Why You Shouldn't Ignore Bloating | Gut Health, Acidity & Cancer Red Flags

[00:00:00]Dr. Schubam, thank you so much for being my podcast. I'm very excited for this podcast because how better it could be like speaking to another gastronologist.

[00:00:06]>> Dr. Schubam Vatzia, MBBS, >> MD, DM in gastroenterenterology and heptoiliary sciences, >> director and head of the Institute of gastroenterenterology and hepidiliary science >> at Isc Multiology Hospital. Vasant Kunj, your trusted gut and liver doctor.

[00:00:22]>> What do you think about constipation management in your practice? that the incomplete evacuation is more common than the actual constipation.

[00:00:31]We have to ask them do you insert your finger in your anus to remove stools and when they keep straining very commonly these patients start bleeding.

[00:00:39]The biggest myth in the country that yolk causes heart attack. It does not.

[00:00:42]100% biologically available protein. The gold standard protein. But the egg yolk has vitamin B12. Again, very important.

[00:00:48]Vitamin D again very important. It has choline. Choline helps in fatty liver for your neurons. Very important for your brain health.

[00:00:57]Your take on coffee and fatty liver. Uh there are studies which say that black coffee drinkers 3 to four cups a day have significant lower rates of fatty liver disease, liver fibrosis, liver cerosis, liver cancer. The most important thing is that people get counseledled against black coffee because of anxiety issues, because of insomnia.

[00:01:16]I see a lot of colon cleansing here in India. I think people are taking 15,000 20,000 rupees for colon cleansing. Your body does not need a detox. It's a major major scam. Before we dive in, can I be honest with you? It blows my mind that 63.1%age of you who listen regularly still have not subscribe to our channel. If you enjoy the podcast, the stories, the signs, maybe even laugh at our jokes, could you do us a small favor? Hit that subscribe button. It takes only 2 seconds and helps us keep bringing you better guests and episodes every week. I'm truly blessed to have all your support and I'm sure you will support me in the journey.

[00:01:56]Now let's get into today's episode.

[00:02:00]>> Hello guys, welcome to another episode of our podcast series gut feeling with Dr. Pat. In this episode we are interviewing Dr. Shubam Batsia, a medical gastrontologist similar to me working in Delhi has been a wonderful wonderful gastrontologist for many years and I'm very excited for this podcast because what else can get better by discussing the common issues with the other gastrontologist. We're going to compare the US-based practice, India based practice, IBS, gluten sensitivity, celiac disease, lactose intolerance, eggs, oats. All your questions are being answered on this podcast. I'm very excited. Let's dive deep into it. Dr. Shoubam, thank you so much for being my podcast >> and thank you for inviting me.

[00:02:38]>> Beautiful, beautiful. I'm I'm very excited for this podcast because how better it could be like speaking to another gastronologist.

[00:02:44]>> Yeah. Yeah. I was excited about the same.

[00:02:47]So we'll have to decrease the science part to make it more uh >> palatable for our uh >> non-scientific like not scientifically qualified uh viewers.

[00:02:57]>> Correct. Correct. Correct. So make it simple with a >> we want them to learn also. Correct.

[00:03:01]>> We'll have to put it in simple language.

[00:03:02]>> Correct. Correct. Correct. So in your practice in the last like 5 years, you're a very busy practitioner in Delhi.

[00:03:09]>> Yeah.

[00:03:10]>> Why do you think people are starting to talk more about gut health these days?

[00:03:14]>> So there are two things. One is the philosophical side of it, one is the medicinal side of it. So I'll talk about the philosophical side first. I think uh as our country has gone ahead, uh we have actually seen better days. So the the financial struggle somewhere has gone down with the middle class and uh the purpose of life has also gone down.

[00:03:33]So what happened was like maybe you've seen with your parents but I have seen with my parents like my grandparents and me and my brother we were dependent on our parents.

[00:03:42]>> Mhm. So they were very busy. They were struggling and they were everyday seeing that how they will get dwaki roti in Hindi or two times food where will they get it and they were struggling struggling struggling and in that process they made themselves financially stable and financially retired now in their 60s.

[00:03:58]>> So on our generation the the major mental stress of taking care of my parents is not there. Point number one.

[00:04:08]Point number two the per capita income of everyone has gone up. So people who are earning 50 60 70,000 rupees a month they're also okay with the yolo lifestyle the genzi you only live once.

[00:04:18]So you're not looking for saving or anything. So there's a major loss of purpose of life that what am I doing?

[00:04:23]Why am I doing that's point number one point number two the medicinal side with the corporatization of everything the tech side and you know a lot of people like in Gurau like Delhi now like Bangalore these tech sites >> a lot of Indian people are working in US time zones >> UK time zones >> and they are being paid better because when the similar population is paid in USDs and euros in those part of the world it is much higher.

[00:04:49]>> Mhm. So even when they are paid double in INR which is more for the person earning it is far less for the company paying but that comes with a lot of things because you're working from home when you work from home there are no hours >> so there's a lot of stress >> and capitalism breaks stress by incentivization you understand >> right >> like the more you work the more you learn so the stress goes down because the earning at least goes up >> right >> with these people it's a fixed income they are targets and they are all the time working on on the screen. So it brings a lots and lots of mindless stress.

[00:05:26]>> They are always irritated. They are sleeping poor. They're not sleeping with their biological clock.

[00:05:32]>> In in my practice, I can tell you that every patient with IBS or almost >> uh I'm sorry, I'll take that back. Every night shift person will have some kind of a GI symptoms coming to my uh office.

[00:05:46]You eat at 7:00, sleep at 10:00, wake up at 6:00 7 align to your normal circadian.

[00:05:52]>> Yeah. I I asked them to live according to the time zone they're working in.

[00:05:56]>> Match one with the UK or the US time zone.

[00:05:59]>> So that slowly slowly you adapt to that time zone. So even if at 6 p.m. here, >> you can call it your breakfast.

[00:06:05]>> So you'll be much more in a normal zone with your body >> because you are at peak alert at 2:00 a.m. in the night.

[00:06:12]>> You will not be able to do it. It will cause problems. Like there was a drug called it's still called modafanil.

[00:06:18]>> It was used for night shift workers.

[00:06:19]>> Yes.

[00:06:20]>> But it will help you adapt but if you continuously be on it you'll not sleep at all.

[00:06:25]>> So uh what I tell them that is that you know adapting a night shift worker job is an choice that you made. Yeah. And that could be because of better life you know because of better pay. But we need to understand that there's a compromise that is being happening in our body to make sure the compromise doesn't affect significantly is where your diet plays a major role.

[00:06:47]>> Yeah, it does >> in terms of uh whatever side effect that you are you're dealing with working late nights. How many people come with late night shift workers with IBS symptoms to you?

[00:06:57]>> A lot of them. Uh because see uh we cannot call it a percentage of the society because it's already a bias.

[00:07:01]People coming to us already have symptoms.

[00:07:03]>> Correct. So can't call it a uh become it'll become a sampling bias but yes uh a lot of people have that and the people who are not night shift workers they definitely have a problem with their sleep.

[00:07:13]>> What's the most common symptom that they come to with?

[00:07:16]>> Bloating is very common. Constipation is very common. Uh in increased frequency of stools with feeling of incomplete evacuation is very common.

[00:07:24]>> So this becomes very common in our day-to-day life.

[00:07:27]>> And uh the uh we had made some reals and some went viral. So I now a lot of patients come to me already with those tests done. M >> so like uh I have talked on multiple podcasts and I think it is very important for the platform I'm going on >> because I think it is purely clinical that how do I evaluate see diagnosing someone IBS is not a problem >> but not missing a colon cancer is important >> correct >> not missing a stomach cancer is important >> because once what happens is as a super specialist if you label someone uh IBS you stamp it on the forehead as IBS >> correct >> no physician no uh what do you call alternative medicine expert will think anything else M mhm. So proper history taking becomes very important like I call it the Harrison as teaches us the our bible of medicine seven to eight red flags like it is very important for us to understand that all these functional disorders like irritable bowel syndrome functional dispsia like irritable bowel syndrome constipation predominant irritable bowel syndrome diarrhea predominant irritable bowel syndrome mixed >> they have to have a long-standing history >> you can't have a recent onset two week history and call them IBS that's a red flag so that's point number one.

[00:08:36]>> Mhm.

[00:08:37]>> Point number two, all these symptoms disappear during sleep.

[00:08:42]>> These people when they are sleeping, if you actually to sensitize them, you I asked them multiple times that why does not it happen in sleep.

[00:08:49]>> When you're sleeping, you don't have diarrhea. You don't have constipation.

[00:08:51]You don't have bloating. Why? You don't have brain fog while while you're sleeping. Why? Because your mind is resting. I also ask them right now I'm taking such detailed history. So when I talk to you, do you have symptoms? Why do you don't you have symptoms? So you don't have symptoms when your mind is busy or it's resting. You have symptoms when your mind is going around. So that is again very important part of history.

[00:09:11]Third becomes an unintentional weight loss. Any weight loss now according to the American college of gastronology and a lot of American associations more than 5% of body weight loss in the last earliest was 10% now it's 5% >> 5% unintentional >> unintentional without any effort to decrease appetite or exercise to lose weight in the last 6 months becomes a very important red flag. Then first degree relative your mother your father your brother your sister having any cancer >> and a bigger red flag becomes a GI cancer >> any colon stomach any pancreas any gallbladder becomes very important >> then another point comes that do you have any hemoglobin low anemia >> anemia >> any malabsorption of iron B12 any loss of iron from the GI because as you say after 50 years any iron deficiency is a GI malignancy unless until proved otherwise >> correct So becomes very important. So a lot of uh physicians MD medicine asked me how did you catch this colon cancer?

[00:10:07]I told him when you referred me he was 9 HB.

[00:10:09]>> His iron was so low 65 year old man. You have to tell him it is a class one indication.

[00:10:14]>> M >> right. And last progressive vomiting any lympadinopathine examination these becomes the seven eight very important things h these have to be absent.

[00:10:22]>> These are blood and stool.

[00:10:24]>> Blood and stool. Yeah blood and stool.

[00:10:25]>> So I missed that. Blood and stool or blood and vomiters. Yeah becomes very important. All these things have to be very very clearly written down on paper or on his prescription that these are not present.

[00:10:35]>> And then once you have that I establish the New England Journal of Medicine 2012 paper of ruling out gut inflammation by the four C tests.

[00:10:45]>> So which be >> complete blood count >> complete blood count which brings your hemoglobin is normal. When your hemoglobin is normal mainly mainly your iron and B12 is normal right because they are the major uh what do you call uh sources to make the hemoglobin then your serum CRP it is a basic test for blood inflammation if that is normal even your gut inflammation uh should be normal >> C reactive protein >> C reactive protein then comes your fecal calotin it is a substance which comes from the neutrfils of the WBC so when there is a neutrfilic infiltration into your bowel your fecal calotin is high So you're talking about the stool sample which measures the cal potential.

[00:11:22]>> Yeah. So >> so that has a high negative predictive value. A positive test might not be uh establishing a disease but a negative test almost in 99 to 100% cases rules out a gut inflammation. And last becomes celiac cerology because it is not prevalent in the south because major rice eating population but in north there was a paper from as >> very common in Punjab.

[00:11:43]>> Yeah very common in Punjab, New Delhi.

[00:11:45]Yeah. 1% population has it. That's a big number. Ah >> so celiacology IG antg IG anti-ma so this becomes these four C's become very important for us to actually not miss anything so if I do this in the first 15 minutes with the patient like I was telling you what I do with the patients I'm very sure whether I'm dealing with an organic illness >> a functional bowel disease >> and what which way do I need to counsel the patient more >> whether my nutritionist needs to talk to this patient because if it's a functional thing the gut serotonin becomes very important the FODMAP becomes very important And I need to counsel this patient for the importance of diet more than medicine in the long term.

[00:12:21]>> So what do you do in your practice for bloating?

[00:12:25]>> So dietary modification becomes the most important part like that becomes very important in these patients because uh >> see two things which India is grossly deficient in is fiber and protein >> and these people a lot of people have bloating with oats with the with the advent of oats these days. A lot of people consume oats for breakfast. So we have actually studied this and we have found that is the reason is that when they were not having oats they were fiber deficient and now they're suddenly having oats. So they are fiber overloaded.

[00:12:55]>> M >> so their gut microbiome the bacteria and the gut. So fiber is basically not for your not for the body >> it's for the gut bacteria.

[00:13:04]>> Yes.

[00:13:05]>> The fiber is a complex carbohydrate which is made from the uh sources of the plant structure. Right.

[00:13:12]>> They're resistant to digestion. M >> and uh be soluble insoluble both are two types of fiber they resist to destination and suddenly when you give it to the system bloating becomes very common >> so uh you you don't train your gut the gut bacteria and you start loading it with fruits with everything so I think for people it sometimes it can be a transient symptom where you actually ask them to gradually so this side of counseling becomes very important with these patients that you slowly increase the fiber load to your gut.

[00:13:45]>> Yeah.

[00:13:46]>> And you actually see in four to six weeks these patients start becoming better, >> right? That's a very critical point. I wish the subscribers know about this is that >> um let's say they come with bloating, right? And then we say that you know you need to follow a specific kind of diet called low map diet. F >> oligosaccharides, disaccharides, monols and polyols.

[00:14:05]>> Polyols. Correct. uh that's a specific kind of diet where we know that the good fiber content your gut will not be able to handle at that point of time.

[00:14:15]>> Yes.

[00:14:15]>> So in our lifestyle medicine program you know the new me clinic that we have virtually when patients come with IBS we do flow FODMAP diet and when we remove chana rajma from their diet they get really upset that these are all good food and they are all good protein richch and fiber richch stuff. Why are you asking us to reduce it right? So the key thing is that at that point of time your gut bacteria will not be able to handle that particular food now. Very correct doesn't mean that you will not be able to eat it at all. So you remove it for like four to 6 weeks and then you reintroduce it later and when reintroducing will also have to have a very minimal increase similar to what you are uh saying.

[00:14:57]>> Uh and the most other thing that we have seen in my practice is constipation which is the main reason for bloating.

[00:15:03]Our viewers should know when should we seek medical attention?

[00:15:08]>> Yes. The red flags.

[00:15:09]>> Red flags. Red flag. What do you think about constipation management your in your uh practice?

[00:15:14]>> So again the seven eight red flags become very important. The test for gut inflammation become very important once I'm clear with them. So the simp when patient says constipation I very clearly ask him that whether there is a lack of generation of your intestinal pressure to urge to defecate or do you have a feeling of incomplete evacuation >> with these patients. What I have seen in my clinic is that the incomplete evacuation is more common.

[00:15:39]>> Mhm.

[00:15:41]>> Than the actual constipation. So the actual constipation is defined in three ways. The slow transit constipation where there's no urge for days. the normal transit constipation which is classically IBS which is these people correct feeling of incomplete evacuation and pelvic disiners >> where your uh where the rectum in the anal canal do not align and maybe you are uh straining against a closed anal sphincter >> so and you have to insert your finger so this becomes a very common thing we have to ask them do you insert your finger in your anus to remove stools so that becomes a classical solitary rectal ulcer syndrome kind of a picture >> so these people are classically having feeling of incomplete evacuation. So again what we have seen in the last 40 50 years is from so I don't know about this part of the country because very less exposed to the south of India but uh in north there was a concept of uh taking your you understand lot >> what is lot >> lot is a mug of water okay >> used to mug of water and go to the farms to defecate in the open >> yes >> so that was the Indian style of defecation right >> so the Indian style was always squatting >> correct >> so squatting actually makes your reto anal angle aligned >> aligned So the straining becomes less and you not straining against a acute angle.

[00:16:55]>> So the recto anal angle becomes straight on squatting.

[00:16:58]>> So with the from those farms >> to our very classical western toilets the squatting position the Indian position has gone.

[00:17:06]>> So that is also a very common thing which we have seen. So we counel our patients to put stool >> correct >> beneath their legs so that at least it becomes semi-quatting.

[00:17:14]>> Correct.

[00:17:14]>> So it aligns the rectum and the anus >> right?

[00:17:16]>> So that it's easier for you to strain.

[00:17:18]So the stool just gets aligned with the toilet bowl >> at the bottom >> semi stool. So it's semi-quatting at least.

[00:17:24]>> Okay.

[00:17:25]>> So because today it's tough to find Indian style washroom. So it's difficult to squat squat.

[00:17:30]>> So but squatting is a very important position for constipation patients which we have lost with time >> right I think in in in US we do something called squatty potty. Okay.

[00:17:39]>> Okay. It's a small stool that goes right at the base of the toilet bowl. Okay.

[00:17:43]>> And then you try to maintain that angle what you're talking about.

[00:17:46]>> Okay. So uh not aware about it about it in India but we do it the Indian way.

[00:17:50]>> So we asked them to put a stool >> stool. Okay.

[00:17:52]>> So that's one. Second what we have seen is the advent of processed foods and the decrease of fiber. So 40 50 years ago we were predominantly a fiber eating country.

[00:18:01]>> Right. It has gone down with millennials and further with genzes. So these ultrarocessed foods of pizzas and the uh increase of ma as a delicacy the refined flour. So and the fiber going down. 70% of Indian population today is fiber deficient. So fiber does a very important job in uh in particularly the insoluble fiber in cleaning your large intestine like a broom.

[00:18:25]>> We call it a jadu like and it pulls water and makes tool soft. So fiber becomes a problem. So so immediately adding a lot of fiber is a problem. So graded increase in fiber intake is very important in these patients >> and that becomes very very important. So two things are very important here when we manage our constipation patients.

[00:18:45]>> Third, we have to ask them not to keep straining.

[00:18:49]>> Not take cell phones, newspapers to the washroom because they want to make their toilet time productive. They call it me time but they keep straining and when they keep straining very commonly these patients start bleeding >> because they have the normal veins around around the anal area which get swollen and we call them hemorrhoids or piles.

[00:19:07]>> In Hindi we call them basir. M >> so a lot of these patients start bleeding and that becomes a very big trauma for the patient.

[00:19:14]>> And these patients with the advent of alternative medicine and classically these bleedings they stop on their own.

[00:19:20]>> So these are the patients because in India it is seen that alternative medicine everything is safe.

[00:19:26]>> It is natural. So they keep doing that they stop on their own. So I tell them that even if you hadn't take any medicine the symptom would go away.

[00:19:33]>> The disease is still there. So there's a difference between a symptom and a disease. A symptom is what you see on the outside. So like you say a lot of patients say my mother had gallbladder cancer but we came to know in last stage.

[00:19:45]>> So that cancer was going on for 5 years.

[00:19:48]There was no symptom.

[00:19:49]>> When the symptom came it had already >> was all over the body. It has metastasized as they call it.

[00:19:55]>> Right? So as gastronologists we were taught by our teachers that you have to investigate.

[00:20:00]>> You are not supposed to miss any diagnosis. M >> so we don't want our patients to have blood and then ignore it and then harbor a big illness.

[00:20:09]>> Correct.

[00:20:09]>> So straining so with constipation these three four things become very important.

[00:20:13]>> So the three proper ways I ask my patients to >> clean their gut. The three natural ways to clean their gut 25 to 40 g of fiber mixture of soluble insoluble 25 to 30 grams for a female 30 to 40 grams for a male. Right?

[00:20:27]>> Move your body. If you cannot do anything else 10,000 steps of brisk walking everyone can do even at work.

[00:20:33]Otherwise the classical recommendation is a mixture of an aerobic >> and a strength training >> and a strength training. Aerobic comes with brisk walking, jogging, cycling, running. Strength training comes you can do it not naturally at home. I asked them to do push-ups.

[00:20:48]>> Mhm.

[00:20:49]>> 10 10 push-ups, three sets.

[00:20:51]>> Correct.

[00:20:51]>> 10 sets, three sets of 10 squats. Three sets of three sit-ups. If you do it three times uh a week and two times brisk walk, that is good enough. So 150 minutes to 240 minutes is the recommendation. And third at least three three three liters of water >> and if you're non-diabetic you can have one coconut water daily >> because this is important because the fiber will pull water and if you are dehydrated then again you'll have bloating constipation gas with all the fiber intake >> correct >> so all this has to be told to them very clearly and I I think with these three problems with constipation and three natural ways to clear the gut becomes a very important thing to >> counsel our patients >> two things that came to my mind one is um you know I add psyllium husk to my patients pretty much all the time.

[00:21:35]>> Okay.

[00:21:36]>> Um there is multiple brands that is available in the US. What is your there's a thing called isabol husk over here right. How is that your common practice?

[00:21:45]>> Uh I definitely ask patients to take it if they uh are comfortable with it and want to take it but I again see as a gastronologist I have to tell the positives and the negatives.

[00:21:55]>> Celia husk is a very very very good thing. It is a soluble fiber. So uh your 60 to 70% soluble fiber much more than your chia seeds which are again a very popular uh superfood if you can call it >> in India and in the west.

[00:22:10]>> So much more than that.

[00:22:12]>> Second es goal is a soluble fiber. So it is going into your gut and becoming a soluble gel matrix. Now this matrix one will give you satiety. So it'll prevent overeating. Second it will slow your gastric emptying. So it will slow the sugar absorption from your gut. So the postmeal sugar spike would be better.

[00:22:30]>> Mhm.

[00:22:31]>> And third, it will bind your bile acids in your gut and it'll prevent the LDL cholesterol from going high. So there are studies with soluble fiber all kinds that when you use them, the binding of bile acids reduces the LDL levels. So a liver has to remove the LDL from the blood. So there is significant reduction in LDL >> which is the bad cholesterol. Right?

[00:22:54]>> Right. So these three are the very important genuine benefits of isabol or silium husk.

[00:22:59]>> But along with this you have to understand if you're dehydrated >> it needs water to form that gel.

[00:23:04]>> Correct.

[00:23:04]>> So again it will it'll cause bloating uh maybe vomiting upper abdominal pain >> cramps as well.

[00:23:11]>> Yeah. Second if you are a diabetic patient and you have a condition called small intestinal bacterial overgrowth.

[00:23:18]>> So your anorobes are in the small intestine. It'll cause fermentation in the small intestine. Mhm.

[00:23:23]>> And third, because it is a soluble fiber and it is going to make a gel. So if you're on important medicines like BP lowering medicines, like diabetic medicines, like blood thinners, you have to space out at least 2 to three hours from euphol because its absorption will be reduced and your blood parameters and all these things the drugs won't be able to act.

[00:23:43]>> So these three things you have to keep in mind with the positive effects.

[00:23:46]>> Definitely sub goal is going to help you with diarrhea and with constipation both. both m >> according to the water intake you take along with it >> correct >> and it has genuine metabolic effects >> right usually the powder uh it doesn't dissolve unless you add more water to it um so sometimes what happens is that they think that they take three times a day as well again I tell my patients that you know you need to start very slowly half a scoop and then add more water similar to what you said it forms a gel only when there is a water there as well and that's a important point that LDL cholesterol sterol can also be uh influenced by this uh fiber intake >> and sir I think a lot of people don't know I'll use your channel why is LDL bad cholesterol and HDL good cholesterol a lot of influencers talk about this without knowing >> so why is it bad and why is it good so I would like to tell your uh I'm sure you know I I want to tell the viewers >> so HDL cholesterol we healthy that's what we say LDL is lethal >> so tell us why do you think >> so LDL cholesterol is the vehicle which takes fat triglyceride away from the liver >> into your system. So LDL particularly the small particles of LDL they very commonly invade the inima the inner lining of the blood vessels and they deposit there. When they deposit there they bring the inflammatory cells and they cause the classical plaque formation >> the clot the clot. When the clot is formed in your coronaries the vessels which supply your heart they call heart attack. when they they clot in your brain they cause stroke.

[00:25:20]>> So when your LDL is high all these complications of metabolic health increase.

[00:25:24]>> So that is why it is the bad cholesterol. Correct.

[00:25:27]>> On the other hand the HDL the good cholesterol is the reverse cholesterol transport.

[00:25:32]>> It takes cholesterol from the periphery and metabolizes it in the liver >> and excretes it in the form of bile acids in the stools.

[00:25:40]>> Correct. So it is basically reducing the cholesterol from your the lethal cholesterol from your body. That is why HDL is the good cholesterol.

[00:25:51]>> I see a lot of colon cleansing here in India. What is it about? Why is it more prevalent over here in India? There there's there is this practice in the US as well but it's getting more common in India and because I've been traveling back and forth.

[00:26:06]>> It's a myth.

[00:26:07]>> It's a myth.

[00:26:08]>> It's it's a scam. Not even a myth. myth is something which we believe in and can be done. It's a scam. So, uh I think people are taking 15,000 20,000 rupees for colon cleansing >> and it's it's a major it's a major major scam.

[00:26:22]>> See uh you are you have to understand even liver detox all these syrups are scams.

[00:26:27]>> One brand I'll not take the name has been there for 70 years >> used left right and center for detoxification of the liver.

[00:26:34]>> Some 55 56 in the brand name. So uh so some 50s I don't know what is the exact number but something 56 or something 57 >> so all these things are proper scams your body does not need a detox >> correct >> your detox mechanism are already in place your liver >> that's why you have kidneys you have >> yeah liver they already are doing you don't put in the toxins so and I think the liver detox industry is uh in billion dollars >> so all over the world I think uh with the advent of science uh a lot of infection infectious diseases have gone out of the window.

[00:27:09]>> We don't have uh small pox anymore.

[00:27:12]>> We don't have uh cowpox anymore.

[00:27:14]>> We don't have plague anymore. In '92, I think there was a epidemic in Surat which went all over India.

[00:27:20]>> Right?

[00:27:21]>> We don't have plague anymore. TB is on a decline. We have eradicated polio. They are going to eradicate HPV if if influencers don't go crazy and misguide our public.

[00:27:31]>> They're going to uh >> eradicate HPV. So, >> but we have to die in a way. Mhm.

[00:27:36]>> But people don't want to die.

[00:27:37]>> So that is where the biohacking, the colon cleansing, the detox thing comes.

[00:27:42]Why does why does it come? Because people want to live. They don't want to die. But they don't understand that there has to be a way to die.

[00:27:48]>> Mhm.

[00:27:48]>> So if you take away the infectious diseases which used to kill so many people, something will come up. The metabolic disease have come up. So why these functional medicine uh coaches who have nothing, why are they coming into the picture?

[00:27:58]>> Because these are lifestyle disorders.

[00:28:01]Now diabetes, now some person comes and says I can reverse diabetes. Mhm.

[00:28:05]>> So I had a fight before I start disengaged from all of this that medically you cannot reverse diabetes.

[00:28:12]>> It is remission.

[00:28:14]>> You do it with diet and lifestyle, it is remission with diet and lifestyle. You do it with oral hypoglycemic drugs like medicines, it is remission with oral hypoglycemic drugs. If you do it with insulin, it is remission with insulin.

[00:28:27]>> Mhm.

[00:28:27]>> It's not like you go to your patient or you go to the world and say I'm reversed. You stop your lifestyle. then >> it'll come back.

[00:28:35]>> So it is not reversed. Reversed means I gave you antitubercular therapy and your TB has gone. Now you don't need to do anything to to be free from TB.

[00:28:46]>> All this discussion I want my patients, my viewers, everyone to know. I tell them these seven things which should be in your professional dashboard. Like today it's a dashboard, right? People with iPhones and everything have a dashboard. So I say always have a look at one your serum triglycerides. They should be less than 100 milligram per deciliter. Two, always have a look at your HDL, your good cholesterol, which I explained. In pre-menopausal women, it should be above 50. In post-menopausal women and men, it should be above 40 milligram per deciliter. Right?

[00:29:16]>> Third, always have a look at your abdominal circumference at the belly button. In males, it should be less than 38 in. In females, it should be less than 34 in. Because your belly is telling about your visceral fat, >> right?

[00:29:28]>> Mhm. So when your belly is soft, when your belly is protruded and soft, it is basically subcutaneous fat.

[00:29:33]>> But when you have a hard belly, it is the visceral fat. The visceral fat which deposits over your liver, your kidneys, your intestines, which is actually responsible for the insulin resistance.

[00:29:43]>> Fourth comes your BP. It should always be in the morning fasting less than 120 by 80 mm of mercury.

[00:29:50]>> Very important, >> right? Fifth is your HBA1C. Your average sugar in 3 months, it should be less than 5.6. In a healthy adult 5.6 to 6.5 is pre-diabetic. More than 6.5 is diabetes.

[00:30:03]>> And diabetes again is a lifestyle disorder. Has a is the most common cause of blindness in the world. Is the most common cause of kidney failure requiring liver requiring kidney transplant and requiring diialysis in the world. Is the most common cause of MSLD metabolic dysfunction associated sticotic liver disease which is now in India also the most common cause of liver cerosis and US also the most common cause of liver cerosis. Then comes your serum creatine.

[00:30:27]Very important to catch early because if you look at the way we calculate cockroof gold formula as you age your serum creatine increase your kidney function declines >> and the last but not the least the seventh thing is your SGPT >> the liver function.

[00:30:43]>> Yeah because SGPT is a measure of your liver inflammation which correlates with your cardiovascular health also. They say if at 24 your SGPT is more than twice the normal at 36 your chances of dying due to heart attack are two times more than the normal population. So these seven things I think as a general awareness like people go for tests annually these are the seven things they should look for and if they are actually in these range your major health issues are not round the corner.

[00:31:12]>> Sorry to interrupt but I really need to say this about my mission and passion.

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[00:31:59]And if you're someone who have tried everything and nothing has truly worked long-term and you're looking for a lifetime change, new me is for you. But a small request, don't join if you're looking for a quick fix. This is for only people who truly want to transform their health for good. This is my mission. This is my passion. If I change one person's life, I know I'm changing the whole family. Link is in the pinned comment. Now, let's get back to the podcast. Lot of patients with fatty liver. You see patients with >> Yeah. Yeah. Yeah. Left, right, center.

[00:32:28]>> Huh. And before, how about alcohol use and fatty liver? Is that common or non-alcohol?

[00:32:33]>> Both are common. But I think uh with the with Indian females in uh late 40s early 50s it is actually becoming a major major major problem.

[00:32:42]>> The earlier non-alcoholic fatty liver disease or now the metabolic dysfunction associated serotic liver disease it's a major problem.

[00:32:48]>> It's a big big big problem.

[00:32:50]>> Have you seen a patient with a non-alcoholic fatty liver progressing to cerosis >> every day?

[00:32:56]>> Every day.

[00:32:57]>> Every day >> every day with esophasial viruses we are banding them with lower GI bleeds with upper GI bleeds. It's a core what do you call uh bread and butter case for us.

[00:33:08]>> So it is left undiagnosed and untreated.

[00:33:11]That's why they're coming in with complication.

[00:33:12]>> Yeah. Because sir early see it's there are stages early fatty liver you only have fat in the liver. So uh medically they say when more than 5% of your liver cells have laden with fat it is fatty liver.

[00:33:23]>> M >> but there is no what do you call uh dysfunction in the LFT >> which is generally a late process. So you have it for years. So that is non-alcoholic fatty liver disease or a fatty liver disease.

[00:33:37]>> Then comes when your LFT starts deranging your SGPT becomes high.

[00:33:42]>> That is the NASH or the MASH state hepatitis.

[00:33:46]>> Correct.

[00:33:47]>> And then comes the fibrosis part where your fibrocans >> there is a scar tissue.

[00:33:52]>> Yeah.

[00:33:53]>> The elasticity goes away. Like we I to make our patients aware we say that when you're born your liver is like a sponge.

[00:33:59]M >> it's like a suspension of your Mercedes.

[00:34:02]>> It absorbs everything.

[00:34:04]>> But as it's absorbing, >> it becomes harder, harder, harder, harder, harder.

[00:34:08]>> So the loss of sponginess and the acquired nature of the hardy hard tissue becomes fibrosis.

[00:34:17]>> And this is the last reversible stage.

[00:34:20]Once you have more than 80% of liver tissue scarred, you call it cerosis, which is per se irreversible.

[00:34:27]And then you have all these complications of varicile bleed, ascites, hippatenal syndromes, hippatic inflopathy. So it's a spectrum.

[00:34:36]>> Let's say a patient with fatty liver in your practice. What do you do? You recommend weight loss.

[00:34:42]>> Uh yes sir. Recommendation of weight loss is very important. And uh now I don't know if we want our viewers to know we have drugs which can reverse fibrosis.

[00:34:50]>> USFD approved.

[00:34:52]>> So the advent of GLP1 analoges they are approved. Remicitum is approved.

[00:34:57]>> We we also prescribe. Yeah, >> these two are actually approved scientifically.

[00:35:01]>> So in in my practice, I do prescribe ZLP1 agonist. Okay. But I don't prescribe without a structured program.

[00:35:07]>> No, it cannot be done without a structure structured program.

[00:35:09]>> I mean structured lifelim because the reason >> the nutrition is very important, lifestyle is very important and the last part is GLP1.

[00:35:16]>> Correct.

[00:35:16]>> The GLP1 is making up for maybe 30 to 50% you are not able to make up. But if you think it is 100%. And you replace lifestyle with it, then that's not the answer. That's the most important thing to be told to people.

[00:35:26]>> Correct. Um your take on coffee and fatty liver. So after diet and lifestyle, coffee is definitely one of the best normal uh substance which present in everyday home which helps in uh fatty liver. Uh there are studies which say that fatty liver drinkers 3 to four cups sorry black coffee >> three to four cups a day have significant lower rates of uh fatty liver disease liver fibrosis liver cerosis liver cancer. So polyphenols in uh >> the coffee >> black coffee are very important for your uh liver health and they are not even for liver health for alertness >> for uh like satiety for uh decrease fat in your liver. It is very it is genuinely good. It is good for your heart good for your brain good for your liver. Uh the most important thing is that people get uh get counseledled against black coffee because of anxiety issues because of insomnia. So our job is to ask them to desensitize themselves. Start at low dose. Maybe I ask my patients to take two sips daily for 10 days.

[00:36:31]>> Four sips from 11 to 20 days.

[00:36:33]>> Six sips from 21 to 30 days and slowly slowly till where you're comfortable.

[00:36:37]Just see if you are having insomnia reduce the uh what would you increase the time period between your last coffee drink and your sleep. Correct.

[00:36:46]>> We have it before 4 or 5 p.m.

[00:36:47]>> Right.

[00:36:48]>> And uh don't take instant coffee. Take coffee beans, ground them, mash them, >> put it in a what do you call a normal patila, like a bowl, and boil them.

[00:36:56]That's about it. No sugar, no milk, and you're good to go.

[00:36:59]>> That brings the next question for acidity, right? So, you know, how common is acid? I mean, it's very common, but how do they present in your practice?

[00:37:08]>> So, it's only mostly retroal burning like burning in the center of the chest, upper abdominal pain, and burning here.

[00:37:13]>> M >> that's the most common. Okay. And it is a long-standing thing which helps you differentiate from a cardiac burning. So heartburn is a classical misnomer because there's no heart burning in heartburn.

[00:37:22]>> Exactly.

[00:37:23]>> There's no burning of the heart.

[00:37:25]>> So but you should get an ECG done in these patients. Very important.

[00:37:29]>> And ask for cardiac history so that there's no angina overlapping. And a lot of these patients don't have actually acid reflux. If you look at papers from uh ASLD, ACG and uh European organizations that these patients if you do a 24-hour pH mitry 23 of patients don't have acid reflux. It's air reflux mostly.

[00:37:48]>> So again anxiety, stress, poor sleep, obesity, lack of activity, smoking, caffeine, uh chocolate, peppermint, all these things reduce the pressure of the lower esophagial sphincter which is a which is a unidirectional valve at the junction of your food pipe in your stomach. M >> so you have to go into it ask your patient to elevate the head end of the bed.

[00:38:11]>> So all of this becomes very important.

[00:38:13]>> So I think we have to counsel our patients in this direction.

[00:38:16]>> So the one thing I tell my patient is that you know the GI tract is such an such a brilliantly created uh by God that every sphincta muscle has its own function. For example we talked about defecation right? So the the internal anal sphincter should contract the external anal sphincter should relax and it needs to be repetitative to have a normal ball movement. Similarly when you are eating the esophageal sphincta muscle which is the sphincta muscle controlling a foot pipe and the stomach has to stop has to close after you eat to prevent the food from >> to prevent the food from reflexing back.

[00:38:54]So to all this to happen the brain get connection should work.

[00:38:58]>> Yes. and see what do you do for GD you actually take so you've worked in the US and I'm sure you know that you can't take over the counter PPIs or proton pump inhibitors but in India everyone is on PPIs >> no even the US it's over the counter it's available yeah >> so so you're killing the acid the acid is not the problem the acid at the wrong place is the problem >> right >> so you you have to understand all our viewers have to understand we have to discuss this that the gastric acid is a part of our innate immunity it prevents against the external world >> it detoxifies a lot of things we eat. So when and it is very important in digestion and absorption of a lot of things. So if you are killing your acid so your acid is very important for B12 absorption.

[00:39:39]>> It is very important for iron absorption. It is very important for calcium absorption, magnesium absorption, zinc absorption, right?

[00:39:46]Protein digestion. So it's a normal thing involved in all of this and it is very important to prevent the >> term which is very popularly misused these days SIBO >> because your small intestine is free from the small intestinal bacterial overgrowth anorobes which were supposed to be in the colon are growing in the small intestine. So when you kill it, kill your acid with these over-the-counter acid suppression drugs, your small intestine starts developing anorobes because that acid stimulus in the dorm is very important for your pancreatic secretions which are the alkaline secretions which keep your small intestine sterile.

[00:40:20]>> Right?

[00:40:21]>> So again telling everyone that killing the acid is not the answer is very important.

[00:40:26]>> Right? So the acid reduces does play a role because that'll help your symptoms that'll prevent further progression in case if it is acid induced damage but long-term usage you know more than a year or two that can cause significant amount of problems. So what I tell my patient is that you know if the acid reducer like omipresol is omipresol pantropol whatever it is >> it is helping your symptoms >> and it is suppressing your symptoms.

[00:40:52]>> Ah >> not the disease >> not the disease correct. So in due course of time if you go just manage your stress, anxiety, diet, lifestyle, you can use this as a temporary band-aid for now and then you can have like 6 months to one year as a distin structure and try to improve within that. There are few patients who will need long-term PPI therapy for few uh indications like you know bar esophagus or something uh acid induced damaged esophagus but majority I agree with you that it has been used without a proper uh structure >> and long-term use of PPI can cause bad bacteria >> fractures all of this due to calcium magnesium malabsorption iron deficiency iron deficiency is such a common problem in India >> it's such a common 25% men 57% females have iron deficiency We see a lot of patients colon cancer in the US. Stomach cancer is pretty common here.

[00:41:43]>> Both are common here.

[00:41:44]>> Both are common.

[00:41:44]>> Very common.

[00:41:46]>> So if you have an iron deficiency anywhere after 40, your prescription should have an endoscopy. Colonoscopy written over it.

[00:41:53]>> Can you tell me a story where there is a stomach cancer that you found?

[00:41:57]>> Yeah. Yeah. So there was a 44 year old last week only 44 year old guy came with uh hemoglobin 78. I did iron B12. Both were low. I told him that you need an endoscopy and a colonoscopy. Looking at your age, endoscopy becomes more important.

[00:42:10]>> So, uh he said that can cannot we do it cannot we do without a endoscopy. I said >> medically we cannot.

[00:42:18]>> Mhm. So if I don't write it on my prescription and tomorrow something comes out, you can bring me to the court of law and the judge will ask me the medical board which will sit will ask me that why didn't you advise >> and I if I tell them that in India patients think that I'm a I'm a thief >> and I want to loot their money that is why I didn't write the court will again put me in jail that this is not your duty to think about it. You have to be medically correct.

[00:42:43]>> Right? So I'm not forcing you to get it done. I'm telling you that this is class one indication and you should get it done >> and after 10 days he came we did an endoscopy and we found a mass in the fundus >> the gastmach >> the stomach we found a mass we did a biopsy it was gastric adino carcinoma >> luckily luckily uh he had u a reectable disease on a PET scan >> and he got operated 2 days before I came >> with a total gasterectomy and I think we'll be able to save him >> another very uh a very good story comes to my mind so we're talking about blood and stools right Yes.

[00:43:15]>> So a friend came to me with his wife 7 months pregnant >> having blood in stools. So uh they said that uh they had seen four gastronologists three gynecologists >> and they said that hemorrhoids are very common in pregnancy because of constipation and all >> and so just wait for two more months for delivery and it'll get better.

[00:43:36]>> They were having something or something.

[00:43:38]>> I just told them that uh can you tell me your history? Can I just ask you your seven red flags which I ask? Mhm.

[00:43:43]>> So I asked for family history of disease.

[00:43:45]>> So she said her her father had ulcerative colitis >> and uh died of uh ca colon colon cancer.

[00:43:53]>> So I asked her you didn't tell anyone.

[00:43:54]She said nobody nobody asked me asked me.

[00:43:57]>> I saw such big gastronologists and so many people. So I said let's do a sigmoidoscopy. We'll give you anema.

[00:44:03]>> We'll see that area and we'll come back.

[00:44:04]It'll take 2 minutes. It'll have no effect on your pregnancy. So you're very scared husband wife. I told them that you can trust me.

[00:44:10]>> You have come through a friend. We did it. It was ulcerative colitis.

[00:44:13]>> M >> we started her on miselamine just miselamine with a a suppository and an oral.

[00:44:19]>> Yesterday I got a message in one month we are absolutely off symptoms. What do you want? Shall I shall we come to you?

[00:44:23]>> I asked them that you can wait for one more month please don't stop the medicines get the baby delivered >> and then maybe come and see we'll do a full length and then see what's the extent of the disease.

[00:44:33]>> So again uh if you just talk to the patient like Harrison preface says talk to the patient carefully the patient is telling you the disease.

[00:44:40]>> Correct. Correct. Correct. So it becomes very important. So these are two stories which come to mind when you ask.

[00:44:43]>> Right. Right. But coming back to the iron deficiency anemia. So celiac disease is pretty common in northern part of >> Yeah. 1%. It is a paper published in clinical journal of gastronology. Yes.

[00:44:53]Dr. Govind Mukhar. Yes. 2010. And there's another paper Dr. Ajit Chud from Ludjana.

[00:44:59]>> Both say one in 96 people in North India have celiac disease.

[00:45:02]>> Right. That's a lot. Yes. That's a lot.

[00:45:04]But >> I've seen so many. There was a 26 year old girl 10 days ago. Uh I can I even remember her name. Okay, I won't take on a podcast but a Cindi girl living in uh North India. I'll tell you off camera her name. So uh 26 years extremely thin has been iron deficient since 4 years of age when first time iron was done.

[00:45:27]>> I asked them to get a celiacology done >> the blood test.

[00:45:30]>> Yeah. IG antiTG was 1,000.

[00:45:33]>> Lower limit is 20. M >> I asked him to get an endoscopy done biopsy celiac disease march 3A of gluten for 6 months first time in life hemoglobin is 14 >> iron is normal first time in life ever seen >> so these things are very common very commonly missed >> and it's our job to write it on a piece of paper anyone who ever gets them done will always remember me because I was the first person to >> actually enlighten them out of this >> when you talk about celiac disease There is an another group called non-seliac gluten >> gluten sensitivity right >> that is where when patients get better on gluten-free diet and they go through this like fat diet call okay everybody should be on gluten-free right what is your experience on that >> caes sir uh so again going to the basic sciences >> IGA mediated hypersensitivity is celiac disease >> correct it's an autoimmune disease >> IGA >> five types of antibodies IGA >> Mhm is an Ig mediated is non-seliac gluten sensitivity. So that is allergy.

[00:46:39]This is sensitivity.

[00:46:42]>> So everybody going gluten-free is absolutely wrong.

[00:46:46]>> In a country already protein deficient, already fiber deficient.

[00:46:50]>> Taking away wheat, which is a complex carbohydrate for just a social media promotion, an influenza style promotion or uh like a fad jenzi cool term is absolutely wrong. Has to be discouraged.

[00:47:02]M >> you can make it a multigrain to reduce glycemic index for diabetics and to reduce the carb load. You can add ragi which is very popular in south India.

[00:47:10]>> Yes.

[00:47:11]>> For calcium and iron. You can add jaw for diabetics. You can add basin or bajra for protein.

[00:47:19]>> That is something you can do.

[00:47:21]>> But everybody going gluten-free, I don't agree.

[00:47:25]>> You can add soya chunks to increase the protein content of the ata. You can there's something called a kapli ata you can use that it is an old old standard go back to your basics whole wheat ata you can do that stay away from maida asking them not to take maida is more important >> like a refined flour made from the endosphere of wheat where bran is taken away >> correct the outer covering >> yeah the outer covering is taken away which is full of insoluble fiber >> and uh the germ is also taken away which is which has so many nutrients we have vitamin B vitamin E vitamin See and only using that has to be discouraged but discouraging wheat gluten is something which I don't agree >> coming from north India where celite disease is very common >> so I don't agree I cannot agree scientifically >> I would rather get a calpectin done but ask this patient to have so in celite disease also calin would be high again coming to your point then multiple papers so this you must have heard this name an pulymood >> this uh gastrointestinal pathologist from CMC will lower multiple papers multiple papers So talking about your velour, your neighborhood sitting in Chennai.

[00:48:33]>> So uh you remember Baker and Ethan.

[00:48:36]>> Huh?

[00:48:38]>> So these were the people who uh discovered tropical sprew.

[00:48:42]>> How did tropical sprew came into the picture? Talking to a gastronologist.

[00:48:45]What is the history behind tropical sprew? You tell me. I take your podcast now.

[00:48:49]>> No. Educate us. Educate.

[00:48:50]>> So I tell you this part of India had a major vitamin B12 deficiency.

[00:48:54]>> Major vitamin B12 deficiency. So they studied these people in velour. M >> right and velour CMC Velour one of the premier institutes of India like one of the topmost institutes of India they found the disease called tropical sprew >> m >> where they found multiple bacterial infections and they gave four weeks of cyprofluxin and c white and vital deficiency disappear so they called it tropical sprew >> it's a non-seliac sprew they called it tropical sprew because this comes in the tropics and celiac disease was already more in the north >> this area did not have celiac disease So this this was a diff non-seliac sprew.

[00:49:30]>> So they called it tropical sprew >> and now they have erat. Now tropical sprew is almost not known in this part of the country >> because advent of non-veg food, sanitization, education. South India is way more educated than north India.

[00:49:43]>> Uh uh so all of this has come tropical is not known in this part of the world.

[00:49:48]>> But Baker and Matan coined this term and they wanted two nutrients to be deficient unrelated. So they were seeing iron deficiency and B12 deficiency. B12 deficiency was much more >> correct.

[00:49:59]>> So today also 50 to 70% in India is B12 deficient.

[00:50:02]>> And B12 is required for RBC production.

[00:50:05]Your DNA synthesis >> neurological support.

[00:50:09]>> Yeah. And your sheath formation the milein sheath which is the conducting sheath outside your nerves.

[00:50:14]>> Nerves >> that's very important.

[00:50:16]>> Yeah. So these people who have B12 deficiency very commonly early they develop tingling sensation in their hands and feet. They are non-diabetic people. Axonal demalinating neuropathy on uh an NCV you do a B12 it's very low on PPI since 5 years suppressing their acid. So acid reducers can cause B12 deficiency.

[00:50:40]>> Alcohol can cause B12 deficiency. Acid deficiency in pancreas, chronic pancreatitis, SIBO, >> 100% vegetarianism, >> right? All of this is very common and these people will have high MCV, low hemoglobin and the neurological symptoms, >> brain fog, dementia, reversible dementia, B12 deficiency, >> right? M >> uh >> you see a lot of B12 deficiency in your vegetarian population.

[00:51:06]>> Yeah. Yeah. Yeah. Yeah. Amazing.

[00:51:08]Amazing.

[00:51:09]>> So what I have started again is that I get iron B12 D3 in every patient also.

[00:51:13]>> Mhm.

[00:51:14]>> I write it down along with those four C's.

[00:51:16]>> Because I catch so much and these people get so well so fast.

[00:51:23]>> And you are actually telling them their thing which they have never known.

[00:51:29]>> Right. Right? So B12 becomes so important and that is why I promote egg eating.

[00:51:34]>> I say that egg is vegetarian and I I'm I come from vegetarian family. I'm a northern Brahman.

[00:51:39]>> Okay.

[00:51:40]>> Right. No one in my family, my wife, my parents, my mother, no one eats non-vegetarian.

[00:51:46]>> Never taught to eat non-vegetarian. No egg, nothing. But I'm the biggest propaganda I have taken against taken with egg that I ask everyone to eat egg.

[00:51:55]There have been comments on my reels. If you see if your team has seen that people say I have a egg uh shop >> and I tell them don't tell it to everyone it's a top secret.

[00:52:05]So I've even brought down whey proteins in the in my podcast saying that an egg in one uh so you did this uh podcast with Anchel I saw >> so I did it where I said that uh kaca egg a raw egg comes for three to four rupees a lot of said it doesn't come for three to four rupees I asked them to understand the concept even if it is 10 rupees you eat three eggs you have 18 grams of protein >> 100% biologically available protein the gold standard protein the amount you eat it's in your blood there is no other protein which has 100% % bio availability according to K park >> the textbook of PSM >> right >> social and preventive medicines >> okay so all nine essential amino acids so nine essential issues phenyl alanine methionine tryptophanine valine isolucine histadine leucine >> all of them are there all nine essential amino acids top protein the yolk the biggest myth in the country that yolk causes heart attack it does not Mhm.

[00:53:04]>> Only egg whites have only 3 g of protein, no other nutrition.

[00:53:07]>> But the egg yolk has vitamin B12 again very important. Vitamin D again very important. Vitamin A again very important. Selenium very important. And it has choline the vehicle >> for neurons >> for for your uh LDL and HDL all these to take away fat from your uh liver.

[00:53:25]>> So choline helps in fatty liver for your neurons very important for your brain health. And then there are two proteins lutein and zeizanthine which are very important for retina. It prevents against diabetic retinopathy. So how can you discount egg and it is giving you only 77 kilo calories which are so nutrientdense so calorie dense >> and so cheap.

[00:53:46]>> So they discard why do they discard eggs?

[00:53:49]>> Eggs one they increase body heat.

[00:53:51]>> Body heat.

[00:53:52]>> I don't know what concept this is. I've made multiple reals on this. I have a 10-minute long video on eggs.

[00:53:57]>> Okay. uh on YouTube. It's a viral video where I've discussed about everything.

[00:54:01]I'll talk about body heat also right now. Okay. They say that yolk has bad cholesterol. They are okay with samosas.

[00:54:06]They're okay with jile. They're okay with bread pakoras.

[00:54:09]>> They're okay with fried onion rings.

[00:54:11]They're okay with all of that. But they have a problem with boiled egg yolk.

[00:54:14]>> I don't know what kind of uh teaching is this. Okay. They are okay with the ras malai.

[00:54:21]>> They are okay with fried dosa, with a lot of aloo. They're okay with all of that. But they have a problem with egg yolk. So that becomes a very big issue.

[00:54:29]>> That's why I have an egg shop in Delhi.

[00:54:31]You come I'll have you I'll give you eggs. So they asked where do you get three to four rupees eggs? I said at my shop.

[00:54:39]>> I'll tell you another school of thought is that uh yes I completely agree with everything what you said you know bioavailability complete source of protein. Um but the egg yolk does >> is a rich in saturated fat.

[00:54:51]>> Yeah. So three eggs I say if you're non-diabetic you're you don't have a family history of CAD you're okay you're early young three eggs whole are okay with you don't exceed that but three whole eggs is good >> right >> but the second thing which I have seen a lot of problem with the nutritionists and a lot of problem with influencers is saying complete protein is not okay >> knowing what complete protein is is very important >> so for our viewers nine essential amino acids what is the meaning of essential amino acids like I told you all these nine they are not made by the body correct so they're required from outside. So they're essential.

[00:55:22]>> Okay.

[00:55:23]>> Second thing, egg is the gold standard protein.

[00:55:26]>> The bio availability of every protein is compared with egg.

[00:55:30]>> Okay. It is the ideal protein. So when you talk about complete proteins, you should divide the proteins in animal origin and plant origin.

[00:55:38]>> For vegetarians also, right? So animal origin that is why I say key I called milk as non-veg or veg as egg because origin animal so egg milk whey protein curd paneer cheese >> egg uh chicken mutton seafood all these are complete animal origin proteins.

[00:56:03]Now talking about plant-based complete protein, soya, >> the young soya beans which are edomame, tempeh, >> yeah, >> tofu, >> fermented soya is tempe.

[00:56:13]>> Yeah.

[00:56:14]>> Amarant, buck seeds, >> uh, chia seeds, quinoa, hemp seeds. All of these are plant origin uh, complete proteins. But again being a vegetarian, I'm telling you the bioavailability of plant proteins is way less. But but the plantbased complete protein is only soya. All the other proteins plant-based is you need a mixture of two or three to make it complete.

[00:56:39]>> No sir. So I have done my full research on this. I will actually show you that all of these have nine essential amino acids. The bailability is less.

[00:56:48]>> But I'm very sure of this. I can even show you right now. I I'm uh I'm reading very very in-depth about all this these days. What I'm telling you is right out of textbooks.

[00:56:58]>> All of these are nine. The mixture I agree see cereals are deficient in lysine. Pulses are deficient in methionine.

[00:57:05]>> Right?

[00:57:05]>> So dal chaval becomes important. Dal r dal sorry rice rajma becomes important.

[00:57:12]Rice cholelay becomes important because that is a mixture of complete protein.

[00:57:16]But the uh again nine plant-based proteins I'm telling you I'll just show you. So these are complete proteins. The bioability is lesser.

[00:57:26]>> Yeah. Uh so you know for example when you look at for gut microbiome right so gut microbiome loves fiber.

[00:57:31]>> Yeah.

[00:57:31]>> So the fiber comes with plant-based diets. So the problem with plant-based diet is where the protein consumption might be a little bit lower until you include a large variety. When you include large variety that would be the best source of protein ever because you also have the fiber accumulate along with it.

[00:57:46]>> Yes.

[00:57:47]>> Uh one of the most important vegetarian plant-based complete protein is soy is is complete.

[00:57:54]>> Does not give you man boobs. does not give you mops does not does interfere with thyroid a little bit. As long as you space it out, you're good. And the isoflavon content differs whether you are in the US or whether you're in India. Actually, the problem is more in the US compared to India because of tropical weather. So all this combined vegetarian source of protein can be obtained if you spend too much attention on it. I agree.

[00:58:17]>> And uh you were saying egg is a supplement you can add to meet the protein recommend.

[00:58:22]>> Yes.

[00:58:23]>> Yes.

[00:58:24]>> Yes. That's what I'm saying. Exactly.

[00:58:26]>> And uh how about uh you know you are a north Indian. I grew up in South India.

[00:58:33]>> Which food is better? You think?

[00:58:35]>> I I like south Indian food a lot because of the fermented uh nature of the food, the low glycemic index. I think ragi is very common in Karnataka.

[00:58:43]>> A lot of my Canada friends introduced me to to ragi which I didn't have uh much in the north. So I think uh my daughter has a lot of ragi because of the calcium content, the iron content. So I'm a fan of north Indian food. See uh I the best part about growing up in north India and and Delhi particularly it was always about growth.

[00:59:05]>> It was never about which part of India.

[00:59:06]>> So I have wonderful friends from Kerala.

[00:59:09]>> So a gastronologist was with me Rizwan Ahmed >> uh I think uh he his father is is Tvandra medical college principal Zulfikar Hammed son of him. He was a gastronologist. My closest friend and uh is from Kerala. So similarly a couple of Tamilians were my friends. Canada were my friends. So I have nothing against any part of India food. I think there's a good part there's a very good part about South India which is much better than North India as far as food is concerned.

[00:59:33]>> But I think South Indians are very u not as loud as North Indians. So they are not very good marketing agents for their food.

[00:59:41]>> But uh so we would market butter chicken as a very healthy food. But I think uh uh idli with a I had idli with uh sambar and uh coconut uh >> chutney today in the morning breakfast and I think it is one of the best breakfasts ever made >> because of sambar with veggies and I found moringa also in the drumsticks also in the sambar here.

[01:00:00]>> Nice. Yes.

[01:00:01]>> We use a lot.

[01:00:02]>> Yeah. Yeah. So I didn't know about it before Narendra Modi Sab talked about it >> right >> as his favorite food. I didn't know when I made a real it went viral. There's a lot of people from Modisa, Tamil Nadu, Karnataka were commenting that how can you say that it's Modi's uh moringa?

[01:00:15]It's our moringa, right?

[01:00:16]>> I was like but Modi told me about it. So I I thought it's Modi moringa.

[01:00:20]>> So one of I think the one of the beautiful thing about India is that they have their own fermented foods from each state.

[01:00:26]>> Yeah. So I like it because of the batter, because of the coconut chutney, because of the sambar, with the veggies, with the idli, with the less fried vas.

[01:00:35]I think good. If you can make it a paneer dosa, I'm very happy with >> paneer. Yeah, that adds a lot of protein.

[01:00:41]>> So I think uh with north sir the major I think of food comes is vegetarian spices and the gravies which are not as healthy.

[01:00:50]>> But I think one life do have rajma at my home when you come.

[01:00:54]>> Yeah.

[01:00:56]>> Have you ever heard of kanji?

[01:00:58]>> Kanji. Yeah. Fermented >> fermented black carrots. Right.

[01:01:01]>> Yeah. Yeah. Very good. Very good. In every >> Excellent. M >> so see fermented foods are mainly probiotics >> right we talking about probiotics probiotics means inserting live bacteria >> into your gut to replenish good bacteria in your microbiome >> correct >> so kurd the I call it the best fermented uh food >> right >> has protein >> has B12 so B12 vegetarian source comes from dairy >> so vegans have almost 90% B12 deficiency >> because they don't have dairy >> right >> so if their foods are not fortified Beetle will not come from anything.

[01:01:34]Right?

[01:01:35]>> Curd is fermented. Paneer is not fermented. It's condensed. But uh again your buttermilk chach lassi is fermented.

[01:01:44]>> Your kanji is fermented. Your uh idli is fermented. Your ragi very good fermented food. So I think uh a lot of options we have with fermented food.

[01:01:52]>> Right. Right. Let's touch a bit upon lactose intolerance. Um do you see a lot?

[01:01:59]>> Yes, it is common.

[01:02:00]>> Mhm.

[01:02:00]>> Uh it is common all over the world. Uh so we have to understand uh lactose intolerance self diagnosed is more common than actual lactose intolerance.

[01:02:13]>> Lactose is made of glucose and galactose >> right >> beta4 linkage. Lactase is the betalucosidase which breaks it into glucose and galactose and then they're absorbed.

[01:02:24]>> Right? So lactase is the enzyme that you need >> which is present. So if you look at the small intestine, so for my viewers, for our viewers, what is the difference between small intestine and large intestine? It's not the length, it's the diameter.

[01:02:36]>> Diameter, right?

[01:02:37]>> The small intestine is longer than the large intestine. And if you take out the small intestine, put it on the ground, it is almost as long as a tennis court.

[01:02:46]>> Yeah. 6 to 8 m.

[01:02:47]>> Yes. Yeah.

[01:02:48]>> So small intestine, the lumen is small, but the absorptive area is enhanced by villa.

[01:02:52]>> Correct.

[01:02:53]>> And at the top of the villa, there's micro villi. The villi is a finger-like finger production. So these have an enzyme called lactase >> which breaks them down. It is seen with aging the lactase level drop >> and the ability to uh break down lactose decreases. So this lactose goes to the large intestine >> where the anorobic bacteria ferment it.

[01:03:16]>> Correct? And that fermentation produces gas active metabolites which pull water causes diarrhea. This is the actual lactose intolerance which is called primary lactose intolerance has to happen at some age like I remember in with my parents in north India >> they used to say that >> milk doesn't suit me anymore so I have tea that was the classical soft definition of lactose intolerance right so this will cause bloating also because of fermentation everything so this is one how do you diagnose it two important test stool pH because of the fermentation stool pH drops acidic less than 5.5 and hydrogen breath tests which are a little complicated will not be telling to my viewers not important.

[01:03:55]>> These are two things >> but you have to understand not all dairy has to be avoided >> because of two three important reasons.

[01:04:04]See, even if you're lactose intolerant, 12 to 15 gram of lactose per day according to science is digestible. That is around 250 ml of milk of milk.

[01:04:14]>> The major problem comes from full cream milk, >> right? Or the the buffalo's milk, correct? Which is high in fat, high in lactose. But as it is fermented or it is condensed, the amount of lactose decreases. So when you ferment it to kurd the lactose decreases and you have live lactobaceline kurd which are fermenting lactose even before it goes in.

[01:04:40]>> So kurd is normally in proper doses one to two bowls in a day is even with primary lactose intolerance well >> digested tolerated similar with paneer and these things are absolutely different. They are enzyatic condensations. So they should always also be properly digested >> and with cheese again it should be digested. There should be no issues. The lactose content is going down. The fermentation and enzyatic condensation is reducing the lactose content.

[01:05:08]>> So this again cool thing that I'm lactose intolerant and staying away from dairy in a vegetarian population like ours is again a problem. M >> so this should be very clearly brought out in front of the public that yes lactose intolerance is common >> but self-dagnosed lactose intolerance is more common than the actual lactose intolerance in our public >> have you prescribed lactate tablets >> I don't think they work I haven't >> uh with multiple studies I have looked into I don't think they work >> and in my practice many patients with IBS has some kind of a lactose intolerant symptoms they come >> that is common >> but when we treat them with the proper diet, proper stress management after two to three months the symptoms get better.

[01:05:52]>> Yeah, >> they will not be able to handle a full scoop of ice cream before but after that they'll be able to tolerate half. So that was the beauty of thing what I uh introduced was it's all comes down to basics in terms of how do you structure your lifestyle. So yes, we talk to our patients like with lactose intolerance.

[01:06:10]I have seen people with vegetarian all these all these multiple issues. I asked them for three food combinations in my clinic.

[01:06:18]>> Like I told you for Indians I think please with your spinach with your pulses with your rajma with your cholelay please squeeze lemon into it.

[01:06:28]One >> right to increase your >> availability of iron.

[01:06:33]>> Yeah. The non-heem iron absorption increases. Second, take two spoons of chia seeds with curd every day.

[01:06:42]>> And the third is the popular haldi turmeric with black pepper because curcumin is not absorbed as much without black pepper. So always mixture mix black pepper. 2,000% increased absorption of curcumin is seen when you mix them. These three combinations in my population becomes very important for gut health. I've seen patients improve.

[01:07:01]I've seen patients get feel better. M >> I've seen patients be more aware of themselves having more confidence in me than anything else. So I think these three combinations I would like to tell all my viewers.

[01:07:13]>> Wonderful.

[01:07:14]>> Very important.

[01:07:14]>> Wonderful. Super. We have some rapid fire questions for you. Are you ready for it?

[01:07:18]>> Yes sir. Okay.

[01:07:20]>> All right. So the first thing I mean just a general information. Um what do you think the biggest nutrition scam being sold today?

[01:07:28]>> Liver detox syrups and uh tablets.

[01:07:32]What's the biggest health myth Indians still believe?

[01:07:35]>> Lemon water uh causes in the morning detoxes your liver.

[01:07:40]>> Which common food deserves a better reputation?

[01:07:42]>> Mangoes.

[01:07:43]>> Mangoes.

[01:07:45]One food people avoid unnecessarily.

[01:07:48]In your case, I think it'll be egg.

[01:07:51]>> One food people think is healthy, but actually it's not. Fruit juices.

[01:07:54]>> Fruit juices. Yeah. One gut health tip that is you think it is not useful at all?

[01:08:00]uh I don't know uh supplements >> supplements >> uh unadvised unprescribed supplements particularly with using of influencer codes >> which supplement do people spend the most unnecessarily in your experience >> I think this collagen supplement is a very big scam right now >> very expensive and uh yeah they don't understand that uh collagen is formed by hydroxy proline and proline with vitamin C so I think your protein intake with vitamin C has to be important.

[01:08:32]>> I think if I am health minister of India, I'll add vitamin C in all the vegetarian dishes in the in the country.

[01:08:37]>> Nice. Wonderful. Such a such a detailed conversation. I absolutely love it. Uh one last tip that you can tell my viewers in terms of how to improve their gut health. That would be great.

[01:08:47]>> Sleep for 6 to 8 hours. Have 3 to 5 liters of water every day if your kidneys are normal and if you don't have any hydration issues or any fluid retention issues and exercise regularly.

[01:08:57]>> Super, sir. Thank you so much for your time, sir.