Doctor Breaks Down Constipation, Piles & Gut Health

Doctor Breaks Down Constipation, Piles & Gut Health

Author Name:Ryan Fernando

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

Youtube Video URL:https://www.youtube.com/watch?v=Pt_Rp8XuAtQ



Transcript:
(00:00) The only cancer which is diagnosed late in the country's colorectal cancer. >> Dying after a fight with colorectal cancer, the second leading cause of cancer death. Colorectal cancer is now the number one cause of cancer-related deaths under the age of 50. >> My name is Chrissy Garrett. I am currently 34 years old.
(00:18) >> My name is Santosh Jain. >> This is the one of the fastest growing cancers in the country. >> I was diagnosed at the age of 26. >> My life has been stripped from me. >> It was heartbreaking. Colorectal cancer is the fourth most common cancer in India with over 64,000 new cases and 38,000 deaths reported in 2022.
(00:43) [music] Dr. Mia board, what's the biggest problem India is facing today? >> Constipation. Constipation is hard. >> [laughter] >> 44% of the Indians have lifestyle constipation. Every single person in this country, at least once in lifetime they use the word constipation. Talk to me about quackery [music] that's happening.
(01:04) >> is a person who practices medicine without [music] having any prerequisite qualification. You will see some roadside tents now. >> Yeah, yeah, you see that, yeah. >> Radha Krishna, all gods they use there. One quack in Bangalore rural, he will use a bullock horn to, you know, this [music] tightness. You will use a bullock horn to put inside and widen it.
(01:27) Another quack is there where he will take betel nut juice. His saliva has got some healing properties. He will chew that betel nut leaves, put it on the tape of like lungot, you know, you should tie it for about 2 weeks. Every day they come, he will [music] chew betel nuts, put a lungot, tight. >> This actually exists in our country.
(01:42) >> Country in Bangalore, in Karnataka, around Bangalore. What is the problem with children today? >> Pizzas, [music] burgers, french fries, chips, pasta. No fiber in it. No fiber in it. What [music] are the reason because of these eating habits, Ryan, children are developing IBD, inflammatory bowel diseases.
(01:59) Which is Crohn's disease and ulcerative colitis. A very bad inflammation in the gut. Out of [music] every 100 cases diagnosed, 25 are in children. Can you imagine this? And this ulcerative colitis and Crohn's disease, you can't cure that. There is no treatment. What is the youngest cancer case [music] you've operated on? Uh The road to health is paved with good intentions, but in this case, [music] good intestines.
(02:24) Hello guys, today I'm sitting with a doctor, someone who has done immense work over the last two decades treating thousands of patients with piles, fistula, constipation, and even [music] colorectal cancer. He's one of India's leading colorectal surgeons and the founder of the Smiles Institute of Gastroenterology in Bangalore.
(02:41) Yes, you heard [music] me right, Smiles, Dr. Parameshwara C. M. And the moment I met him, he threw a smile on my face. Now, what I really liked about doctor is how simple and how humble he is. At the same time, the vibe he carries is so electric and so energizing, [music] it just connects. As a nutritionist, I always see the gut as the center of everything, [music] digestion, metabolism, almost like a second brain.
(03:03) And when I met him, I genuinely felt we were on the same page when it comes to understanding the gut. This podcast today [music] is about you and me understanding the gut from the guy that goes deep inside. Okay, without wasting any time, let's start. [music] And I can tell you this, this conversation is going to make you look at a lot of your daily habits very differently, which is why we're bringing this podcast to you.
(03:23) [music] It might even challenge things you've always thought about that were normal with your gut. So, let's [music] break some myths, talk openly about your poop, and really understand what your gut [music] has been trying to tell you all along. Doctor. Yeah. You're a gastroenterologist. >> Yes. What does that mean? Gastroenterologist.
(03:49) Gastro is stomach. Yes. Enteron is intestine. Okay. >> So, we treat diseases of the stomach and the intestine. That's why it's called as gastroenterologist. And what's the size of this organ? It's 30 ft from entry to exit. 30 ft? >> 30 ft. Wow. You know, 30 ft is not in Bangalore? Yeah. 30 ft from entry to exit.
(04:12) So, when you as a doctor are looking at it, Yeah. you're analyzing 30 ft. >> Wow. What are the biggest mistakes Indians are making today with regards to this organ, the the stomach, the gut, the intestines? >> Yeah. The common mistake is irregular food habits, irregular sleep, less water, less fiber, processed food, packed foods, junk foods, they eat at odd hours, cravings, midnight 2:00.
(04:46) So, these are the common mistakes every day every Indian is doing in this country. Unknowingly. I just want to pause you over here. >> Yeah. Now, doctor is not an influencer. >> Yeah. He's a surgeon. >> Yeah. You operate on people. Yes. So, you are talking from experience of seeing people do this. >> Yes. Talk to me about what's the biggest problem India is facing today.
(05:10) Constipation. Constipation is one of the India's biggest problem India is facing today. Okay, what do we call constipation? Because everyone uses this term very liberally. >> Yes, yes, yes. Ryan, every single person in this country, 1.47 billion population, at least once in lifetime they use the word constipation. It is a most abused word.
(05:35) Okay. Okay. Number two. 15% of Indians have constipation which has to be treated. Sorry, say that again. >> Which has to be treated. 15% of constipation which has to be treated. Either medical management or a surgical intervention or a physiotherapy. Right? 44% of the Indians have lifestyle constipation.
(05:59) You said now, what are the common mistakes Indian make today? 44% of Indians have lifestyle constipation of water, fiber, fruits, sleep, physical activity, smoking, alcohol. For my fans out there, >> Yeah. okay, I'm going to assume that we don't know what is constipation. Is it got to do with the stomach, intestine, or it is the byproduct that is coming out of this organ? It is mix of both. So, we call that stool? Stool.
(06:31) Poop. Poop. Are there different types of There are different types of shits, Ryan. We'll come to that. You take every day, no? Sometimes. You take every day from people around us. Yeah. Yeah. So, now I will you asked me different types you asked, right? Yeah. Constipation. Yeah. Yeah. Number one is one type of constipation is people go to the washroom. Mhm.
(06:57) They sit in the washroom Mhm. and they put pressure. Okay. The normal time is about 7 to 10 minutes. Okay. >> Beyond 10 minutes if they sit in the washroom, Mhm. see, they put pressure Huh. and the poop is not coming out. >> Huh. In this condition, when we pass stools, we put pressure on the abdomen. Yes. The muscles push down. Correct.
(07:18) The rectum muscles open. Yes. >> muscles open. Mhm. They push, they open. But here, they push, this also closes. And that's constipation. Yes, one type of constipation. >> Okay. Understood? Yes. So, this is called as dyssynergia. Okay. There is no synergy between the abdominal muscles and the rectal muscles. Can I ask a question? >> Please.
(07:42) A lot of people think that they have to go first thing in the morning. >> Yeah. Could that be that they are not designed to go first thing in the morning? These people, they think all of us are designed first thing in the morning is this. Yes. They go there, they put pressure, it doesn't open. And they say I'm constipated. >> I'm constipated.
(08:01) But I I ideally speaking, they have a different poop regime. Different poop regime, no. Huh. They have one type of constipation where there is no synergy for abdominal muscles and sphincter muscles here opening. So, this is one type of constipation. This type of constipation, unfortunately, the parents abuse children. Children are abused.
(08:25) They say, "My daughter takes mobile to the washroom." I had a child of plus two grade. Parents come, child is sitting, abusing child there. She doesn't drink water, she doesn't take fruits, she doesn't take vegetables, she takes mobile to the washroom. Child is crying. I do all, sir. Mhm. Your parents are complaining that you don't do anything. I do all, sir.
(08:48) Then what happened? Sir, I sit in the washroom, I'm not able to poop, sir. I put pressure, it doesn't come, sir. That's why I sit in the washroom for a long time, sir. From how many years you're doing this? Sir, from fifth grade, sir. She was in seventh grade now. Then after that we investigated this child.
(09:10) It's like delivering every day putting pressure on the pelvic floor. We have bladder, we have uterus, we have urinary rectum. These muscles hold this three organs. This child is putting pressure every day. Little child of 16, 17 years, she had urinary incontinence. What is urinary incontinence? When this child coughs, Yeah.
(09:38) laughs, sneezes, in the school she cannot go for a sprint, urine will leak. That is urine incontinence, which is called as stress incontinence. Because of the pushing. >> Huh, because of the pushing, bladder also come down. >> [snorts] >> The second type of incontinence is urge incontinence. Child is studying in study room.
(10:00) She wants to go to the washroom. Before going there, she can't hold it. She can't control it. Urine leaks. Child did not tell this. When I probed this, child says, "Yes, I have so." When we investigated, bladder was at come down. There was pelvic floor muscles relaxation. Rectum had come down. One senior bureaucrat in the state has the same problem.
(10:26) So, this type of constipation is under-diagnosed. So, they are taking a mobile phone to the toilet. >> Yeah. Is that also part of the problem? Yeah. How? There are two things, Ryan. One is these Gen Zs Mhm. for them everything happens in mobile in the washroom. WhatsApp, email, chats, social media, everything is in the washroom for them.
(10:51) The new term is something called as bathroom camping. They feel it is safest place on the planet where there is no stress. Husbands get inside the washroom. They feel there's no stress outside there. I'm happy inside in the washroom. So, they do all the work in the washroom. They sit for hours together in the washroom.
(11:10) You must have seen, no? Washrooms are a new luxury at homes now. True. Am I right? Yeah. >> So, washroom bathroom camping, this is one. Second thing is they are not able to push their poop. They don't want to waste time there. They take the mobile to the washroom. Thinking that they can relax. >> Ah, relax. Do some work before the comes out.
(11:34) The doesn't come out, they come out. That's it. So, will it break some sort of signal between the brain and the the poop sphincter when you are distracted? No. There are some people, Ryan, you must have seen in your clinical practice. They come and tell you, "If I don't smoke, I don't poop." Mhm.
(11:55) What's that? Huh? People are habituated to it. Their brain is designed, their gut is designed only when they smoke, it moves. It's become habit over a period of decades. >> But is it important for people to break the taking the mobile phone or the iPad to the bathroom? >> Very, very important to stop it immediately from this moment.
(12:16) So, we are talking about constipation, right? So, we come back. >> [clears throat] >> One of the constipation was the signal not reaching. What are the other constipation? >> The other type is, Ryan, uh you know, irritable bowel syndrome. Mhm. Your stomach is normal, your intestines are normal, your big bowel, large bowel is normal. People have constipation.
(12:36) So, one type of constipation is IBS constipation. Irritable bowel syndrome constipation. So, this type of constipation is also in huge number in this country. Right? The other type is chronic idiopathic constipation. There is no cause. They are constipated. So, so, doctor Yeah. that means sometimes you can't figure out the problem in this? >> Yes. Tell me more.
(13:02) >> no functional problem. You do endoscopy, it's normal. You do colonoscopy, it's normal. All your gut microbiota test we do, it's normal. And they have constipation. So, it's the problem in the brain here. So, we treat this with tablets. That's it. They will settle down. Are there any other types of constipation? >> Yes.
(13:21) Another type is, sudden obstruction. Huh? Some growth in the colon. Some growth in the large intestine. There is obstruction. Poop is not moving. There is a jam there. Like Bangalore city traffic jam, right? So, there's a jam there. So, this type of constipation is called as obstructive constipation. This is commonly seen in colon cancers, colorectal cancers.
(13:50) Do different genders and ages >> Yes. have different constipations? >> Yes. Children. Just born children. There's something called as Hirschsprung's disease. Where there absence of nerve fibers in the gut lining. So, they have one type of constipation which is by birth. Next is the old age. Old age, you know, the muscle motility comes down.
(14:20) So, they have some type of constipation called as motility constipation. Then, one of the biggest problem country is facing, specially women, is constipation after delivery. Mhm. After they deliver a child. What's happening is one out of two mothers who have delivered have this problem. What is the problem? One out of two mothers. Very scary numbers.
(14:48) What happens is there is a normal delivery happening. People prefer normal delivery. Correct. >> Right? But actually C-section or a normal delivery should be an informed choice for the mother. The obstetrician will explain what are the consequences of a C-section, consequences of a normal delivery. Here in normal delivery, what happens is if the doctor says, uh "We will do a C-section from day one.
(15:23) " when she conceives, this physician doctor will go to some other doctors. There's a blame on our obstetricians that they do unethical C-sections. So, what this obstetrician does is through 9 months, she will promise that we will go for a normal delivery. It so happens the mother is short, very narrow pelvis, and there is a big baby.
(15:49) People expect normal delivery. So, they go to obstetrician. The delivery, labor is happening inside the labor room. Outside there are, you know, husband, husband's friends, in-laws both sides, they are there. So, this doctor knows that normal delivery will not happen, but she has to try, no? Otherwise, they'll think she will directly go for a C-section and make money.
(16:14) So, this obstetrician will come out and tell, uh "I tried normal delivery. It's not happening." The person like me will be standing next to the husband. Husband is panicky what's happening inside. I tell him, "No. This lady is, uh, money-minded, unethical. She makes money by doing unnecessary C-section." This is mother-in-law will hear, "Ah, yes, my son, this lady is, uh, planning for a C-section to make money.
(16:42) " Then, they take a decision, "No, don't do C-section. Go for a normal delivery." So, while doing that normal delivery, there is a push happening. Push happening. So, while pushing, sometimes the baby doesn't come out. Mhm. They put a vacuum and pull out. Mhm. Or they do an episiotomy, it is called.
(17:02) Or they put a forceps and pull out. While pulling out, the urinary bladder is in the front. In the middle, there is uterus. Behind, there is a rectum. Mhm. All the three will come down along with the pelvic floor. So, this one, post-delivery, the mother, when she passes stools, it will not be complete. It will be incomplete. So, when it is incomplete, the mother is not able to poop completely outside.
(17:30) Some amount of stool is stuck there because the rectum is sagging down like this. It gets stuck there. Can this be corrected? Yes, it can be corrected. Very much. But it has to be diagnosed to be corrected first. Okay. Uh this happens what the mother does is, very painful it is, uh. I have seen mothers suffering for 20, 30, 40, 50 years.
(17:54) I've seen mothers coming with grandchildren. Grandchild says, "My mother had this, my dad my dad was born since the day my dad is born, my mother has my grandmother has got this problem." Mhm. Right? So, what they do is they go forward. They go backward. They go right. They go left. They put pressure on the abdominal muscles. They put pressure on the back.
(18:15) They put pressure around the anal canal. Some others put finger and take it out. Some try powders, laxatives, colonoscopies, Ayurveda, homeopathy, everything, yeah. They would have seen at least 25, 30 doctors and given up. Mhm. So, this is one type of constipation which [snorts] is bothering every alternative mother in this country.
(18:40) Every alternate mother in this country. Right? So, people watching this show, I'll come to that later. So, this is one type of constipation. Along with this, Ryan, you was mentioning that child story, right? Mhm. Urine leaking. Here also the bladder comes down. Mhm. When the bladder comes down, the mother, when she coughs, when she sneezes, when she laughs, the urine leaks.
(19:09) When there's urgency, when she has to go to the washroom, the urine leaks. Because of this, there are repeated urinary tract infections. They go to the doctor. Urine test, urine culture, antibiotic. Urine test, urine culture, antibiotic. This keeps on happening repeatedly over a period of time, decades.
(19:34) What is the scan that can be done or what testing can be done to discover this problem? Yeah. So, a lot of people come to my clinic, right? >> Yes. >> UTI, UTI, UTI. UTI. >> And we try and think only nutrition, probiotics, but we don't realize it's a functional problem. >> a functional problem. When the urine leaks, it is on the private part.
(19:53) It's there. They can't clean it. So, they get they landed up in they land in UTI. >> Does the patient know that there is a leak or sometimes it's >> They know that there is a leak. They know that there is a leak. And many people they go to doctors and say it's normal, don't worry. Tell me, Ryan. Mhm. >> The urine is leaking for a young lady of 28, 30 years.
(20:16) Uh I had a story of a bureaucrat where she said, "Sir, I'm not sleeping with my husband, sir." Why? "So, my urine leaks and I've got UTI, sir." What if he gets UTI? She says, "Whenever I sit, whenever I sleep, I sleep next to the washroom, sir. I can't control, sir. When I travel, I don't drink water, sir." >> This is after she's had a kid.
(20:44) Yes, two kids. Normal deliveries. "When I travel, I don't drink water, sir. When I go to uh uh uh uh movies, I don't drink water, sir. When I go to functions, weddings, ceremonies, I don't drink water, sir. This is the problem I'm facing, sir. How to solve this? I've gone to any number of doctors, sir.
(21:03) My UTI is not coming down. So, irrational use of antibiotics in this country, you'll agree with me, Ryan. Your gut bacteria is destroyed. Yeah. The biggest cause of death in the world is not cancers, not cardiac problems. It is antimicrobial resistance. India, this year, will [snorts] be declared as the antimicrobial resistance capital of the world.
(21:35) Any doctor you go, Ryan, antibiotic. They don't know why antibiotic. So, this is the problem India is facing, especially with mothers. And you're seeing this in your surgeries? >> In our surgeries. In our clinic, out of 10 women, six have this problem. Six have this problem. People from all over the globe are coming to this problem here, to my hospital.
(22:05) So, we've talked, doctor, about children having constipation, um teenagers having constipation, young adults, mothers, and elderly people. >> Yes. Yes. What happens if constipation is not treated? >> Yes. Uh Ryan, constipation is the mother of all diseases in the butt. >> [laughter] >> I'm also laughing because there is a joke about uh if the if the anal sphincter closes up, the brain thinks he's the boss. He's the boss.
(22:36) He's the boss. But actually it is the the If you poop correctly, >> You true. This anal canal, it is only 2 cm, uh It so happened there was a discussion happening between brain, heart, lungs, kidney, and these fellows, uh Brain says, "I'm the boss. I control the whole orchestra." Heart says, "Man, if I stop for a second, you're out, uh" Lungs says, "If I don't give oxygen, heart, you're waste, uh" Kidney says, "If I don't excrete, you're also waste, uh" This guy anal canal said, "How come you guys are telling you're the boss? I am the boss."
(23:11) Hey, shut your mouth. You're just 2 cm and you say you're the boss. Okay, take it. Shut your ass. This will shut. And keep quiet. And there is traffic jam. Then finally everybody agrees, "No, no, boss, you are the boss. Please open it." So, then goes out. Understood? So, the the constipation, if the doesn't come out, this is the mother of all diseases, constipation.
(23:39) You know in the US how constipated they are and they land up in big problems, no? They land up in piles, fissures, abscess, fistulas, polyps, diverticulum. So, these are the consequences of constipation. Can you tell me what is each one so that our audience knows what is a pile, what is a fissure, what's a fistula, so they have a problem and watching this, they might know that, "Hey, I need to get this checked.
(24:06) " >> Yes. Ryan, the biggest problem in this country is anything happens in the anal canal, it's a taboo. Taboo. But why is that? >> I'll tell you. Because even in the US, even today it's a taboo. Oh, it's not only India. Even in the US. It's a taboo. Even today it's a taboo in India, US. It reminds me of one Squatty Potty story in the US.
(24:33) In 2015, a case study was done by your institute, IIM Ahmedabad, on Squatty Potty. Squatty Potty, one couple, they saw big problem in the US, constipation. So, for that, they were to make a stool, raise stool, to convert this European commode to Indian commode. They designed it and they wanted to place it in stores.
(25:01) The store people say, "Sorry, we don't keep that because it's a taboo subject. People not buy it. And people doesn't want to open in public." Then these people tried, "Let's try some influencers." They didn't have money. They went to small micro influencers, paid them little money, and said, "Why don't you do some content on this?" It was done. It became viral.
(25:22) Then the Shark Tank guy came. He invested in that. He's a billionaire now. So, it's a taboo even in US today. People are bullied. They make fun of constipation. They make fun of these gases, bad odors. They make fun of this noise, gas noise. They make fun when people can't walk properly. "Hey, this fellow has got piles here.
(25:43) He's got fissures here." So, people, you know, whatever happens in the anal canal, in the butt, it's piles only. It may be fissure, it may be abscess, it may be fistula. For anything, they think it's piles. 78% of people come to us, "Sir, I've got piles." They don't know what they have. They come to us with piles.
(26:04) But when you examine them, they may have a fissure, they have a fistula, they may have piles, all the three, or they may have a colon cancer also. What are the differences, doctor? Yeah. Simple. When the anal canal is tight, when the muscles are tight, when the stool is hard, when they put pressure, it cracks. That crack is called as fissure.
(26:28) When it cracks, it pains very badly. It bleeds. It burns. People just can't sit on the chair. I had a patient from the IT industries. Saturday, bottoms up. Mhm. Sunday, bottoms up. Mhm. Monday, bottoms down. >> [laughter] >> I'm sorry. I'm sorry. I'm laughing, but it's Got it? Yeah, it's really funny. >> once it happened, uh this guy came to the hospital and I came at 7:00 and this walked in at 6:00 in the morning.
(27:05) There were blood spots on the floor. Entry. Then he was taken to the third floor in the uh the room where we do scopy. I went there and asked, "What happened? What is this blood happening?" "Sir, I had a party, late night party, yesterday and day before, sir. Morning when I pooped, it was like such big elephant elephant poop, sir. Mhm. And I passed the stools and I saw very bad fissures here because of big poop.
(27:33) Because of dehydration, overeating, junk food, >> Alcohol dehydrated. >> Alcohol dehydrates very badly. And after some time, one peg or two, you know, until they go to bottoms up, they would have forgotten what they would have eaten. Whatever comes, they would have eaten. Mhm. Including the mud there. So, this very commonly I see on a Monday morning in my hospital with bad fissures.
(27:59) And we work on Sundays as well. Sunday morning also I see such people. Because Friday, Saturday, the weekend. >> Friday, Saturday, weekend. Sunday morning also we see that. And most techy people today, or even the youngsters, Gen Z, they don't stop at one drink. >> Huh? >> It's a peer pressure to finish eight or nine drinks.
(28:16) >> Eight or nine drinks, uh full bottle they want to finish. >> And in your time and my time, >> Huh? >> we didn't have enough of disposable income to afford so much. >> Didn't have. Honestly. So, we kind of were limited to one or two pegs. >> Yes. >> Or three pegs. >> Yes. >> But today a whole bottle can be consumed.
(28:31) >> Whole bottle. But today, you can afford, I can afford, you don't consume. What's a piles then? Huh? Piles is this constipation happens over a period of time. In the anal canal, there is something called as anal cushions. These cushions are nothing but blood vessels. >> Okay. >> Clear? These cushions will help us in controlling the gas leaking, holding the gas.
(29:01) These cushions. >> Okay. In controlling the loose stools, the diarrhea, the loose stools. These cushions over a period of time, because of constant pressure due to constipation, will bulge. The bulge is inside is called as grade one piles. Next, the bulge will come out and goes in on its own with the patient's knowledge or without his knowledge. That is grade two.
(29:28) Most of the time people come to know something is coming out and going in. Indian squatting position, people take pictures and show it to me, "See, sir, look at this my problem." Next is it comes out. It doesn't go inside. We have to push in the hand. Next is come it comes out. It doesn't go inside.
(29:49) It will always remain outside like a cauliflower, they rush to the hospital. Napoleon in the year 1506 Battle of Waterloo he had great four piles. He could not sit on the horse's saddle. He lost the Battle of Waterloo and the history of this world changed. So, this is the piles which changed the history of this world. And many people have lost their jobs.
(30:18) Performance came down. Peak performance is gone. They're disturbed. Bleeding, weight loss, they can't share because people bully them. The fistula? Fistula. Good question. Fistula is one of the most difficult surgeries in the world. In Bible of colorectal surgery book, Goligher mentions you can operate a rectal cancer, but not a fistula.
(30:52) You can If you If you Many surgeons' reputations have gone because of the fistula surgery than any other surgery in this world. Because if they operate a fistula, it comes back again. So, what is a fistula there? And again, this constipation while passing stools, they put pressure. Number one. So, while putting pressure, there are bacteria in the gut.
(31:22) So, this bacteria will go through the gland, cause an abscess there. Abscess is a very painful condition. There's a huge swelling. There is pus there and some people get fever also. This abscess, these people don't go to doctor. It opens on its own and forms a fistula. Part one. Next, sometime people sit in the washroom.
(31:50) The most cleanest washrooms in the world say for example, Putin's washroom has got bacteria colonies. You will agree with this. So, people from airport on a long flight, they would use the washroom twice, thrice, straight away they come to hospital. My hospital is close to airport. They would have developed a huge abscess.
(32:11) So, when they go to a hospital with abscess, the doctor opens the abscess. Out of every hundred abscess opened 40% will end up in fistulas. So, one thing is it opens on its own and forms a track. That is fistula. Second thing is a doctor opens on its Doctor opens it and gives a gift to the patient as fistula.
(32:39) Two things. And we have diverticulitis. Before going to diverticula, I want to talk more on fistula, Ryan. This fistula in women sometimes it so happens the opening is in the vagina. The poop comes out from the vagina. I I I read this somewhere. Rectovaginal fistula. Yeah. Rectovaginal fistula. Yesterday evening, I operated a very complex rectovaginal fistula.
(33:14) There is a connection between the rectum and the vagina. And this is not genetic. This is created because of the constipation issue. Exactly. Because of constipation, because of abscess, because of wrong surgery by a surgeon, because of obstetric trauma. While delivering a big baby there are perineal tears.
(33:37) First degree, second degree, third degree, fourth degree. So, in third degree and fourth degree tears, they give a fistula. Women pathetic due to this childbirth. The consequences what they face. It's a nightmare, Ryan. It says that normal delivery is like breaking 20 bones at a time. That is the kind of pain they experience. Normal delivery pain.
(33:59) Okay. Next step. Men. It so happens this anal canal is connected to the urethra where the urine comes out. So, urine is coming from anal canal. Fecal matter is coming from the urethra. That is rectourethral fistula. Rectum and the urethra. >> rare? I've seen six cases till now in my last 25 years. Does the prostate get affected in all of this? Yes.
(34:32) Many people there is something called as prostatic abscess. Actually, it will not be prostatic abscess. The fistula would have traveled very high in between two muscles in the anal canal. Many mistake it for prostatic abscess and they drain it and give damage to the urethra. Understood? Mhm. It happened in Bangalore.
(34:59) One of the biggest corporate hospitals in Bangalore. Very senior most consultant. It happens to anybody. They diagnose as prostatic abscess. Actually, it was a fistula. Abscess intersphincteric. Number one. When it is prostate in men, in women there is something called as Bartholin's cyst in the vaginal wall. Many obstetricians mistake this for a Bartholin's abscess.
(35:30) Actually it would have been a abscess starting in the anal canal traveling all the way up to the vagina. Gynecologist is the first point of contact for our mothers and they diagnose as Bartholin's abscess and drain it and send it. After sometimes it start releasing pus. They go to the gynecologist. Then they realize there's something wrong.
(35:55) Again, they do some intervention there. Finally, they find us and come to us. There will be a connection between vagina and the rectum. Very common. Bartholin's abscess. Abscess in the anal canal mistaken for Bartholin's abscess. Bartholin's cyst abscess. Very common. So, now we've navigated a minefield. Yeah. Big mine. Of issues. Yes.
(36:21) Many of them explored, too. You know what is a mine here? 36% of India's population at any given point of time either a fistula, fissure, abscess piles. At least 50% suffer once in lifetime. 15% are constipation. 10% are fistulas. The only cancer which is diagnosed late in the country is colorectal cancer.
(36:50) 78% is diagnosed in the late stage. They can't do anything about it. So, this is the problem. This is the minor the problem India is facing. And so, when I leaded my question, what happens if constipation is not treated? So, you've explained what are the problems that can happen. >> Yes. Now the thing over here is one is it a taboo which you defined already.
(37:12) >> Yeah. Yeah. But the other one is all these percentages, everyone is scared to do surgery. Yeah. Let's not go to a doctor. Let's do some quackery or something >> Yeah. Yeah. >> So, one, why are we scared to do surgery? Yeah. Uh because I'll be honest with you. Yeah. Everyone says No, you said the doctor's taking money. He wants to do the surgery.
(37:32) >> Yeah. Unethical surgeries. So talk to me about this taboo for surgery and talk to me about quackery that's happening. >> Yeah. Ryan, very good question. One is taboo for surgery. One is people shy. They feel they're bullied. They feel they're kindled. They Jokes apart, uh fear. The fear is two things, Ryan.
(37:53) This fear is spread by quacks actually in the country. Mhm. What fear is that? What is a quack? Quack. A quack is a person who practices medicine who practices colorectal surgery practices without having any prerequisite qualification. With due respect to all religions, one particular religion the quacks are dominant in that religion.
(38:20) Second thing is this Bengalis. You see a lot of clinics on railway stations, bus stations. Biswas Roy Mondal in the surnames in India. There are about 1.5 million quacks in this country which is published in the European Journal of Colorectal Surgeries by one Indian doctor. Okay. 1.5 million quacks. If each quack earns about 20,000 a day, 25 days, it will be a 25 lakh crore economy for this India.
(38:55) Number one. Number two. These quacks resort to different unscientific techniques. When these people end up in quacks because of taboo, because they're all in gullies and small clinics, now. One quack in Bangalore rural, he will use a bullock horn to you know, this tightness. He will use a bullock horn to put inside and widen it.
(39:17) Bullock horn will go inside and they keep on widening it. It so happened once, it injured the sigmoid colon and they came to me. They tie threads. They tie acids. One quack in Tumkur he will give a silver ring. And that silver ring you should wear for three months, which is 25,000 bucks. He has to clean the ass in the left hand for three months.
(39:38) The piles, fissure, fistula will disappear. One more quack is there in Shimoga. He's called as piles Pandu. This quack this quack piles Pandu you should go some you know the coconut beetle nut leaves plantains and he'll give one more ringa in 3 months the ring will open up and these guys will be free of piles fissure fistula. Another quack is there where he will take beetle nut leaves his saliva has got some healing properties.
(40:07) He will chew that beetle nut leaves put it in the paper or a uh pad like langota you know you should tie it for about 2 weeks. Every day they come he will chew beetle nuts put the langota tight. This actually exists in our country. Country in Bangalore in Karnataka around Bangalore. Ayyo right? Not only this quacks are also in this sexual practices.
(40:31) You'll see some roadside tents now. Radha Krishna Ishwar all gods they use there and you see such people. So 1.5 million today in the country you go to any tool you find out they are there in the country. So this because of these quacks. Is it because people are scared therefore they go to these quacks or is it because there's no awareness? There is a belief these quacks you know when anybody goes there they say when you go to your doctor he will operate you.
(40:59) When you you operate it will come back again. When you go to your doctor he will cut your muscles you lose control of your stools. This is widely spread myth among the population of this country. Second thing these guys promise that we will do without surgery we will cure you.
(41:19) Tell me Ryan for any individual if somebody says without surgery we will cure you 30 minutes procedure go home on the same day next day back to work it will not come back again. It will not uh you know damage your sphincter muscles. They do advertising like proper I M Ahmedabad people. These quacks. So because of fear of losing control because of fear of getting piles back again or fistula back again they'll end up there.
(41:48) They give their lives and come back Ryan. I'll tell you one more thing. A doctor radiologist my close friend my neighbor his brother is a contractor. His daughter is a MBBS doctor preparing for NEET PG. He had an abscess. This guy goes to a quack. Quacks. He has put some acids and this is completely you know the entire belly has become gangrenous.
(42:21) There's something called as Fournier's gangrene. If the abscess is towards the scrotum scrotum testis the private part entire thing was gangrenous [clears throat] Ryan. It is a doctor's own brother radiologist brother going to quack. Imagine others. I was surgeon from Bangalore Medical College my college my junior he had a fissure.
(42:47) He went to a quack and he says I went there because I thought they were all experts in this field. MBBS MS surgeon from Bangalore Medical College. He goes to one quack in Huskotay he does some damage. Again he goes to one more quack in Srirampuram he does some damage. Then what he does he lose control partially. He goes to another surgeon who is his junior because it is a taboo.
(43:12) He says his junior boss I will tell you the way you should operate you please operate on me and he lost complete control Ryan. This boy meritorious boy from a rural village in Bangalore rural wants to commit suicide one day. He calls me. Sir I become cabbage sir cabbage. Why what happened? This is my story sir.
(43:35) I want to end my life sir. Ryan before dying he called me and we saved his life. He came to my place we did a rehab now he's fit fine control back married children now he's serving in a medical college and HOD surgery. Wow. You said rehab. Is there physiotherapy for colon? Uh Ryan when they damage the muscles there are different degree of damage Ryan.
(44:02) Imagine this anal canal I'm holding the anal like this. This this one okay this is the most important muscle the ring anal rectal ring. There are three muscles three parts here external sphincter. If I hold this if I release this control is there. If I release this control is there. If I do control is there. If I cut this out. So many people cut this muscle without knowing where to cut how to cut when to cut what degree to cut.
(44:28) The most disastrous consequence of fistula surgeries losing control. That's why doctors are scared to touch fistulas. You said physiotherapy. Full control out no physiotherapy. We bring a different muscle here rebuild it again reconstruct it and then do a physio they get the control back. You know in the old people I have a client who is a godman. Yeah.
(45:02) And bowel evacuation is always his biggest complaint. We do everything possible in life you know. Obviously he's diabetic neuropathy is there. He was talking about sitting on some chair which stimulates the Kegel muscles. What is your opinion on this? There's some sitting on some chair and stimulating Kegel's muscles it is only a stimulation Ryan.
(45:26) Stimulation. >> [snorts] >> You want to build your muscle you need to put work out you work to them but not stimulate. Imagine I want to build my muscles here. If I stimulate will it build? No. The Kegel's muscle it is holding releasing holding releasing. It is called Ashwini mudra in yoga Ryan. Kegel's muscle is very very important it will strengthen the pelvic floor muscles plus in men it will prevent prostatic cancer in old age.
(45:58) It also prolongs the intercourse time in men the Kegel's exercise. So whenever people sit in the car watching TV or in office you know it is always great to do Kegel's exercise so that the anal canal muscles sir fit fine and have very nice prostatic health and also sexual health. It So we talked about all of these constipation and the problems and all come.
(46:25) The last problem that you said that can happen which happens to sizeable amount of the older population is colorectal cancer. Talk to me about that how do we know to detect when should we do screening for it what sort of screening should we do and how can we give people a comfort saying that after the age of 50 you should do a colonoscopy and what is your advice? As I told you the only cancer which is diagnosed late in the country is colorectal cancer.
(46:56) This is the one of the fastest growing cancers in the country. Why? Because after 1991 our food habits changed Ryan. So there is 1991 there was privatization liberalization globalization. So along with LPG our food culture also changed. We started eating what the West was eating. So now we are seeing the increasing incidence of colorectal cancers.
(47:25) One reason is because of eating habits packed foods processed foods junk foods alcohol obesity smoking. So all these are the precipitating factors for colorectal cancer. Number two. Why it is diagnosed late? In colorectal cancers Ryan recently Kidwai Institute of oncology published a study. Actually people go to physicians.
(47:53) They say I have pain abdomen I have constipation I have loose stools sir. They brush it away and say you take this syrup the cojega. You take this powder the cojega. Actually a simple bleed can be a colorectal cancer Ryan. 20 days back one inspector from Bangalore city. This gentleman had a simple bleed. He came to hospital.
(48:20) We examined. It was so tight there was a fissure. We thought it was bleeding from the fissure. My finger should could not go inside. Next day we called him for a colonoscopy. When we put a colonoscope there was a very low rectal ulcer which was a cancer. Fortunately this guy came in the first stage. 95% of colorectal cancers if they come in first stage we can be we can completely completely cure it.
(48:56) Right? Second story of an IPS officer young lady who is battling for life in the city [snorts] now. She conceived. She had pain abdomen. She goes to the gynecologist and says I've got pain abdomen. She says your fetus is growing your baby is growing legs are moving hands are moving that's why pain. She goes to the radiologist sir I've got pain here sir.
(49:19) He's focused only on the baby. No ma'am your baby is moving and nobody will bother about the pain. She delivers pain increases we do a colonoscopy it was a colon cancer. A very bad type. So why it is diagnosed late it is a simple bleed can be a colon cancer. Constipation can be a colon cancer. Alternating constipation and diarrhea can be a colon cancer.
(49:49) Weight loss, constipation, diarrhea, loss of appetite. So, all these things are the signals from your gut. Hey man, look. Go to your gastro surgeon. Go to your colorectal surgeon. Instead what they do, bleed they go to quack. They go to some They go to some Ayurveda. They go to some homeopathy. Not that I Irish people don't diagnose even they do diagnose, but many times so 98% of times they think it is piles and fissure.
(50:19) I told story of inspector. Even we thought it is fissure. When we did a colonoscopy, it was rectal cancer. So, we practice colonoscopy for every single patient coming with any anorectal issue in a hospital. By doing this Ryan, we have miracles we have seen in patients. Is there any test diagnostic blood test other than the colonoscopy that can give a forecasting for a person to be cautious? >> Yeah.
(50:50) See, one is symptoms, bleed, loose tools, constipation, pain abdomen, weight loss, loss of appetite. This is number one. Number two is simple occult blood test. Simple occult blood test. >> What is occult blood test? >> The blood which is not visible to the eyes. You take the stool and test it. You see blood in the stools. So, when you see blood in the stools, uh you can do a colonoscopy and find out where this blood is coming from.
(51:19) So, but in India, there is no protocol for screening now. In the US, every person beyond age of 40, they have to do a colonoscopy for the insurance. Not for the insurance, uh Ryan. By 2030, there'll be a 30% increase colon cancer in 30 years age group in the US. By 2030, 30% increase in 30 years age group in colorectal cancers as per American College of Colon and Rectal Surgeons.
(51:52) This thing you'll see in India after 30 years. Is it because of the food habits and >> Food habits. And the insecticides, pesticides in our food chain. >> Yes. Yes. So, I was reading in a book. It's not about food contamination. We are living in a contaminated planet. Your water Your water is contaminated. Your air is contaminated.
(52:15) Your food is contaminated. Insecticides, pesticides. My daughter picked a book from airport, Sick Nation. She said, "Dad, this will This book is very very relevant to you. Please read this book." Sick Nation. We will face a huge problem in this country. What one end we are becoming a superpower, the other end we are becoming a sick nation.
(52:38) Nobody is bothered about this. You mentioned the statistic now that they are seeing a rise in colorectal cancers in India. >> So, is it that also many people are not even diagnosing colorectal cancer? Yeah. I said no. 78% as per ICMR report are diagnosed in the late stage. Why? One is because 45% of doctors they're not serious about this.
(53:07) 2 minutes, 2 seconds. Sir, constipation. Constipation, take it. You sit up later. Loose tools, take it. You lay low. This is how the approach of doctors I'm not telling this. This is published by Kidwai Memorial Institute of Oncology in Bangalore. But last month, March was colorectal cancer awareness month in the world.
(53:28) Kidwai published this report. As a doctor >> Yeah. who is a surgeon >> Mhm. of the gut. >> Yeah. What do you do? >> Yeah. From a forecasting knowledge for your health. [clears throat] For my health, uh I'm very mindful in what I do. I sleep solid 8 hours. I do yoga every day. I do 6 km of walking every day. Never smoked in whole life.
(54:02) I took my first sip of alcohol at the age of 42. First sip of alcohol at the age of 42. My diet is uh very very neat, clean, perfect. I don't eat outside at all. I don't indulge at all. >> So, you carry your tiffin box to your surgery? >> is You see my car? My car is a lunch box now right now. I never tasted a pizza in my life, burger in my life, pasta in my life.
(54:25) >> Why? >> Never. >> Because you know what it does to your gut. I know what it does to my gut and I My palate is not burger palate or pizza palate. My palate is typical ancient Indian Karnataka palate of ragi mudde, ragi ball, ragi paratha, ragi roti, all these things. That's what my palate was. Yoga, walking, eating, mindful, sleep.
(54:50) That's it. So, doctor, I have a 12-year-old. Yeah. Uh my kid >> Yeah. He's quite nutritionally disciplined. >> Yeah. Okay. Mhm. And he educates a lot of children how to eat and all. And I've educated him about fiber. Mhm. From your perspective, >> Yeah. you must be seeing a lot of children. >> Yes. >> What is the problem with children today? >> Yeah.
(55:11) You said 12-year young kid you have. >> Yeah. Ryan, I see this in 5 to 15 years age group, Ryan. Why in that >> All these kids, they eat fried chicken, pizzas, burgers, French fries, >> pasta, >> chips, pasta, peri peris. >> No fiber in it. >> No fiber in it. And their parties happen in some outlets, pizza outlets, burger outlets, fried chicken outlets.
(55:35) Whatever the reason, because of these eating habits, Ryan, people children are developing IBD, inflammatory bowel diseases, which is Crohn's disease and ulcerative colitis, a very bad inflammation in the gut. These diseases, when I was doing my medicine, it was 0.5% of India's population as per AIG study. Today, after 25 years, AIG did a study again. It is 5% of India's population.
(56:07) >> That much a hike. >> Yes. 5% of India's population. Very scary it is. Out of every 100 cases diagnosed, 25 are in children. Can you imagine this? And this ulcerative colitis and Crohn's disease, you can't cure that. There is no treatment. And Crohn's disease, every injection is 1.1 lakh. Whole life, when you give treatment, there is a remission.
(56:39) No treatment, there is a relapse. So, 5 to 15 years age group, because of these eating habits, people are landing up in IBD. When they have this, there is bleeding, there is diarrhea, there is mucus, there is pain abdomen. They go to doctors, they fail to diagnose this disease. One of the biggest founders of this country which went on to become an unicorn, son in Bangalore, was not diagnosed with ulcerative colitis for 3 long years.
(57:10) Some auto editor will go to Yeshwanthpur, there's a doctor there. They came to me and first time I saw it was ulcerative colitis. Child is doing great now. So, ulcerative colitis and Crohn's disease, out of every 125 are children, but still it is under diagnosed. I want to touch upon this point because as you said, 0.25% went to 5%.
(57:31) That means earlier we were eating correctly. >> Correctly. And now the children are eating wrong. >> Wrong. >> Could it be that because the children under peer pressure are convincing them to convincing the parents to eat junk food? >> Yes. Yes. >> Or is it some other medical thing that is causing it? Peer pressure.
(57:48) Exposure, social media, celebrity endorsements. You've seen celebrities endorsing these kind of foods. Will they eat that food? No. Never. >> They never eat it. >> They never eat it. >> I do their diet plans. >> Yeah, I know. You do many celebrity diet plans. They never. So, children peer pressure, endorsements.
(58:09) Parents also, you know, there's a book uh Ryan, Anxious Generation written by Jonathan Dutt. It's a great book on this generation which is He calls it as uh uh dopamine driven generation. So, in that book he explained all these things, eating habits, mobile habits. So, peer pressure, exposure, celebrity endorsements. Not in urban, even in the rural areas.
(58:32) Children are there at home. You see roadside masala puri, pani puri, kebabs, and gobis, all this stuff. Parents carrying in plastic covers to those children. You know what happens when they use plastics. You know how left, right, and center we see plastics coming to home when you order on Swiggy, Zomato, and all this stuff.
(58:50) Plastics are directly carcinogenic. They causes cancer. What is the youngest cancer case you've operated on? 23-year young rectal cancer. A boy was working in Samsung. So, it's outside food. 1991. >> father or his family have genetic You asked that question. >> Every patient who comes to us, we see holistically. We go to grandfathers, then parents, mother's side, father's side.
(59:23) Detailed family history is taken actually. So, a lot of times it's environment. >> Environment, social factors, genetic factors, dietary factors, smoking, alcohol, obesity. I had a case where son had a rectal cancer first. Son. We operated. After 5 years he came, "Sir, my father got bleeding." We did a colonoscopy.
(59:48) Father had After son got, father got it. Then we went back. Said, "My grandfather also had." See how fast the grandson has got. So, if a person gets it 50, a colorectal cancer, they start screening every person in their family, in that lineage, as early as possible. I convince everybody, "Let's do a colonoscopy. Come." How often should a person do a colonoscopy? Ideally, according to me, there are different guidelines by Indian College of Colorectal Surgeons.
(1:00:19) >> What is your guideline? >> My guideline is every year. Every year to do a >> Every year. Nothing wrong in doing, boss. Nothing wrong in doing. >> It's a taboo, right? Huh, it's a taboo. What's wrong in getting a colonoscopy done? Now, in India, everybody has bloating. The concept is scope in and scope out. Because we're doing colonoscopy, I mean, endoscopy, very often on every patient, the incidence of carcinoma stomach has gone down. It's not gone down.
(1:00:47) We're diagnosing early. Screening is the best tool. Best tool. We're diagnosing early. We're diagnosing early because why? We put a scope. Nothing wrong in putting a scope. See, I'm a diabetic. And I'm a very long diabetic. My father was a diabetic. No cardiac history in the family, but religiously, every 5 years, I get my angiogram.
(1:01:12) This is last month's angiogram. Okay. My heart is fit. I can perform now for next 5 years. We are responsible for our health. We should We are accountable for ourselves. In turn, we are accountable to our family, accountable for this country, and the planet. We are here with a purpose in life. As a gut guru, doctor, Yeah. smelly farts, bad odors when people pass gas, Yeah.
(1:01:39) please describe. Most embarrassing is the smelly fart. In the aircraft, in the meeting halls, even at home, nobody will accept he has farted smelly. There's a blame game starting there, and they hold it like this. Yes, when they consume too much of protein, when they consume too much of uh bad food, the bad bacteria acts on that, it releases sulfur, and it causes bad odor.
(1:02:05) So, a good gut technically does not give you bad gas, actually. >> Yes, a good gut. Bad gas is a signal to your yourself that something is wrong. Go to the gastroenterologist. Speaking of signal, Mhm. a lot of people have low libido in our country. Yeah. As a gut guru, Yeah. any link between the gut and libido? Yes, there's a very big link because you know, 90% of serotonin is produced from the gut.
(1:02:32) 10% of dopamine from the gut. So, when there is stress, when there is anxiety, when there is depression because of all these things, there's a decreased libido happening. Do you see a lot of your cancer patients or gut-related issue patients having sleep problems? Plenty of people come with sleep problems around these days. The problem is when they come with sleep, our doctors give sleep medications.
(1:02:59) Wise improper sleep mode, nobody goes to the root of the problem. And the gut could be the root of the >> Gut Gut is the root cause. That's the gut-brain barrier. Gut-brain axis. Doctor, I know you have a purpose and you have to get back to your surgeries and all. I got a few questions that I want to you end rapid fire up. Yes.
(1:03:17) Okay. One mistake you would tell people to stop >> Uh immediately for better gut health. Start eating early before 7:00 p.m. and go to bed after 2:00 and after 3 hours. Don't eat throughout the night. Don't have craving. One habit you would ask people to do every day to avoid piles and constipation. Hydrate yourself.
(1:03:41) Fiber, sleep, physical activity. What's your favorite fiber food? Naturally available fruits and vegetables in this country. Not from the shelf. Are you able to see a good fiber client's gut versus a bad fiber client's gut when you do a colonoscopy? In that, I will not be able to see. We should go to the DNA level, at the molecular level, and then analyze whether it is a good fiber gut or a bad fiber gut.
(1:04:09) On the colonoscopy, we can't do that. One food you would recommend for improving gut health and preventing any of the issues we talked about today. You know, gut health Gut is housed with 100 trillion bacteria. The best food for bacteria is your fiber. So, one good food is you consume any amount of chicken, mutton, protein, but fiber is very essential for the gut.
(1:04:34) Curds, dosas, idlis, fruits, vegetables for the gut. Fermented, fresh. That's it. You are known as the gut guru of India. Yeah. Protein powders. Yeah. Do you see problems coming from this in your surgery? Every day we see these gen Z's coming with protein powders. They don't consume fiber, they don't consume water, they consume non-veg, they consume 25 eggs along with that protein powders, and they land up in constipation, in turn giving piles, fissures, and fistulas.
(1:05:18) So, if you are taking a protein supplement, >> Mhm. take it from nature. Nature. Cuz nature has balanced out protein with the carbon fiber in it. >> Yes. Yes. I hope nobody wants to troll me on that statement also. Doctor, do you want to ask me any questions? Ask you any questions? Ryan, you were one of the celebrated nutritionist in this world.
(1:05:46) And you have trained uh many, you know, top-notch celebrities like our Virat Kohli, then Aamir Khan, Anushka Sharma, some Olympic medalists, all these people. So, now you tell me what inspired you to do this work because it's one of the best works you're doing in the world. You made science simplified. Two things. Personal experience.
(1:06:11) I also have a bad gut. I have discovered in my entire family Yeah. that around 90% of all my mother's side have Huh. uh piles or hemorrhoids. >> Huh. So, this started off with that. Gluten sensitive, lactose sensitive. Yeah. Try to put on weight, skinny kid, never put on weight, eat the protein powders, eat the weight gainers, everything, still don't put on weight, and then you find out that something with the gut, something with the food.
(1:06:36) Yeah. And hence started my journey, and I studied at Goa Medical College. Goa Medical College? Yeah, clinical biochemistry. >> Okay. Okay. So, the dean of Goa Medical College was the head of Department of Biochemistry. >> Biochemistry. So, I used to be kind of like walking around with her and going on rounds and everything, but we were the MSc clinical biochemistry.
(1:06:55) So, we were more like the peons, the chelas. Yeah. Yeah. I know. Medical College, yeah. >> We learned a lot. >> Yeah. Yeah. Yeah. In that learning, Uh I would be part of the pathologies and stool samples, urine samples, blood samples. And in 1995-6, we manually pipetted everything. Uh-huh. These machines had not yet come out.
(1:07:15) So, imagine thousands of samples. Long story short, it used to overlook a football field. Uh-huh. >> And I was like, if I could only take blood test and medical test and have the football player down there, that would be more exciting Mhm. than sitting under tube lights and pipetting samples. Obviously, you're young. Yeah.
(1:07:36) You want something a little bit more exciting than blood, stool, and samples. >> Correct. Um and that started my journey towards sports. Correct. And in sports, it started with designing products for athletes, yeah. Uh executing it for them, and then slowly athletes saying, "By bolo dal chawal roti kaisa lene ka Okay.
(1:07:59) And that started the sports nutrition diet planning process. And over the years, it was one athlete, two athletes, then athletes' wives came to me, then athletes' neighbor who was a celebrity politician comes to you, and then it's a long story of 20 years of getting people to come in. But what has allowed us to build Qua Nutrition Clinics is the science behind what we do.
(1:08:20) >> Correct. So, in the past, people were quacks. Correct. And they may be medically >> quacks here in health care. Yeah. So, they may be They may be qualified, but they didn't bring science into the diet planning process. >> Correct. Two idli, two sambar, two dosa, no logic on why it's being recommended, only patient's palate choice. Yes.
(1:08:40) What we did was bring in genetic testing, microbiome testing, omega-3 testing, functional medicine testing. And I'm not talking about now, doctor. We did this in 2010, 2011. >> Got it. So, when we began to integrate, people who are medical stalwarts, Yeah. they got the most difficult cases. >> Yes. Those cases came to us.
(1:09:03) >> Yes. So, can you give a structured sports nutrition plan, sorry, cancer sports, gut problem, cancer problem, liver problem. So, we replace sports with liver. So, the function over there was not to win a medal. Yeah. Was how to treat the liver. Yeah. The function in sports was find all the nutritional deficiencies or the nutritional overloads.
(1:09:26) Function over here is a parallel. Yes. >> Today ABS brakes Yes. >> in cars Yeah. are a function from Formula 1 sports cars. Correct. The same thing is happening in medical nutrition today. So, that's what we bring to the table and I think uh what's going to happen is AI is going to change a lot of things. >> Yeah. It's going to allow layering Yeah.
(1:09:44) of diagnostics. >> Yeah. And in the past humans had to interlink. Yeah. Okay, this patient cannot eat brinjal but can eat bhindi. Correct. But when you have 300 patients, how do you remember which patient to give what? >> Correct. Correct. So, your AI will help in this. >> So, AI is doing a lot of >> Precision medicine.
(1:10:03) Precision medicine is getting far better. I've seen it evolve over the last 2 years. Yeah. And I think it's exciting over the next 3 years that even subject like yours, gut health. >> Yeah. Uh precision supplementation, precision probiotics, precision Sapad. Sapad. Uta. Yes, Uta. >> is going to is going to be the changing game for us.
(1:10:23) We've started that uh uh Ryan with the Smiles we started >> with precision gut uh and it's been 3 months now. When are you going to start fecal transplants? Fecal transplant uh you know, 3 to 400 years back in China they used to make people drink the poop Mhm. the family members. Today clinical trials have proved that for IBD Crohn's disease, ulcerative colitis, they're giving poop tablets.
(1:10:47) They're doing it already now. Right? So, it started in India and in Bangalore it will start very soon. So, the gut is one of the most powerful organ. >> Mhm. Boss, if your gut is not all right no energy, no sleep, no sex drive, no drive to work anything in life. People are depressed uh and one more question to you, Ryan.
(1:11:07) You said quacks, right? Quacks in nutrition. I see many people coming on social media and they're not qualified nutritionist or experienced nutritionist. They come and try to you know mislead billions of population in this world. What do you What's your See, we have one type of quackery in our practice. Nutrition also have many quacks on social media.
(1:11:28) Am I right? Yes, you're right. Um and it's it's more like nutrition is a subject that even my mother and your mother is an expert. They're experts. Right? >> Yeah. And so, when you challenge that expert it's like it's handed down uh data and information. >> Yeah. I look at it this way. When when we look at a practice >> Mhm. I tell the public we are not influencers because our clinic and our team Yeah.
(1:11:57) existed before the internet despite the internet. >> Correct. Your practice existed despite the internet, despite influencers. >> Correct. But you and I come forward Yeah. in social media >> Yeah. to bring about an awareness >> Correct. so that people when they begin to pick their choices >> Correct. will hopefully be guided >> Yeah.
(1:12:19) based on true data coming to them. And I think the best data in my opinion today >> Yeah. is the case studies that we present to the world. >> Correct. Also known as Google reviews. >> Correct. Where people >> Google reviews, yeah. actually will >> can type it out and and the world knows that you can't manipulate the Google reviews.
(1:12:35) >> nobody can manipulate Google reviews now. So >> Last few years. So, it's a it's a great thing um and finally we have to be answerable to a higher power. Right? Not views. The act of >> And and not virality. >> Yes. I think from that perspective Yeah. um you and I are sitting in this room >> Yeah.
(1:12:56) because we have got our together. We got our together. >> [laughter] >> Because we hold it correctly. We know what to do, when to do and what to do. >> as friends we used to go to open air and together. This we have done it. Camps. I remember my camping trip. >> NCC camps. Yeah. NCC camps. Yeah, we've [laughter] done it. Uh On that note Yeah.
(1:13:19) Yeah. Thank you so much for joining me today. >> Yes. And if people want to reach out to you >> Yeah. where can >> they find you? Uh Ryan, we are in Bangalore north. We have done very well in last 5 years. We are the fastest grown in the country in the last 5 years. We have nine clinics in Bangalore. 27th of this month we are opening our premium luxury center at HSR, Bangalore.
(1:13:43) Very prime location. So, they can reach out to our website. I am in Bangalore north. And I'll be in Bangalore south very soon. Okay. >> Smiles Institute of Gastroenterology. And that's why I see you smiling right now. Smiling, yeah, yeah, yeah. We make uh people smile who come to us, you know, they come with so much of pain in the butt, you know.
(1:14:03) And one lady came to us and she wanted some dental scaling. Then our people said, "No, madam, it's not a dental hospital." Many people think we are actually a dental hospital. But actually we make the other end smile. Only when the other end smile you're smiling now. And on that note if you want to meet with doctor and his team at Smiles, we'll leave a link in the description.
(1:14:24) This has been one of my smiling podcast. But I want to bring this information out to you to understand that the gut is a very powerful organ. You put food into this organ and choose wisely because I always tell people your body is the most expensive real estate. And in this real estate the gut is the biggest room in your body, the most expensive room in the body.
(1:14:50) So, decorate it well with the right food. And when you have a problem don't think of it as a taboo. Modern medical science has an ability for you to suffer very little if you treat it on time. As they say an apple a day keeps the doctor away. It might be true. You'll have a lot of fiber in apple.
(1:15:13) But better than apple in my opinion is guava and coconut water. But if you do have any problems, reach out to doctor and he will help you solve that problem that might be plaguing you today. Doctor, thank you so much for today. >> Thank you so much, Ryan. Very nice show. Yes, apple a day keeps the doctor away. In my clinic I give apple to every single patient who comes to me from last 10 years.
(1:15:36) That was a really good podcast and honestly a very good experience sitting with doctor and having this conversation. I learned so many things that I can take back to my nutritional counseling session with you, my fan and followers. There's a lot of knowledge he carries. But did you notice what stands out? He actually lives what he talks about. And that shows in his energy.
(1:15:57) His moth his uh the way he just smiled and laughed. The way he approaches all of these things as a surgeon, the consistency follows and the respect he has for his body and for his work. It's all very real. The whole conversation felt very easy. We spoke about serious things. We had our light moments, talked about in all of its livelihood and it just flowed so naturally.
(1:16:21) I genuinely enjoyed the session. Did you enjoy the session? Let me know which part of this session. Go back and tell me which time you liked the best. For me it was talking openly about poop. And honestly, it just leaves you with something every day to take back and think about. Especially when you're sitting on that potty, it makes you pause and look at your own habits a little bit more closely.
(1:16:43) So, what you put in be cautious. Now, if you found this podcast very valuable do like share, subscribe, comment. Share it with people that you love. Share it with your friend who's constipated or somebody in your family who wants to understand their gut health better, too. And in parting words same different day is always a good thing because you know you've eaten correctly, you've digested correctly and you pooped it correctly.
(1:17:07) And hopefully you don't have to meet Dr. Parameshwara with a smile at the Smiles Institute of Gastroenterology.