The Future of Medicine: Preventing Disease Before It Develops

The Future of Medicine: Preventing Disease Before It Develops

Author Name:Dr Samatha Tulla

Youtube Channel Url:https://www.youtube.com/@drsamathatulla

Youtube Video URL:https://www.youtube.com/watch?v=yyNlkMz90j4



Transcript:
(00:00) The human age was supposed to be 120 years but nobody lives 120 years. Maybe we will much less than what we should do. >> People most of the times they have a question as to why they're asking me to do so many tests. >> All of us don't have. >> Today I'm joined by one of the India's most respected gastroenterologists Dr.
(00:19) D. Nayeshwar Edigaru both founder and chairman of Asian Institute of Gastroenterology Hospitals and he's the first Indian doctor to receive all the three Padma awards. emotions. In fact, emotions and eating are very close together. That's why when you're depressed, you eat more. In fact, there are more bacteria in our gut.
(00:36) Approximately 37 trillion bacteria compared to 30 trillion human cells. So, these bacteria are producing products which stimulate the nerve which goes and releases dopamine in the brain or suppresses dopamine in the brain. Related to that, we either eat more or less. There are people who eat a lot but don't put on weight.
(00:52) Those who eat less put on weight. All this is partly related to this bacteria. We are as Indians genetically prone to tranquil obesity. Part of it is genetic but lack of exercise, high carbohydrates that we eat, alcohol, smoking, all these make a complex situation. >> What is that one thing sir that you feel AI can never replace doctors for sure.
(01:12) I think what AI cannot replace normally people have fat in the liver but if it becomes more than 5% we call it non-alcoholic fat limit and we found that 80% of people 90 sector have non-alcoholic fat limits this is again very sad >> this is personal question I want to ask you sir how do you take care of your health >> for me it's very simple >> I'm Dr. Dr. Samtaser.
(01:41) I am a longevity physician and medical director at PMX Health. We're trying to make prevention in healthcare again a new normal today especially with you being a Padmabushian you have kept healthcare at the forefront not just in India in a world. So I'll be happy to have this conversation with you because despite developing this metabolic burden I see that you in many of the previous conferences like AI precision health I want to learn and also share with the audience today on what kind of awareness public need to get in both health when
(02:18) we say health it's both metabolic health mental health all of it so today I want to have this conversation with you >> thank you so Although I'm a gastroentertologist, I strongly believe that we should see health as a holistic phenomena, not confined to one specialtity. A lot of this comes from the gastrointestinal tract, liver, pancreas and so on.
(02:39) But I think the skeletal health is very important, the bone health is very important and so on. So I think you run a very successful unit promoting this health concept to the people. So I'm glad today that we're in a conversation to learn about recent advance in this area. I think it's very important also to let the public know that simple things can actually make a lot of difference in the health and it's not going just to some big corporate hospitals they think they get better but simple steps may better so let's start the conversation yeah
(03:06) >> thank you sir that has been a great start um so when I was preparing what kind of conversation we need to have today I felt what if the next revolution in medicine isn't about treating diseases it up but preventing it before it begins like you said gastrointestinal tract is a very core of where the disease begins so I would like you to expand and talk a little bit more about it >> no I think this is a very good concept preventing diseases before they occur I mean it's a very simple concept like we using vaccines to prevent disease why
(03:42) not we use a holistic phenomena to prevent diseases as such from occurring we know that the average age if you look at animal kingdom where animals live Each animal is say given a certain age like dogs usually live 13 14 years. The human age was supposed to be 120 years but nobody lives 120 years.
(04:02) Most people die very early. In fact we look at the lifespan of people. It used to be in India at independence 40 years. Now it's 70 plus years. Western world maybe 80 years. So this lifespan concept also tells us that maybe we're living much less than what we should do. The second concept is health span. Health span meaning how healthy you live.
(04:22) In fact lifespan is 70 health span is only 60 years. We are living much less than healthily than what we should do. So if we can prevent diseases some of these chronic dis diseases like uh cardiac problems, lung problems, liver problems, diabetes and so on we can not only increase our lifespan but increase the health span.
(04:43) We now have several tools to tell us how to prevent this because we know the basis of many of these diseases. There's a genetic basis which you can now identify by whole genomic testing. There's a metabolic basis which can be constantly monitored by various devices that we have now in the market. We can discuss about some of these.
(05:00) We also have now a precision medicine. We can target exactly which areas we want to. So all these are part of preventive health. I think we're in a very exciting field. There are only few countries which is actually concentrating on this part of uh the west coast in US there's a lot of emphasis on this in Germany there's a lot of emphasis on this in Japan there's a lot of emphasis on this so all these I think are um important areas we should learn from them and see how we can improve our or prevent diseases from occurring
(05:31) >> that is very well said sir people most of the times they have a question as to why they are asking me to do so many tests >> yes >> I have only this particular problem but I see I was advised all these different tests that define different things. >> Yes. >> So identifying disease is not enough. Predicting what happens in the future if we continue the current lifestyle is also an important trajectory that people need to understand.
(05:58) >> As you said people need simple things to change or start their prevention journey. >> It could be as simple as doing minor changes in the sleep nutrition lifestyle. to what extent we can predict that is where we're talking about genomics, metabolomics, all of that. >> Since you got the topic of genomics, this is very exciting like we have predictive genomics, pharmaccogenomics, now nutrition and fitness genomics are also coming into uh >> existence.
(06:27) Now I um got to hear from you in the recent AI um summit that happened here itself in AIG about pharmaccogenomics very precisely financially how much burden can be reduced to an individual by doing this one time test in lifetime. So little bit on that. >> Yeah. So I think this is a very important concept.
(06:48) Uh as medical students I mean we all went through this. We are taught that each drug is to be given once or twice or thrice. So it's very easy. All prescriptions are once daily, twice daily or thrice daily based upon the so-called half-life of the drug which experimentally has been tested on volunteers. And we all write these prescriptions, one tablet for hypertension, one tablet for diabetes.
(07:09) But what we re realized few years back was that every person is different metabolically. The reason is that every drug that goes into the metabolic system into our body is metabolized by series of enzymes. And all of us don't have the same concentration of enzymes or the same quality of enzymes. They're different.
(07:29) So what we found strangely when we started looking at people by giving them a medicine, we found it was totally different from what is in textbooks. For example, one patient may require one diabetic tablet a day. Some patients may one tablet for two days is enough. Similarly, for acidity problem, patients get reflux.
(07:46) We give them one tablet for some, some give two tablets. We used to never understand this very well and we used to just randomly start prescribing or increasing the dosage. Then when we started looking at a cohort of about 2,000 patients who coming to a hospital with say diabetes, hypertension and so on and we looked at their genetic profile of how each of them was metabolizing their medicine >> through their genetic mechanism.
(08:10) We found that no two persons were similar. You can lump them into fast metabizer, slow metabolis and so on. And what we found from our study was that uh you can actually divide patients based on their genetic background. So we call this pharmaccogenomics meaning drug related genomics. So each of us has certain genes which are responsible for metabolizing these drugs.
(08:34) So when you did pharmaccogenomics we can then characterize and say okay you need only one tablet not two tablets a day. >> The cost for doing phiccogenomics very cheap. It's only 5,000 rupees to do and this is once in lifetime. You do this once in lifetime you're set and then anytime you go in future to your doctor you just have to show your phcogenomic report which is translated into a very simple way even for even for doctors are not having much knowledge is in there you have to see so that will tell you your diabetic medicine you're a slow
(09:04) metabizer take only one tablet twice a day instead of two so this has changed the prescription pattern in a hospital and all over the world coming into focus so this is a part of precision medicine pharmaccogenomics is one aspect and like you said you can apply the same to neutrogenomics and neutrogenomics is very interesting I think this you're aware of these very interesting experiments that Eric Seagull Israeli scientist did so what they did was they gave a cookie to one group of people and then looked at what happens to blood
(09:35) sugar levels cookie contains high sugar so the sugars went up like anything another group of people given the same cookie the sugars didn't go up at all so which means that they have a different genomic mechanisms to how this um is processed in the body. So similarly part of it may be rel related to microbiome that's separate subject we should come to later but what it showed essentially is that all of us don't react in the same way to same type of food because I had many patients coming and telling me look I'm eating lot of sweets and all I
(10:06) never put on weight but my sister eats only one sweet or looks at the sweets puts on weight so there's a difference in how we metabolize so I think this is another area where we can actually look into before advising patients what they should eat and so on so the standard diet prescription eat so much of this so much is absolutely wrong because we're so different with each other.
(10:24) That is very rightly said sir when we we were also looking into data we see a lot of variance in adoponctin gene especially >> and especially with Indian uh population Asian and also for that matter all the south Asian population they they are tophi phenotype they are thin outside fat inside that is also one of the risk factor where they appear normal and still they walk with the disease uh on the streets and I was uh taking out this interesting data released last 2025 meta analysis which looked at 62 studies over 40,000 participants mostly
(10:59) India but it found MSLD prevalence is 34% in the general population rising to 60% in the diabetics >> and in rural it's 18.5% but in urban settings it's 47%. And um contrary to what the genomics can instill as a risk factor again there's another study I picked up from all the South Asian countries where we say because of my genes I'm obese.
(11:27) >> Okay how much percent does that contribute to when I looked at that study it was like 20 to 24. So that means remaining 70 to 75% of the epigenetics we have in our power today to take control of the genes. So that is where let's move ahead from genetics towards what is the 75% of the epigenetics that we can alter through metabolomics transcrytoics or lipomics utilizing all of this.
(11:55) >> Yes sir. >> So before moving there we are talking about gut microbium. This is very interesting as well. Uh today we're talking about nutritional psychiatry changing the way a person eats nutrition and see that they're feeling better in uh depressive symptoms or anxiety symptoms that means we are today we have the power to modulate the gut microbiome and who better than you for me to ask this question because there is entire research team on gut microbiome today and Indians are different so I want to understand this latest study that you're
(12:26) >> so for again lay publicly let me start with a little introduction on what microbiome is that in Our body right from surface of our body to eyes to mouth the gut there's lot of bacteria there viruses and other things but predominantly bacteria the totality of which we call microbiome the microbiome of bacteria in the gut are the most important thing because they are heavily populated with this bacteria in fact there are more bacteria in our gut than human cells approximately 37 trillion bacteria compared to 30 trillion human cells
(13:00) which means We are not human cells but we're actually bacteria bacteras and this is nature's mechanism how it nature put in this bacteria to control our various metabolic processes and one of the important things we realize is bacteria in the gut producing lot of substances and again for lay public these are um the end product of these substances are acids you know they're called short chain fatty acids >> yeah short chain fatty acids like butyric acid and all so these metabolic phenomena that metabolites coming from
(13:32) bacteria are acting on in the gut changing how the gut that is entraight or intestinal cells absorbs nutrients also more important is they're acting on the nerve endings in the gut there are two things in the gut which is very important for lay public to learn one is that the whole of the gut gastrointestinal tract contains lot of neural cells in fact there are as many nerve cells in the gut as in the brain so it's called the Second brain.
(14:01) Second, there are lot of endocrine cells in the gut. As many endocrine cells as are endocrine organs. So gut is very rich in endocrine cells and neural cells. And for long we didn't understand what's the use of this. Now we realize that the bacteria are influencing the gut through their metabolites which act on this endocrine cells and act on the neural cells.
(14:22) These two and what happens is they the feedback that goes in. So the neural cells act and the feedback goes to the brain and all our activities in the brain hunger appetite the need to eat even after eating you want to eat the so-called hedonic appetite you want yeah you want to eat say desert after a full meal all these are controlled in a small part of the brain the mid part of the brain there's a big circuit there hypothalamus and so on so they all emotions in fact emotions and eating area very close together that's why when you're depressed you eat when you're
(14:54) excited to eat more because they're very close together and they share a circuit which is related to dopamine release. So these bacteria are producing products which stimulate the nerve which goes and releases dopamine in the brain or suppresses dopamine in the brain. Related to that we either eat more or less.
(15:13) Similarly the bacteria are also making these endocrine cells secrete substances called GLP1. Now we know about all these drugs people are using mangaro and so on. All these drugs are actually naturally produced in the body by the action of bacteria on the intestinal sense. So they produce this. So again depending upon the action more or less is produced.
(15:33) So some people naturally have their own mangaro high quantities. They don't have take external mangaro. Some people don't have. So all this influence bacteria have and they regulate our mood. They regulate our um activities. They regulate how we digest food and also they regulate our metabolism. So that's the reason why there are people who eat a lot but don't put on weight.
(15:54) Those who eat less put on weight. All this is partly related to this bacterial. So I think this is an important phenomena. We didn't realize till recently but we now know. So when you're talking about genetic and epigenetic phenomena I think we are as Indians genetically prone to trunkal obesity.
(16:12) you know the obesity around uh the abdomen the trunk the belly part uh compared to western population which has more uniform distribution of obesity part of it is genetic but partly I think a lot of epigenetic phenomena come in I think are lack of exercise the high carbohydrates that we eat alcohol smoking all these environmental factors all controlled together and this is something that can be controlled very easily so there's a very complex interaction between environment bacteria microbiome uh then additional factors like alcohol,
(16:44) smoking and then of course your activity, physical activity. I think all this make a complex situation but we now know that we can control these things so that it's not just don't eat more exercise excess more that's not the thing there are lot of other factors >> this is very interesting uh thing that you have brought it's >> all these years there was only one phenomenon to stay healthy or lose weight which is calories in calories out model where you do more move more eat less but now we understand no it's it's
(17:14) it's more complicated than that there are hormones there is HP There is gut brain access all of it. >> This is very interesting where while eating healthy people can lose weight. Yes. >> While not eating people sit and gain weight. >> Yes. >> So today we have explanations for whole lot of this.
(17:34) So in the gut microbium that we think uh talking about >> this is very interesting the uh endocrine and neural interactions that are happening in the gut. So we see the whole lot of market arising out of gut micro. It could be testing, it could be specific probiotics. Now we have acurmancia known to get better glycemic balance with that.
(17:56) Now we have supplements around it. >> Also in a way people go and when they listen only one thing okay they think okay I'll take this one probiotic then I can change the whole lot of things. So I want you to talk about how >> no this is very interesting s I think we should actually educate the public on this also >> uh it's been sometimes you know markets or even commercial interest simplify everything into one simple thing take one tablet of tablet of acromemancia mucinophilia and then you lose weight but that's not true because it's a very
(18:28) complex environment here and our knowledge actually from this came in a very interesting way there were these patients with inflammatory bowel disease is in US who have been given fecal microbiome transplantation that is microbiome from one person another person as a part of treatment for this intestinal inflammation very effective it's inflammation goes up >> but what was found was some of the people were becoming obese when they took this transplant and we went and looked at the donor the donors were obese so the obese donors were actually
(19:01) producing obesity in these people who took so that means there's something in the intestinal microbi which was transmitting obesity. Similarly, sometimes when you get take lean stools from a lean, this has been shown in experimental and lean mice and give it to a fat mice, it becomes lean. So, there's something in the intestinal microbiome, but it's not as simple as a simple substance.
(19:22) It's a whole environment. It's all the bacteria coming together, uh the products, what they produce, the environment, how they are fed in terms of food, all these things make. So, it's not so easy, it's complex. So by just giving one or two bacteria we should don't change. But the most important misnomer that most people would do is to take this probiotics.
(19:43) And this is what I'd like to warn people against. If you go on taking a probiotic which is supposed to be good. This is probiotic is a single species or maybe two or three species that are given together to you. Our intestine has 1,000 species of bacteria. So if you give only one species, one species, one species, slowly what happens? the whole bacteria population changes and becomes only one or two or threes which is not good.
(20:06) Diversity is important. You want to have many many different types. So probiotics are okay for short periods of time. So when you have a diarrhea after that you want to take probiotics. It's okay. But long-term probiotics is not the answer. Single bacteria not the answer. The answer is to study this very carefully. So still science in evolution and then give a mixture of all different types of bacteria and environment where they come from.
(20:31) It's the simplest thing of course is take a stool of these people they put them in pills they're called the crapsules the crapsules can be given in a particular so healthy individuals to those who are having certain diseases you can see that some changes occurs but what is happening in this field is more refinement is coming there are companies now which are taking 7 8 9 10 species of different bacteria putting them together for a short period you give them you'll find some changes in the metabolism and so on diabetes and all these As you rightly said, it's it's an
(21:00) interplay of lot of things. Prebiotics, the presence of bacteria, what you're feeding it, what it's producing postbiotics and how you're feeling in the mind, mood, energy, all this is the interplay. >> And uh it's very natural for humans to find shortcuts. >> Yes, >> they have very little time or they prioritize prioritize very little time.
(21:20) They want results in very quick results. So I think that is the way humans have been. I think they always enjoy shortcuts. That's how our dop dopamine systems work and that's also majorly how these com uh companies come in. Of course, when rightly used for short period of time as you said there could be metabolic benefits but depending on the sole therapy or a sole probiotic just thinking that everything will change is not right.
(21:48) >> Absolutely. You're absolutely right. >> Not right. And other interesting thing um about again little bit going beyond um microbiome towards mitochondria about the energy production cell in every cell that we have >> mitochondria also has become very central crucial to the entire cellular medicine today.
(22:12) Um in practice also we see people though two people from the same family eat same carbohydrates a person breaks down a person feels intolerant because of the absence of certain micronutrients within the cell as well. We have been seeing this a lot. >> Sir if you can on that >> probably some of the your knowledge is more in this than mine because the gas cell tract but my understanding is the mitochondria are like um the electrical stations in our body.
(22:38) They produce lot of electricity of power which the body all the cells have mitochondria which use the power that mitochondria makes to for various enzyme functions and all. And here there is a substance called NADH. The NAD NADP actually in the body gets converted to NADPH and the energy is released and this is what mitochondria do.
(23:00) >> So again there is a lot of hype that came with that. People start taking NADH thinking they can energize the mitochondria which is not right. We're still understanding that. So there is inherently certain people who have very active mitochondria which is producing lot of energy and all the glucose that comes is metabolized.
(23:19) If you have for in simple language a mitochondria which is not like that then you can have accumulation of glucose which gets converted into fat in the body in the liver and other places. So mitochondria plays a central part in our but unfortunately at present we don't have any way to change the activity of mitochondria still lot of work going on in this area where we can give antioxidants NADH all these are being trying in animal lab but >> a wrong practice that is done frequently I think this again to warn people that they go to this nutriaps you know where
(23:49) they get IV glutathione NADH all that saying that this is good for mitochondria that will be good this is not absolute >> I keep hearing hearing from a lot of people asking for do you do this can I take this my friends are doing it or my family is doing wherever they keep hearing this from or there's a hype some people have taken they're finding it better >> so I think context matters here right sir because a person having neurodeenerative disease will have defaultly >> unhealthy mitochondria they might feel better
(24:21) >> so what can work for one person may not work for another >> for general public it's very important to know about liver fat. I think maybe that's something you should normally people have fat in the liver but it's very small percentage less than 2%. If it becomes more than 5% we say fatty liver >> very often fatty liver is caused by alcohol or things like that or very obese people but when fatty liver is not caused by alcohol we call it non-alcoholic fatty liver disease.
(24:51) NA field is the term now it's changed to metabolic associated liver disease because abnormal metabolism can cause this fatty liver disease this as Indian population is very high and we found this non-alcoholic fatty liver disease in up to 80% of certain groups of population for example we did this study in IT sector >> and we found that 80% of people IT sector have very significant and we grade them into grade one grade two grade three of them in grade two or grade Three, you know this is again very sad. I think basically because this
(25:24) culture of physical activity has gone up. The most important physical activity too much of fast foods. Ultrarocessed foods are extremely bad. I think this something we should emphasize about ultrarocessed foods contain preservatives, coloring agents and all which change the microbiome which cause major problems also change the dopamine circuit in the brain.
(25:45) You want to eat more and more because they attack the body's asking more. So I think all these are causing a change. society. So the so-called non-alcoholic fatty liver disease even in lean people those may not be fat there wrong notion that you have to be obed to have even in lean people you're seeing a lot of this and we now know that this is the root cause of various disease for example if you have too much fat in the liver 20 30% fat that itself can produce diabetes that can produce heart attacks that can produce uh bone degeneration and so on
(26:15) so the liver has become more central for this so for the public I think we should emphasize that have when you go to ultrasologist if your fat in the liver is there try and quantify it by using a special technique called fibrocan which will tell you the exact amount of fat if it is more or very abnormally more I think you should see a doctor to see how you can reduce it there are drugs but that's the last resort I think it should be healthy lifestyle >> yes yes sir and uh as you said it could sound as simple as fat around the liver
(26:46) or a fatty liver but it could end up with a heart attack though people feel like there's a long way to go but >> um we have uh done this study you know more than 500 uh people now we saw that people who had um fatty liver above more than 500 g >> the heart rate variability was low pulse I mean pulse velocity and arterial stiffness were so high that means their blood vessels are aging faster than their chronological age >> so as simple as it may sound it is not going to harm me anytime soon.
(27:21) But they're already carrying the burden or progressive disease every day. >> Yes. >> So >> you're absolutely right. There's something in the fatty liver producing toxic substance. For example, uh they produce fatty acids. Lot of fatty fatty acids are going into circulation. These fatty acids will actually destroy the epithelial layer.
(27:40) So blood going into the liver again is partly blocked. Going to other organs is decreased. And aging occurs faster. People get they age faster. faster. I think uh prevention has been the simplest and best key for >> most of >> and most important I think we should emphasize prevention start from childhood. Yes, >> we all say after 50 years you think okay I'm now putting on weight but prevention start from childhood.
(28:04) I think we should teach our children this is very important. It's a wrong one of the very funny concept for example in US that came is that when a child gets up the first thing they do is give a glass of orange juice to the child before going to school and that's the worst thing because orange juice >> has calories fructose no fiber has preservatives and this is the best way to destroy a person's microbi produce fatty liver disease and so they're starting with a disadvantage from the beginning you know nobody drinks coconut water in the morning which is much more
(28:33) healthy helps the microbi and all so It's a orange juice. Uh I think this type of thing starting in children and most of children you know their breakfasts are some fast slice of bread with what happen even even India it's all all these cornflakes and all which again contain lot of preservatives and the traditional Indian breakfast is much better and we don't have the time for those things.
(28:58) So I think right from the childhood it starts again because of the stress of reading going through exam the physical activity is completely gone. Uh and and of course the social aspects also they're all the time confined reading they don't the only entertainment for them is eating. So naturally you tend to overeat. So it's it's a big pandemic I think especially in children.
(29:20) So we as a society and especially parents should take this very seriously that we should start inculcating these healthy habits in our child. Proper eating, traditional Indian food is still the best. High fiber, low carb, low refined carbs, lot of exercise and not emphasizing too much on u sitting there studying all the time. >> That gets us to sleep also.
(29:42) I think sleep is extremely important and >> more than ever we see now people wearing uh tracking devices and wearables. We see that more often now. >> Yeah. So this tracking devices is funny because a lot of people wear I know a lot of health conscious people wear I have view about them they're good initially now you have a continuous glucose monitor you can check what is your response so that's way of indirectly knowing what type of food you should eat and all the devices which tell you how what type of sleep you had
(30:09) whether this thing the the aura ring I think is becoming very famous the watches which smart watches which tells you how much you're walking how much energy you put what is your v max and things like that all these are uh my view is that okay initially but I think using them long-term all the time looking at this >> Bluetooth data anxiety >> so I think that causes more anxiety I would say that you can use it initially to track but later on I think we should start now that you know okay these are the things get back into natural thing
(30:38) >> so we all have those periods where we lose track it's often it's okay to have one health day on the body to get us in track it's good to adapt to the behavior but once you're on track I think we we should let go of all of these. >> Yes. Yes. Yes. >> So this was very interesting sir I want to bring this up.
(30:57) So we we we often see now recovery has been a great part of fitness journey performance individuals. >> So they wear variables morning look at the recovery score and then decide if how good or great the day is going to be. >> So interesting was people who didn't see their data went ahead with their day. Actually the day went great >> for people who saw and saw that the recovery was so bad in red.
(31:23) >> It it went worse than ever. >> So I think it adds >> yeah not to overdo this not to overdo this. I think it's very important a lot of people when what happens is you see all these um very successful people sundar p and all on interviews wearing all these devices and when they're talking people think okay maybe that's important but you don't realize that too much of concentration on that also is not good.
(31:46) If you can do initial tracking, see what is your baselines and then get back to natural. That's very important. >> That's that is very important. Also, there's one drift that we have been noticing. Suppose a person has been wearing a variable but never looks at it. It is okay and nice. Because if it has been 2 3 months, they have not been working out.
(32:05) They went for a travel or uh nutrition went off and their heart rate somehow has gone by 10 beats higher. That means they're carrying the burden of disease. That is where uh the data becomes important for a clinician or a physician because there has been 10 beats updrift and there has been 10 points down drift in the HRV then it makes u sense but everyday looking at the data can be >> yeah can be a problem but like you said >> init some baseline data and see what's the variation that occurring >> can help very much >> true that's it all this is definitely
(32:37) definitely exciting but I want to get to a point where Now since you're talking about data so today health data is not a problem. >> No >> gathering data also is not a problem. Interpreting it digesting it and intervening is a difficult part and last time when we had this discussion about multiomics it has it's going to be great.
(33:02) So I want to understand I want you to >> so this is I think again a very interesting aspect and this is where artificial intelligence is coming in. So our body is generating large amount of data every second. Uh we don't capture all this data normally. Some of these data are metabolic data like some of them are also very obvious things like heart rates and um you know your oxygen consumption and things like that which can be measured by various devices.
(33:27) To some extent we can look at this and say okay your heart rate is more so it's not good and very simple things but also in the micro level we are producing lot of data which is uh which is billions of data for example the genes are producing lot of substances in our body just take the example of a microbiome microbiome if you take it out in the microbiome lot of genetic variations are there in different different species the microbiomes producing lot of RNA which can be different types of RNA which is and now we know that RNA has got a huge
(34:04) activity the study of which is called transcrytoase transtoics then we have metabolites coming from that we call this metabolitics metabolomics and similarly we get proteins coming out is called proteomics so there are billions of data points and for a normal human eye to correct all this it'll take years and years together but using artificial intelligence we can correct all this very rapidly and say for example this person's genetic activity producing these things and at this activity is there and then the data becomes
(34:37) wholesome and then you can analyze this data to say what is his current omix data altogether we call it multiomix now all this multiomix data can be gathered again lot of this is in evolution we're studying them there's a guy in the world called Leroy Hood who who actually had a Seattle study center and uh they got this million.
(35:02) So what they're now doing is by studying 1 million Americans for the next 10 years using all this data at different points and see if you can predict 10 years before what disease would come based on this. So it's very interesting that is going to come out now and I think uh again for the public may not have practical value but this know they should know that there's a multiomics available that all this data can be integrated to tell you uh give you a certain um final viewpoints of what your health is likely to be what your longevity is supposed to be what
(35:34) are the modifications you can do in your diet excess and so on to get better results. So this is a very exciting >> very exciting field that is evolving into maybe in tomorrow's time we'll all talk about more about systems biology system biology the organ systems that we're talking about. >> So when actually came up with this concept of system biology 20 years back everyone including me we thought this guy what is he talking about? Why so many millions millions of dots to be connected? And now we know there are
(36:01) billions of dots to be connected. In fact, now they're thinking of using quantum mechanics to try and get all these data. So it's very fast. What you can do with regular computing which takes about say one day is about 10 minutes with quantum quantum. So ultimately that's where we going. >> That's where we are heading.
(36:20) It's exciting though it's exciting to see where the medicine is heading with the augmented intelligence, artificial intelligence, all of it. And people have already moved from the stage where now they know AI is not going to replace doctors anymore. we only leveraging it >> but what is that one thing sir that you feel AI can never um replace I mean it is it's not going to replace doctors for sure what is one thing that next stage physicians will definitely have >> so you know something Sam I taught a few years back AI may not be able to replace
(36:50) compassion in a doctor you know patients require compassion but I was actually surprised by this study which came in JAMA two years back where people had surgery done went back home and they called the hospital to tell followup you know and then sometimes they had complaints sometimes so then when the calls came in they were randomized into one calls which went to computer and one calls which went to human beings and when they analyzed from the patients response which was better the patients said that the calls
(37:20) which came from the computer more compassionate so they in fact better because they went on listening went on reassuring whereas before humans you get tired so so that broke the myth that we are more compassionate Right. But I think what AI cannot replace is consciousness. All of us have a consciousness which we don't still understand.
(37:40) The consciousness is something which can never fit into AI. Although in the movies you see you know robots and all having consciousness. The capacity to think reason out as a human being a computer can never do. I think that's consciousness is something that we'll never be able to achieve. That's my impression.
(37:58) I don't know things change but presently I would think that it's very difficult to put that into a computer consciousness >> that is very rightly said that >> people call it soul and other things but consciousness is a term that >> true sir a decade ago how your thoughts or perspective was towards AI is also your perspective in itself is changing that means we don't know there is a lot of unknown for all of us >> yes >> so I had this very interesting opportunity to meet Dr.
(38:26) Peter Clardia and Yuci Matias directors for digital health for Google health. So they were the people who were building this up-to-date medicine. So I had this opportunity was asking these same curious questions to them. >> Then um but I'll ask the question first and then I'll say that answer to you sir. >> If you are a physician uh if you're a medical graduate in 2040 >> Yeah.
(38:52) and you're studying medicine then and there is AI we don't know what else is there how differently would you study or uh what are the few things that you'll look forward to >> so I think it'll be different since there won't be all the standard textbooks and all that they won't be any longer there it'll be case-based individual med individualized medicine the patient comes with this thing what does he have and also we'll have so much of data coming in along with the patient it's not just Clinical examination unfortunately the art of clinical exam
(39:22) is going to go to lot of database treatment so patient comes to you he says he has fever for 10 days not getting cured but he has a whole lot of all the tests everything done AI has already analyzed that this page even now you put all this in chat chat GPD you get some answers so already giving giving you >> so then as a doctor your >> concept is totally different your way how you approach your patient how you treat is going totally different It's and then our duty at that point of time is just to see whether a is okay or not
(39:55) whether it's doing right things. Yes sir. >> And then adjust the doses and so on again which will be depending on patient medicine. So it'll be totally different mechanically also a lot of things that robotics would be doing that which now what we're doing with the hand like endoscopies and all that robotics would probably be doing robotics.
(40:13) So our role would be getting little more distanced from the patient and these things take over completely. That's that's my imagination. >> It's very interesting to hear that some very great takeaways. One individualized medicine client comes with patient comes with lot of data. We little bit distanced but still making the decisions.
(40:32) So decision maker is still the physician. >> Compassion yet is still there is AI or robots still learning. >> So other three uh this is fantastic. like I'm enjoying this conversation. So what I learned from or what the conversation was >> perception, perspective, empathy, ver trust and verify. These were the few things I heard as you also said trust but as a clinician you're very has it given good prediction or outcome or action plan or not >> and as you said consciousness >> yes >> uh perspective of the clinician still matters though AI could be giving
(41:12) something else >> so that is very interesting and exciting to see where medicine is heading and where medical graduates could be learning interesting things >> yeah it'll definitely change the world is changing in all aspect effects. >> Yeah. >> So the question is whether all this will produce healthier lifespan, healthier longer lifespan or not is a question that we'll have to because whatever progress occurs, something else occurs to spoil it.
(41:36) The fast foods came in to spoil all our progress in healthy nutrition. So on something else keeps coming in but I think we are in a very exciting field because we are in this crossroads of AI understanding all this multiomics putting all this together and now thinking lot on uh health spans and wellnesses which we didn't maybe 10 years back I think all this changing >> moving from there little towards um population averages we have been practicing medicine definitely evidence-based medicine But whenever we try rating anything it could be uh the
(42:13) biomarkers or the medicines we always look at population averages we want every individual to be in that age bracket >> but since we're talking about healthy lifespan years now we don't want people in averages >> yes >> so we want the biomarkers also to be optimized to the best functionality or the best metabolism so where do you see sir uh how can we move away from the aid based population averages towards optimals.
(42:43) So actually most of these population averages are have this bell-shaped curve you know the standard bell-shaped curve where majority come in the center and then the outlier on side. I think we have to change the bell-shaped curve now we have to make a curve which is more unilateral that is on one side it goes up where most of the averages should come on that side.
(43:04) So ultimately I think to have optimum health span and so on we have to look at all these biomarkers hinging towards optimum level in majority of population now we're saying 40 50% of population has 40% as this then you should talk about 70 80% of population having this type of and that ultimately should be arignment of course biologic the biological behavior varies it doesn't follow because whenever you look at biological behavior you have the ideal situation only in about 50% of the population rests are outliers but that has to be changed. Yeah,
(43:37) >> as very rightly said sir uh since we can't put every person they could be either falling in that outliers or the normal >> because uh we have been seeing HPA1C's are around 5.5 5.6 non-diabetic zone but still they're carrying the burden of the disease because we see their fasting insulin levels are more than 25 they're hitting 30 and have fatty liver.
(43:58) >> Yes. So that's the typical situation for insulin resistance to occur and then things follow up. >> Things follow up as you're saying prevention should definitely begin from the childhood. >> Childhood I think that's very important. We should emphasize public that you start prevention right from childhood.
(44:14) Right from 2 or 3 years age of child they should start thinking about what is optimum for this child in terms of nutrition activity very simple thing I think we've discussed all very high-fi things but it boils down to very simple >> of healthy lifestyle which means adequate exercise nutrition which should be again very simple our ancient nutritions are example of how healthy nutritions are I think de-stressing ourel of course here meditation yoga and all come and the fourth of course is sleep which we didn't discuss too much
(44:45) but I think sleep is something which again people don't understand so very well uh the amount of sleep each person needs the type of sleep the REM sleep the non-REM sleep and all those things so if you actually break it down into these four simple things that's all health is about and uh I think people say then why did our older elders don't didn't live so long elders because infections were a problem yes >> the mortality rates were high because we take out the infection part we run statistics actually take out the
(45:13) infection part our the lifespan or health span of our ancestors was much higher than what it is now if we take out the infection part >> yes but people like to look at the other way around oh they have also been eating the same food that we are eating they were >> no I think they changed I think the type of food they're eating is completely different all these preservatives artificial foods were absolutely gone and look at some of the practices they used to have like they used to soak rice you know overnight and then that kanji
(45:42) and all that you know Now that you know that it becomes very highly microbiomic and then you're taking it in the next day morning. So these practices fiber the amount of fiber they eating a huge compared to the fiber that we used. There's no preservatives in their food. Most of the farming was organic you know everything was totally and the other problem now >> more sunlight exposure to that >> more sunlight exposure and also the type of um even the animal protein they got superior because now animal proteins now
(46:08) antibiotics or plastics of course that's another problem microplastics in fish and so on so I think there was huge amount of difference >> so if you actually take out the infection part they were much much healthier than us >> yes very truly said sir if we can follow similar lifestyle to what they led is more than enough for us to live 10 to 20 years more than what we live today.
(46:29) >> And not only live but in a healthy way. You want to all live healthy way. And dementias for example, we now know that there are lot of emphasis on mental health because that's becomes very important and lot of dementias are related to nutrition, microbiome, environment, microplastics. All these are again interconnected and which was so you see many of our older like our grandparents were very mentally sharp till they were 90s or something.
(46:55) Now it's very rare to find somebody very sharp. Most of them would have almas and so on. And look at the incidence of autism we're getting now. Huge amount again because of something in the environment causing. So I think this is we'll have to get back to our old days. >> Get back to our old days.
(47:10) And I think we should invest more time in cooking, cooking method, slow cooking, slow eating. When we ask people do you chew your food? They feel it's a very alien question. But that was the basics where digestion starts. And uh I think that >> saliva plays a very important role in dish. It contains a lot of we're now starting to look at saliva.
(47:29) It contains lot of very important substances which breaks down the food. We don't give that enough time for >> once the food is on spiggy it's in the tummy. So it's like that fast the root has become. >> So I think bypassing taking shortcuts has been the major reason for what we are facing today. And on top of it now we have uh social media uh constant screen time that is constantly hitting this headonic circuit as well.
(47:55) >> So I think that is feeding to that loop also is feeding to eating behaviors. >> Yes. Well I think all this in the midbrain they all very close circuit the circuit between and all this controlled by dopamine release and dopamine you know is a a substance that gets released when there's a high.
(48:13) So each time you want to get high high high with all these things that's a problem. >> So this is personal question I want to ask you sir. You are very busy person. >> Yes. >> From starting to end uh starting of the day till the end of the day you play many roles. You have many hats. You research practitioner clinician build things manage things? How do you take care of your health? >> So I for me it's very simple.
(48:37) Uh I of course work long hours. The only complaint I'll have is probably in the sleep. Sometimes the sleep amountless but I think I can manage that by going into REM sleep very rapidly. So deep sleep you don't waste time on non-de sleep but what I do is typically my day starts at 7:00 I come and then uh in the morning is to thinking the research part reading journals and so on.
(49:01) Then from 9 the routine work starts. Um usually I go up to 12:00 in the night you know work. I whatever I exercise at least one and a half hours every day. I make it's compulsory. I have my personal gym. So I'm doing uh 45 minutes of aerobics strengthening of muscles for 15 20 minutes and stretches another 15 minutes. So this is part of me.
(49:23) It's not just 5 days, 6 days, sometimes 7 days a week to exercise. I'm extremely careful with food what I eat because a lot of temptation the biggest problem with doctors is patients come and give you sweets each time as a gift. you know that in western world is wine here it's sweet so I immediately see it goes off to I don't want so I'm very careful I have a personal chef who does calculates how much proteins are required and all and it's always all organic type of food I never ultra food I'm totally against uh so exercise diet and sleep the third
(49:55) important I think for me the way I sort of captured it was that if I really work very hard if I'm working 18 hours it is very difficult you get tired your brain gets you know burnt out. So I have sort of converted my work into enjoying. So when I do endoscopy I enjoy myself. I see the pictures.
(50:13) I'm when I talk to patients I enjoy enjoy listening to their stories solving their stories or when somebody gets better the pleasure you get out of this. So my whole day is full of enjoyment. I keep enjoying it and when you enjoy things then it becomes much more easier. >> I think this is the fifth element of living and getting healthy which is we say guy.
(50:33) So the reason for living >> enjoy the reason for living >> it's enjoy yeah so I think in all our relationship that's important even in a family you see all these fights coming in people are very tense they're not relaxed they're not enjoying life and life is after all maybe 70 80 years 100 years you live very short after that you're gone nobody knows what happens so in that period I think if you enjoy your life your all your hormones get set in the proper way your metabolism gets set and so we that's something that people
(51:00) are missing out uh it's partly stress model or whatever it is. But I think and also it doesn't depend upon the wealth you have the the setting you have. It's just that how you take your life. You take your life as a whole series of enjoyments and you'll enjoy every conversation like we're now having a very interesting conversation.
(51:22) We enjoy that. So everything should be like that and it should be very >> I think this is the fifth element that we we should had from for all the four elements. I think your lifestyle in a day has defined all these five elements very thoroughly about sleep, relationships and your uh passion. You're enjoying your life.
(51:41) You're exercising nutritionally. You're taking care of yourself. >> Contrast to all of this. Okay. There is one interesting thing I hear from people. >> Indians treat food as an experience. So they say food is an experience. uh my sister or my wife or made a very sugar rich cake or I need to enjoy it. Okay.
(52:06) For people asking these kind of questions. >> Yeah. No, I think food is an experience. Each time you eat it's an experience because right from your mouth receptors are going into the midbrain from your stomach everywhere. So food is an experience. But I think this should be experience that you don't overindulge in. >> Yes. >> Just because you say going to Kashmir is experience.
(52:26) You don't go to Kashmir every day. So it's >> so the same way if somebody is making a very nice desert you your somebody in the house has made a small part you can take once in a that's not going to change your metabolism but eating it every day know there are people who eat desert every day after every meal saying they're used to that that is a problem.
(52:45) So if you do it occasionally still an experience. So I think they people mistake uh this of course the common saying of we are not living to eat but eating to live that's very easy to say that that's a I think one should enjoy a food not that you shouldn't enjoy but I think it should be it should not actually destroy you otherwise.
(53:05) >> Yes I think actually I sometimes in fact my concept changed long back when I had gone as a very youngster. I was not very into this nutrition all that world congress and this world congress of gastrontology after the congress were over we all sitting outside on the beach there this was in us a nice beach was there and I found that all the delegates you know some of them had pot bellies and all was sitting and watching and all the speakers that is the those who were the more experienced guy the speakers were all running on the beach so that
(53:39) differentiated who was a speaker who was a delegate so to For me that was very striking that um as I think it's very important for all doctors not only for all doctors should set an example to the public uh that healthy lifestyle they should follow themselves so that when the patient comes to doctor he knows that what he says is true otherwise I find it very now sometimes you have doctors or pot bellies and all treating patients it looks a little odd so we should set an example by example yes yes >> it is very true too So we have been
(54:12) talking about where medicine is heading to public awareness to building systems to systems biology to your personal life. Now I think we have talked all about this very interesting stuff. Let's step outside and I want um to all the physicians who are building things. >> Yeah. >> Thinking new uh propagators, promoters, that is when practitioners come in.
(54:39) They're early onset promoters and propagators. What is that one message sir you want to pass on to >> those physicians who are trying to build things? >> Yeah. So I think the most important one if it's one message should be never stay quiet at your comfort zone. So all of us reach your comfort zone.
(55:01) You're a physician, you're practicing or you started some small thing, you get enough number of patients are comfortable. If you stay at your comfort zone, you're comfortable rest of your life. Whenever you reach your comfort zone, raise the bar up. So now okay, now you've got big practice.
(55:17) The next step is how can you build an institution? Raise the bar up. Okay, building an institution doing middle. How can I build more institutions? Then how can you build a research institution? So I think each time you raise the bar, you reach a different level. Sometimes if the bar falls down like in a high jumper, I know balls, but if you put it back and try again, you'll definitely jump out it.
(55:35) So never settle at your comfort zone. Keep raising the bar and then of course you'll see success coming in. the other factors you know like uh teams how to build teams how to be positive how to get help from the correct people and those things but the basic concept is to never settle at your comfort zone >> I think this is a great message for all of us who uh look up to you every day get inspired especially um I'm way more inspired by how you look at things very proactively like when it comes to AI precision medicine
(56:08) >> all these things and um people like because we feel very courageous when we see when we look up to a senior who has built and is looking forward and also we want to work in the same direction. I think this is very important. >> Yeah, I think we should we should keep all the time.
(56:25) If you're static, if you stand there, the world goes off. You have to keep walking walking all the time. >> Yes sir. We have been learning and who better than you. Uh we we keep learning all the time. Thank you for your time sir. Thank you so much. Thank you for uh having this very interesting conversation. I enjoyed this conversation.
(56:45) Again this is for uh all the public who are um listening. Again today we talked a lot about public awareness, primary prevention, all basic five lifestyle habits that all of us should start building to prevent from bunch of diseases, lifestyle diseases we now know are very much preventable and can add decades of healthy life years to this.
(57:04) >> So and also for practitioners out there, please break your barriers, break out of your comfort zones, start to build things because knowledge which is not transferred is >> is wasted. waste. So thank you sir. >> Thank you Sam. I think again congratulations to you and your team >> for thinking different from what an average physician.
(57:24) Your concept of functional medicine, longevity, health span I think all these are very important concepts. Not many people in our country have taken this up as the solo aim and you have done this very well and hopefully the institute keeps growing. >> Thank you. Thank you very much sir. >> Thank you. >> Thank you.