I think people are expecting us to talk about Aur and like have our little cage fight Aura is a pseudo science do you think all of it is a pseudo SCI tell me one traditional ayurvedic formulation which is recommended or approved for any disease condition by any clinical Society in the world huberman is not a clinical doctor so I would not take his.
Advice as clinical advice at all what's happening in India where such intense problems are happening is it correct to say that the number of patients you're getting is increasing there is a lot of patients on the weight list who are actually dying without getting a liver on time how long is the waight lose people who have multiple sexual partners.
They have a high risk of developing sexually transmitted disease like Hepatitis B or C you think eating street food plays a role panipuri Chutney especially this sharbat you have the sharbat drinks that you get on the road sides they all spread hepatitis do you know how the organ donation Works Chinese has a different idea they kill.
People on the death list and use the organs for the patients people would consider this murder it is murder I know that this two sets of audience members watching this the first set is the ones who are watching it for the liver doog only and who haven't seen too much of TRS I promise you it's not as pseudo science oriented as some media.
Portals and some Twitter accounts would tell you we dive deep into science on this episode but for the second group of people watching this who watch TRS regularly I'll tell you about this episode as you know we've been creating a lot of podcasts with doctors lately we've been deep diving into biology I've never had more fun deep diving into.
Biology than I did with liver doog Dr Abby Phillips he's got a very ferocious Persona on Twitter a lot of his opinions polarize a lot of people but guess who else's opinions polarize people yours truly so there were points in the show that we had to debate a few things but mainly this is an exploration of Science and specifically an exploration of one.
Of the most important organs in your body the liver there's a lot of very very pertinent biology related content in this one I enjoyed the heck out of this conversation I enjoyed the heck out of meeting the liver do honestly and you'll see why I'm saying that by the end of this episode I request both sets of audiences to not hold any prejudices.
While watching this particular podcast there's an audience that dislikes me there's an audience that dislikes him but I think that the internet needs more of this way two Echo Chambers two different verticals of the internet Collide and grow together lots of love to all the audience members watching this but for now it's the liver dog on.
TRS do I call you liver do or do I call you Dr Abby just call me Abby okay yeah people view you as a bit of one of the Avengers like of medicine on the internet like I don't know if you're an Avengers fan I'm a big fan of anything graphic novel it includes superheroes so yeah I'm a fan Dragon Ball Z I have the.
Same one oh okay you like dvz of course okay lovely so uh you know you're one of the key Z Fighters like on the internet when it comes to the medical community uh I think we live in a very politic Ally heated up time I understand yes I get your point yeah that kind of paints an image of healing medicine all these things onto many people's heads uh the.
Thing is India India's population is so big that all you can do is do your best put it out there and then whoever has to gain from you will gain from you you'll find opponents Etc so while you polarize the internet in many ways I think in the medical community you're respected and loved throughout that's the sense I got like all the doctors got very happy that.
You were coming on the ones I spoke to I'm glad to hear this um there were like some things they were saying they said that he has very strong opinions but uh you know I I don't see the problem with that because I think the world is built out of people who have strong opinions in the first place I mean in certain areas it's important to have strong.
Opinions because at some point um you know it's not easy to change everyone and we don't we are not looking to change everyone the way they think the way they have their their own style of seeking Behavior you know we can't change all of that but at some point people a few people will understand that this is how it is because uh.
Consistently and strongly these opinions were voiced and at some point there is going to be evidence also for that empirical evidence that you know these opinions were not opinions anymore now there is actual factual basis to it and that's when people understand that this these were all important so I'm not look we I mean people like me who look look.
At fighting Health misinformation or giving Healthcare education we don't expect changes just to happen the next day it might happen only maybe after my lifetime or maybe decades later people will come and see that you know these things were actually important for those good things that are going to happen in the future so that is the whole deal so.
I'm not looking at polarizing anyone I'm not looking at you know making sure my opinions are the only opinions heard no nothing like that it's it's everything put together and shown together from both perspectives and people can choose logically which is going to be good for them uh we have to begin at the Bas because the format of the show is that.
We first grip the 8-year-olds the 9-year-olds and let them understand the beginning of our conversation about the liver and all that okay uh so uh my my only angle here is let's include everyone in this conversation because I don't want to shoe away the people who are your haters I don't want to show away the people who are my.
Haters person everyone be included exctly uh everyone's bodies are the same uh are everyone's bodies the same uh it's going to be an interesting conversation when it comes to the liver livers can be slightly different so we're going to talk about that now about the liver let's start at the igam basics of what a liver does can I have a.
Go at it and then as a doctor you correct of course okay when I'm saying something wrong uh please feel free to interrupt I'll give you my rudimentary understanding of what I remember from school Great Stop biology in 10th standard but I love biology till the 10th okay um so it's got multiple functions.
Uh urban legend is that liver is one of the only organs that regenerates fast which is why people use it as an excuse to drink I'll drink and like my liver will be fine um so it regenerates fast it's got multiple functions it's one of the key detoxifiers of the body so if there are toxins that your body gains from food or your habits uh I believe in.
Your intestines there is blood vessels some kind of veins that send it to the liver wow excellent right uh what What's the name of that so we have the superior mesentric vein that joins with the another vein that comes from the spleen so Superior mric vein actually joins from the uh it comes from the intestines it joins the splenic vein and then it.
Becomes the portal vein which goes into the liver gotta and that's the vein you're talking about basically your your blood is sent to the liver the liver purifies the blood uh if you're drinking too much alcohol in the process of purification it gets very Dam damaged uh and I think then the blood is carried to the heart if I'm not mistaken and then.
Sent to the rest of the body exactly but the thing is over time as you age I am assuming that your function of regeneration reduces because as is the case with aging with all your body's Parts uh regeneration becomes slower so your body can't take that much load as you grow older so one way to easily damage your liver is alcohol another way.
Possibly I'm assuming could be like you know a eating a lot of like fatty liver disease I mean to oversimplify it yeah but but I can I can just you know expand on all of these points that you said so um just to expand on it um so the liver is the uh is it by weight it's the second largest organ in the body so in adults it weighs about 1.2 kilg in.
Women and about 1.5 kilg in Men in men what is the heaviest the heaviest is skin yeah so if you take the whole skin out and weigh it it becomes like 4 kg really yeah so the heaviest organ is skin the second heaviest is liver third heaviest is the brain so it's it's a second heaviest organ sure now the liver is very special.
Which is why I also chose hepatology as one of my you know professional carer practices uh it's very special because one you said it has definitely the it's one of the most powerfully regenerating organ ever which is why we have that Greek mythology where promus who stole the fire from gods was punished by the gods and he was.
Chained on a rock and every night an eagle would come and feast on his liver but the eagle would not kill him he'll just eat part of the liver and then go away and his liver would regenerate the next day for that eagle to come back and again eat the same parts so this was like an eternal punishment so un unless you know somebody actually kills the.
Eagle or somebody kills promethus you know this this punishment is going to go on for for life so that is how the whole aspect of liver generation was first uh discussed in mythology now if you cut a healthy liver 90% of it and just just cut it off from the body the rest 10% can actually become a whole liver which is about 1.2.
Kg to 1.5 kg in four to six weeks that is how fast it regenerates even in a slightly older person yes so as you get older your regeneration capacity is still the same but then it is affected by a lot of other things for example um you have fatty liers uh you have other chronic illnesses with in you and also your uh regeneration potential or your.
The potential for the liver to actually um what do you call that uh to respond to a stressor actually becomes lesser as you age in order to grip the masses let's talk about stressors because people watch health-based podcasts from the sake of lifestyle and health yeah as in Fitness how can I improve my daily life in order to improve my organs yeah.
So an obvious stressor is alcohol and we we'll get into details about alcohol but before that I want to ask you what are the other stressors so the commonest stressor that we see in India is alcohol uh the second commonness that is now still coming up is exactly what we discussed that is lifestyle change related and metabolic diseases so.
Metabolic disease there is something known as a metabolic syndrome so metabolic syndrome has different components in it so there is diabetes mtis that that is your high sugar levels you have hypertension which is high blood pressure you have D lipidemia which is high cholesterol and lipid triglycerides you have hypothyroidism.
Which is a low functioning thyroid you have high uric acid which is hyper uricemia all of this is seeming like it's bad diet related yeah so it can be genetic also it has a lot of familial it it can be within the families also and it can be acquired also through sary life lack of physical activity uh obviously U taking a lot of carb rich.
Foods or calorie Rich calorie dense foods all of this can contribute to it so it's never one of these stressor that is happening it's maybe in people multiple stresses so there is a guy who's drinking alcohol and who's obese that guy has double stressors on the liver so these are the common stressors from a metabolic Health Point of View.
That is not as metabolic syndrome which is why now the terminology called non-alcoholic fatty liver so we have alcohol related fatty liver and non-alcoholic fatty liver that is nfld non-alcoholic fat liver disease the terminology is now changed to MLD that is metabolic dysfunction associated steatotic liver disease so steatosis.
Means fat in in technical terms so it's now MLD so that's how the name is changed because metabolic health is a huge stressor for the liver I think this is a great point to actually grip the general audience let's talk about fatty liver why do they call it fatty liver is it just because the liver is getting damaged or is there a lay of fat.
Deposited on the why does the word fatty even come yeah so um there are different causes for fat to get deposited inside the liver so when I mean inside the liver it's actually inside the liver cell so the liver is made up of different types of cells so this is also something very interesting because there are no organs as complex as the liver so.
I mean if some if I ask somebody which is the most complex organ that you can think of they'll say the brain because brain is so complex right but brain has only two types of cells that's it two types of cells make up the whole brain look at the heart four types of cells make up the whole heart heart but look at the liver five types of cells make up.
The liver and that those are primary types and there are so many different types of it and all in all there are like three 30 billion cells in the liver 30 billion cells that make up 1.5 kilogram so the liver is so complex and the most common cell that you find in the liver is known as a hepy which is the liver cell what we call as liver.
Cell now when you say fatty liver it's basically lipids in droplet forms getting deposited inside the liver cell M you around the nucleus within the cell so that's a fatty liver and when that happens and more than about you know 5% of these uh liver cells are uh affected by this droplet uh deposition then we call it as a fatty liver because we see.
That on ultrasound so when you do a simple scan you can actually say the liver is grade one grade two Grade Three fatty those are patterns of deposition patterns of damage patterns of deposition of the fat but does that mean also damage no it doesn't mean so when when you for us to call it damage that lipid should cause inflammation within.
The liver cell so that is known as fatty liver disease so when you just see fatty liver on an ultrasound that's just fatty liver that is an ultrasound or radiological fatty liver now you look at the liver function test now if you see your liver function test there are various parameters there is total B Rubin there is direct B Rubin there is a.
Component known as a Al which are liver enzymes sgot sgpt you can actually look at the liver function profile and see that and ggt alkaline phosphat these are all liver enzymes now if these enzymes are high especially the A and ALT that means there is some damage happening to the liver cell so then we call it as fatty liver disease or stti hepatitis.
Okay so the first stage is just deposition of fat around the nucleus and at some point if you don't control your lifestyle or if the disease you're going through goes out of hand then that same deposited fat causes inflammation exactly and then that inflammation is what is referred to as the disease exact part now the inflammation does something.
Else in between now this is the most important part because just the inflammation is to some extent fine easily reversible but sometimes the inflammation actually damages the liver cell so that the liver cells actually die and in their position you get scars so you have scarring where the liver cell was damaged so that is known as.
Fibrosis in in technical term so you can have stto hepatitis with fibrosis which means not just the fat deposition or the inflammation now your liver is getting scarred and that scarring goes beyond a particular point so the scarring is considered as F0 where there is no scarring that is no fibrosis F1 which is an F2 which is early fibrosis F3 which.
Is Advanced fibrosis F4 which is what we call as curosis so that is that that that range of scarring is also important so it goes above F2 that becomes significant scarring and you have a high chance of developing curosis so this much is there to fatty liel God okay so I think sosis is one of the words that everyone commonly knows and I'll be very.
Like raw and honest here with you usually people look at say Neuroscience neurology or cardiac related stuff as the most common and also probably put diabetes into that situation uh into this conversation people look at heart brain and diabetes as the most common medical problems in my eyes I believe India is.
Going through a bit of a liver problem on a mass scale uh because of our dietary habits because of alcohol consumption increasing in our country right uh there's two questions for you firstly from an India perspective am I saying the right thing and secondly in your experience as a liver doctor have you seen an increase.
In the number of cases because I remember I don't know whether it was your Tweet or I'd read this somewhere that uh there's a lot of people in the late 20s and early 30s also going through liver disease which doesn't make sense to me but then what I will say is I'm a 30-year-old man I've grown up with other guys my age I'm seeing guys who.
Are dealing with erectile dysfunction at my age like legitimate erectile dysfunction guys who are dealing with hypertension and all the guys who actually focused on the Health Fitness uh diet they're all fine but even our bodies are like I'm a I'm a weight training I'm a sports guy I have injuries that I'm dealing with now so.
Even after taking so much care of my health at some point your body begins to respond with some kind of injuries it's just the process of aging as a man I'm sure even you like why do athletes retire exactly but my point is we don't have liver disease so what's happening in India where such intense problems are happening so is it correct to say that.
The number of patients you're getting is increasing um so I think uh this question I'm going to take it in two ways one is basically the landscape of liver disease in India you know what at the moment what we are facing and why is it so uh so the commonest uh liver disease I still see in my outpatient is still alcohol.
Related liver disease uh but it'll be different in North India uh it'll be Hepatitis B related liver disease in North India and uh in Punjab it might be hepatitis C and it's it all depends on various environment and other RIS factors that are prevalent in these areas but if you look at any place be it south north east or west in India you.
Can see there is one cause that is just climbing up and just shooting above everything and it will become the commonest cause in the next decade which is what exactly what we speaking about is non-alcoholic fat liver because of lifestyle diseases because of metabolic diseases so the landscape is now changing from alcohol viral viral cause.
Of liver disease to alcohol and now it is non-alcoholic fatty liver that is more coming up in every parts of the country and uh the reason why we are seeing this now is because one uh we are detecting it early so previously uh there was this I mean if you look at 25 30 years back there was this group of liver disease known as cryptogenic or.
Idiopathic so people have shrunken livers or feat ceris and they did not know what this was due to shrunken livers yeah so when in advanced stages of liver disease in therosis the liver shrinks and becomes small because the cells outside get dead yeah no because all the cells inside get dead and is replaced by Scar Tissue so it becomes.
Shrunken so that is the end stage of liver disease so uh a lot of patients that kades before they did not know why that was happening so they were not consuming alcohol they were not having this viral hepatitis no viral viral infections were there so they used to call it as cryptogenic which is mysterious crypto means mysterious uh.
Idiopathic means unknown that is what the technically we use and uh as the decades went by now we understood that you know lifestyle diseases and metabolic disease also can harm the liver and all of those cryptogenic causes idopathic causes are now clubbed under non-alcoholic f fat liver so the uh improvements in uh Health technology.
And Diagnostics has actually helped us understand non-alcoholic fatty liver as an important cause for liver disease now because of which it is now getting detected very early even in younger group of people who have metabolic disease who have some lifestyle uh you know changes that are unhealthy what would metabolic diseases include exactly.
Like we spoke about before diabetes obesity um a low thyroid function which is hypothyroidism uh high cholesterol and lipid profiles high uric acid presence of heart disease uh lack of physical activity sedentary life overweight all of these become part of metabolic disease and you would say that all these are partially due to genetic.
Factors and then partially due to lify exactly so there are genetic factors there are environmental factors there are epigenetic factors there are these factors that will affect you before you were born you know while you're inside your mother's womb there are factors that can affect you there which can actually promote fat liver disease or.
Some diseas liver disease in the future so even such factors are all there so it's not just one factor which is causing non-alcoholic fat liver disease but many things that come together at that particular point but you said that you know you're seeing an increase of this one thing which is what we're talking about here there has to be a.
Reason that in 2024 or the 2020s generally this one thing is increasing so we got to see what changed because effectively I would assume that the genetics of Indians roughly would be the same now 20 years ago 40 years ago 60 years ago would be different right would be different because now uh see it it all depends on uh imagine that there was.
This particular family who were getting married in that only particular community in that particular region now they have moved to another place and they get married to people in another region where more of metabolic diseases are prevalent so they have a high risk of developing metabolic disease now which it was not there before so all of.
These things matter right so human uh migration uh risk factor s in the family within the family the environment that you are in for example very interesting thing is um there are certain occupations that promote fat liver disease for example people who work in night shifts so your normal biological clock is meant for you to sleep from.
This time to this time right so when night shifts come they have a disrupted sleep cycle and they don't get the actual good sleep that they need to get a lot of people get lower hours of sleep just that can promote fatty liver so lack of sleep poor quality of sleep or a nonrestorative sleep you are sleeping but you don't feel fresh in the morning.
Like you have not slept at all you sometimes you feel that I mean we all feel that so that nonrestorative sleep also can promote fatty liver it has nothing to do with your genetics or your environment or your family nothing so there are so many such factors now yeah um you know I I actually want to get into this genetics conversation a little.
Bit because there's the thing of dominant genes and submissive genes and we had a genetic scientist on the show Dr n r he spoke about basically how you shouldn't marry within the same community and when you marry outside it's just genetically a healthier thing to do and that's basic human biology that yeah that's that's something known.
As consensual marriages where you marry your relatives in the sense your first degree cousins or you know their second cousins and things like that and liver diseases do come with that kind of I'm saying the opposite of that yeah if you if you do exact opposite it becomes better so that thing you said about migration I would assume that if someone.
Is in say Kerala for example then they move to Asam and uh if they marry an asamese person shouldn't it actually help with the liver function so it depends on who are marrying so if you are marrying somebody who has imagine Hepatitis B in the family you are at a risk of developing Hepatitis B okay or your children are at a risk of.
Developing Hepatitis B but if you're marrying somebody who is healthier without hepatitis B without any other genetic dis diseases it's fine it's fine yeah so say if they don't have Hepatitis B uh first of all do that many people have Hepatitis B huge numbers India is actually a huge region which has an epidemic of hepatitis B and it's mostly.
In the north what is hepatitis let's get there and then like open up um so um when I say hepatitis sure it just means inflammation of the liver simple sure there is some swelling and damage happening in the liver that's a general term hepatitis can be due to various causes for example alcohol can cause alcohol related.
Hepatitis uh our simple fatty liver that is your metabolic fatty liver disease can cause inflammation because of the fat what we were just talking about talking about nonalcoholics tier to hepatitis viruses can cause hepatitis that is hepatitis viruses are many types the common ones that we see are viral hepatitis A viral hepatitis b c and e.
That is what we see in our country viral hepatitis A and E are spread through contaminated and bad food and water where viral hepatitis B and C they are mostly spread through other Roots so Hepatitis B and C requires blood to blood contact to spread it doesn't spread through air or water or food and that means that uh four major uh roots.
Of spread one is during blood transfusions I mean usually before the 198 when we did not know about these viruses we used to have people who did not undergo screening for these viruses at that time and they got transfused with infected blood and got Hepatitis B later on in Life or hepatitis C now there are others who use people who use.
Injectable drugs and this is very common in Punjab heroin yes injectable drugs and they share these needles and that's how they get transmission of hepatitis BN C then uh people who have multiple sexual partners they have a high risk of developing sexually transmitted disease like Hepatitis B or C and the fourth one is what is very important in India and.
Very importantly what I see something known as perinatal spread I'll just simplify it down it's very interesting so if uh somebody's parents father or mother has Hepatitis B but they don't know about it because all hepatitis B viral infections does not become a disease the virus just stays in your body it doesn't do anything in some.
Cases it might promote liver damage cause curosis liver cancer whatever but in many patients many people they are just inside we don't know about it so in such people they transmit this virus to their children so the mothers can transmit the virus to their children during child birth and fathers can transmit the virus to the children.
During the early years of life uh due to excessive uh what do you call that uh handling and kissing and all so usually only the yeah usually only the eldest son or daughter gets it because fathers then get you know the Second Son third son fathers like okay fine and this is actually identified in Indian Studies by the way fantastic studies so this is not.
As horizontal spread father to children and from mother to children it's not as vertical spread so this is what we see commonly that is why when we are we identify a person with hepatitis B viral infection we screen the family you know we screen the brothers and sisters we screen the parents to for us to confirm that even they if they have it or not if.
They have should we treat them or not so this is very interesting to curb this hepatitis epidemic effectively what I'm seeing the solution as is education of course awareness awareness awareness people just need to know which is why it's important for people to hear this podcast you know what challenge I'm facing see I'm I'm talking to you right.
Now parallely I have to ensure that my podcast is interesting as a listen for people which brings me back to that heart disease brain and diabetes thing everyone listens about these things because those are common conversations in living room no one talks about Liver Health I know I important yeah so I'm I'm I'm going to just uh I mean you know.
Butt in here and say that you know uh I understand a lot of there is a lot on cardiac heart health and gut health and brain health but the real sexy organ is the liver you know this is the organ that you actually should know about I mean no offense to cardiologist um it's just a pumping system so if you have a block you clean it and uh if it stops.
Pumping you restart it that's Cardiology I'm very sorry no offense to cardiologist but when it comes to the liver it's so much more complex because it handles so many complex things for example from your immune system fighting infections from digesting and metabolizing every nutrient aspect that your body requires to hormonal.
Balance uh to protecting like you said from outside Invasion from your intestines because our intestines are always full of bacteria viruses and fungi all of this and maintaining brain heart lung and all that Health the liver is at the centermost position so it's the core organ which actually connects to everything that is why we have a gut.
Brain axis because of the liver we have a gut heart axis because of the liver all of this because of the liver it's like the center back of the body in football terms yes so so we have a master organ which is actually something known as a pituitary gland in the brain but that is a master gland but the master organ I would say is definitely.
The liver H okay so many tangents have to go on but let's go back to what we were talking about that increase you spoke about in India yeah so uh my argument was that it has to be lifestyle and then you said that no it's also this hepatitis stuff and that is happening because of a lack of awareness and education so perhaps if every Indian.
Understands hey go and eat clean food hey don't have multiple sexual partners hey uh don't drink too much alcohol you will curb that hepatitis epidemic to a large degree uh yes to some extent of course because some of these are preventable for example Hepatitis B you take a vaccine you won't get it everyone doesn't take the vaccine no I don't.
Think everybody takes the vaccine even though it's under the national guidelines policy children do get it when they are uh you know at Birth but then a lot of them are unaware of it and they don't actually check for antibodies and then do a booster and all later on in life and this is very important what percentage of India do you think has.
Taken it if you are to just do guess work I mean if you go by the national guidelines it should be 100% but I'm not sure I'm just going to guess here maybe maybe 40 45% so that remaining 55 is sitting in small town India possibly yes without access to actual medical care and access to actual vaccination programs would you argue also without.
Access to information of course because if they are aware they would definitely do it because this is a pre preventable cause of liver disease and I would say that this there are two liver diseases which you can definitely prevent one is alcohol related liver disease and one is Hepatitis B Because alcohol don't take alcohol you're fine Hepatitis B take a.
Vaccine you're protected you think eating street food plays a role I would say eating street food from unhygienic and and poor sanitized places plays a role in spread of hepatitis A and E but not the other ones you know I mean people can enjoy street food no no problems there but if they are going to go into a place where it's po poorly.
Poor hygiene and sanitation there's a high risk of developing Hepatitis A and D which by the way are self-limiting causes for hepatitis for example they'll come I mean you get it you have jundas and you have high bobin levels and all that and then within few weeks time it'll go away so you don't actually need to treat it you just have to support.
Give supportive care and then prevent going to uh such places and hepatitis A by the way is endemic in Kerala so every rainy season we have a lot of cases coming in because people go and eat Street bad street food unhygienic street food and they get Hepatitis A which is why there is a travel advisory if some somebody's coming from outside to Kerala.
During the rainy season please take a hepatitis A vaccination about 2 weeks before coming so it protects you if you want to eat good street food how does the human eye that is not educated even spot good versus bad street food CU everyone Lov street food I I'll give you the the rudimentary input I've gotten from Doctor friends is.
Uh ideally try avoiding cold things and try avoiding things that are liquid based which means we got to say goodby to panipuri I mean I I would I would say that's that's good advice because water I mean liquid formulations is what actually spreads these things because it's water contamination mostly so.
Chutney yeah and yeah I mean like panipuri Chutney especially this sharbat you have the sharbat drinks that you get on the road sides they all spread hepatitis I mean I get a lot of young teenagers who come and you know get treated under me with hepatitis A during rainy season because they go for a college trip to some place and they take.
These sherbets and all these um you know fizzy drinks that are made on the roadside shop and they get infected with hepatitis A and come soda damn I mean you can see I mean where they're using the water from and how hygienic they are the surroundings and all that and be aware of that and then enjoy your street food let's go one layer deep in this goe.
Soda and sharbat thing how is the sharbat and goti soda actually getting contaminated so it it's from the water source that they use so uh if they are not using good water source so for example they might just be using the street pipe water to fill and use the sodas and all really yeah Street pipe water yeah so I have seen um these.
Stalls where they have a small tap on the side which is directly connected to some Pipeline and they'll be just filling that up and then you know putting it in the water or it may be they'll be taking that and then putting ice in it and keeping it on the side and then be using that so those things actually I mean it it it has a very high.
Level of infection rate especially during these rainy Seasons where you I mean there is something also known as leptospirosis which is known as uh Rat fever in Kerala where it comes specifically during rains and it's because of contaminated water because of rat urine the rats come out from the fields and it contaminates the water.
Sources and when they use such water sources people get infected and it also presents with jaundice so that is another cause of hepatitis leptospirosis very and it's very commonly seen in Kerala and we call it as Triple R it's not the movie It's rats rains and rice Fields so these are the three risk factors that promotes in this infection.
Rice fields Yeah so basically where there are right rice fields there'll be a lot of rats around and when it rains these rats come out and then pollute the waters so three respect factors for this leptospirosis which is known as Wheels disease in clinical terms uh is rrr and uh that's also one cause for jaundice that we see in Kerala because of poor.
Hygiene have you read sapiens by U noaj yes I have I have um you know he draws out this pict picture of the time when human beings as biologically evolved as us were hunter gatherers yes and how that was a much more beautiful life if you really think about it okay there was less pressure of social media there I understand yeah there was no.
Industrialization I think that's the whole stress of it his argument is that lifespans were shorter but uh probably that quality of life was much better because it was a cleaner life there were lesser human beings polluting the world uh yeah so there is something I might add here uh so if you if you look at in 1800s or 1600s our life span or.
Life expectancy was somewhere around uh maybe 25 to 30 years that's it uh and before what year is this um 1600s to 1700s our life expectancy was somewhere around 30 years of age and uh a lot of that time there were a lot of diseases which we never knew about so diabetes is one of that so many kids with type 1 diabetes which is insulin dependent.
Diabetes they used to die at a very young age because of complications of diabetes at a very young age you know just infections after infections but then we had insulin baning and best discovered insulin and when we started insulin therapy for people with diabetes we saw these kids growing up and developing complications of diabetes in.
The old age so something that we saw acutely the all the problems of that disease in a younger stage we are now seeing all of that in a later stage so exactly what what we are discussing here I mean at that time of H gatherers I mean they had shorter lives but they are more they had more diseases that killed them faster now we have diseases which.
Kill us slower but helps us live longer you know it's it's it's I think it's a bargain that we made with science science has improved our life expectancy but in the process we are seeing a lot more complications related to what actual diseases bring to us in the long term which was not possible before very interesting conversation yeah um earlier.
It was survival of the fittest now it's survival of the fittest and cleanest to some extent yeah so I think this vaccination which we were talking about now it has uh become very important because did you I mean did you come across this news in the US and I think in the UK where now children are getting diagnosed with misiles and they are.
Getting meil related debts now because of the antivaccine movement that is going on in the west uh as in they're not even taking measles vaccines as a part of the antivaccine exactly so it started off with the covid vaccine and now it is spilled over into the vaccines where these vaccines prevented childhood death meils mums that is rubella uh dfia.
Tetanus and all of these so this old world diseases are now making a comeback so we are back to the Honda gatherer stage maybe in the next 10 or 20 years because if they don't vaccinate and uh especially kids with these childhood diseases we can prevent we're going to see a lot of these old world diseases come back to us what is the original.
Point of this thought of saying no more to vaccines oh that start off with the small pox era so at the time so basically it's something to do with being going against the authority so your government or some Authority is saying take it so there are a group of people why should you why should we listen to you we don't want to take it.
So any amount of information logic or reasoning that you give that particular group they will not accept it because they're just looking at going doing things against the authority because they feel stronger that way so the one deep why I think it's just so this is something more important it's known as the Bor hoers theory of stupidity right.
So uh the more people are misinformed or more they are illiterate from Health Care point of view the more they are uh know the more likely they are going to fall for conspiracy theories so I'm going to say that you know there is this new vaccine for small pox I mean I'm talking about small pox so we disc the new vaccine and now this prevents small.
Pox so everybody take it so some group will say that you know this is actually some company has made this and government is getting a cut out of it and that is why they are giving this vaccine that's conspiracy theory and now this will reflect and uh do well in groups where there is low health literacy who will believe anything and.
Everything because they have maybe poor education they're not literate enough to understand consequences of these actions and they will just swallow this whole right and there are these groups and these groups it again become bigger and bigger because you I mean if you ask me uh the theory also says that a small group of stupid people is much.
Threatening than a single evil person you know if you have a very evil person you know take maybe Hitler for example you know a small group of stupid people is more damaging than that guy and because there was lot of stle people around evil people evil people were able to do evil things oh damn right so this is the whole antivaccine movement so.
There is this evil guy who has conspiracy theories in the head and there are lot of stupid people who will believe him this keeps going on and on and becomes a moment I think the thing with conspiracy theories is that the human mind grasps it very fast because it's stories exactly one layer deeper than what we're talking about is human.
Psychology probably that you're able to grasp stories much more than you're able to grasp data and fact exactly exactly and it's easier which is why the process of education is important it's very important and and and it's not just education because I see a lot of educated I'm sorry stupid people education does not mean intelligence.
Actually and uh I think it's all to do with critical thinking so you have a problem in front of you or I give you a problem in front of you you must be able to analyze that problem in different angles and come to a conclusion which is most logical for example I'm going to say that you know Hepatitis B vaccination prevents hepatitis B.
Infection so you can ask me me how many of people will develop side effect against this vaccine so I'm going to say you know maybe 100,000 people take the vaccine one person could develop a side effect so you'll say you ask me is that side effect going to be life-threatening so I'll say maybe it's lifethreatening maybe it's self-limited.
Side effect then you'll say what if I develop that side effect you see how the way the thinking is going so it's going into a negative conclusion already so that person decided that have B vaccination May harm him but the truth is it will protect him more than harming him so the critical thinking will allow us to balance these two factors so what.
Is benefit risk ratio so something is more beneficial and less risky rather than more risky and less beneficial your mind should automatically conclude that something that is more beneficial and less risky is good for you I want to talk about that one evil guy yeah what do you when when it comes to antia as a concept right have you ever thought.
About where it originated because there's another conspiracy theory attached to this which says that if more people follow the Pharma industry makes more money see I mean this is this is in a way U if you look at how Medical Science has evolved and why we have vaccines now why we have a lot of these drugs now which prevents diseases like.
Tuberculosis we can cure tuberculosis now when it was killing Millions centuries ago it's because of the Pharma industry you know Pharma industry we can look at it two ways you can look at it a glass half empty or you can look at it a glass half full and people who love conspiracy theories will always look at it half empty you know uh your.
Rockefeller comes in your Soros comes in I mean everybody comes in and even simple doctors like me come into that picture you know we are all big Pharma agents and working for it and we don't I don't get a single penny from them and what what this has happened is that see we need the pharmaceutical uh industry because we want to produce medicines.
That are going to save lives and we want them to do research and produce new molecules that will save more lives in the future so just looking at Pharma as a bad thing is I I I think it's it's not uh it's not U righteous to do that it's it's an inaccurate way to look at Pharma because they're doing more good than the bad that little conspiracy bad that you.
Are thinking that they're doing you know there there are bad pharmaceutical practice I'm 100% I'm not denying it there was one where ran backi and I think you have you might have heard of this book called bottle of Lies uh written by Katherine Ian and uh she actually showed that this person whom I uh I mean I'm very good friends with him.
Uh he's also a follower and friend on Twitter uh DH takur he actually called out uh Rand backi for doing unethical trials in Africa where they actually gave uh children and adults uh tablets which did not contain the drug but you know something like a chalk powder or something like that it did not contain a drug and then they made money out of it.
So he was a whistleblower and he took them to court I mean and they took him to court actually saying deformation suit and but he won and run back just collapsed after that so there are B ethical bad ethical practices in the farma industry 100% bad ethical practices among doctors 100% but that does not mean the medical science is bad.
Medical science is good it brings me to that Avenger conversation we had at the start yeah that we need more doctors on social media yes because when the average person gets to know you guys as human beings uh it'll sort out a lot I think what I read as the fear of doctors uh is again exactly what we're talking about conspiracy theories and the theory.
Of negative biases that one small bad person will actually you know the picture for the whole industry but uh I think human beings generally need to understand more Nuance which is what I enjoy about my job which I've understood is kind of the purpose of podcasting that we can have very long stretched out nuanced conversation rather than like.
Like you know yeah I mean just just putting it out there in a point I mean there is so many things around it uh I mean I don't know if this is the time to talk about it but uh like you said there is one small thing that can actually impact everything uh in a bad way instead of looking at it uh wholesomely and understanding that it is actually.
Not so bad it's actually pretty good uh I think it is about transplantation liver transplantation there is something uh that I would like to talk here from a personal point of view also because I have been in the eye of the storm on social media on this um I mean the something that our country lacks uh is a good transplant system and.
I'm talking about just purely from the liver transplantation point of view we don't have a centralized system for liver transplantation you'll have to give some context here you mean there needs to be a body where some people can come and donate livers after death yeah so uh in the US let me take the example of United States so they have something.
Known as a Unos that is a United Network for organ sharing so if and they have a lot of diseased donor so we have two ways to get the organ for patients who require the liver who are end stage liver disease one is something known as donation after brain death so the person is alive but the he is brain dead which means he's not going.
To wake up any time so they donate voluntarily the organ to person who requires it what if the person wakes up and you that that is why we have brain de certification rules so there are rules there are clinical uh guidelines setup to ensure that that that person is brain dead and after that and it's a step-by-step process which takes many.
Many hours to do that but they can survive without a liver no the brain dead patient means he's he's dead he's considered dead he's not clinically Dead He's brain dead but then he'll die at some point anyways so before that we use him to give life to others that is the whole point of voluntary organ donation and that that that that's actually how.
How Humanity or humanism Works in transplantation medicine so that is one way to give the organ the second way is something known as living donation so for example I'm not getting a brain dead donor on time and the patient is going to die very soon so a family member decides to donate a part of the liver so that is known as living donation so a.
Part of the liver whichever whatever amount of liver that is required for the patient to function quickly because the liver will grow like we said before it will grow very fast within four to six weeks we give that part of the liver to that person and he will survive so this is not as living donation and it come from the relatives as in the relatives.
And the patients liver will both grow because of that one healthy yeah so the patients liver will fully come out because that's the bad liver the whole liver will come out and the part of this the relatives liver will go in and both will grow yes both will grow because it's a healthy liver it'll grow very fast and both the patient and the donor.
Will be fine so that is living donation which is what is happening mostly in India in the US they have more of disease donation so you have this organ sharing Network where they have all these people who have pledged their organ donations or Vol donated the liver they'll all come into that and then they'll match that with whoever the.
Recipient is at various parts of the country whoever requires it faster whoever can wait a little bit so they will transfer this organ accordingly to that Uber for organs yeah I mean Uber we can just call usually here you have you have to wait yeah so so it's like uh it's like a good system that works uh depending on.
Who needs it first so it's well well well settled there in India we don't have such a system so if you go to Delhi or if you go to Kerala they'll have their own organ sharing network uh which is for that region so for example uh if I have a liver for if a patient is brain dead in Kerala that uh brain dead patients liver cannot be used in Tamil.
Nadu or in Karnataka because it's not centralized you can use it only in here but there might be people who might be requiring that organ much more there than here so that kind of stim is not available here so we have these two so most of these is from living donation that we have in India now because of this uh and there are there are cost.
Differences so you're getting a whole liver from a brain dead patient versus you're getting part of the liver from a living person the surgery is more complex in the living because it's a healthy person you have to make sure that the person will be okay after the trans after the surgery and it it's two surgeries at a time and here it's just.
One surgery because already the person is brain dead and you're just getting the liver and putting in the so there are difference also in India because of this there is a lot of patients on the weight list who are actually dying without getting a liver on time how long is the weight list I mean I have patients who waited on the list for 2.
Years and died in front of me in my ICU when we could not offer them a liver and they did not have a matching donor in the family and they tried their level best to get a matching donor but we could not I mean I mean this is not one story I mean I have hundreds of patients like that is this the biggest problem that transplantation medicine is facing.
In India this is the pro core problem but there is a bigger problem what happens is that um I mean Kerala was one of the states where we had maximum numbers of brain dead sharing you know it was as good as Spain till 2017 2018 and what happened was that in 2017 2018 if I am right a movie released in.
Kerala a Malayala movie by the name Joseph not sure you have heard of it that movie actually showed uh people were actually getting killed and their organs were given to hospitals as part of uh a racket kidney kidnapping kidney and liver whatever you know it's like a huge racket going on like that it was a fictional story but people took it to.
Heart you know and the organ sharing just suddenly collapsed in Kerala after that movie came out because everyone thought all the hospitals doing transplantation is doing doing it for the money killing people and people thought that people on the brain dead Proclamation list were actually not brain dead but doctors are making them.
Brain dead and taking their organs this conspiracy just flew so much out of control that me my father my father is a very senior gastrologist he is one of the first gastrologist in India only he's done a lot of he's a pmry award winner also in 2010 uh his name is uh Philip Austin his name is Dr Philip augus.
So uh him me all of us were actually sucked into this conspiracy and this happened also recently really yeah where uh my father started the first living donation transplant program in Kerala in Lakeshore Hospital and we had very good program there and somebody a conspiracy theorist who's also a Doctor by the way proper mbbs doctor he said that you know.
This hospital is actually killing young men and collecting their organs out of jealousy I have no idea or maybe out of that 15 minutes of Fame that he wanted or maybe he is doing that for money because people do that to hospitals and hospitals don't want their name to come out in the open so they'll just give him settlement money you know don't go for.
This case just take this money and be on the side you know people do that but we did not because we never did that and I was not part of that hospital at the time I was doing my uh you know training and my studies in Kolkata and Delhi but uh when this happened in 2009 this just blew out of proportion and uh we had this huge conspiracy theory going in.
That you know this hospital and other hospitals are actually collecting patients uh I mean making killing patients and taking their organs out that has actually impacted the transplantation program even now why I'm saying this out here in the open on your podcast is that when somebody makes that conspiracy theory and and by the way.
That theory has never been proven even now I mean the guy has been started he started cases in 2009 now it's 2024 no doctors were arrested no doctors are charge sheated uh it went to the Magistrate Court it was taken out from there there it went to the National tribunal commission for organ transplantation was taken out from there.
Then he sent a private complaint again in 2019 to another local code there which the court ordered again let us look at it again and then the whole thing blew out of proportion again and this keeps happening and now it is all settled again because nobody could prove anything I mean this particular case but these things keep coming and coming and.
In social media people keep talking about it again and again taking my name my dad's name taking the name of organ transplantation in the name of killing people and all that please don't do that because when there is a death of organ donation voluntarily from people there are people on the list dying we should consider that also so this is one big.
Bigger problem that we are facing now this whole conspiracy theory in organ transplantation like we have anti vaccination in the west it's spreading throughout India and we are getting lesser and lesser brain dead donations and because of that young people are dying on the list were you guys attacked because of this I mean attacked in.
Different ways not physically but the whole social media disinformation campaign was quite quite bad my dad is 76 years old he has done everything spent his whole life giving back to people and uh I mean to face this now at this age it's it's quite sad to see that and uh I mean we fought it tooth and nail our lawyers are good and now these.
Guys are on the back foot because we have evidence to show that everything was done as per rules and guidelines and nobody was killed for any organ but these stories will keep happening again and again in again and again you know maybe about 5 years data 6 years data but people should understand that this is where the critical thinking comes you.
Know these are stories never proven and organ transplantation saves lives it does imagine a patient of mine who was an alcohol abuse alcohol use disorder patient uh with severe liver disease decides to quit alcohol become good uh wanted to care for his family now wanted a new life but also needs the liver to do that so he's fully abstaining he's.
Changed his ways he changed his life and he's waiting for a liver and he does not get that liver and he dies after 2 years with young children and a wife leaving a young children and a wife I mean the the hurt that I go through the hurt that that family goes through because this conspiracy theory has been moving around and we are not getting livers on time.
It's just so damaging okay sorry uh you have to go through this sir honestly I mean it's it's I think it's important because only with confusion we can get clarity very interestingly so I mean do you know how the organ donation Works in India so it's an it's an exclusive program for example if you pledge your organs to.
That particular society only then they will consider you as an organ donor otherwise you will just go I mean after I mean whatever brain dead or after death you'll just go 6 fet under or get crated I mean whatever is the tradition and then that that body is gone right so if you are part of that donation list you want to pledge your.
Organs only that organs can be used but look at France France is so beautiful they have a small legal or a law which stay says that everybody is considered as an organ donor until they refuse wow yeah so they have an exclusion list so you have to go on the list and say that I refuse to give my organs to other human beings you know and then they will.
Not take your organs otherwise everybody is an organ donor by law which is why you get very high rates of organ transplantation in France very high rates of advanced Li disase patients surviving for longer duration in France it's fantastic so such a system we need to promote uh you know better health care.
Or Better Lives for patients who are on Advanced liver disease listing in India let me switch to another country from this point of view China so if you look at all the liver transplantation research clinical research uh uh you'll actually see very very less research being published from China so you have very big big uh journals where we.
Publish our Li research findings and all that and we have journals for Li transplantation also uh in US and Europe and all but you will see very small numbers of Publications from China you know why because the Chinese has a different idea what they do is they kill people on the death list and use the organs for the patients kill people on.
The death list hasn't so there are these prisoners who have been serving life or maybe on the death list so what they do is they make them brain dead and then they use those organs for they make them brain dead yeah how do you make someone brain dead I mean it's it's it's easy to do that I mean you give a set of injections.
And you do certain procedures you can make a person brain dead and then they harvest organs and give lobotomy I think it's called yeah I mean lobotomy is one part of it but this this this I mean they won't be conscious you know they won't be conscious but they'll be conscious conscious but not alert and you know like that so Chinese do that.
Which is why you don't get many Publications from China in liver transplantation journals and there are many articles retracted after publication many articles were actually retracted and removed from these journals because they found out that the transformation that was done in those particular articles were actually from.
Killed prisoners because worldwide retrospect yeah people would consider this murder it's murder it is murder it is it is murder it is murder yeah so so that is what is happening in the China part of it so such a gray Zone this is because those guys are evil that's why they're in prison but there's a whole argument or false accusation I don't get.
There but yeah but it's not easy to discuss that topic at all because they have their reasons we have our reasons because we are all humans we are not supposed to kill somebody to save somebody and ultimately that's it's it's a gray area I I don't know how the transplant Community also looks at it because China is China and uh we don't I.
Mean so they don't publish such uh cases and articles from them based on this kind of thing in transplantation so uh that that also happens on the side so that is why we need a good govern govern uh part very good program that is governed by a proper body a regulatory Authority which can ethically and morally consider organ transplantation.
For people in India which is lacking here you know I was going to ask you about what the possible solution here is the possible solution here is policy yeah so my angle is why can't and tell me the honest input why can't doctors all over the country get together go to the health Ministry and say listen this is what we need next what's what's the.
Friction there like this is a very important question you know what because our Public Health infrastructure and services are not up to the mark to provide organ transplantation across the board in the country as in even if the government agrees and policies are made the infrastructure the hospitals the number of doctors in the hospitals are.
Not up to the mark yes I mean public sector so if you look at the transplant programs in India it's all shouldered by the private sector so the maximum number of organ transplantation that is happening in Kerala is probably in major three hospitals that is one is amraa Hospital one is aster Hospital fantastic programs and one is our place rajagiri.
Hospital so three uh institutes in in koi area takes a lot of Burden of liver transplantation Ki also has a Medical College a government Medical College but they don't even have a hepatology department there they don't have a Gastrology Department there they have absolutely no organ donation facilities or organ transplantation facilities.
There so if it has to be a program that is governed by the Govern government body it means that it has to be an equitable and and affordable program where the financial burden on the person or the patient and the family becomes much lesser in the private sector that does not happen because you have to pay so you're approaching this from two.
Angles one anything you're saying about transplantation medicine is actually from a mass perspective we're talking about the masses of India where their bodies are the same as our so they'll go through the same problems yeah uh but the second angle here is that we just don't have enough hospitals and we we have enough hospitals but we don't have.
Enough of uh infrastructure and state-ofthe-art Facilities to promote this on a public health scale you know uh see it's it's easy to say that you know this person individually somebody can afford a transplant they will get a transplant but there is somebody who needs a transplant but cannot afford it so he has to be in the public health.
System where he'll get an organ and he he he can survive so everybody has a right to health everybody has a right to live I'm trying to see this from a very business point of view to solve the problem that our country is facing when it comes to medical healthare at least from a providing doctor's perspective uh I hope that this.
Conversation leads to some kind kind of change I hope so cuz actually it's not seeming like there is a out andout solution you have to go into each Hospital redo the way those programs are done I mean there are there are uh inspections and lot of things done but everything everybody can get a certificate anytime in this country in.
Any place I mean people have to you know nurture that thought that you know this is the righteous thing to do by this group of people I mean they are students and they need to learn also apart from doing work and uh I mean I don't know how we can do that across the board um you become better at your job as a medical when you are practicing right.
Practicing and also teaching I mean uh because that's the final step of learning yeah so uh a doctor ideally from the Greek it means teacher first it does not mean healer or a physician it means teacher so doctor has to be first a teacher a teacher to the patients and a teacher to other Juniors other doctors and then comes.
Your practice so when you practice you gain experience and experience may not always be the right thing to guide you see I understand there is a Doctor Who's maybe like you know 50 years of experience and all that but he'll still treat fatty liver disease wrongly really yeah because he might I get a lot of such.
Cases in my uh in my referral unit so I get a lot of patients who have been treated by very senior uh gastrologist and very senior Physicians the wrong way uh with just multiple prescriptions for simple disease which actually required only lifestyle change so my main job actually in my OPD most of the time is something as deep prescription so.
They'll have 20 tablets they'll be taking for they'll be taking medicines for breakfast lunch and dinner it's all for the liver almost all for the liver some for the uric acid some for the diabetes so it's it's too much so there is not as poly Pharmacy where you just you know carpet bomb patients with medicines and something will work out so.
What I do is I deprescribe all of that and make it into either one one or two medications and patients are so happy because one they understand that their disease is not that bad and they can control get a control on it that actually satisfies the patients it gives them motivation and two financial burden comes down which is a big thing and a.
Big deal for our patients in this country and just because of doctor is has got a huge practice and is actually uh uh seeing patients for about 10 or 25 years that does not mean that doctor is actually a good doctor now he might be a good person but when it comes to iCal practice he might be flawed so this is my whole idea of talking about what an.
Experienced doctor is versus what a doctor who is actually educationalist so when they actually teach they they're updated and they know exactly what is the right thing to do by their patient I think one of the bottom lines I've learned for the non-medical population which is everyone minus doctors is that always look for a Doctor Who's.
Constantly getting updated with what's happening I I would definitely choose an academic clinician rather than just a high practicing clinici how does an average person know key okay this doctor's an academic Clin it's it's difficult because I mean now it's I think it's little more easier because we have social I mean we have information.
At the fingertips so if you just go and look at the doctor's profile most of these institutes or most of the hospitals now have a section called as Publications and research and expertise so you check on that so a well-published doctor with well good expertise in that particular area we have lot of Publications and lot of credentials.
Under that particular area of but is you're publishing research based on your field of uh work exact exactly so for example if you're a liver doctor you're constantly studying about different diseases constantly studying about different solutions clinically testing it then publishing those paper exactly anything else you'd like to add I'll.
I'll make a small statement here about allopathy sure right so we equate the term allopathy to modern medicine sure right all the time I mean even our media do it and it's it's very inherent to uh India uh where people call modern medicine as allopathy but I think everybody should know that allopathy is not modern medicine because allopathy.
Was a term coined by the person who uh invented Homeopathy so Homeopathy is basically German invention it's a German physician uh his name is Samuel haniman he invented Homeopathy because during the early Century I mean 1800s and all uh there were no actual treatments or for diseases so it was a time the light bulb was not invented you know early.
1800s so at that time if somebody had a headache people used to drill a hole in the skull to reduce the headache uh people used to bring the blood out that is not as blood letting to reduce the headache or if people have some infection and all I mean they never knew that the germ Theory the Infectious causes for disease also was not known at.
That time so there was crude forms of treatment which were actually very painful and torturous for the patient so this guy Samuel Hyman felt very bad about it it so he invented a system of medicine which was very gentle so in the process what he did was to give very diluted forms of medications which actually contains nothing ultimately.
Which is very diluted forms to treat lot of diseases that is what Homeopathy is so to uh distinguish to differentiate Homeopathy from that crude form of treatment that was actually given at that time he called it as allopathy so allopathy was an ancient uh heroic type of Med crude medicine that was practiced in early 800s it has nothing to do with.
Modern medicine so when people talk say allopathy I always correct them and say it's not allopathy because allopathy is now obsolete because after the invention and after the after we have now scientific medicine coming up that term is now uh buried what would you substitute that term I would call it as just medicine because medicine is.
Medicine and then you have alternative medicine so if alternative medicine is found to be useful it becomes medicine yeah yeah um some people also call it as science-based medicine which is sbm another group calls it as evidence-based medicine which is ebm but I will just say it as medicine okay I'll tell you what what I am trying to attempt through.
This conversation is one to understand your strong stance on uh ayurve and Homeopathy and two to improve my own understanding of all these things without completely discounting any of the three yeah so I mean I would like to take this as an opportunity to say that see I'm I'm not going to I'm not here to convince everybody's about right or.
Wrong but what I'm going to give here or talk about here is plain simple rational and logical approach to healthare simple so uh the first is let me give you an example uh imagine if I have a patient comes to me with Jas so jaundice is not the disease it is actually uh a um a symptom associated with a disease so jaundice can be because of a liver.
Disease it can also be because of a blood disorder a blood disease so jaundice is a symptom the patient feels it patient can see that the eyes are yellow and the urine is yellow that is jundas and even the doctors can see that the eyes are yellow so it becomes a symptom and a sign which doctors can also see it's.
JIS now when I approach that jaundice patient what will I do I'll work him up for the causes of jaundice so I'll first look at hepatitis virus is causing jaundice I'll see if the patient is having significant amount of alcohol use I'll see if this patient is on any specific drugs which can cause jaundice because there are drugs that can harm.
The liver so I I'll I'll look at all of these and ultimately I'll figure out yes the jaundice is because of this disease imagine it is Hepatitis B the jundas is because of that so I give him a medicine for Hepatitis B and the jundas is gone so he gets cured from the jundas because he got cured from the Hepatitis B so the medicine is an antiviral which is a Dr.
Drug that acts against Hepatitis B and then he's fine now imagine the same person going to a ayur aura has no concept of root cause even though we keep hearing root cause root cause in alternative medicine practice they have no concept they have a concept of treating symptoms only but not diseases so jaundice in Aura is just.
Jaundice you know they'll come with jaundice and they have these ancient texts which is written ages ago by these uh sages at the time based on observation and faith and belief but not tested not validated not experimented on without any other replication that means so some for some treatment to be useful to be recommended or approved a large.
Number of people large number of people has to be tested and it has to be from different groups so I make a drug and I say that this drug is good for this doesn't Mak sense because another group also has to say it so otherwise it becomes a bias from my side so it's my drug so I say it's good but that is known as validation and repli.
Replicability so this is all part of scientific medicine in Aura it's it's not there so it is not validated not tested you cannot falsify it in the sense that you cannot change it because it's already fixed in the textbook that in this case you have to give this only right so the different causes for jaund is so if somebody comes with Hepatitis B.
Or somebody comes with hepatitis A jaundice or somebody comes with alcohol hepatitis jaundice Aur treats them all same which is actually not right by the patient because patient deserves to be treated for the disease that is causing the jaundice so which is why I say that ayura is a pseudo science in the sense that do do you think all of it is a.
Pseudo science of course because the principles are all the same it's it's it's based on wat kafa and it's based on based on the elemental theory of disease for and if you ask in Aur what a v is what a kafa is how do you measure it please show it to me they can't they'll go philosophical so it's it's a philosophy.
Of treatment in Aur all that there's a lot of philosophy lot of belief and faith and all attached to it so which is why I say that for realistic Healthcare these are not good options for people to go for now you'll hear stories that you know Aura has actually improved certain conditions so the skin disease is there it's gone or this asthma was there it's.
Gone this jaundice is there it's gone because of a I mean you do hear it I mean I get a lot of such responses also so that is where the natural history of disease comes in so every disease so like for example we are all born one day we have this life expectancy and we die this is how life goes same with the disease so there are diseases which.
Start which keeps going very long those are chronic diseases and there are diseases which start and they take a course and then they automatically Al come down after few years or few weeks or few months whatever take the example of childhood asthma like we spoke in the in the beginning I was an asthmatic child uh I.
Used to take a lot of inhalers and I used to be admitted for asthma attacks and all I used to take a lot of medicines including steroids as need be during my childhood but by the time I was 12 years 13 years my asthma is gone because childhood asthma majority of childhood asthma will go away at a certain age there are other forms of.
Asthma which can come later in adult hood for for that it's a it's a different treatment so somebody will start asthma medications at the age of 5 years imagine modern medicine so they're taking this taking this but asthma attacks keep coming in between now it's for 5 years 6 years 7 years 8 years 9 years 10 years of age they have tried.
Modern medicine 6 years they have tried modern medicine now they are not happy so they say okay let's try Aura so they try Aura in between this also so now they go for aurvedic treatment and they do it for 2 years so now already the child is 10 years of age so in 2 years they try Aura and by the time the child is 12 years of age asthma is already.
Gone because it is supposed to go away at that time because that is a natural history of childhood asthma but what would the parents feel the parents will feel that okay we started aurad now so aurad has cured the disease because it was started the last so they feel that it's a bias it this was started so it has gone but in reality the asthma.
Supposed to go away at the age of 12 and it has gone on its own and a has nothing to do with it so this is why we have to Define anecdotal experiences from scientific evidence yeah okay right so this is my my take on ayura versus scientific evidence and the same with Homeopathy Homeopathy has a different set of principles Al together which are.
Observed it is made by Samuel haniman only where he claims that something that can cause a disease in very dilute forms it can cure the disease which is impossible so basically if I have alcohol Li venom theory yeah so when that is antivenom you're giving antivenom against the snake venom but this is not like that so imagine I have.
Alcohol liver disease so if I give myself diluted forms of alcohol I can cure the alcohol liver disease I mean it doesn't it doesn't work that way you know something that caus a disease cannot cure the disease so there are separate set of principles similar to what in Aura because it cannot be tested and it cannot be experimented because.
The principles themselves are very weak and illogical H okay uh I have no perspective on Homeopathy never been through it never even spoken to anyone who has practiced Homeopathy so I have no perspective I have some perspective on Aura through the show and through uh you know even like lifestyle coaches and all who've been on the show uh in my.
Eyes I don't first of all I'm from a medical family like so my parents have like drilled uh your kind of logical thinking into my system as as well in terms of what you spoke about that if you see someone with jaundice the way your mind works as a doctor like a medical doctor is that you'll find the pathway to the root cause and then the.
Medicine and whatever you've learned and the constant education that you're doing even now will lead you to the solution you cure the root of or control it or control it uh and then what you see on the surface will also start getting C and you're improving Health that way exactly uh my first thought if I'm ever ill is to.
Obviously go to a doctor like yourself uh but as a consumer because I am meeting such crazy people on the show like I've met people who practice some kind of alternative medicine in South America which is iasa and all these things okay uh have you heard of iasa no no okay uh like as in I'm there's there's a botany PhD I had.
On the show called Mark Plotkin his whole life is dedicated to plant medicine in South America okay and one of the active ways he makes money is that he consults uh big pharmaceutical companies who try making uh medicines based on his research from the world of Botany okay so I can't remember the name of the.
Exact plant but uh Serpentine rurine yeah reserpine serpentin that is Rafia serpentina serpentina correct uh so I'm just giving one example yeah uh that drug I what is it used for so it's used for high blood pressure high blood pressure yeah so that is not from uh South American uh knowledge that's actually from ayura knowledge so in.
Ayura even now uh the Aur practitioners treat high blood pressure by giving the extract of this particular plan known as rolia serpentina so the active component in that is rer pine rer pine rer pine now rer Pine was initially used as a BP control agent but now it is completely stopped because it has lot of side effects including depression and.
Suicidal Thoughts so that is no more use because we have no safer uh antibp I mean uh BP lowering medications at the moment so the traditional I mean I I'm not denying the fact that we have natural sources of medicine yeah that's what I was getting toward wordss with Aur exactly now if you look at aura's contribution to any particular medicine.
Or a drug that we use currently now it is zero if you look at traditional Chinese medicine there is something known as artemisin which is an anti- malarial drug which was FD approved and all that which is one of the most common drugs that we use in to treat malaria that knowledge came from traditional Chinese medicine but it was not.
Traditional Chinese medicine practitioners who actually discovered that it was actually modern medicine practitioners and modern pharmacologist who identified it based on the texts that they studied from traditional chines medicine such a similar Discovery or drug Discovery from aurad does not exist so.
We have lot of knowledge about plans and the effects in the human body we also have a huge database where we know what what plan contains what all molecules and what all compounds these are these are there I mean it's not like it's waiting to be discovered this is already there there's a huge repository database of all the chemical components Active.
Components in every plant I'll give you a very simple example so there is this uh drug called I mean there is this plant called ashwagandha so ashwagandha is heavily uh talked about in aurvedic literature people consume it for anxiety stress relief and things like that some Jim goers do it to improve their oxygen Toler I mean the tolerance and oxygen.
Capacity and all that but there are studies I mean it's already known that what all does ashwagandha contains so ashwagandha contains a particular compound called withanolide a that is Von a which has been shown to damage DNA of the liver cell now this is this is a fact I mean there's a huge study that has shown that the withanone a component.
Of ashwagandha herb can actually damage the liver cell especially by damaging the DNA which is why we are now getting a lot of patients with ashwagandha related liver injury even in my practice and across the globe so we just recently published the largest series of ashwagandha liver injury from our unit in the official Journal of um American.
Association of study of liver diseases which is the journal known as hepatology Communications a fantastic Journal high impact factor PR review publication where we showed that there are people who actually develop uh liver injury because of certain herbs and the component in the herb that causes the liver injury is this so what we have to.
Do is that if we are going to identify a particular natural compound from a particular plant we have to ensure that that natural compound is what we require and it is beneficial and safe instead of using the whole plant okay hypothetically speaking if um some big Institute carries out very very detailed tests on ashwagandha.
Again and and this is this is my issue with studies in general and you can talk about dror huberman also or generally studies I feel you have to study two opposing studies together and then look within the nooks and crannies to like find gaps in both and then come to the yeah I mean it's very simple you know the scientific method is quite simple.
You know you have a hypothesis you have a theory like for example so I know that ashwagandha is going to reduce stress so I know this because it's already written in maybe classical text ancient text and now we have some data from preclinical studies preclinical means before human studies are taken up we do the studies in in the cells or tissues or in small.
Animals so from that we have some data that you know this ashwagandha is reducing stress levels now what in ashwagandha is reducing stress level is the next question yeah now we don't want the whole ashwagandha we want that particular part of it so it may be one compound it may be two compound it may be three compounds but we have to.
Identify it now you take extract those one or three compounds and then test it again in animals and see that they are actually causing this beneficial effect with lesser side effects so everything will have side effects but you need more benefits than side effects now you know that in animals it is safe so let's move on to humans so in humans we have phase.
Two phase three and phase four studies where we look at larger groups of people we control for lot of other things and then look at safety and everything and in humans we identify that you know this particular compound or three compounds reduces stress levels and this is what is going to be used as a drug in the future we have to go through all of that.
So what is now happening is that people are just promoting ashanda okay take this first stress I think what I'm understanding about you as a medical practitioner is that your problem is this carpet bombing of advice that exactly for this problem take Ash it's not like that no it's not like that it has to be refined so that you know that.
The person who's getting it is going to benefit from it more than getting a side effect and when if if you use the sentence Aur is a pseudo science then a consumer would view it as you're completely against the world of plants so yeah so the aura is not about plants I think this is what I think people should actually understand a is not.
About plants so plant medicine is different so we have herbal medicine we have traditional medicine we have complimentary medicine we have alternative there are different forms of medicines which uses plants Aura is not about plants ayurveda is a principle so it's it's a it's a healthare which includes some principles in it which is.
What we are looking at so uh in scientific medicine what is the principle the principle is scientific method so you have to identify something as beneficial or not based on testability falsifiability validity and replication this has to be there in Aura it's based on beliefs and observation which is done in the past without.
Further testability accountability or any other uh changes that has been made so something that is written 3,000 years back following it again in 2024 doesn't make sense so that is what I'm calling a Pudo science I'm not calling as that plan part as Pudo science I'm calling the principles as Pudo science so the whole of Aura if you take away the.
Principles it sees us to exist got it got it so fair to say that uh from all the stuff written in AIC texts there might be some things that need to be studied further and then can be applied into modern Medical Science exactly so there will be something there that we can actually use for drug Discovery okay so drug Discovery is actually one of the.
Most powerful arms of scientific medicine it has nothing to do with traditional medicine or alternative medicine but don't you think it can get inspiration from aspects of traditional medicine yeah so we borrow observational knowledge or observed uh entities from Traditions but then what we do to it is based on the.
Scientific method sure because if you live it to the traditional healers to find a cure for Hepatitis B they will never right they will still be stuck on that herb that I Ed that time that is the only herb they'll be stuck like that but you put it in a scientific method they will find what in that herb actually did that and then make it a.
Drug I mean I have read the whole of ayura text which is taught as part of curriculum in BS so there is a bachelor of aurvedic medicine and Sciences that is taught in India it's a 5-year course they have all these textbooks in the curriculum I have all those textbooks in my uh house um it happened so because when I was actually talking about ayura.
Practices and products not practice per se products related uh liver injury uh of which I have the first public in the world um a lot of patients actually died because of herbal liver injuries and we had to transplant some it's a huge it was a huge study that is it something related to heavy metals by so heavy metals were part of it but then there.
Are also inherent toxic plants also there are some plants which are very harmful for the liver for example giloy dinosor cordifolia which is gillo that we commonly call as guchi it's very toxic to the liver ashwagandha in some people are very toxic green tea is a very toxic thing to the liver green tea extracts so there are plants that are.
Toxic to the liver so when we start we published that particular uh study and started talking about it um you know there was a lot of uh backlash because people did not understand uh the whole aspect of how uh we approach it you know it's it's from this from the scientific medicine perspective from from evidence based.
Point of view so instead of publishing on side effects we actually need to actually publish on the benefits of it so which which is why I I say that you know it's not just uh the herbals that are part of Aur Aura is a huge uh thing I mean it's a huge practice and what I learned read from the text of Aura what what they were teaching in the colleges.
Is that uh it's mostly to do with you know just practicing it you know you find a person you look at whatever the principles they follow and then you serve them this particular bunch of herbs or whatever and it contains it may contain heavy metals as part of the preparation or it may be a contamination or adulteration of it or it might be.
That plant which is already toxic that is causing the problem so that is a whole aspect of what I have found from my own clinical research work um the only fair way to do this breakdown conversation is to actually have an ayur expert with you who's as eloquent as you and for you guys to talk so I'm consumer perspective you I I understand I mean I.
Have invited a lot of irwes to talk on clubhouse talk on Twitter they don't come they don't come I mean I'm inviting them anybody wants to have a realistic conversation on how to approach patients and diseases from an ayurvedic perspective versus a scientific medicine perspective I will guarantee that I can change their way of.
Thinking on how Medical Science actually works this is something known as uh appeal to Antiquity which means that just because something was there for so long doesn't mean that it is actually useful for example um we've had modes of transportation which was possibly uh Bullock cards many many decades ago or centuries ago or animal based modes of.
Transport but at that time it was good but now we have better modes of Transport so we use them now so just because it was good at that time doesn't mean it is better now or can be considered equal to the modes of transportation that we have now so that is that is known as appeal to Antiquity it's a logical fallacy which a lot of.
People actually make and the second aspect is that uh about mixing both so you have a scientific evidence-based practice and you have this traditional wisdom or knowledge and you include that also in this to get Best of Both Worlds this is what is classically known as integrative medicine so I have a yeah integrative.
Medicine so integrative medicine is you you have scientific medicine or real medicine and then you put in some alternative medicine also in to it to see you getting the Best of Both Worlds and a lot of people practice it uh what I'm going to say might uh might not be uh very digestible for people but the way I see integrative medicine is you.
Have a glass of apple juice and you have a glass of urine so you mix this urine with apple juice what are you going to gain from it are you going to say that the urine gets better because it's in the apple juice now or the apple juice is getting worse because the urine is there that is integrated.
Medicine something that works and something that does not work you mix both you are giving undue credit to the thing that does not work so that is why even though we have this traditional knowledge and wisdom and all that we don't have evidence of them actually working but what if they invest time resources into doing the research would.
Would you change your mind if you saw the research I see I'm not denying the fact that there is no research huge research is going on in this aspect I mean look at our country I mean look at India every budget 3,000 CR uh 3,000 uh CR INR is given to the aush ministry to conduct research now it's been almost say 10 14 years and.
This research has been going on even before tell me one traditional aurvedic formulation which is recommended or approved for any disease condition known to humans by any clinical Society in the world we need an AIC doctor for that no I mean I'll tell you the answer zero because I'm treating patients for lot of disease conditions endocrinolog are.
Treating there are there are guidelines for treatment of all disease conditions in the world and none of them feature Aura none of them feature Homeopathy why because that is alternative medicine alternative medicine is medicine that has not proven to be working or has been disproven from working so that is why they are there and realistic medicine is.
Here so this is I mean it will come out as a strong opinion on evidence-based medicine but for when I look at it from a patient perspective just imagine uh I mean I'm I'm telling this from my own experience so I said I mean we have a lot of patients with hepatitis A right so hepatitis A patients have usually in 99% of patients the hepatitis A it.
Presents with jaundice abnormal liver function and the patients have nausea vomiting General know low appetite and all that for few weeks and then the jaundice settles within four to 6 weeks that is what is that is what is happening in 99% of patients so all they need is good nutrition simple supportive medications for nausea vomiting and all.
That and they're fine but imagine this patient is going to a traditional medicine healer or an Aur or a herbalist and they give him take these herbs for jundas now some of these herbs are not tested they are not they're not evidence-based herbs for this particular condition there is no data to it it's just based on their generation knowledge.
Or ancient wisdom they giving now instead of getting uh better the herbs are going to cause liver injury herbal liver injury on top of hepatitis A so that patient instead of getting better within four to six weeks lands up in a hospital undergoes a liver biopsy takes about 2 to three months to uh two four things to get improved spends more money.
Than what is required so this is what happens when you mix something that is not evidence-based with something that is evidence-based or not okay right so that is why I want even ayura practitioners to bring to the table evidences not observation and faith-based but actual evidences empirical evidence from.
Studies and not just simple studies or reports proper clinical phase trials on evidence level 1 2 3 4 5 there are clinical levels of evidence that we have to follow so evidence level one and clinical evidence two is the ultimate so if you have such data that that means that that treatment is going to be approved or recommended for that.
Particular condition there is no such data okay um you know we SP Lane not an Andro he's a biologist neurobiologist neurobiologist so I'm not I an engineer who's turned into a content creator there's no way that I'll be able to take you on in like disease based conversation we need like an AIC person.
Like for it okay but what I will give you again is little consumer perspective which is what we want you know um so uh we spoke that that first Theory like we spoke about that you can't take an old thing and just Antiquity yeah appeal to Antiquity appeal to Antiquity or appeal to tradition you call it my only reason for being open to appeal to Antiquity is.
Based on my own subjective life experience which is that until age 22 hour was very against meditation pranayam yoga also and as life has moved forward not only have I become open to it based on my own experiences but uh it benefited my own subjective reality meditation specifically and from a personal personal perspective which is.
Where I think a lot of ayur cheerleaders come from that maybe in their subjective reality it may have helped them exactly so these are known as anecdotal experiences which is not part of the scientific methodology it just makes people open to the possibility because also say again I'm using meditation yoga and pranayam as three uh kind of topics.
Amongst a vast number of misunderstood or certain group of disorders but we are waiting for like I said clinical levels of evidence 1 2 3 4 and five five is basically like this I mean personal anecdotes and opinions then comes case reports case series randomized control trials then comes metaanalysis of these.
Trials and then comes umbrella review of those metaanalysis of Trials it's a huge that's the ultimate evidence so until we have that we will not recommend it that is how the scientific medicine works I I understand what you're saying I think all these domains are trying to explore just what's on that other side of the wall exactly which also brings me to.
That urine apple juice thing I understand what you're saying because probably you've seen patients who have gone to an ayic doctor and things have not resulted good they've actually created a bigger problem for you as a medical doctor and that's why you view it as urine instead of whatever it is yeah it's supposed to it doesn't make.
Apple juice better but it makes it worse in my science is definitely apple juice but I view this whole world of ancient wisdom not as urine but as cloudy grape juice like in terms of there there might be a lot of Gunk there but it's it's yet to be researched upon and understood like I would like to see Decades of uh scientific research going into the.
Direction of all the ancient wisdom be it South American Chinese Indian uh after Decades of research because your industry which is Medical Science has had Decades of research behind it so it's the advantage your argument has in the first place yeah so it should be structured research you know Ian I mean I'm not denying the fact that you know.
Yoga or aura or Homeopathy has no research I mean they're doing a lot of they have their own journals and they have their own Publications everything but it's not structured the way it has to be you know you cannot use that as a moders operan for you know treating patients because just because it's there yeah see I mean if 10 20 years later we.
Have the same conversation and the uh Compass has not moved at all like if you're the argument that you're making now still valid then then I'll be completely on your side I need 10 years we'll have this conversation I need to wait for like two three more decades honestly unless someone does like very ferociously fast research which I don't.
Think is possible it takes time it takes time but then I understand that you know Aura is not something that has come yesterday it has been there for centuries it we have been doing it for decades and still what would another a couple of decade add to it one one last point I'll make is uh see like I started this podcast in many ways for C for my.
Own curiosity you know to ask questions to further my own understanding rather than to uh just like put forward what I think and I began there and after meeting so many people have really begun to think that okay true knowledge is knowing that you know nothing that allows you to like keep exp which is why I'm like you know understand I.
Understand yeah but I've also noticed that people who come from a scientific background be it yourself be a Dr huberman even twoo scientific temperament oriented people for example you're disagreeing with Dr hubman on some stuff I yes I do disagree on some stuff but he has got a really good uh Outlook at how the neurobiology is and.
Especially his older videos fantastic but some of them are not both of you are still following the same scientific structure of thought I feel at least or at least your own yeah I mean he does he does that but then uh there are instances where uh he just blindly promotes based on very low levels of evidence so the consumer angle is.
Perhaps and I'm not accusing you of anything so but maybe even you are doing the same thing like this is the consumer perspective Ive yeah I'm not accusing you at all yeah no I understand where this comes from but huberman is not a clinical doctor right so I would not take his advice as clinical advice at all I am a clinical doctor and when I.
Treat patients or I talk about treatments they are always evidence-based and they are not based on flimy preclinical evidence consumer perspective that's what hubman also says that it's all evidence based so yeah so that's where we have this domain expertise right you have to yeah I'm I'm viewing you both as champions of science.
One is Spider-Man with certain powers one is Iron Man with certain powers so all I can do is observe what you guys are seeing but I feel like some human emotion and some human biases always come science so I'm I'm saying that and I'm I'm giving additional pictures to it you know so somebody says that you know this is what is given in this evidence.
So this is what you should take I'm saying that you know this is also there so take this also into consideration I'm not saying that this is completely wrong or completely right I'm saying that there is a balance and it's a logical balance that people can take for themselves because I'm very transparent in putting up my evidence there huberman.
May hide proper evidence or may not hide I don't know but whenever there is evidence that is hidden I just bring it out and I don't do it for everything there are certain areas where I feel that there is a misinformation that's all I need to have Dr huberman on the show with you.
Too that's the truth I mean like I said it has to be on the same page right everything has to be on the same page I mean for or against it has been on the same page and then people balance benefits to risk ratio regarding that particular intervention and then take the right call and that is what we are doing here also again this is like.
Little meta but on a human level this is what life is in terms of You observe the world and then eventually you do what you think is best observe test validate replicate okay that's it uh Before I Let You Go on today because we out of time for our first episode yeah uh I have to ask you about the liver again because that's the overarching theme I think.
People enjoyed the cage fight this was a very cute cage fight yeah because it was I mean it was interesting and I love such conversations where there is balance to what we discuss yeah yeah before we head into our second episode uh very quick uh kind of recap on lifestyle related factors for Liver Health just to summarize a bit of this.
Episode because we have to do a whole episode on alcohol I think it's a very practical modern Urban problem but uh minus the alcohol side of things what would you put as lifestyle based factors for healthy Liver Health we have some very interesting things that we can do uh so first is that uh one is there are I mean something known as preventive.
Medicine which is very important that uh you know you do a set of things or you avoid a set of things you can actually avoid getting into trouble so doctors don't want damage control they actually want people not to get sick so the number one is that physical activity is very important for Liver Health by physical activity I mean and.
This is studied also well you need to have 150 minutes of moderate to rigorous physical activity per week which is easily doable for everybody so it's 150 minutes of moderate to vigorous rigorous physical activity in a week so let me Define moderate and rigorous so moderate is just cycling swimming brisk walking brisk walking is basically you take 100.
Steps in a minute so that's 100 steps in 60 seconds that's brisk walking or simply running for at least 3 hours to 4 hours in a week so that is good moderate physical activity rigorous is what you do inside a gym under a train protocol where there is structure and you actually do a lot of aerobic exercises you do weight training you do resistance.
Training you do high intensity exercises you do circuit training all of this will come under vigorous activity this actually helps prevent lot of liver related diseases especially the ones to do with metabolic liver disease that is non-alcoholic fat Li disas and other things second is like I spoke before black coffee is a very good uh.
Intervention that you can uh include in your diet uh three cups which is about 150 ml each uh every day perhaps decaf and decaf so if somebody has cannot take caffeine does not tolerate caffeine you can go for decaf because caffeine is not the uh good part of coffee it's something known as polyphenol and coffee is another intervention that you can.
Third is sleep which is very important because uh poor quality sleep non-restorative sleep lack of sleep these all promote uh poor Liver Health in the form of fat liver disease so sleep try to get at least 7 hours minimum every day and the fourth is that identify yourself as having some risk factor for liver disease for example if.
You have immediate family members with liver disease and if they've had metabolic disease like diabetes or OB obesity or heart disease or stroke or high cholesterol high blood pressure anything so you are directly at risk of developing liver disease so please check yourself in the in the sense that you go to a doctor get a physical uh Health.
Checkup and also a checkup for the liver so uh liver checkup can include liver function test as part of the blood work and in the liver function test if they find some abnormality plus you have some additional diseases that are putting you at risk for the liver disease then they will ask you to do Advanced liver testing which may or may not include.
Special types of Imaging something like something we everybody knows like fibro scan or Shear wave which is basically ultrasound related Imaging which they will do from the outside and identify if the liver health is good or Not by looking at the liver stiffness how expensive is it it's anywhere from free because there are a lot of companies and.
Uh you know camps that do it for free to 3,000 rupees okay so it's it's it's not done for everyone one it's done for those with high risk of liver disease especially from metabolic or alcohol related liver disease so that is how you do a li liver checkup and those who need to do little check up uh fourth is please get vaccinated for Hepatitis B uh.
You need to know if you are protected against Hepatitis B or not simple just do a two blood test one is a test called as HBS Ag and second is a test known as anti-hbs if hbsag is not reactive negative and antihbs is not reactive or negative that means that you need to get vaccinated because you don't have the infection you don't have the protection.
Also if hbsag is positive that means you have the infection in that sense antihbs will be negative antihbs is basically antibodies or protection against Hepatitis B but if you are protected then your HBS AG will be negative and antihbs antibodies to Hepatitis B will be positive so that positivity also matters so if it if your antibody Titus.
That levels of antibody against Hepatitis B in your body is more than 10 but less than 100 then you have to take a booster only for of the hepatitis B vaccine but if it is more than 100 you are well protected you don't need to take any vaccine at all simple things I mean these are preventable causes for liver disease is there any other test.
You'd recommend that just an average healthy person take to figure out liver function um I would not recommend any such test because ideally we want to save resources and use resources for people who require it so tressing the you know the health system doesn't doesn't make sense for me but uh if there are RIS factors definitely and.
Also I would like to say that liver function test does not actually mean it shows a healthy liver so a lot of cancer patients liver cancer patients that I treat they have perfectly normal liver function test even better than mine but they have liver cancer so but they have respect also liver cancer for example Hepatitis B diabetes obesity alcohol use.
They still have normal liver functions so we have to look at everything from a whole perspective damn okay liver do yeah sir thank you this was a great first episode uh We've not even touched upon alcohol and that's a whole segment so that'll be a sequel but all I'll say is it was great getting to know you off of social.
Media like I was waiting for this and I think it's not just me uh there's a lot of people who need to get to know you uh because you're doing great work for the Indian medical community I know because I spoke to the doctors and they gave me a medical perspective on you so I'm just glad to be doing it through I'm also very glad that we had this conversation.
And and uh it was really uh enriching for me also and um I I hope the the the viewers also identify this as one of the best podcast they have heard on your channel no 100% the good news is that the only two podcasts that grow over time like constantly are spirituality based stuff and medical stuff it's just these two so I hope that this stays on.
The internet for like 20 years and just keeps giving me too me too okay thank you sir and we'll head into our second one thank you thank you that was the episode for today and we have recorded a second one with the liver doog which is much more casual lots more jokes lots of chatter about liver damage because that episode is about alcohol the a to zed.
About alcohol it's one of the most important episodes for me because I've been on both ends of the spectrum drank a lot in my life I'm a te Toler currently so if you enjoyed this episode you're to enjoy that episode as much if not more it's a very casual side of the liver doog that you'll get to see in that one I'm enjoying the heck out of.
This biology phase of TRS I'm so glad that the audiences are finally accepting content that's so deep that's so medical love talking to doctors it's some of the most fun interesting invigorating conversations please tell me what other topics you'd like for us to cover on TRS I'm happy to do three-hour podcasts with doctors I'm happy to keep making content.
Like this for the rest of my life honestly give me a feedback in the comment section and you guys will now kind of be open to the possibility that even TRS can create some medical content some kind of biology I highly recommend that you check out our other medical podcasts they're as deep as this one I welcome everyone especially those.
Who have the ability to change their mind and change their perception about people once they watch long form content I feel that the truth about an online Persona or a content creator can only be understood when you watch them over the course of a long conversation so you're welcome there's a massive Library full of scientific content full.
Of spiritual content that you may or may not like but at least explore it first and for the ones who supported TRS lots of love to you guys big hugs we'll be back with another biology special very soon