the whole system is a joke it's a joke insurance is basically now an obstructionist party in healthc care where they're just trying to throw as many roadblocks in you can utilizing care and we haven't given doctors the time or resources to talk about root causes and then we're giving them all this misinformation about nutrition heck we were demonizing fat for 60 years ignoring the role of refined carbohydrates and alter processed foods we said opioids were not addicted for 20 years igniting the opioid crisis we said penut allergy abstinence helps reduce the risk of penan allergies later in life we had it backwards we ignited the modern day penan allergy abidon so we need to talk about these root causes that nobody is talking about welcome to the checkup podcast I'm really excited for this episode's guest Dr Marty McCary he's a distinguished cancer surgeon professor and public health Advocate based at Johns Hopkins he actually serves as a professor of surgery at the Johns Hopkins school of medicine and is a professor of Health policy and management at the Johns Hopkins Bloomberg School of Public Health he's also an incredibly successful author Dr McCary has written several New York Times best-selling titles like on accountable and the price we pay which shed light on the inner workings and challenges of the American Health Care System his new book blind spots which is again a New York Times bestseller focuses on ways in which modern Healthcare has dropped the ball when it comes to helping people's stay healthy in going through some of the points he covers in his interviews surrounding the book I found myself disagreeing on several important topics so I thought it would be great to get them on the checkup to discuss these differences I do recommend sticking around to the end of the episode for a more thorough fact check than usual given the number of claims we discussed let's get started and I hope you enjoy the episode doc I'm excited for you to be here we we've had conversations throughout the years because what I really appreciated about your approach has been your focus on not being afraid to be a skeptic when it comes to the world of health information health literacy we run into extremes at times where you have some individuals that are very anti-modern Healthcare then you have people who are very promodern health care don't check the establishment we know exactly what we're doing you're not smart enough to question us because you didn't go to the exact IV League school or publish X number of articles but what I like and the approach that you've taken is no one is above scrutiny we need to be able to be transparent honest skeptical without becoming cynical I think that's the greatest uh takeaway that I've gotten from your books we even had a conversation around your book uh which was the New York Times bestseller the price we pay about how much fraud there exists in the healthare space why are health care costs are so astronomically High let's start with that because people often times will come to me and say Dr Mike doctors are paid too much and I'm like well where are you getting that from they say well you guys are always so wealthy and I frequently have to bring them back and explain that the cost of healthare has gone up at a rate that is enormous but the doctor's cost of that rate has not contributed that at least to the majority of the degree yeah why do you think the cost of healthcare has ballooned as much as it has well great to see you Mike and um we've got to ask these big questions right we're kind of told put your head down as a doctor focus on your billing anding and then if the health cost too much work harder as a doctor right but the reality is we have a tremendous amount of waste in the system and we can keep throwing good money after bad into this broken system we've got the majority of adults on medications 20% of kids are on medications all these chronic diseases are skyrocketing what are we doing we've got to take a step back and ask ourselves what can we prevent and where's the waste that we can cut and it turns out there's a ter tremendous amount of waste in the middleman industry of healthcare yeah that people can bypass but with good decisions on how to buy your health insurance how to approach a hospital or doctor with a credit card and um negotiate your bills um people don't know bills are negotiable and turns out that price gouging is a real problem in healthcare it's a huge problem and you talked about surprise billing in your book I find that to be so terrible actually when we did our show um our live tour we ended on a segment where we talk about surprise billing how an individual can be insured can be healthy still have a negative Health situation happen because not all of health is under our control and be left with this tremendous bill that would ruin most people's lives and yet you did everything right how is that happening these days like where is the break in the health insurance space that you think we can plug to Great get the greatest benefit well first of all if we had honest and fair prices for medical services why do you need insurance networks what's this whole thing about oh you're out of the network or you know where's your network card it's like a Shakedown you go to your doctor and it's like the receptionist is shaking you down for an insurance you're just like I just want to know the price I'll pay my deductible is high I'll just pay so if we can get to honest and fair prices then that'll clean a lot of the waste cut out a lot of the middle why do we need giant armies hired by hospitals and insurance companies to negotiate prices prices are not even that good sometimes that they negotiate that's true and we have that on the pharmacy side with Pharmacy benefit managers that were initially created to create discounts for us as consumers but instead started splitting that discount of savings with themselves and becoming billion dooll entities in the process they came along to say oh there's a lot of price gouging we're going to fight for you and negotiate better prices and then they started price couching the American people and so um people need to know what they can do and what their rights are and so I think um there's a lot of good stuff happening right now uh we got a price transparency executive order signed by the White House it was bipartisan didn't matter who was in The White House they it was just upheld and the fines increased for non-compliance these are American ideas right transparency they're not partisan and so people are now starting to party starting to scrape the data make it available on apps so you can see the price and people should ask about the price when we told people ask if a if food is organic ask if the fish are wild caught at a restaurant guess what happened the market moved restaurant supplied differently when we started educating people about added sugar guess what food companies started advertising no added sugar they will will respond so we want people to ask for prices and we want to call out the hospitals holding them accountable for price gouging and predatory billing let's call it Spade to Spade that's what some of them are doing they're some of these hospitals are filthy rich they're like hedge funds with hospitals on the side yeah and um and it's not coming this the the money is not trickling down to the doctors and nurses it is sort of corporate greed at its worst hospitals were designed to be a safe haven for the sick and injured that's why we went into medicine everyone in medicine every nurse physical therapist everyone comes to the field out of a sense of compassion they want to help somebody who's coming in Earnest when they're sick or hurting for help and we want to help them so to ruin their life financially or give them these forms to sign their life away financially it violates the very ethos of the profession yeah do you feel like it's contributed to this issue because doctors have slowly been pushed out of the SE Suite executive role 100% 100% I mean what some of these doctors have no control over their billing uh now some do but most of them have no control I don't have any control if I do an when a patient asks me about a cost of an MRI I can't even give a reasonable answer we we had a math genius this guy Tim Shu as a medical student and he did a paper on our the price markups that hospitals add on to a to a bill the same IV service could cost 18 fa facility fee all the games and he was like hm how are we calculating these how do hospitals generate these bills how who decides we're going to mark this up 18old or 23-fold so he's a genius he did a master's in math after college before med school I was like why did you do a masters in math they're doing like calculus five in high school now like and we have calculators like what are you doing he's like I just wanted to bone up on my on my math this guy's a genius okay he goes to the billing department to figure out how they calculate the markup and he spends hours with them and he comes back and tells me Marty I can't figure it out he's a genius so it's like a forensic accounting he attempted to do basically at that point I mean I don't know if you need to do an autopsy on all of this but I feel in general the health care industry where I'm the biggest critic of it uh falls under the Avenue of private Equity entering the health space I feel that uberization of healthcare is not compatible with healthare um right now Young Folks don't have a PCP they don't have a primary doctor that they have a relationship with they don't have someone that they go to when there's nothing wrong and that's important because we can check in we can make lifestyle recommendations we can make guidance before a problem happens and they're moving more to oh well why would I create a relationship with a doctor when I can go to the local urgent care when I have a stomach ache or a headache migraine what have you and that model responds very well from the money side yeah cuz you can make a lot of money from a hedge fund private Equity owning a chain of urgent care centers which exist but it's not good for Health Care the health care outcomes are worsened we don't have the preventive care aspect when we're treating those visits because they're not sharing in the savings when you have a primary care doctor talking about Healthy nutrition healthy exercise healthy sleep that's added value down the line and I feel like one small change and I'm not a policy expert by any means that I would love to see made and I've tried to discuss this with politicians but because I don't have a big institution behind me that's hard at times I wanted to Institute a rule where if an insurer starts covering you well let's move back right now I feel like the problem is when people get one insurance coverage the odds that they'll have the same insurance coverage in 5 to 10 years is very low is that fair to say yeah so they don't want to invest in things that'll save their competitors money in the correct because that person will switch jobs they will go on the marketplace again that insur will go out of business they'll sell it to another hedge fund and then open another one what have you but people will ultimately not have the same insurance so there's no benefit to investing in the future because you're investing in the future for someone else's savings and yeah I would love to see a rule where if you're going to insure someone you're insuring someone for a longer period of time and I don't think that's not that's not a reasonable thing to ask for it's a reasonable thing to ask for right now now we're talking about enrolling young people into like the Obamacare World in order to generate Revenue so we can take care of those who are sicker and we understand the benefit of that because everyone once everyone Buys in it kind of averages the risk and cost out across everyone but young people are like we don't want to do that okay that's an individual right but why not force the insurance companies to take on that role and say hey let's get everyone covered that wants to be covered but that we have to cover them for their life align their interest better yeah yeah the whole system is a joke it's a joke insurance is basically now an obstructionist party in healthc care where they're just trying to throw as many roadblocks in you can utilizing care and then we're just playing whack-a-mole on the back end and we've done a terrible thing to doctors we've told them focus on billing and coding and seeing patients in short visits we're going to measure you by your throughput and we haven't given doctors the time or resources to talk about root causes and then we're giving them all the misinformation about nutrition heck we were demonizing fat for 60 years ignoring the role of refined carbohydrates and alter processed foods we said opioids were not addictive for 20 years igniting the opioid crisis we said penut allergy abstinence helps reduce the risk of peenut allergies later in life we had it backwards we ignited the modern day penergy epidemic so we need to talk about these root causes that no body is talking about maybe we need to talk about school lunch programs not just putting every kid on OIC when they come to the doctor maybe we need to talk about treating diabetes with cooking classes not just putting everyone on insulin and maybe we need to talk about these environmental exposures and toxins that cause cancer not just the chemo to treat it sure I um we're kind of getting to the topic of your book blind spots and I think that the healthcare industry as a whole has created a lot of blind spots because of the mixed up incentives where doctors get 15 minutes with a patient last Thursday uh I had my entire schedule 9 hours 15-minute appointments essentially I think one was 30 minutes for I don't know how you do that and my first visit I walked in the the chief complaint or uh reason for illness was dizziness and when I walked into the visit it was a mother and a daughter and they were talking about very sensitive things that were going on in their life from a personal standpoint undergoing massive mental health stress I had to ask the child to leave the room in order for me to become versed on what's the dynamic here what's the actual mental health concern is there a role for medication for therapy uh is the dizziness brought on by something that's going on with this major stress that's put on their lives versus is this a neurological issue is it a cardiac issue in what world am I doing that in 15 minutes it's impossible it's like fully set up for failure and then we wonder why Dr burnout rates are at record high levels why doctors have the highest they don't want to be on the hamster wheel they can they're smart enough to know this is a broken system now what we we do what we can in the short visits I'm the same you know we have to work within the system but can we talk about what we're doing to children in America I mean we're forced to deal with these issues in a short visit but we wake up kids early messing up their circadian rhythm we tell them to sit sedentary at a desk for 7 hours a day we feed them poison for lunch and they go into a food coma and then if they don't like it or they can't sit still we medicate them with a diagnosis so we've got to be able to talk about these underlying issues that bring people to care and I think there's a movement now of doctors that are like I want to get off the hamster wheel for sure um I I very much love supporting doctors who want to get off the hamster wheel and put out the accurate info to the general public at the same time I'm very aware of how talking about these issues if done with too much Vigor with not enough concern for how this can easily have the pendulum swing completely the other way how it can misguide people so I'd love to go through those issues like one by one if you want um the medic not the medication the the dietary standpoint of it all you mentioned school lunches um tell me what your thoughts are on what's going on in our current state of things and we can discuss going off of that well first of all I think you you're touching on a very important topic and that is what's the right balance right cuz we live a real world we know microplastics are bad they have hormonal disrupt but how do you avoid it right you can do your best uh child birth is a good example that we sort of swung as a profession to the overmedicalization of ordinary life and then people are swinging back to delivering babies in the woods with nobody and that's dangerous so there's a balance with all of this and with school lunch programs if you think about our the big food big a in their lobbies you might think these are evil companies trying to poison us but I actually see the best in people we have good people that went into those Industries and those Industries after World War II were asked to address food insecurity to maximize food production and address hunger and they did that and an unintended consequence of all the GMO and pesticides and added food ingredients that the food scientists engineered to be addictive so a kid finishes eating the school lunch and they're kind of full but they're kind of it's kind of queasy full it's not really they don't really feel full and so their hunger level is designed to increase with the food additives and so they want to keep eating and we never saw this before we don't see it with any other species in the animal kingdom you didn't see it before just the current generation try overeating broccoli it's like impossible yeah exactly right and so we've got to look and say what are some common sense things we can do California just banned seven food chemicals that have been implicated in attention deficit disorder hormonal disruption genetic mutations and so there are some things we need to do and a lot of it's just educating people you don't need a lot of these food ingredients that are for sure I think the description of putting in processed and ultr processed foods into kids lunches kids snacks and then marketing it to them in a incredibly impactful way with the rise of social media television programs that that is the most wild thing that I never expected to happen especially as a young person how effective their marketing was in getting kids to eat these Foods parents to buy these foods for kids and then have the kids be perpetually hungry now again I'm trying to be as careful as possible with all these ingredients you mentioned like GMOs for example I hesitate to say that putting in GMOs is like a problematic thing right because what I've seen on social media is again what you're describing here is good intentions creating bad outcomes right the good intention was they're trying to feed a wide group of people bad outcomes they created a problem where the foods became irresistible nons satiating and therefore led to potentially the Obesity crisis that's our suspicion but now with this in talking about how those food additives are a problem good intentions we're also scaring away people from things that may not be terrible for us like GMOs yeah so how do we strive to keep that line safe without fear-mongering to people because what I see happening my patient population is they're confused yeah the distrust is happening because our government and our institutions make mistakes which can happen I get that but then it is also happening as a result of people labeling those institutions as failures or demonizing all ingredients trying to make you sick yeah trying to make you sick that sort of thing so how do we yeah be careful with that line so I think it's good for people to prioritize certain changes in their food choices and behaviors so we don't have a pile on with just demonizing one thing right and it may be the cumulative burden of all of these things going down our GI system that's increasing inflammation when chemicals go down the GI tract things that do not appear in nature like vegetable oil and seed oil derivatives these are chemicals they sound healthy but they're not uh microplastics toxins arsenic Ultra processed foods it may be the cumulative burden of all those things that is causing some of this so we want to give people good guidance and so here's something that I think is a good way to think of it for people who are listening you want to think about your gut health it may not be say the GMO food itself that is that toxic and poison but why are these Foods genetically modified in the first place well they found out after using agent orange in the war that it kills um a lot of stuff including insects and so they started using it as a pesticide to get rid of the insects in crops and they found it kills the crops and the pesticides so then they thought let's genetically modify the crops to be round up ready so it can handle the pesticides and then we eat these Foods coated with all these pesticides the average strawberry has been sprayed over a dozen times times with 7.8 different pesticides one sample of school lunches in the DC area found that a school lunch can has up to 38 detectable pesticides it's showing up in the urine now when tested in children shows up in the umbilical cord of moms so these pesticides have been added but the GI tract is not Round Up ready humans are not Round Up ready so what may be happening is the pesticide itself may not be poisoning you it may be altering the microbiome the lining of the GI tract of millions of different bacteria that normally live in a balance but when you throw these all this stuff down it's changing that balance and you get overgrowth of certain bacteria and we know those bacteria are involved in digestion it's a beautiful thing it's normal it's natural those millions of different bacteria train the immune system some make serotonin involved in mood and mental health some produce gp1 the active ingredient in OIC in low doses it's this incredible organ system called the microbiome and so when we we've got to think about our gut health so it may not be the GMO food itself sure but think about what those pesticides are doing yeah so you say statement like the strawberry has X number of pesticides on it what is the takeaway from that the takeaway is should I not eat strawberries buy organic strawberries because they won't have pesticides especially if the that's not true they still have pesticides organic technically means they're not produced with pesticides but they're are Organic pesticides well um there are ways to kill bugs without chemicals so it means technically no chemical pesticides according to the USDA organic label which is the organic yeah exactly the organic label has a lot of flaws in it so I I I always want to give the most practical advice so if I'm saying like just the other day I even caught some Flack for this I did a video about black Plastics in um in food products and where that black plastic came from was VCRs DVDs wires that were made you know 20 years ago had an ingredient in it it's called Deca bde and this ingredient was a flame retardant and it made sense why good intention so that the wire didn't burn but then those Plastics were recycled also good intention we want to recycle not cause pollution they were recycled into some products that ended up in kitchen utensils spatulas takeout containers where that ingredient actually has been linked to some harms and I did a video talking about it and the takeaway was um try and get rid of them out of your food products like can't get rid of them out of your life fully that's ridiculous so food products washing your hands after you handle them so that if you have some residue in your hands it doesn't end up in your mouth and actually they said dust was one of the biggest contributors of those Plastics binding so I said dust your homes and people were mad that I'm talking about chemicals and scaring people but I think in that instance we're talking about chemicals in a way where it's empowering there's three steps you can take I'm not selling anything this is very reasonable advice but when we say a strawberry has scary chemicals on it yeah and we say buy organic and organic is more expensive yeah and not available in every area as you know with food deserts and all and also has potential pesticides on it yeah I don't know if that's worth if it's practical if it's practical and also worth the time spent with the patient I feel like there's so many larger issues that we can get so much benefit from and I see that happening with a lot of podcasts and clips from like even famous doctors where they'll say like strawberries are now basically poison or Apple's not the same that it was not the same as it was you know 100 years ago and like okay but like you're just saying something to get a lot of viewership but what is the Practical takeway remember that Apple Scare at one point from our friend so um here here's um how think of it we have got to try something different all these chronic diseases are going up we know pesticides have hormone estrogen like binding properties we're watching the age of puberty go down every year by a week and a half it's now years sooner than it was just a generation ago and you don't think obesity can be partially related to that I think it is and so the the truth is if I'm being really honest I don't know I don't but I'm looking epidemiologically at these massive Trends one living generation autoimmune disease skyrocketing infertility skyrocketing obesity skyrocketing diabetes skyrocketing autism skyrocketing what's happening we're altering the microbiome in ways we don't appreciate or don't recognize sometimes when we test individual things you'll see these really concerning trends like pesticides have gly glyphosate having uh a precursor to leukemia my dad's a hematologist he can tell you more but it's it one thing is where we've added all of these chemicals so I do think um if you can reduce the pesticide load the chemical load in general in one's life washing things really well and remember it's most important when you're eating the surface of a fruit or vegetable so it's not as important when you're eating watermelon you know and sometimes you can waste a lot of money but for people who say you know it's a little more expensive to buy the organic um Foods I tell them try insulin that's you know that's expensive we're watching all these chronic diseases go up I think we need to take a look at these things we haven't been taking a look at I think the idea of taking a look at it is so important like doing the proper research and the lack of funding that exists for it because there's nothing to sell on the Pharma side of it is absolutely a real problem uh I also using your own thoughts uh using the peanut uh situation where in year 2000 it was recommended by the American Academy of Pediatrics to say hey take out Peanut out of of a child's life early on and that's going to decrease allergies where in 2008 we actually saw the flip side to be true that we should be introducing highly allergenic Foods one at a time starting at four to six months and we Chang that guidance and you talk about how that guidance was made in the year 2000 based on just expert opinion because people were being asked right is that a summary of yeah the claim now I feel like right now we're almost doing the same thing in this conversation by saying we don't know which is what you said about the pesticides and chemicals and why these rates are going up and yet we're giving advice are we not just doing the same thing so people say look we're confused we don't know what to believe the research is mixed well if we actually look at the research in General on food additives that is ingredients pesticides chemicals in the food 83% of studies show a harm when studied but 93% of studies funded by the food industry show no harm so I think we have to recognize this conflict of interest I personally look at studies showing um that demonstrate that pesticides have hormone like estrogen like binding properties as a major flag and although we can't do a a 10-year randomized control trial on this well we can do a cohort that tests out people who have and have not and that's not perfect well maybe we have that I mean look at the Amish community in the United States the Amish community that doesn't sneak in all the junk food the Amish community that eats Whole Foods from good soil and regenerative farming lower rates of all these chronic diseases all of them now we could say they're also active yeah there's a lot of differences there's a l there's a lot right absolutely and that's that's also true so activity matters but how do we explain the fact that we have infant obesity in the modern world how do we explain the fact that um we have six-year-olds now with type 2 diabetes you would rarely hear of a case a generation ago a pediatrician their whole career maybe see one well the average pregnant person is more obese than they were 20 years ago so that's why those babies are being born in that way at least that's my logical way of thinking about it um the the idea of these pesticides and all being problematic and needing research I think is so important I guess the the Practical side of things because I'm family medicine right so like I have the patient in front of me what should I do um do you think as America as a whole we follow the ameran standard diet which is rich in Ultra processed foods Burgers hot dogs all these terrible foods that are not great in the amounts that we're consuming them and that's saying it LLY is is that the problem or is that those people are eating berries with pesticides on them I think it's all of it I think it's a poison food supply with pesticides ultra-processed Foods refined carbohydrates engineered chemicals that are designed to make food addictive microplastics and heavy metals in the water supply all of it is changing the microbiome and an amazing study down at the Mayo Clinic that I go through in the book when they gave antibiotics to young children in the first two years of life now one thing we know about antibiotics is they massively alter the microbiome they shift all those that balance of millions of different bacteria are altered when you carpet bomb the microbiome with antibiotics now antibiotics save lives you and I have seen that but over 60% are unnecessary according to Big studies right so so they looked at kids who took antibiotics the first couple years of life 20% higher rate of obesity 32% higher rate of learning disabilities ADHD um this is a maleo clinic study um 14,000 kids pretty well controlled um and it had a dose dependent relationship the more courses of antibiotics a kid took the greater the risk of all these chronic diseases that we are also seeing increase in the modern era of antibiotics so it's all of it I think it's all of it so we need to teach antibiotic appropriateness avoiding C-sections when they're unnecessary which is a fraction maybe 40% avoiding all this junk and poison in our food supply and I think that includes recommending people not eat pesticides buying organic or washing their food uh very well but when you make this change in society to poison the food supply and then you see all these chronic diseases Skyrocket and then look at the one control group in the United States that is not seeing the skyrocketing the Amish community old manite community and by the way other people who have lived from good soil and good foods right you want to cook and not buy sure then um and in other countries you see much lower rates where they have not adopted the Western diet y I mean I think the Western diet and like I had um Maran Nestle uh food politics expert on the other day and we're talking about how why are pro ultr processed foods so bad is it one chemicals it one this and the reality is like it just makes us overeat we over consume and when we over consume that throws our body off equilibrium hormonal changes shift when we have high rates of obesity and the biggest part that is not just changeable but the reason for why these health concerns happen is because of the overc consumption of food and I look at um again a practical takeaway from the water is Poison the food is poisoned this and that if I have a patient in front of me I can't make 20 changes right that's just so not realistic because no human can undergo 10 changes of their lifestyle when they have a job kids multiple jobs at time so I think of big things the big rock what is the one big rock that I can pick up to lift the most amount of weight not the smallest amount that I can put on top and the biggest ones is the processed foods the ultra processed foods getting them on Whole Foods so when I hear these messages which are the loudest messages of berries having pesticides and scaring the person that's eating the burger say why would I eat berries they're poison uhuh I worry about how that message lands for those people do you have any concern with that or do you feel like that's I'm overthinking it look I I see where you're coming from I I'm in the same situation with my patients they come in overweight morbidly obese and we need we want them to lose weight before surgery right because it radically reduces complication risks so what can I do in a short visit to get them to lose weight sure right this is a long problem with many factors in society of course and so I usually tell them eat Whole Foods as you're recommending Whole Foods that you think are Whole Foods are sometimes not healthy foods when you say the whole foods are not Whole Foods which like if you just buy bread from a grocery store you don't realize it's enriched Ultra processed flour they've you have to see the whole wheat component you have to see the whole wheat and not whole wheat die yeah but actual actual um uh true whole wheat CU most bread is stripped of its fiber and chopped up and functions like sugar in the body and so um and then I tell them to drink water instead of you know all the other juices and stuff with added sugar absolutely um fruit is not bad right these are not it's not these it's not that fruit fruit has fiber and that's important but um you know maybe I'm a little more concerned about the pesticides since I've been reviewing the literature on its hormone properties but um Maran Nestle I know you had her on on I like her I interviewed her for the book cuz she was involved in the food pyramid I would say I criticized the food pyramid to her by the way good yeah she I did too in the book so I give a couple of these I I interviewed a couple of these people who have been around during the dogma of the food pyramid and asked them you know I asked her is there any evidence that natural saturated fat causes heart disease and she basically didn't have any studies but she said you know kind of everyone believed it at the time and this the consumption of the the consump eating natural fats uh eating saturated fats causes heart disease it was a theory from the 1960s they did three major studies to try to prove that was true all studies failed to show it causes heart disease but we have most of the American public to this day on a lowfat try to tiptoe around cholesterol diet when cholesterol is not even absorbed by your GI tract dietary cherol dietary cholesterol 90% % of it goes through your system do you not have the belief that consuming saturated fat raises cholesterol levels that then increase your risk of having a heart attack or stroke so eating uh natural fats in high proportions can increase your LDL but the real important lipoproteins are the subfractionated um APO lipoprotein B and LP and LP little a but don't you think they correlate very well with the LDL numbers so LDL has been a and I know it's imperfect it's an imperfect test so you can it's a screening test also that we use a lot of times it's a screening test and it's done okay not as good as the other tests that people should be getting now everybody get an LP little a and a when you get your blood work but um if you if you overeat anything U you can do harm but the idea that natural fat increases your LDL and that translates clinically into more heart attacks was disproven with three major studies the Minnesota hard study they randomized 9,000 people half got the lowfat half did not the lowfat group had more heart attack deaths but that's not comparing Apples to Apples necessarily cuz putting people on a lowfat diet doesn't necessarily mean you're putting them on a healthy diet in fact when on a food product that says low fat that also probably means they added a ton of sugar to make it taste better that's why more people died in that coup I think exactly yeah but when we look at the longitudinal research of those who consume more saturated fat have higher LDL figures they have higher risks that's not up for debate is that fair to say I I I would say the women's health initiative and I go through all these studies in the book Women's Health Initiative study and the nurse's health study out of Harvard both failed to show a correlation between reported saturated fat intake and cardiac risk and that's why the the recommendations are being rolled back and they're focusing on the refined carbohydrates like you're talking about things that stimulate your pancreas I never thought I would be when I became a pancreas specialist I never thought I this was going to be the central organ of society sure but I kind of think it is like the pancreas has never been stimulated at rates that we are seeing in the modern world it's our generation and that drives the insulin resistance metabolic dysfunction and general body inflammation that are probably the three main drivers of all these chronic diseases that we seeing yeah I think it's we ALS always have to be careful when we're saying ingredient a is bad is it bad replacing what you know people often times will have these clips go viral diet soda is so bad for you it's like well if you're morbidly obese and you're drinking tons of regular soda maybe switching to diet soda and decreasing the amount of caloric intake you're taking in could be helpful yeah and I of course I wouldn't recommend someone who drinks water to replace that with diet soda then it's not a healthy choice right but it's always like in lie of what in Le of what yeah and when it comes to talking about nutrition I'm so careful of not misguiding people to have the pendulum fly the other way where it's absolutely refined sugars are a problem they cause you to overeat they have all these problems from an insulin perspective the pancreas perspective but at the same time I feel like the world has now pushed so far again we said fats were bad we villainized them now we're going to they're completely fine and saturated fats aren't the problem we have to like bring bring people back to the center the homeostasis of information if you will and what I've seen is that's not popular for television for social media and the world that I play in so often because it doesn't get the attention you know like if honestly if this interview was done on a different Health podcast the title of this would be Dr Marty says strawberries are poison I'm not going to lie that would be the headline of it and I know that's not your main point I know that's not even what your main goal is of changing in your patient's life but that's what sticks in people's minds so I'm always so careful about what is the impact of these statements and I'm curious what would you like for the impact if there was like one impact from blind spots what would be the impact that you'd like to see made we are witnessing a chronic disease epidemic we've never seen before and we have got to challenge deeply held assumptions that are not based on science they've been dogma and there's a whole psychology to this of course a matter of fact a Harvard student I don't know if you saw this he just ate 720 eggs in a month which again is not valuable from research perspective I'm not encouraging it I don't want be to go out there and do it but his LDL went down a tad so I mean it is he is I'm not saying he's the new Einstein I'm saying we need to challenge some of the deeply held assumptions my dad who's a doc grew up in an era where they just piled on and demonized two things in society smoking and saturated fat and that was like that's our charge to go out there and educate the public so it's good for us to start asking about these chemicals that are studied in radically different ways with food industry and chemical industry studied sponsored studies and with independent studies and look at this objectively it's not part of our medical school education I wish it would have been I mean how much time do we spend on nutrition and the little nutrition we got was the old sort of mar and Nestle food p calories in calories out which we we know is not really a good model right calories in well why is it not a good model because not all calories are the same if you take prazone you're going to gain weight and it's not because the calories in the pill and so some calories bound to fiber are slowly absorbed by right are you just finding an extreme though like it's a it applies in most situations no um if you overeat calories you gain weight yeah most situations but what we did is we got people counting their calories so they could get they could get those equivalent calories from Ultra processed foods they switched over the food industry said hey come on over you can get your calories here you know here's the number of calories in in a um uh what are those diet plans like your Weight Watchers and they're serving ultr processed frozen food in waste Watchers what's it doing it's altering the microbiome it's stimulating the pancreas the process is not bound to fiber when things are bound to fiber you know eat fiber people should eat fiber fiber is enables the carbohydrates to get absorbed slowly that's why we encourage fruits and vegetables they've got sugar but it's it's complex carbohydrates it's bound to fiber it's not stimulating your pancreas to Surge insulin and you mentioned um artificial sweeteners just two seconds on my take on that because thought a lot about it I think we're messing with the pancreas we know that from psychology if you think about eating food your mouth will actually start salivating right sure this pedral response and what's happening in the pancreas with the artificial sweeteners I think are the same thing if they're very sweet but no sugar load comes you've kind of trick the pancreas and the insulin is sort of getting ready to get released it's not released but the pancreas is ready for it and when it doesn't come your appetite can go can increase and so people can eat a lot of these artificial sweeteners and then at night binge e we go out for the Ben & Jerry's or the Oreos and because they have a craving that's been um created by these sweet uh things that are telling pancreas food is sugar is coming but it doesn't come I like Stevie I like some of the natural sweeteners I mean they all taste differently and people have their preferences but anyway that's that was my take on when it comes to those Foods the same concerns you share about it feeding uh or changing the microbiome because the bacteria consume it uh because it's not absorbed like a traditional sugar wood I think there's truth and validity to that research has shown it um when we look at randomized controlled human trials with uh diet sodas or artificial sweeteners Lane Norton who's a popular PhD that talks about this he's been a guest on the podcast he's pointed out these randomized controlled studies that showed those who if you Rand rized and controlled so it's a very controlled study in dietary world is very rare and they had people with sugar uh artificial sweetener and water and then milk and some and they found that people did lose weight and it's not perfect because there are harms just like with any risk reduction right so you know this probably wasn't in my generation of education but there was at one point a villainization for doctors that recommended condom use because they said well that's not abstinence you're still creating risk cuz now people might use them wrong or they might do this and all those risks are true you know condom use from a research article doesn't yield the same results as out real world condom use and there are still issues with it but it doesn't mean that condoms are bad so what is the takeaway from what you're saying with artificial sweeteners should we avoid them at all costs are they a valuable step down tool off of sweeteners where what's the Practical takeaway of that advice so the reason I'm going into some of this detail is that um people can really make their own decision try it and switch it you know if someone is on uh sugary sodas and juices with added sugar and they want to switch to the artificial sweeteners watch to see if it increases your craving at night later in the day if if you find this desire to binge eat which is not a natural human instinct it is a modern byproduct of what we eat for sure then be aware of that maybe that means don't uh eat eat or drink with artificial sweeteners maybe use less sweet natural sweeteners and sometimes it's a combination of sweeteners that can taste better so it's not monk fruit is is the best sweetener in the Coconut the newest generation the newest generation sometimes it's a blend of all those and people cook with all of those and it creates sort of a blended flavor and you can titrate each right I think we can talk about these extremes ad nauseum there are so many instances where there is an relative contraindication there's an absolute contraindication but what I worry is we're these days in scientific communication being so out in the open we're having these inside baseball discussions over minutia of extremes and it's leading people to actually lose trust in us so I can see how people would lose trust in the CDC when they make a mistake or they say something inaccurate I can get why that's happening and it's almost not preventable because ultimately we're learning they're going to make changes all these things will happen there are things they can do better but it's mistakes will happen but uh for example do you think when someone reads blind spots and sees the instances that you've brought up with the peanut allergy with the hormonal replacement do you think that creates trust or hurts trust or neither I think what's hurt what's really harmed trust in doctors and hospitals is saying that we have to have one curated message and we can't really have civil discourse in the public domain I think that is what what has hurt public trust public trust in doctors and hospitals went from 71% just before covid and I don't talk about covid in the book too tribal 71% down to 40% a 31o drop in public trust in doctors and hospitals I mean that's a little offensive to us right because we work hard and we're trying our best but people saw what happens when you have sort of a Central Command um with that makes recommendations that doesn't really invite different opinions and ends up getting it perfectly backwards and I think that's what happened with the food pyramid I think that's what happened with opioids I think that's what happened with the peanut abstinence for 15 years we were telling parents don't allow your kids to be exposed to peanut butter you know what the right answer right recommendation should have been we think peanut exposure early on may cause penan allergies late but we're not sure agre a lot of times the right answer is we don't know I think that's healthy to have that out there so I'm a little bit of the school mindset that we should be having the Civil discourse out there people should hear different expert opinions the guy who said look added sugar is really the the devil in refined carbohydrate not saturated fat Dr John yudkin was sidelined railroaded pushed into retirement had his lad lab shot down and it was with the same argument we can't have the public hearing this discourse you'll confuse them and I so I I actually am on the side of discourse yeah I think I'm on the side of discourse too obviously that's why I'm so happy we're having this conversation I think truth seeking is so important when it's done with the goal of Truth seeking I think if we look at the mistakes modern medicine has done as listed in the book there's plenty of mistakes to point out our system is so flawed I could point out a mistake every two seconds if I want to but if we're trying to create Goodwill with the public and we're trying to explain that for every mistake that's been done here because of the scientific method we are actually catching these mistakes like why did the 2000 recommendation from panut allergies change in 2008 because we did a study yeah science autocorrected yes and sometimes it's slow and I agree with you because of medical inertia we carry things sometimes for too long we have egos those things absolutely do happen but at the same time I think that when it happens it could be the right move so sometimes times we have a lot of evidence pointing in One Direction then something new comes out we don't automatically change to that otherwise we'd be flip-flopping so aggressively like the media headlines about coffee can causes cancer saves cancer causes cancer useless right going back and forth so I think that there is some value to Medical inertia of not just constantly flip-flopping when you see a new study come out but absorbing it into the Fe the the general field and seeing where it lands and seeing how the consensus changes over time do you not think that this is how modern medicine works it feels like you're saying medicine is this Antiquated notion that is never changing that is constantly holding on to its beliefs but I actually view it as a young doctor where it is apt to change and it is open to making new recommendations and when it does it's villainized even more don't do do you see how that cycle vicious cycle can keep happening so we don't want to create cynicism we want to educate people about truth and I think sometimes the way to educate people about their health is to give them the backstory of where the recommendation came from where it went wrong and where it should be today sure that's what I'm trying to do in blind spots so um the worst thing you can do in medicine the worst thing we can do as doctors is to make a recommendation absolute and suggest that it's scientific when it's not it's just a gut feeling and that's what they did with the penut allergy thing women who slipped peanut butter into their kids because they believed in the old dirt Theory which actually has some truth it they were seen as anti-science and when the medical establishment saw peanut allergies surge after their recommendation in the year 2000s they thought gosh what's going on we told them to avoid peanuts and now we're seeing panies go up we got to double down and get more peanut abstinence in the first few years of life 15 years later 2015 the ultimate randomized trial was published in the New England Journal showing that the TW 15-year Dogma was wrong now in the absence of science I think it's good to have a healthy debate a bunch of Pediatricians said I know Immunology I studied Immunology this violates basic principles of Immunology I'm going to encourage my moms to introduce a little bit of peanut butter when the kids's five or six months of age now some of these dogmas in modern medicine are still and by the way I'm proud to be a doctor the operations we're doing at John's Hopkins are a tour to force they're incredible um a lot of the major achievements in medicine are to be you know to be highly respected but when you look at say hormone replacement therapy for women in the per menopausal period we have had a Dogma that it will cause breast cancer and increase the res risk of breast cancer mortality scaring away 50 million women over the last 20 years since that Dogma was announced so in the book because people still believe it will increase your risk of breast cancer mortality I explained 20 years ago how they made that announcement how the study they pointed to never showed a statistically significant increase in breast cancer mortality and why there are tremendous benefits for women because I want women to know about that option I want Mo the vast majority of women are candidates you live longer feel better heart attack rates go down Alzheimer's risk goes down cognitive decline goes down 50 to 60% and it at iates the symptoms of menopause this is where I get worried we're selling hormonal therapy right now don't you think that's a conversation should be spoken with with their doctor because you know how the commercial Enterprise of healthcare Works after hearing you say that as respected as you are in your field all the work that you've done how many women that will see this interview and say Jesus I haven't been offered this screw the Health Care System I'm gonna go get this and they're going to go to a doctor that has a a hormonal Clinic that will not do the proper counseling and will prescribe the hormone don't you agree that that would happen that's a very jaded cynical sort of interpretation I'm trying to educate people you you live in the world of uh John's Hopkins very educational academic center I'm in New York City do you know how many people here are as you said overmedicated on stimulants on anti anxiolytic medications sleep medications when they don't have any one of those diagnoses or if they do they are could be treated but with some lifestyle changes and the reason why is the doctor wants to please the patient and give them exactly what they want consumerist culture consumerist culture totally so don't you think that that is going on at least I've witnessed this maybe it's just not happening across the United States as much as it's happening in the LA's or New Yorks of the world so are you uh suggesting I shouldn't be educating women about the benefits of hormone replacement therapy because I talk about the risks and the lack of you know the contraindications in the chapter on that well I don't think we just did right now I think right now we just said that it makes you live longer positive positive positive but we didn't say what are the contraindications and why it might not be right for everyone yeah it's in the book right but I'm saying like the clips and the way that it's communicated makes it so problematic because then people say well doctor you're not giving this to me you're withholding valuable information and it ruins that doctor patient relationship um so I'm just trying to figure out the best way to communicate a meaningful message and I'm not a women's hormonal expert I I don't pretend to be so I don't know the exact nuances of the research on it but I I just venture to say that when imagine for me I would say Advil controls this so well and I never say that there's a risk of kidney issues or this on this podcast people are going to go home and take Advil like crazy so I have to like always be mindful of the impact especially of someone of your fortitude like you have so much knowledge and people will listen to you so I get worried about that so let's say I'm I'm going to sort of talk openly here so let's say you're in my in my situation right you see tremendous long-term health benefits of a medication and we're talking about replacing your body's natural estrogen with estrogen when your body can't produce it plus or minus progesterone what we call hormone replacement therapy you see tremendous long-term benefits to the point where second to antibiotics this may there may be no other medication in the modern world that improves the health outcomes of a population more than hormone replacement therapy and per menopausal women but you see that the vast majority of doctors and the public perceive that it causes breast cancer based on a press conference that I think was a fraudulent press conference the the people there misrepresented data now kind of as a journalist I want to tell people the real story in a journalistic way without telling them take it or don't take it that's what I did in Chapter 2 of the book so if you feel that there is something out there that needs to be said that is not being said I think it's okay for doctors to be talking about this why do you think um the endocrine Society ACOG American College of Obstetrics and Gynecology are not talking about it but you are so a bunch of them are and so I'll cite them for example the osteoporosis um uh conference the biggest group of osteoporosis experts expert s met and they created a list of things to prevent osteoporosis at the top of that list was the importance of hormone replacement therapy in P per metopus women well that's a disease organization what about a major Organization for that specialty because neither of us are women's health experts yeah I'm hormonally right so this affects every organ in the body every organ in the body has an estrogen receptor and so it it affects car cardiac neuron everything thing so um there are a a lot of uh people writing about this talking about it the organiz the OB group probably more than any other specialty was the first to recognize that the original announcement 22 years ago that it increases breast cancer mortality was not legit and so most of the OB Community because they have a lot of experience with estrogen with birth control you didn't see an surge in breast cancer with girls that take and women young women that take birth control um women who are pregnant have high levels of estrogen you didn't see higher rates of breast cancer so they were I think quick to call out this now I've talked to doctors who believe this is one of the greatest frauds of modern medicine so I I believe in civil discourse and to answer your question directly though you're asking why we can be slow in medicine to adapt to new scientific evidence and that's really one of the themes of the book is group think is a powerful thing and we had there's a psychology to the founders effect you hold on to what you believe First not because it's the most scientific or logical but just because you were told about it first you see it in politics confirmation by said it's finest exact that's exactly what it is founders effect uh Leon finger was the famous psychologist who described this and I get into his sort of rationale in the book of why you just you'll have a comfort in just holding on to a belief whatever you hold first it's in your brain it's happy it's nested and a new information comes along that conflicts with it you want to dismiss the new information reframe it to fit what you already believe so you're let's say you smoke cigarettes a study comes out showing that cigarettes are bad for you you say well that didn't apply to me I work out too and that may counterbalance the effects they probably smoked more cigarettes in the study I don't smoke that many and the mind will subconsciously go through AC Rob atics to reframe new information or instantly dismiss it just to hold on to what we believe First yeah there there's ways to overdo it absolutely um the scientific method though is constantly asking those questions H and probing I think you've probably been in way more Journal club uh visits than I have in discussing flaws of research or ways it could have been done better and part of the scientific method is even for the authors to say where there's limitations in their own research so you don't feel like that's being done because when I'm in a journal Club we're constantly asking is there confirmation bias in the study what possible biases could be here you don't feel like that's happening is you're saying there is there evaluation of new research by experts yeah like that new expert uh new research is presented and trying to be balanced against existing research not just what an expert believes yeah so we have we have that we've done gosh I don't know how many uh critiques of the study you cited that coffee causes pancreas cancer you know in our world of pancreas that created a lot of problems for us and ultimately it was a very clear control group problem it was a very clear methological flaw so this is the discourse we we need to have in the world of hormone replacement therapy and maybe you're sick of this topic we can move on I just wish I was more well versed in that specific topic but we can get into one about gp1s or something else where I'm more well okay well in that world of hormon there's been intense discourse in the profession but what there hasn't been up until the time I wrote this book was investigative journalism on the background of the announcement that said it increases breast cancer mortal that I W for sure yeah good there you go I mean no one is I I I hesitate to think even from a partisan standpoint that people wouldn't want to see the investigation on any kind of potential fraud in in in our Healthcare research because we put so much weight on the value of taking care of our health and I'm I'm under no guise that I'm sure fraud happens and needs to be sought out um there was one point you mentioned about you kind of gave credit to the mom that heard the pediatrician uh Society stance of removing peanut butter and the one mom who secretly giving it in general do you think it's wise for parents to not follow the academy American Academy of Pediatrics advice so these based on gut because I'm sure that Mom wasn't a microbiologist or immunologist deciding that in the example right so I I know where you're going with this so let me let me put this out there if there's no scientific support for a recommendation I think it's okay for people to have their own educated uh uh judgment on it and it's a it's it's you know I understand there's hazards with that but um you look at some of the stuff today that's being put out there um putting six-year-olds on OIC that is a massive push right now by the same organization I personally think uh not against it but I just think we're not talking about the right topics of the food right I'm more so in the back of individuals going against guidelines yeah I don't want people to just be a rebel well because that's what I feel like we're telling them to do right now that we're like look at these organizations they make guidelines based on expert opinion which actually in the Healthcare Community we know expert opinion is the lowest form of evidence right in our little hierarchy of you know met analyses being up there of randomized controlled studies cohorts and then moving down expert opinion is the lowest form so we kind of know that yeah but the general public probably is not very well versed in that I hope that they would be at some point but that's not general education and then when they hear a recommendation being made they're like well look they made mistakes in the past so why would I listen to them on this and I worry about where it Tak there extremes there's definitely extremes but if somebody says Hey the experts say opioids are not addictive and I just I don't you know there people out there you met them I just if I can get by without the medication I'm going to avoid the opioid I'm okay with that I'm okay with that for sure in that specific example and the examples that you site with the peanut and the opioids you've highlighted the heroes of people who've disagreed but how many people well the mom was not an expert well that's not really the the what I do in the book is I show how these leading experts challenge the American Academy Pediatrics recommendations showing that there was no science it was dogma and then they did the studies proving it wrong and that's a healthy exercise but what's the difference between dogma and expert opinion in your mind uh Dogma takes on a life of its own it has a couple common properties one industry is often funding it number two uh it's sort of taught to younger people as if it's scientific truth and they sort of Silence dissenting opinions when it's really just an opinion that they're Pro propagating what industry was funding the peanut b or recommendation for avoiding peanuts so in that example was not industry funded that was not an industry funded thing um I have a lot of thoughts of the pedology epidemic but we're still reeling in from it we have the worst penology epidemic in the world for sure logically didn't make sense a lot to me either and even when I was learning it in medical school I'm like well this kind of goes against everything I've learned and I think there were a lot a lot of doctors that were questioning it and sometimes I feel these organizations are a little bit too quick to point out or a little overconfident and I think that the point that they should take from your book and your stance is so valid and they should be more aware of being transparent and saying here's what we know now there you go here's where our limitations are and not patronizing the general public and saying this is the the Bible and you have to follow this if you don't you're a bad person absolutely but if what ends up happening and again I'm watching the pendulum swing the other way and it's contributing to the loss of trust is that they say well look the American Academy of Pediatrics did this thing with peanuts why would I trust them on anything if there's no science I don't think you have to blindly but we use the word science that means something different to you and I it probably means something different to me and you because you're more well-versed on the research side of things with 200 plus Publications but for the general public to them science means reading a Facebook article is right like from a practical standpoint if people are in an emergency do whatever the doctor says don't don't ask any questions okay if you but when it comes to like how to manage your your uh how to uh eat healthy there's probably a lot of wisdom from Old School farmers and sometimes we it's not that doctors are giving deliberately diabolical recommendations it's just it's not been our in our domain or purview to understand sometimes the aspects of regenerative farming and healthy foods and nutrients and all that stuff yeah so like in your book you talk about not changing like changing the Obesity epidemic by approaching it from a food standpoint yeah I think that is the correct way of going about it I think if there is a perfect world we would all be doing that and I hear names in the industry I think you've been on his podcast Peter AA yeah um talks about how medicine 1.0 was moving away from the gods causing our health problems and it said no it's not the gods and that was a great win for medicine 1.0 petera says we're now in medicine 2.0 where we're just catching up and treating conditions as they are and then he brings up this topic of what he deems medicine 3.0 which is getting ahead of issues so not waiting for diabetes to happen and instead acting with some proactivity yeah I don't think this is a novel idea no I think that we are doing this I think our Health Care system in the way that the timing is the way that we don't have investment in primary care physicians these days we don't we move towards the private Equity model of just solving the problem with an urgent care center I think that we want to do the right thing and when it comes to food and nutrition I might not be 100% well-versed in the nutrition space to know every upto-date article but most of us work in these centers a lot of us work in these centers where we have a nutritionist where we have a dietitian who can help us with a patient who's struggling nowadays in our office I don't think I have a single patient and this is a community health center we're not some fancy concierge $100,000 a year thing every patient of mine that is a newly diagnosed uh with diabetes gets conversation about the medications they should be on and that could mean diabetic medications or cholesterol medications blood pressure medications which are also helpful for them um a visit with a nutritionist a visit with our nurse practitioner diabetic educator um conversation about their mental health lifestyle habits sleep how that contributes to it so the idea that this isn't happening and this is only happening in books and people are recommending feels not said with honesty so I work with a lot of diabetes Educators obviously as a pancreas specialist um look some of the dietitians out there are still teaching the food pyramid and remnants of it no come on no one's teaching the food pyramid if you go so I went to our benefits uh fair at Johns Hopkins and there was a dietician booth and they and I said oh you know what are you doing here and they said well you have free dietitian Services as a part of your health benefits and I said okay let me just ask you a test question let's say I come in obese what are you going to recommend just a couple things right off the top within a second they went to the lowfat diet okay that is a remnant of a corrupted food industry where we know now the sugar industry was funding Walter Willette my professor and chief of nutrition at the Harvard School of Public Health who wrote The Textbook on nut this is one of the most corrupted of all Sciences I'm not saying they're bad that's outdated they're good people we don't practice that anymore well they just told me this at the health benefits right so you're you're finding an example of someone who's using outdated science and using that as an example to critique all of us no no I we are good people intending well I'm not this isn't the character thing this is just about the system we're not teaching that I teach residents I've taught dozens of them over the last seven years no one's teaching that and just because someone is using some outdated knowledge doesn't mean that we need to drastically change it or downt talk what our current methods are don't you think so let's say you have somebody comes in with Rosa okay we have creams and medications there's IV infusions they're running non-stop ads on commercial where they're all dancing in fields of course and there's I just had a a patient come in who was put for perioral dermatitis 90 days of doxy cycling where I'm like that's a little aggressive and we needed to talk about other ways but go ahead we talk about carpet bombing the microbiome yeah so um do you is it's not in our education and it's not part of our conversation it's not part of our business model to talk about food as medicine as a treatment for rosacea oh for rosacea okay that's very specific yeah even specifically in other words it it takes more time um honestly why did you choose rosacea so there's a great podcast on uh rosacea and dermatologic conditions on the mark Heyman podcast where they go through a bunch of these and the do docs who spend a lot of time really coaching people on the food uh sort of root causes of some of these ologic conditions they say it's not taught in med school it's not part of their residency it takes a lot of time it doesn't fit well it's easier to put them on the IV skyzzy or whatever other medication out there so this is where you know I think we've got some blind spots in medicine we can improve on specifically tied to rosace or dermatologic conditions I think I think all of it I think all of it so but do you think if the average patient walks into uh Atlantic Health System where I work or any Hack and Sack Robert Wood Johnson anywhere here walks into an office with a new diagnosis of hypertension or diabetes you don't think we're talking about nutrition with them I don't think we're talking about Sleep Quality and that is a major driver are we talk you really don't think we're talking about are we talking about the pillow and mattresses the ventilation the light contamination the noise sleep the number one thing discuss with res well you're a good you're look you are an outstanding doctor so you're talking about it but it was never part why am I learning about it for the first time five years ago after med school and residency in a rigorous training I I think what happened and what's happening is that largely the system is broken in that doctors don't have enough time with their patients and another thing has happened with the consumerism of healthcare there's a lot of patients that come in that don't want to talk about that how many patients do I have that either me or my resident come in and start talking about sleep hygiene and they go why are you talking about sleep I don't care I need to wake up for my job this is my life I don't want to make those changes and give me the pill hostile patience I mean the the consumerism is real people give me a pill give me a pill so I don't have to put in the effort or and I will criticize Mark hman for this there's a supplement to fix what is going on with you and a lot of these supplements are not proven a lot of the especially the probiotic stuff carries a lot of false promise where it's an evolving field and it's so interesting and we have so much to do and we're probably going to learn millions of things that we're doing wrong right now that will change right like what's that saying 50% of the things we're doing 50 years from now are going to be proven untrue that's true but it doesn't mean what we're doing now is wrong yeah I've got no supplements by the way to S you no no no I know but don't you think that that's a problem in that world because like I've heard you speak uh with people who are in the functional medical space functional medicine space I hate the term what what's your take on it I don't know what to call all of this everything we're talking about we're talking about getting at the real drivers of Health good Med which really just good medicine right which is what good doctors do and there's bad doctors well that's right well but why are we calling them functional medicine and say that they get down to the root as if Family Medicine doctors don't well I think like you they they um they did a deep dive on nafl D or fatty liver disease metabolic dis there's like five names now because you can't call call it non-alcoholic nonalcoholic people still think it's alcoholic and um they basically said traditional medicine they throw some type of vitamin E at you maybe it's usually the wrong type and if you're really really sick they put you on some drug trial when actually there's all kinds of stuff that we can be educating people about that increase insulin levels that move those carbohydrates into fat storage in the liver and generally it's not a part of the conversation 20% of the public has Naf D or metabolic Associated fatty liver disease and the tests people are throwing at it like ultrasounds don't even pick it up there are certain blood tests that do generally they're not ordered I mean you look at heart disease prevention how many people are getting a lipoprotein a and APO b a small subset of people getting cholesterol lipoprotein testing but not all even all cardiologists from the American Academy of preventive Cardiology would recommend that everyone gets this yes I remember having this conversation with the cardiologist at John's Hopkins at my hospital why um is it so the question was isn't it true that lipoprotein a testing is an incredible predictive screening tool for heart disease and he said yes and I said well then shouldn't we be recommending it for everybody and he said he kind of thought about it and he said well yeah but it it we and that's why we put it into our guidelines and I said well your guidelines the ones I read have it in the footnote like shouldn't this be a major public health campaign and he basically said you know I think that's a good idea and it's something we're going to discuss and it may be soon so I'm like okay you guys are moving at Molasses speed but I feel like over recommending testing as a person who works the choosing wisely there's a balance yeah there it's so easy to get into this space of over ordering I just had one of my patients end up with a functional medicine doctor they ordered I'm not exaggerating 47 blood tests in addition to all of the autoimmune things that I ordered the ESR CRPS things that I've already checked m in addition 47 things that are so ridiculous that have nothing to do with the patient symptoms yeah that's not also the answer for this yes I see it also as a subsp specialist in in my world of pancreas um people came in with a bolt the kitchen sink of tests and I only need one I only need one it's like what were you guys thinking just ask me or how can I talk educate you guys before you send these patients over I'll do a webinar I'll do a I'll come speak speak to you about the workup of a pancreatic mass and this is part of the waste in healthcare that we can reign in I think when we were training or in a prior generation there was a sense of let's get all the information yeah more is better more is better but we're sometimes creating we're allowing false positives to send people down these anxious roads of follow-up testing that is trauma in and of itself and it could lead to Downstream interventions yes prostate biopsies with PSAs in the past that that's why you know I'm going to i' love your take and that's why it was controversial to take the age of mamography down from 50 to 40 in lowrisk women yeah it also depends which organization you look at because the United States preventive service task force gives different recogn uh recommendations than ACOG let's say yeah so it's really dependent and not clear now you're sounding like a blind spots author well no this is why I think there's an interesting distinction here I think that in like right now now you're actively talking about functional medicine being a waste no no not a waste I mean wa there's waste in functional medicine that's what I mean yeah yeah um and there's a lot of that but on the other hand a lot of the messages that the functional medicine doctors have are there's pesticides everywhere there's chemicals everywhere the only way you can get the answer is for me and when they go see those functional medicine doctors they give the same advice Whole Foods eat your fruits and vegetables exercise sleep you didn't need to to pay $100,000 a year for that program all the other stuff was just upselling and over screening and over testing so I just don't know how to get behind any of that that's my struggle with it yeah are they the ones who triggered you about pesticides no I just think again pesticides become a buzzword for this community on social media that is anti- the medical establishment and believe me I'm the first person to call out the medical establishment when they're doing something wrong when I had my Dr fouchy interview I texted Jude and I said hey what triggering or difficult question can I give him that we need to ask that's good because I I'm not afraid to ask these questions and what I found is for all the mistakes that Dr fouchy made as he's not a public health Communicator who was ready to take on this level of pandemic because generally who was he was honest he answered every question I had they didn't ask to see my questions beforehand they didn't ask to see the video afterwards but yet there's a lot of people who are saying the government's a liar they're hiding the information and it starts with the entry of well our vaccines good for us are these medications good for us are they just bought by Pharma it's a truth wrapped in a lie there's a lot of corruption within the Pharma world there's a lot of things where money moves the needle but it doesn't mean that everything we're saying in healthcare is lie in fact the majority of it is not is that your take too or do you feel differently than I no I think we're saying the same thing and I think there uh there's also another ele to this and that is we are living in an era of the hyperpolarization of driving people to extremes both extremes are in my opinion wrong Pharma is not diabolically trying to make people sick to sell products no it's just they're doing their job and their job is to do make the stakeholder their money right raise the share price yes I mean I wish they didn't have disproportionate influence in the research Enterprise of medicine I wish um the NIH would fill the gaps with good studies a lot of these isues talking we're not by from the hi um but I think we've got overall good people working in a bad system it's just nowadays people are being affirmed in their views from the information sources that will pull them into extremes and so you're you're left now with a community that is either deliver a baby 100% how they did in the 1960s and70s do whatever they want separate the babies for 10 days for normal ter or deliver babies with no medical profession anywhere in sight which is dangerous right so you get these you get this camps yeah and tribes but that's a that's a huge problem because then it creates disinformation both ways yeah like even an example that I mentioned earlier when I talked about the black plastic thing on my social media there's people who are the all natural route who are like all chemicals are bad the word chemical means bad and I'm like that's not true there's plenty of chemicals that are totally benign water technically is a chemical there's all sorts of issues with that logic then there's also the people who are like all chemicals are fine they're in small doses it doesn't add up unless you do a randomized controlled study I don't believe either that's also not true if we can make small meaningful changes where it doesn't cost money and it doesn't take up a whole lot of time why not make those small changes so I don't feel like being in any of these camps is necessarily valuable does this have black plastic in it I'm sure it has I mean plastic water bottles in general probably not great but what do I know about like I I was on an interview the other day and someone's like is there microplastics in our testicles and I'm like I have no probably there was a study yes I'm sure it showed it but what do I know about that did you see that brain study on microplastic so they measured microplastics by weight in the brain in in you know cavers and it was 4% of the weight of the brain almost half 1% is microplastic I believe it and I mean look how much of that again I think about the risk balance for anything cuz I'm such a clinician when it comes to family medicine and when I think about that I'm like look that was definitely a tradeoff that we have all these Plastics in but think about how much many more people are fed how much more sanitation we have how many medications that we have where people don't lose their lives instantly from a raging infection that was the cost yeah so do I think it's a problem that we should act on yes but it was a small cost for a big win or at least a bigger win yeah we use a lot of them in the operating room I mean Plastics are a big part of surgery right that's what I'm saying like look at paper straws people wanted those and now look how angry they are about well what you're saying really I think um describes one of the major problems in modern day society which is overuse of antibiotics they save lives when the guy who there's probably nothing that has revolutionized modern medicine and and cure diseases allowed us to do surgery that was never possible before cuz now we could treat the infections child birth went from dangerous to safe it's unbelievable in 1922 when Alexander Fleming discovered penicillin um he went on to get The Nobel Prize in the 1940s after World War I they started mass production and he he described watching one of these mass production facilities and feeling this pit in a stomach that if they were overused and abused it could create resistance what great foresight foresight right and it's unintended side effects and here we are today in that consumerist culture people coming in shaking their their doctor down for antibiotics and now what we're learning about its impact on the microbiome um there's a good example of sort of the pendulum swinging and it's we never want to suggest don't take an antibiotic heck I mean kids will have lifelong learning loss if they have an untreated bacterial ear infection that causes some hearing loss so it's like one it's a classic example I think of what you're talking about yeah I I think the antibiotic thing is so interesting to me because it's such a part of my day-to-day where you're between a rock and a hard place when you're trying to decide whether or not to prescribe an antibiotic if a patient requests and you don't give you can get a bad review bad review bad for your hospital for yourself all of that maybe patients upset maybe they don't believe why you're not giving it then if you say well let's be a little more conservative let's let's not give it and you you get worried cuz my God what if this infection gets bad and now it's your fault that you didn't give an antibiotic so you end up practicing cya cover your butt medicine and you're saying oh my God now I need to give more people antibiotics so I don't get this recurrent infection how many doctors will send to me uh a patient saying patient needs a urine culture before a procedure and I'm like why they have zero symptoms there's no need for well I don't want that to reflect on my statistics if they come in with a UTI and I could see that pendulum swinging back and forth and I would love to see more research in that from a perspective of like right now with strep throat as an example we routinely treat strep throat with antibiotics and that's the sole bacteria unless the patients's very sick that we treat with antibiotics for a sore throat and the reason we do that is because we want to prevent rheumatic fever most people think it's if they don't take antibiotics they're going to be sicker for much longer that's not even really true on average it's like a day maybe even less than a day day that you have symptoms whether you take or don't take antibiotics and then what what's happened is rheumatic fever has essentially become a thing of the past but how many cases of rheumatic fever are we preventing versus how many new problems with the microbiome with allergies or whatever possible problem Are We Now creating by overmedicate that's right and where I see AI actually have value where I feel it's tangible and practical could happen is overviewing massive number of cases to give us better data and I know Pharma is going to be against me prescribing less medications in general but how much better would it be if a patient comes in and I say well actually you will be the one to benefit from this cholesterol lowering medication as opposed to like what do I need to treat like 80 the number needed to treat before I actually save someone's life or prevent a heart attack the number needed to treat is quite High which means that the majority of my patients that are on a medicine get no benefit from it yeah but I would love to see AI narrow that number down by finding who the medicine is right for do you are you excited about the AI future on this yeah I am I mean sometimes I feel like we don't need AI we just need I yeah you know like uh in the military they're still routinely injecting every military recruit that goes to basic training with a antibiotic shot they are everybody no yeah you know just in case no this is this is still Happ this is still happening today no absolutely I just talk to um staffer in Congress about this I got to look at this this is wild it's so wild right and there's actually there's some papers I pulled I can s you but it's like at some point we have to use some common sense I mean that's like common science at this point yeah I mean yeah I I believe so I mean I don't know like I think if I would bring any doctor in the room in my organization they would say that sounds fishy or weird or wrong it's very fishy yeah it's crazy um oh there was something I wanted to point out you mentioned uh in one of your interviews surrounding peanut butter and how medical inertia can hold up and that you saw that I think this was an interview did last week or maybe two weeks ago that Wick which is a program for infants children mothers in order to get them food assistance that they don't allow peanut products I frequently write the wick forms because family medicine is the one that fills them out yeah they allow peanut butter yeah not for infants so over age one it does but under age one it does not oh I see yeah and that's the time when it's most important for people to get it and Gideon lack who's the world expert in peenut allergies in London has actually done and he's the one who did the big research proving the Dogma incorrect he's challenged it early he did that 2008 study you cited then he published that big trial in 2018 a trial that was embarrassingly simple it could have been done prior it should have been done right so he actually found that it's so important to introduce some of these allergens early like peanut butter that introducing it at 5 months is more effective than introducing it at 6 months in preventing pen allergies later in childhood and four months was more effective than five months now you don't want to give them peanut butter until they can obviously eat some food um you know and they never want to give peanuts to a young kid because of the choking risk but that's how powerful bomba snacks yeah the bomba snacks and yeah those are Delicious By the way I really I've never had him to be honest um tell me about your stance on the glp1 medications started to go into that and I interrupted you I'm really torn because on one hand I see these short-term benefits the health complications and for those who aren't aware that's like the oics were goes of the world yeah and so I see the short-term benefits you see and it's no surprise when you're losing all that excess body fat you're going to see short-term benefits and we're going to see a flurry of studies that are going to find more short-term benefits in year one year two maybe even in the first five years what are we doing long term that's where I just I don't know and I'm what do you mean what we're doing long ter so it's reducing excess body fat it's also reducing ex it's also reducing muscle mass because there are receptors on both reducing muscle mass is a concern because the number one predictor of longevity generally is muscle mass and when you reduce muscle mass you may be accelerating Frailty and so are we going to shorten people's lifespan and will that be counterbalanced by getting rid of some of these chronic diseases that's where I just think it's an unknown now there is a new generation there's going to be about 25 new gp1 OIC like drugs that are going to come out in the market between now and 2029 and oic's going to come off patent and so we're going to see the landscape change a lot some of the new drugs in development that have passed now phase one and two clinical trials have uh selective binding to the excess fat and do not reduce muscle mass in theory once you are confident that we're not reducing your muscle mass maybe there's a whole different profile of benefit and safety and benefits that outweigh potential harms got it yeah that would be interesting the idea of the muscle loss has been raised as a important issue and I think it is because as you said it's an important uh predictor of longevity maintaining Independence in fact those who carry extra weight into their elderly lives sometimes live longer and it's a part of longevity later in life earlier creates all sorts of issues um when paired with resistance the right way of taking OIC pairing with resistance training with it working with the nutritionist to make sure you're consuming protein doesn't that risk drop and then the benefit of losing the excess fat go up absolutely I just I don't know a lot of people who are able to do that work out intensely and eat a high protein diet if they did they might not have been obese in the first place now this you're touching on a really important thing if we can use OIC to put people on a new plan a new program where going to get a fresh new start with a boost with a with help right that's when we're talking about meaningful changes is actually now changing lifestyle changing what they eat which is the underlying root cause of a lot of this and um also bridging them with uh some kind of therapy yeah I think that's to me when I sit down with an endocrinologist who's very passionate about OIC it seems like that's their goal the bridge I become a little bit of a skeptic when I ask how many patients have you gotten off OIC and they say zero then I get worried about how long is this going to take or is this actually happening because for example for me when I prescribe an SSRI as an anti-depressant or an anti-anxiety medication I always inform my patients that I'm not prescribing this necess necessarily for life we're going to have check-ins where we plan to gradually get you off and if you're not ready we don't have to but the point is to bridge you to therapy to allow you to make some practical changes in your life so they're not meant to be for for the the rest of your life in this situation are we going to be able to bridge all these patients off into a healthy lifestyle off of those medicines I'd like to see where that goes because I'm not sure of that answer I'd love to see some data on how many people get off of it and then are able to keep the weight off without the drug I'd like what you're saying because and this is really important it gets back to some of the earlier principles we say it's got to be managed with a health professional it's not a one people want One-Stop shopping it's same thing with um fatty liver disease same thing with hormone replacement therapy it's not just here give it to me uh this is something where you've got to track some Labs see the body's response how are they doing redose appropriately so all of this stuff really needs to be managed and I worry in the modern world of sort of impulsive consumerism that we're losing that and I don't I have not heard of anybody coming off these drugs keeping the off case studies here and there but I wouldn't say that's the general pattern that I've seen again anecdotally speaking so I'm looking forward to seeing the research I'm also acutely aware of the fact that there exists a lot of judgment in those who take the medications and improve their metabolic State you know there's people say oh you took the easy way out this is lazy but that's also unfair they're doing something to improve their health if I put a cast on someone that broke their leg I'm not they're not lazy for nonwe bearing for a period of time so at the same time I'm acutely aware of both sides of that equation and understanding how much Nuance we need to bring to the conversation whereas whenever I see a health podcast talk about it they take a stance they say it's either all bad and I'm very worried and it's going to be really bad or this is a miracle everyone should take this I think everyone in America ultimately will be on it and I'm like well that also feels inaccurate I think you're capturing there a lot of the this is not just a problem in medical science this is a problem in Society oh yeah right this kind of everything is all good or all bad Nuance is lost you can't be you can't have different views on different issues you kind of got to be in in a camp and this is doing tremendous damage to our society I mean people aren't speaking to each other in the hospital now after covid sometimes has that happened to you uh not to me but I've seen it I've seen it sort this sort of almost like a political aparti if you will among medical experts and I get it you know people are deeply passionate about some of these issues um I saw it with some of the biggest issues that I was vocal about schools should be open after the fall of 2020 I we fought said till we're blue in the face again I don't write about this in the book but till I was blue in the face that schools should be open and we were told oh there's no there's not going to be any harm with prolonged school closures um so anyway there's there's still some of those sores I actually had a pediatric ICU physician and we talked about the need to get kids back in school and it wasn't a popular video people were angry about it but at the same time they were open to the Nuance of the conversation so I think people are excited for it I just think it's very easy to say government dropped the ball with school they don't know anything they're not checking anything but there are those debates happening we are having those conversations and sometimes it's the wrong party at the head or the wrong decision maker that's making the decision but in general I think those conversations are happening like even we talked about earlier before on camera about Co vaccinations and how Dr Paul offet who was here not too long ago mentioned that there might not be a benefit for everyone to get a booster it's hard I think his quote was it's hard if not impossible to boost our way out of this because it's a recurring virus that is almost endemic now and boosting it is going to have little impact and I was excited to hear someone who's on the advisory committee to say that openly and honestly but at the same time I've seen some fear tactics of IND individuals taking some aspect about a vaccine a side effect a vaccine and basically hinting I think dog whistling is the word or gaslighting to the general public that ah doctors aren't checking your vaccines they don't know what they're doing and it created so much fear where now young mothers are coming in and they don't know what to do for their kids or they're very angry about vaccines have you seen that or what what's your take on that whole situation I like what uh Paul offet was say generally I like what Dr offet said says and I I like how he was very open about cuz it's hard to challenge the sort of narrative that's the prevailing narrative and I think it was hard for at least he he was represented a minority opinion in academics that I think ultimately the data supported and he but he was very open that he didn't recommend the covid vaccine for his 20-some year old son I think it was and um I don't think he took it at one point or maybe it was the second booster I I think the Civil discourse is is good and there's going to be people that misinterpret I don't read comment boxes you know those things can do a lot of damage and people oh my gosh this person said this well um when you look at the actual experts in a civil dialogue it's a beautiful thing oh yeah it's a beautiful thing and it's good and it's healthy now I feel like we lost uh fighting for schools to reopen we felt like there was strong data from Europe that the American journalism community did not report on the schools were free and clear after a brief and understandable closure in the spring of 2020 the data were pretty compelling that the it did not propos an increased risk to the children and there was unintended harm from the closures so I feel like we fought till we're blue in the face for the year and nine months that schools were closed in many parts of the country and I feel like we lost that battle to this day when I go around the country and speak I get often mothers who come up to me and just say thank you for fighting for our kids and for the school um you're never going to get 100% of things correct but I think sometimes when there's important data that people are not looking at that we should be looking at that's a time to to to voice an opinion yeah and I agree with your opinion about schools and how late they opened and how many issues we had with that um again we talked about it openly on the channel I think also foresight is 2020 or hindsight is 2020 it's easy to look back and say Here's the mistakes we made and dump on the government and uh I think that my theory is and why they went the route that they did they almost practiced cya medicine on their own they were worried that if they did open and something bad happened it would be on them so they were probably more conservative than they needed to be by doing that and I can't necessarily fault groups government groups for doing it this way because it was an unprecedented moment there was research showing from Europe that it could be safe someone else would show research from a different study saying that it would and be safe and it was hard for especially legislative people who are not MediCal people to gauge what the reality was so ultimately they ended up doing their thing of expert opinion and saying here's what I think after reading these things and it wasn't perfect and I think there's a lot of things negative that came of it but I think anytime there's something novel we're going to make mistakes and hard to to hold people reliable and say yeah you're liable for this do you feel like we're dumping a little bit on the government at that point Point well I you know I get maybe I know too much I know that the CDC guidance on schools being open or closed was sent to the teachers unions before it was released they edited the documents some of those edits appeared in the final and I and internal people now I think including your health commissioner in New York City had acknowledged that this was really a about keeping the teachers unions happy and so we see this in throughout history right kids pay the price for for fight among adults it's they're the Line in the Sand and ultimately it was poor and minority communities that bore the greatest burden of of penalties from all these Co policies for sure Baltimore City number one yeah local to you um I think that those uh situations are very true in the sense of those people getting harmed were the highest levels uh I think that when I look at teachers union having a say in it I view that as problematic for obvious reasons I'm a doctor and I didn't feel like they should but at the end of the day I think it's a good thing that we have a teacher's Union arguing on their behalf does that slow things down and make us less efficient to react to certain crises unlike an authoritative Nation yeah but in general where would I prefer to live I think I would want to live in a place where the teachers union have a say than an authoritative nation that says we don't care what you say do you agree yeah I agree look I I just wish I could have had a set I wouldn't have mind editing those that document as well so I just we're a big country though it's we're a big country but we're also and I think I think we have legal corruption in the United States you can buy politicians lob absolutely lobbying and so that is that's a very uh bizarre in a lot of countries it happens when it's illegal here it's like legal corruption it's very weird the one thing that I like about it being legal corruption is that at least we can look it up where in other countries it's like you know it's but you're not sure you don't know who's doing what at least here there's some kind of Trace where you have to write down what donations you've given and there's some rules in place they are tracing it here in New York tracing tracing the gr crumbs back to the source and a lot of things here for sure uh to wrap up I want to talk about the microbiome a little bit you mention it quite often yeah this is my sort of stance on the microbiome really exciting a lot of avenues of impacting mental health immunity uh obesity cancer rates a lot of foundational research remains to be done there's a lot of companies jumping on the bandwagon offering to pay me six and figure six and seven figure sums to promote their products these probiotics with claims that are untrue Yeah in our evidence-based system there's a very small subset of instances where we use the medications do you feel whenever we hear about the microbiome it is too preliminary to have practical benefit or do you think that there is some value to doing probiotics where we're not thinking about it yet yes so I think of it in two ways um I think of there are things we do to damage the microbiome that people are not aware of and they need to be aware of and then the second part of it is how do you restore the microbiome and we know there's some general things like eating healthy Whole Food fiber all the all the good stuff that we've known about the good habits the question is what's the role of probiotics and I do agree I do believe that it is too early for most of the probiotics for us to really say this is going to do this and again the worst thing you can do in medicine is to suggest something is scientifically based when it's not or put it out there with absolutism so right now the probiotics and some people find benefits from taking probiotics not taking out individuals on this this is that's right and go ahead and try them but um they can cost a lot of money and sometimes the ones that are most popular are the ones with the biggest marketing budgets not the ones that are most efficacious um and some have harm yeah I haven't heard of harm but I can everything has harm everything we do has harm I think if if you label something as perfectly safe I think it just automatically means it does nothing nothing's safe yeah nothing well no because if it has some positive effect it has to have some negative impact can you name one medical treatment medication therapy Physical Therapy anything that has a benefit that has no negative side effect that we need to be aware of not even the heus be shot at birth that's what I'm saying so everything has some potential tradeoff so when they say oh this supplement or this thing is all safe I'm like well then you're just telling me it doesn't do anything that's right yeah I I agree and so I'm you know I'm thinking about what what do we know about probiotics at Shephard Pratt Medical Center they gave a type of probiotic to people with bipolar and described a reduction in rehospitalization rates um there's probably a big microbiome mental health connection that we're just starting to understand and and we're just observing one signal when we see that some of those bacteria produce serotonin so I wish I I wish I could come in here and say I don't take money from any of these companies which I don't but I here are some that I think are good for you but I I'm I think it's too far in its infancy I want to help people I want people to eat good foods believe me if I knew that there was a probiotic on the market that I could help my patients have less anxiety less depression better sleep immunity whatever on the labels that exist I would be so happy it would shorten the time of my visits I wouldn't have to prescribe medications and all these things but unfortunately I think you're right it's in its infancy and I think on even going past the probiotics of it all there's microbiome testing kits that folks are selling and they check your microbiome and then you get your results and they tell you to eat fibrous Foods it's like you didn't need the kit yeah they're collecting your data not as much helping you but they are trying and then you've got to answer all these questions and then they're going to follow up and then they're going to sell that and then they'll say it's a research study and they made a lot of money and I'm glad they're doing research but tell people it's research right exactly we need research and hopefully the NIH does more for sure I think I I'm really excited about that because I think we've started doing the research but because the people who are very good at marketing it are the loudest voices like before we used to have this mechanism where there would be a promise of something there would be the initial stage one trial stage two trials uh and then stage three and then there would be some press release about them and then we'd learn about them yeah now it's like the concept is there it's on a YouTube video and it cures cancer and it cures cancer you don't see that happening I see it happening so often yeah I mean if we don't have good scientific standards snake oil cures cancer and vaccines cause autism and all this so we've got to use these same basic principles now I did talk to the world expert of the well the the leading microbiome expert running the microbiome unit at the NIH she's a wonderful doctor I interviewed her she's in the book blind spots and she was telling me about some of the preliminary work that they're doing it's unbelievable how it's connected and things like Pepto-Bismol she told me um are altering the microbiome significantly so what they'll do is they'll take common things that we all take other meds or food things in our food supply and see what disrupts the microbiome the most and then you get this interesting list of right you thought this was totally safe and benign but it's doing something to the microbiome and we know that people have tried uh eating well and they can't lose weight they switch and they you what's going on there maybe their microbiome has been altered so much right yeah very possible and again I I don't want people to get so scared that just because we see a change in the microbiome or we see a marker change in our blood that doesn't necessarily yield clinical outcomes practical things that are changing in your life because I've seen it the jump happens so early so often even with medicine like if we look at the history of what medicine is I mean bloodletting all these things that we've done where we jump the gun on things that I'm always like let's be a little patient and not jump the gun but with this book you're like we're being a little too patient we need to swing the pendulum a little back yeah the pendul the pendulum that's really the this theme is that there's a balance and if you look at the history of medicine for most of human history we didn't really have any tools we had a saw to do amputations a lanet to draw your blood we had dexin that barely worked for heart disease and that was kind of it and doctors were respected in society but they weren't like held up uh a matter of fact surgeons were the respected like a barber you know you might respect your doctor back in the day like your hairdresser and matter of fact surgeons and Barbers was the same profession they called him surgeon barbers in the UK isn't that why they have like the little pole outside with the red that's what I was always told yeah I've heard that too so these surgeon bar so we you know we were doing our best but we didn't have a lot of tools and but then came the Advent of penicillin and for the first time we had a magical pill in the 1940s that we controlled and we would pres choose to prescribe or not you couldn't get it through other means doctors began wearing white coats and this unquestioned Authority began we had now technology in the hospital that was doing amazing things iron lung machines incubators for newborns and doctors the pendulum swung where now we had this intense unquestioned Authority and we would take the liberty of keeping babies in the hospitals normal babies at birth for 10 days just to poke and prod them right the moms can't have the babies we were reacting to an Era to an Era of high infant mortality by okay well let's sort of capture these babies like aliens and you know let's Pro study them sure and it took a long time for that to wear down even in 1970s my little sister was remember she was in the hospital for 3 Days totally normal birth right mom came home and it's like when's our sister coming home oh the doctors's haven't released her and this unquestioned Authority swung where we would order too many tests and sometimes do stuff now again good people working in a system where the culture kept shifting and so now we're trying to figure out what is that right balance what's the humility that we need to say we don't know when we don't know here's where we got it wrong here's where where this is there's good science to support what you should do and everyone needs to go out there and and let people know so that's kind of the history of modern medicine in the nutshell it's very true and uh it's cool to see its evolution of where we are now especially with the Advent of technology and how things are shifting for me my general Mantra has been to my patience if you need medical care for a specific condition you should probably get it if the doctor thinks maybe you should get it ask more questions or get a second opinion because so many times we overdo it but there are some instances where you absolutely need a medication and I don't want to lose that trust with the patient and I think doctors need more education on how to have those conversations because nowadays if you're in private practice and a patient comes in and says well you're saying that I need this maybe I why why and the doctor doesn't have time so they get angry and they think that no one should be questioning them because they've never been trained to answer those questions and I too like you think that we should change medical education but in a very specific almost silly way I think we should get improv classes in school to be able to handle conversations in the moment to take the information that we're getting like an improv they teach yes and where you take whatever the person's giving you treat it as a reality and buy in so if a patient's telling you they disagree or they're afraid of something you got to treat it like a reality and respond not say the data doesn't support it leave me alone who wants to have a doctor that's a robot that's right you want a doctor I mean I'm just speaking as a citizen yeah you want a doctor who is going to listen who's willing to say you know I haven't heard of that but I'll I'll take a look at it for you or doesn't seem doesn't feel right to me doesn't make a lot of sense I'm happy to ask someone who may know more about that's the sort of healthy conversation we're not taught the non-technical skills of being a good doctor communication teamwork knowing your limits humility uh doing research on things that may not be in the textbooks um we focus on the technical skills and I'm I'm not speaking on behalf of Johns Hopkins but at John's Hopkins our medical students come in and they come in bright altruistic and creative ready to do exciting things and we beat them down with this roote memorize all these drugs regurgitate them on the exam and when they ask big questions they're basically nudged to well remember you got this exam you got to pass and it's written by one private company every exam in every medical school in the country the US mle the boards are written by one private company so every school is teaching to that right so it's not like college where different curricula are you know are used to introduce more food is medicine or nutrition or um environmental toxins or whatever communication skills it's really kind of every medical school gets in line and we do the same thing we beat them down we put them in this financial trap of all this debt and then they come out burned out and on this treadmill of billing and coding and it's like stop we've got to stop look up look around us and see what's happening the public is getting sicker or they're on more medications the more we prescribe anti-depressants the more people are depressed not because of the anti-depressant but because of underlying root causes know we don't talk about the more OIC we prescribe the more obese the population is the more pain pills we prescribe the more pain there is in society and again it's not causal it's that we have developed these blind spots of big topics that we want to talk about medicine that are just not part of that formal traditional education and billing and coding uh system I remember in med school in anatomy class one of the first days of med school I noticed the I don't if you experience this the lung on some cavers is black yeah and they say oh that's from you know first re action is like holy smoke what you know and they say oh that's City dwellers M yeah and and so I'm like okay I'm naive you know and I'm just like that's but it's all black and they said don't worry Marty it's not bad for you yeah and it's like okay how I mean whether or not it is or isn't I don't know but how dismissive that is of these big questions the age of puberties going down sperm counts are down 50% in the last 50 years you want to ask these big questions we need these big questions to be asked but our current system just kind of has this you know put your head down do your job kind of mindset but I I think good things are happening people are starting to to say no we need to address these big questions yeah I think the big change that needs to happen is on the research side of things to answer some of those foundational questions as opposed to reactive answers um from the clinician side of things we need to create more time with our patients and really invest in primary care I think those are valuable Avenues uh something funny that I think has made me a better clinician is learning how to play poker at a young age because what makes someone good at poker is making decisions with limited information and being okay with it because you never know what the person has but you can get a sense based on bettering patterns what they've done in the past how they've acted in in in different situations what their face is like and medicine is a lot like that not that you're gambling with someone's life but because we never have 100% certainty in healthcare it's impossible like a patient will say how do you know I'm not having a heart attack right now I can say well you don't have the symptoms of a heart attack your EKG looks normal your blood tests or tronin are negative which are enzymes that we look for in a heart attack but that doesn't mean with 100% certainty you're not having one now or you won't have one one minute from now yeah so we're always in the era of uncertainty that way patients can learn to understand that we don't have all the answers we're playing on the margins and we're trying our best so when people come in and act like I IA experts where I know all and here's what's missing and I have the answer I'm like blow off you don't have the answer we can't have that answer and the more you act like you have that answer the more it hurts the field because then patients just distrust all of us yeah so I think we see a lot of eye eye on this dealing with uncertainty that is a skill set yeah and it's probably one of the most important skill sets in medicine and in general in life and the people who are impeccably open-minded are more affable they're more successful in science uh they are more likely to discover new ways of doing things and so um 100% of people who are closed-minded perceive that they are open-minded I believe that to be true I saw some research saying that those who are optimistic are less accurate but are healthier and those who are pessimistic are probably more accurate but less healthy so it's like you got to find that balance on the Spectrum I will say my most freeing moment that I've ever had exam room with the patient is when a patient said but doctor like how do I know it's not this or how do you know it's not this and I just said I don't know and didn't say anything else and they were like oh okay they like it they like they like it they like whoa you don't know why don't you know well because this test only checks for this this test checks for this and we don't have a test for the thing you're looking for Wow cuz everyone else before said it's definitely this and they were wrong and now I'm losing trust so we got to be more comfortable saying I don't know and for patients not writing off doctors who say I don't know as non-n knowledgeable in fact if your doctor says I don't know you should hold that doctor up with some uh some respect yeah exactly that's a good doc well thank you so much yeah good to see you that was awesome great conversation very much appreciated and I think there's definitely room for part two or if you have uh another book coming out by the way congratulations on the New York Times bestseller thanks that's a great title and where can people go to learn more about the work you're doing where do you want to send folks great well um the book blind spots is available wherever books are sold it's sold out on opening day a couple weeks ago so it it clearly it resonates I think it's uh it's nice to see the demand so it's taken time for them to restock it but it you can buy it on those websites and then I'm on social media and on link what are your social media handles um Marty mccarry on Twitter on I'm on LinkedIn Marty McCary and I'm on Insta and Marty M everywhere care great to see you awesome great to see you thank you so much thanks all right after a long podcast it's time for a little fact check you know Dr Marty and I really got into a thorough conversation but I feel like we still left some loose ends and I think it's important that I set the record straight as to where the science is right now on a lot of these topics when it comes to his book blind spots I think it's great to call out mistakes we made I just hope that in calling out these mistakes we don't harp too much on the system being a failure when it comes to to making recommendations because we've already lost so much trust from everyone we need to focus on the fact that we're making changes and we are getting better and I think that that is a good place to start so in talking about uh poisoning our children or the fact that our food supply is poison I think it's a bit of an overstatement because while the foods that we're eating are certainly not great in the sense that we're eating a lot of processed foods fearmongering around pesticides GMOs things like that doesn't actually yield benefit uh those who follow the American Standard diet are unhealthy not because of pesticides they're not unhealthy because of chemicals largely it's all multifactorial but they're largely unhealthy because of the types of foods they're consuming they're processed foods rich in added sugar um not eating Whole Foods that sort of thing so when we want people to eat more fruits and vegetables fear-mongering around pesticides will ultimately lead them to eat less fruits and vegetables I think for the average person worrying about pesticides isn't valuable because first of all there hasn't been a proven risk when uh the USDA has done Trials of thousands of food ingredients they found 99% of them were lower than the EPA levels and some people say those levels should be more strict and that's for the scientists we're figuring that out we're gauging that but for the general public right now the most important thing you should do is wash your fruits and vegetables wash your produce cold water using your hands simple things but it doesn't mean eat less berries it doesn't mean buy organic because when we use the term organic we don't really know what we're talking about just like in this interview when we thought organic means no pesticides that's not true organic can have pesticides they're just naturally derived but they're still pesticides so when we look at real science and when I say real science we look at outcomes we see that organic fruits and vegetables don't have better nutritional content this is Stanford study and at the same time they don't get better health outcomes so if that's the case why are we paying more why are we fearmongering around them don't see the benefit of that so when it comes to fruits and vegetables just eat them organic or not and when it comes to GMOs don't let anyone fear Monger about that there's been no proven risk uh when it comes to GMOs at this time and GMOs help feed millions of people across the globe and in in the day and age where we want to reduce hunger that's an important thing for us to have and potentially a way for us to use less pesticides if we can get those um foods to be bug resistant or disease resistant another topic that I thought is valuable to talk about is saturated fat uh throughout this interview Dr Marty says things about saturated fat that don't quite add up to current scientific consensus he says that uh saturated fat does does not cause an increased risk of uh cvd which is cardiovascular disease and what the evidence pretty clearly shows is that when you overc consume saturated fat you end up uh having a higher LDL which we call bad cholesterol and apob if we check that and when you have those higher levels you also get higher levels of cardiovascular disease now that being said um a lot of the studies that we have surrounding saturated fat are not perfect and some of them even disagree with one another because it depends on the population we're studying the age of the population uh what types of saturated fats are people consuming but as a general rule there's pretty good consensus across all organizations that cutting down your saturated fats to about less than 10% of your total calorie intake for a certain meal is a general healthy thing to do so if you're getting your calories from all the macronutrients going less than 10% of calories from saturated fat is wise the American Heart Association pushed that even further and says less than 6 7% of uh calorie should come from saturated fat and this is because uh good quality research has shown when you substitute saturated fat for polyunsaturated fat or monounsaturated fat you get improvements in your health in in terms of reduced cardiovascular risk and ultimately that's what's important and the same holds true when you replace saturated fat with whole grains and the thing that I think Dr Marty uh conflates in this is back in the day we used to preach a low-fat diet and low fat didn't just mean low saturated fat diet it meant low fat in general and we villainized fats in general where we now come to realize that there differences between fats so as I'm saying in this part right here uh switching off from saturated fats to polyunsaturated or monounsaturated fats is good so it's not that we're saying low fat it's about lower saturated fat and I feel like he kind of mixes that up several times where he says he goes to a presentation and someone in the nutritional space tells him that he should have a lowfat diet I don't think they meant the lowfat diet I think they meant lower saturated fat diet and that is something we recommend to those who have high LDL cholesterol in order to help decrease that cholesterol in fact the two biggest things that I tell my patients in order to reduce their LDL cholesterol would be to lower saturated fat and uh increase fiber and I think uh Dr Marty would probably agree with both of those points but at the same time we don't want to villainize it fully because there are some references to saturated fat especially when it comes to Dairy consumption there's a lot to to be said in this nutritional space but when he says statements like there is no proof that overc consuming saturated fat creates heart disease risk that's not exactly true and we need to be careful with that um he also recommends apob testing for everyone and LP little a testing which which is lipoprotein a uh lipoprotein a is recommended a onetime lifesty uh one time in your life check uh as a screen and not necessarily following it and what you do with that number is a little bit complex and really should be managed by cardiologist APO 95% of the time is the same as LDL as I pointed out during the interview when we talk about hormone replacement therapy for women Dr Marty and myself are not hormonal experts uh when it comes to hormone replacement therapy for women and I think when we talk about the failures of science from the Women's Health Initiative study where it overstated some risk for hormone replacement therapy for women because of the age of participants in that study uh because of the comorbidities of people in that study he labels it as fraud and I I hesitate to say that it's fraud i instead take that evidence I look into what new evidence has come about and I try and make a complete picture and what the complete picture says right now is for menopausal symptoms specifically vasomotor symptoms there are organizations that recommend treatment for hormone replacement therapy and the important point which I think was missed when Dr mcari talks about these issues is the Nuance here and the Nuance is that ACOG which is the American College of Obstetrics and Obstetricians and gynecologists say that the indication is for menopause symptoms and there is no prevention of coronary heart disease not recommended for it the North American menopause society says the same clinical endocrinology and American College of Endocrinology says the same and the endocrine society says the same as well they have special considerations depending on the time when you start it from when menopause begins versus when you begin hormone replacement therapy they have differences and how long you should be on the treatment and all of that needs to be made in a shared decision decision making format the andrin society did a really good job with an image showing a scale with some potential benefits as well as some risks and it's on a scale where the benefits are slightly outweighing the risks but the way it was talked about in this interview as it's all good everyone should be on it this will save your life and the research is just not clear from the standpoint of hormone replacement therapy for women just yet as time goes on things might change but right now we don't have all the evidence for that I think in general there was a big push in highlighting how the American Academy of Pediatrics mistakenly put out our expert recommendation saying that we should avoid peanuts in order to decrease uh allergies to peanuts and it ended up actually fueling more allergies being developed to peanuts and while that was certainly a mistake and it's been corrected since I think Dr Marty highlights some parents that went against the American Academy of pediatric advice and gave their kids penut and it worked out for them I don't routinely recommend doing this in fact I think that's a bad standard to put out there because while the uh American Academy of Pediatrics or the American Academy of family physicians an organization that represents doctors like me make mistakes because evidence changes expert guidance can change generally we're doing the right thing based on the available evidence on hand so when parents go and do their own thing based on a gut feeling that's not a precedent I want to recommend or set because that could potentially cause trouble for children that is unnecessary so I think again highlighting issues from the major health organizations is valid pointing out where we can do better moving forward is valid there's a lot of things Dr Marty and I agree on especially when it comes to over ordering tests waste in our health care System corruption from the insurance companies all of that is so valid but I'm glad Dr Marty was fair game in talking about all of this in fact after our interview uh he looked at me and he said I'm glad this was a tougher interview I'm glad you asked questions in this way because I think it makes both of us better I completely agree with that notion please leave your comments down below and speaking of tough interviews I had a great one with Dr Mike isrel where we talked about steroids deadlifts even AI really great conversation definitely recommend you check out that podcast and as always stay happy and healthy