or the ability to make those jumps. But those are some of the ways to think about it. Oh my God. I love those two linear, non-linear and then, um, opportunity and risk, you know, like, or opportunity and courage. Like I, I really like that. And, um, I think we can practice taking risk. So, you know, smaller stakes to larger stakes. And if we don't, if we don't practice it, when the opportunity arises, we tend to overthink and find all the things that could go wrong as opposed to...

I love what you just did there. So thank you for letting me in. That was really good. The other thing about risk is life rewards risk differently depending on where you are. So if it's someone like you or me um i take a risk i go to

google if i fall flat on my face if my product fails and google fires me and they say hey we don't need this stuff anymore i can go back to being a cardiologist which is not a bad backup plan no i understand yeah whereas like if you're a hourly worker at McDonald's and you take a risk and try something different, you might get fired or your car might break down. And so many bad things would happen that you might end up homeless. Because you have to follow as many linear paths as you can till you get to a point where you're comfortable enough to take risks. I want to add one more piece to that. My first job um i needed to have three jobs growing up my parents

were doing fine but they weren't handing me anything my first job was at a gas station and um throwing throwing newspapers right before that but at a gas station and you know i i bring that up because it was very clear to me that if I could make, it was like $3.25 an hour, $3.25 an hour. And if I could make $12 over, you know, four hours of work, then I was only going to figure out how to spend six because I never wanted to be leveraged to make decisions that I couldn't find those linear steps to your point and so if i would if i would have made 12 and spent 15 on credit then i i just couldn't figure i couldn't square that in myself about how to make that work so i'm not saying i had the right path but i do know that i had to kind of be really

conservative so that i could lay the risks i wanted to lay as opposed to, I don't know. No, no, that's exactly right. That is exactly the point. Yeah. Well, that is exactly the point, right? So you don't go spend the extra $3 on a credit card and then end up with a ton of credit card debt and then you now have to work even harder to pay that off. But the flip side is if you're privileged privileged you can borrow money to start a business

and take that risk knowing yeah right that you have a much greater upside and if it all falls flat you might have assets or friends and family you can call and you won't be homeless right like so that you can take not any risk from a position of privilege that you just cannot when when you're not in that place did you come from a place of privilege at a young age? It's all relative. So relatively, yes. The short answer is yes. Because I was to Zambia,

to people who are working on a dollar a day. For the average American, no. I had to really, but I've never had to worry about a meal where I'm getting my next meal in my life or where, you know, in between my parents who paid for my education and were wonderful people, are wonderful people.

My dad passed my mom's away. But all of that sort of put me in a position where when I came to the US, I had to be very linear. I'm an immigrant. so I had to do things that, you know, give me a visa. I'm becoming a cardiologist, so I have to do things that get me to becoming a cardiologist. So I was still taking very linear risks, but I came from a relative position of privilege compared to like most people. Once I was done with my linear risks, that's when I was like able to take the non-linear

risks because i had i was an american citizen i'd done enough to establish myself so that i had a good fallback plan all of that you're kicking ass and even then i had to be careful like i would have i would have started a company when i was 10 years ago because i actually wanted to start a wearable company on the area in 2014 but i didn't't, I, I, our daughter was just born and I didn't feel comfortable enough taking that bigger risk. So even then my risk was calibrated to, to my position. So listen, again, you're kicking ass. This is so much fun to have this conversation with you. If you were to start, um, if you just jump on a soapbox here for a minute and say, look, I know cardiovascular health. I understand this stuff at a deep level, related to tech, da, da, da, da. Please, if you want to

be around in a high quality way for your family, for your purpose in life, start here and do this in a diligent way every day. Drive that home one more time. Yeah, sure. So if you look up Life Simple 8s, that's the American Heart Association has made a checklist of eight things. And it's the things you would expect, physical activity, don't smoke, sleep at least eight hours, eat well. And you can look at it as like control your blood pressure, cholesterol, and so on. But life's simple eights, right, is the checklist. And then you can go into sort of more things beyond that. But if you just want purely good cardiovascular health and good health overall, that's a great starting point. So there in a sauna, like a dry sauna in particular. Are you, you know, big claims around dry saunas right now, 50% all up mortality rate, you know, enhanced or decreased. Like,

where are you with some of that modalities, some of those modalities? I haven't read the literature to be honest, so I honestly can't comment on it. It's something I just haven't looked at. Where do you take risks for your heart health? I don't. I'm not sure. Come on. Come on.

Glass of wine? Two glasses of wine? No, I'm not sure. Like, do I do things that put my heart at risk or do I do things that might give me outside benefits? I'm not sure what you mean by risk for heart health there. I'm just, I'm clearly not sure. That's good. What do you do that you're not optimizing for your heart health? Is it you're sitting too much? You are, your sleep has compromised yourself? Is it glasses of wine?

100%. For me, it's sleep. My kids are horrible sleepers. I love them too much. We never did cry it out. We did wait it out. We're still waiting. Yeah, it's a tough go. And then when it comes, where do you point people to if they go to their internal doc, internal medicine doc, or they go somewhere to have their physical checkup? What tests do you point them to? I've used Boston Health, and I've loved it. I think it's been a solid baseline for me. I'll do one a year.

Where do you point people to or their physicians to if they're not going to go to a cardiologist? Yeah, yeah. Make a basic workout. I'm super spoiled so like when my friends come to me i send them to my friend who is a preventive cardiologist who's the preventive cardiologist at hopkins so and then he does a very like he's got a he knows way more than i do about this stuff which is saying a lot and so he ends up doing things around, you know, CT scans for calcium scoring, things like that, or very sophisticated cholesterol tests that managers... I had one of those. I had both of those,

like the calcium test I had done when my friends passed away early. And so all of us went, we got our scans done, which is cheap. It's only like, I don't know, it was like a hundred and some dollars out of pocket. Yeah. And I think insurance picks it up as well. And I didn't like what I got back. I'm sorry. And I think it's one of those things where- Dude, I'm kicking ass.

Like I'm doing pretty well. And I didn't like what I got back. It was a score of, it was 94 for calcium score. And I'm like, damn it. And so I think that brings up two important things. So one is you can do everything right, and many people do. And it's not a failing to then have this. There's genetics.

There's exposures in the environment that we just don't know about. So it's not a personal failing to have heart disease or diabetes or even obesity. The amount of fat phobia in this country is ridiculous. It is just unhealthy to blame the victim. And there are some cases, like you smoked all your life, that's different. But for many people, you know, there's a huge psychological guilt that comes with that. And we should not have, we should assuage that the best we can. So that's one part of it. The other part of it is understanding how to talk with your doctors about, you know, sort of one is many of us go online. We find all this information, calcium scores.

I heard it in this podcast. I got to go talk to them about it what do i do and and you have like six or seven minutes you know we're lucky we might have a concierge doc who will give us more time but the average person is like a few and and the doc has their own agenda right like when i show up i'm like okay i gotta go over his meds make sure blood pressure is okay and and they say hey i've got to ask you something wait what right no no i have my own list first um and and and so and this is part of what i do in the book is like talk through like how do you one make space in the visit for that conversation but two how do you process the recommendations and so um i have a good friend um who sort of is in your shoes has a high calcium score i sent it to the expert that i mentioned and they said you know take some statins and he's like runs the

boston marathon like his amazing shape like he he's he looks great and and he's like but he eats terribly so he's like no no i'm gonna do this on my own. And so six months a year, whatever, he goes nuts on his diet. And, and the cardiologist is impressed. Like you've done more with food than you could with just medicines alone. Right. So, um, and, and I'll get back to the tool in a second. So he goes to vacation and celebrates and then falls you know sort of back to his old ways a little bit goes back in six months and his numbers have crept back up and so they sort of do this for you know another six month cycle and then gets better and it gets worse and finally ends up on statins and now he's on statins and that's kind of what he's decided what i try to help him do is

like look there's a chart that you can make and there's a printout in the book and on our website but you can say best case scenario worst case scenario right like best case is like I can fix this with heart disease worst case with the medicine and without the medicine and where would you sort of put yourself at put it next because we're all terrible with math like we don't understand you and i maybe because we have different backgrounds but many people don't understand probabilities and scores and but you can just if you have a straight line you say this x is here and this x is here you sort of can relatively compare and so you can just see like risk benefit like with the intervention statins in this case and without um the statins and it became very clear for him that like

with the statins what he could do is have a him that like, with the statins, what he could do is have a good life, because he would still try on his diet, but he wouldn't have to go all the way to the extreme that he did, which is unsustainable. And so occasionally, if he like left, he was okay. But it turned out he also didn't have as much of the side effects because he could do a lower dose. And so like, he found that like, right middle ground on that. But for many people, what ends up happening is like, you come in, you're like, doc, I know what I need, I need a test. And you know, it's gonna be great, because I've been doing all the right things. And Doc's like, no, you don't, you need to get your flu shot, and maybe a colonoscopy. And that wasn't on the agenda today. And so you end up with this, like, what should be a

collaborative process becomes almost confrontational. And so like, it's, it's a huge waste of energy. And it's sort of like the tantrum and turning that energy, the Judo move, right? Like either. And I tell this to both, like I'll tell clinicians, like if somebody comes in and has questions for you and has read up stuff or has a wearable with information, they're interested in their health. They've invested time and effort to do this. You might think it's useless, and it may well be from a clinical perspective. Acknowledge

their work and redirect. That's amazing. Now look at Life's Simple 8s. It took you like all of 10 seconds to say that, but you acknowledge their work and you send them to where you want them to go. And then you say, I might think you might benefit from a statin and they'll listen to you. Whereas if you say like, hey, that stuff's nonsense. Let's talk about statins. I'll be like, oh, this guy's in the pocket of big pharma. He's just like trying to make some money.

So that's sort of like the context there. Hope that's useful. Yes, it is. And I want to say thank you. You know, again, I've loved this conversation. I have a better sense of why you've been able to navigate with precision and speed across multiple disciplines. And I just want to again say thank you.

I want to encourage people to go grab your book. We'll make sure we've got all the show notes in there. And again, if people want to just kind of grab it right now, it's searching for health, a smart way to find information online and just put it to use. And again, really appreciate you. Oh, thank you for having me. This was so much fun. And I think you do great work. I think you're really helping people understand how to live better and that's phenomenal. So thank you for having me be part of that. Oh, thank you. Finding Mastery is brought to you by Facet.

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And for a limited time, they'll give you $300 into your brokerage account when you invest $5,000 or more in your first 90 days. So just head to facet.com slash finding mastery to learn more. That's facet, F-A-C-E-T dot com slash finding mastery. Disclosure, Facet Wealth is an SEC registered investment advisor. This is not an offer to buy or sell securities, nor is it an investment legal or tax advice. Past performance is not a guarantee of future performance. Terms and conditions apply. All right. Thank you so much for diving into another episode of Finding Mastery with us. Our team loves creating this podcast and sharing these conversations with you.

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Lastly, as a quick reminder, information in this podcast and from any material on the Finding Mastery website and social channels is for information purposes only. If you're looking for meaningful support, which we all need, one of the best things you can do is to talk to a licensed professional. So seek assistance from your healthcare providers. Again, a sincere thank you for listening. Until next episode, be well, think well, keep exploring.