Episode 132: Flourish From Within: Microbiome, Metabolism, and Real-World Stewardship with Anu Simh | Dr. Robert Whitfield

Well, today I have a special guest. It's Anu and she is a board certified functional health coach and founder of Nine Arms Wellness, specializing in helping busy women lose weight and maintain their goal weight. By focusing on gut health, ANU's personalized and unique philosophy has successfully guided hundreds of women in achieving and maintaining their health goals. She is committed to training the next generation of coaches and her proven methodology. With a deep passion for advocating for minority women who are often overlooked in the healthc care system, ANU empowers them to become their own health advocates. She focuses on educating and coaching these women to address lifestyle diseases, conditions particularly prevalent in minority groups through sustainable lifestyle changes. Based in La Jolla, California, ANU works with clients nationwide through virtual sessions are Passion Lies in the Microbiome we look forward to discussing Anu's book Flourish from Within Feed your gut for lifelong health.

The views and opinions expressed by guests on this podcast are solely their own and do not necessarily reflect the views, opinions or medical guidance of Dr. Robert Whitfield.

All right, I have Anu with us now and it's a pleasure to have her. I was on her show recently and we talked about some of our programming for patients and we share a lot of the same things philosophically. We were just talking offline about the gut microbiome and antibiotics, so maybe we'll just jump in there as well as maybe shedding a little light on your mission vision to the audience. So we know where you started from and how you got to publish this great book Flourish from Within Feed you'd gut for lifelong.

Sure. Thank you Dr. Rob. Pleasure to be with you and talk about all the things that we both really think are important and things that you don't see on the outside, especially the gut microbiome. I'm just absolutely passionate about that. I heard somewhere that two out of three Americans haven't heard the word microbiome and it just became my mission to change that.

It seems weird now. I think everybody has heard of that.

You would think, right? But apparently not so. And in, in fact, I was headed to a microbiome conference and the Uber driver said, what are you, what are you doing at this conference? I said, oh, it's a conference about a micro, about the microbiome. And he said, what's that? And that is what really got me excited about this needs to be a book that really simplifies the science and really someone like, like the Uber driver has every right to know about the microbiome like anyone else. And we are in this little circle in this little. And we think everybody hears about it. But I, I just realized that maybe not.

You know, it's funny because you know, if, if they're, if they know about it, they kind of act like they know a lot about it.

Exactly.

If, if they're just hearing about it, they're like what the heck is that? And what does that even, how does it even work? So there's to your point, like a huge disparity in understanding. And in our practice we use different tests the microbiome. Because I have a lot of patients who come in specifically with, I call just everything, just the balance issue. So I have a lot of patients who may come in with a, a fungal overgrowth or a parasitic overgrowth or a, we'll just call it a bad bacterial overgrowth for lack of a better, you know, term. And then we try to work with them through various kind of simple things. Like you expound in your book about, with you know, gut friendly recipes or guidance about recipes or how to eat a little bit differently or what to maybe sub a little bit, a little bit differently for. Because as I try to get somebody ready for surgery, it's very different than a day to day life experience.

Absolutely.

So maybe just from a. We'll start with the more the day to day experience. You try to help your patients, your clients, any family, friends, try to explain this to them in a, you know, like we're all kindergarteners and how we learn to communicate about this so we understand each other.

Yeah. So for people who really have never heard about, about the word microbiome, I usually tell them you have microbes, your bacteria on you, on you, in you. But we're going to just focus on the gut microbiome. There are trillions of bacteria inside of you and they do a lot of behind the scenes work for you. So we have like a symbiotic relationship with them. That and for symbiosis I usually say you scratch my back, I scratch yours. And you do a lot of different functions. The bacteria and the microbes do a lot of functions like producing very important metabolites like short chain fatty acids, vitamins, neurotransmitters. 90% of serotonin is made in the gut. The immune system has, you know, it's it. These microbes are like a training ground for the immune system. They really help them recognize who is friend, who's foe, who, who, when do you remain neutral. And one of the big things I see in a dysbiotic gut or a gut which is out of Balance is this immune health being compromised. And so I believe from all the research that I've done, that food is the biggest needle mover. And of course, there are other things that one ought to be paying attention to. But definitely the research supports changing our diet from a standard American diet to a diet that is rich in fiber. We are like in fiber famine right now in the United States. You know, we don't, we don't take in a lot of fiber and that, I mean, we don't digest the fiber. It's them.

Pause there for a second because I think that's another term that people get confused about. Like what is fiber? And you know, maybe from media or, you know, I hate to use the word television, from streaming or whatever your source of information is, you think fiber is metamucil. Like maybe just clarify what fiber is and there's soluble and insoluble fiber for everybody just listening, like. So we're just going to get some basic things sorted out because the news and expert on this, I talk about this all the time, but sometimes imagine it gets glossed over and it's, you're like, oh, what, what's, what's the fiber? And what do we need to do?

Yeah, in fact, I do get asked that. Yeah, I do take that. Or metamucil is. And which is great. You know, it's a soluble fiber too. But I think people need to understand just the background of what, why even care about the microbiome before we go into fiber? And what is a healthy microbiome? And there's a lot of talk about healthy microbiome, but I don't think we really know what a healthy microbiome is because all of us have a unique fingerprint as far as what is our healthy microbiome. But we can agree that there is a resilient microbiome. And a resilient microbiome is a healthy microbiome, something that can bounce back after an illness, after traveler's diarrhea, anything, or a trip to Mexico, you come back and you're able to handle it, that becomes that resilient microbiome. And a resilient microbiome is a microbiome that is rich in diversity. You have a lot of species richness and species inc. Evenness. And by that I mean lots of different species of microbes, bacteria, fungi. And also you don't have an overgrowth of any one particular kind of microbe. So we, it's, it's. I, I usually use a garden analogy instead of 100 tomato plants and one poor zucchini plant. You just want a little bit more evenness in the garden. And for that, from an evolutionary standpoint, we have handed over the digestion of fiber to our microbial partners and they look at it as fuel. So when we eat anything, and I have been asked this, you know, where do you get your fiber from? It's plant sources does not come from the animal kingdom. It comes from plant sources. So anytime you eat any vegetable or bean or lentil or anything like that, there's an undigested part of the plant source, which is fiber. And, and the microbes, it goes undigested through your entire digestive tract to the colon. And these microbes are excited and waiting for their fuel. They eat it and they produce metabolites. These metabolites, especially butyrate, is fantastic for us. It really helps us in so many different ways, decreasing inflammation, helping us with insulin sensitivity, even metabolic, you know, conditions. Really, it really does help with that. I have seen in my practice that increasing that buty really, really helps with keeping that weight off and in weight management. So yeah, they do a lot of behind the scenes for us and, and fiber is the main source. And I think most of the research is showing that you need to have a diversity of these fiber sources. And by that I mean like soluble, insoluble prebiotic fibers, because not all fibers are prebiotic in nature. So you want prebiotic fibers that help you grow bacteria that support you. So that's pretty much the premise that I start with. And then of course we go into more details.

Well, you know, that was. And thank you for the explanation. The, you know, when we're trying to talk to patients because there's so much, I think we talk about. There's a problem with financial literacy. Like, we don't understand things about finance because we weren't ever, you know, taught those things. It's very similar in terms of nutrition. There's a lot of problems with nutritional, just literacy. So I appreciate you explaining it. I always try to keep things fundamentally very, very simple in terms of balance. Like to your point, you don't want to have a lot of imbalance. You just want to have as much or as close as you can be in. In balance. So a lot of people struggle to get certain things in their diet based on where they live.

Right.

Maybe how their, yeah, work life situation is. And for me personally, like, I get most of my, my fiber really from like fruit.

Mm.

That's basically how I get, you know, my fiber. I'm not a High consumer of any, you know, vegetables. I'm, I'm a really high consumer of a fruit. So that's just how I get my fiber. I get a lot of it, but I get it all basically more that way than any other. And I don't use any fiber supplements or anything like that. So like, you know, in terms of that component of the diet which is probably responsible for, you know, a lion's share of the problems when it comes to bowel function and constipation or for that matter, diarrhea, it all motility. Yeah, yeah, you don't have enough psyllium. That's, you know, there's a problem. So we talk a fair amount about, you know, that within, you know, the confines of the gut and you know, try to keep it, you know, relatively simple in terms of discussion, you know, for, for patients. And then I always knew, I tell patients, I don't really care what kind of diet you follow. I don't care if you're a pescatarian, a vegetarian, you like animal protein, carnivore. I don't care. It does not matter to me. You have to get a certain amount of protein in for, you know, what we need to do in prep and recovery for, for surgery. So maybe when you're discussing, you know, ways to help patients, have you found with the western diet that that's from a protein perspective pretty hard for patients. Do they understand like what I, I'm.

Very much like you. I don't really go into their personal dietary choices because everyone's so attached to their diet, right. You know, it could be pescatarian or over lacto, vegetarian, vegan. All I focus on is, listen, choose the protein that you like, you know, be it fish, chicken, whatever. Just. All I would like to propose is a diet for your microbiome and that means I'm really helping you understand what fiber is, what are fermented foods, what are prebiotic fibers, what are functional foods. So I propose a diet just to feed your microbial profile because it makes a huge difference for your overall lifelong health. So I really don't go into that. And of course protein is very important. So if someone comes to me as a client, I will say muscle protein synthesis is important, leucine is important, 2.6 grams to start your day. All of that is of course added into it. But in the book itself, I just focus on a microbiome related health diet because it, yeah, it's a, it's a bit, bit complicated these days, Dr. Rob, because food is so personal and Everyone has just huge battles over it on Instagram and things like that. And people are struggling and fighting over single nutrients and I think we should just step away from that. Gosh, have your seed oil or whatever it is that you want to, but let's just have basic rules around food. You know, let's have adequate protein, let's have good fats, and let's have some fiber and end the story.

I'm glad you brought that up. I feel like the hardest thing to help guide patients on is healthy fats.

Yeah.

And healthy fats are critical for a number of reasons. And maybe that is a nice segue to like, the next set of things to discuss about as it pertains to, you know, short chain fatty acids, long chain fatty acids. And how do healthy fats help, you know, in, you know, enriching your patients lives through their diet and health of the microbiome? Because I, I know for, for my patients when I start talking about healthy fats, I get a bunch of like, no, I don't want to get fat. I'm like, you're not going to get fat by eating healthy fats. That's maybe kind of, there's this misconception about that specifically.

Yeah, yeah. I think the whole idea of good fats is a little complicated for people to understand because fat has been demonized for so long. I, in the book, and I tell my clients, let's start with foundational layers. You know, foundation is your fruits and vegetables. If you can tolerate things like beans and lentils, things like that, those are create that foundation for you. Then you go into enhances. And in the enhancers list is good fats. They kind of give you that omega 3, omega 6 balance. You get some flax and chia and walnuts and olive oil and olives. And even there, there's a lot of confusion for people, oh, is olive oil good or bad? But you have to look at all of the studies out there, and generally speaking, olive oil is considered really high in polyphenols. And polyphenols is something that your gut microbiome is really adept at digesting and metabolizing into for our better health. So I kind of keep that simple and say, just get a variety of good fats from, from your food. And then of course there are functional foods that can really help. And functional foods are like things that are rich in beta glucans, you know, like shiitake mushrooms or oats or barley and things like that. So you all start with a baseline, just add a few things and Then if you're really, you feel like, gosh, I have, I got my test back, I have some diversity, but I'm, I'm missing keystone species, then we can go really in depth into what could be some of these functional foods that help grow some of these keystone species.

Right? Yeah, it is, it's a. So I have this kind of group of patients who think back in time and they didn't have enough breast development, so they went and had augmentation surgery because maybe a fat transfer wasn't discussed or they didn't have enough body fat. And then later on this doesn't align with them. There's lots of reports of how chronic inflammation can dysregulate your gut. So you know, when I'm talking to patients and they have a lot of chronic inflammation like you see, and that causes a ton of gut dysregulation and alteration of probably their, their gut microbiome, some people will argue like how much and to what degree and then they'll get down in the weeds of something that doesn't serve the patient where if you just are to your point trying to help them really just unwind message, restore some balance so that they can, you know, for lack of a better word, you know, rest and digest and recover. So if, if most people simple actually.

You know, it doesn't have to be complicated. I mean, I do. See, I know being a surgeon, you just told me that you don't use antibiotics, but I see a lot of clients who are post antibiotics, right? You know, broad spectrum antibiotics and what it does to the microbiome is pretty huge. I mean there's so many studies that are showing us that post a broad spectrum antibiotic client, a patient can take about six to 12 months to get back their microbial diversity. And I see that in practice that they really struggle. Their gut becomes leaky dysbiotic chronic inflammation, their CRP numbers are high IL6, so all of that, you know, just from that use of antibiotics. So I think the judicious use of antibiotics is something that I really kind of proposed to a lot because there's a lot of over prescribing happening. Take for example root canals. You know, the ADA does not really say, does not recommend a broad spectrum antibiotic. But I see so many clients coming in after root canal being prescribed once or twice antibiotics, full 70 course of Augmentin or something like that. And they take, their gut takes a beating, you know, because inflammation increases. They are more prone to have C Diff, you know, and diarrhea BLOATING It's. It's pretty bad, you know.

Yeah. That it's. It's fascinated me that even, you know, I'm. By the time this airs, I'll be 56 my birthday shortly. And I. It's not like I don't practice from my training. I do, but in plastic surgery, there's just this theme of principles. You're taught a set of principles and you have to apply them. And if you stick with things that are dogma, using antibiotics all the time after a surgery, or using drains and surgery all the time, or these absolutes. Right. The whole absolute thing is just so odd to me because there'll be study after study that says you don't need to do. Yeah, antibiotics. And the standard of care in this country is one dose IV, 30 minutes prior to incision. And if the case is going to be, you know, longer than a designated time of, we'll say three hours, then they would get redosed to protect the patient from what's called a SS skin site infection. That's what it's for. That's basically it. And it varies across, you know, the disciplines of surgery. But I'm a. Basically a person who operates on the skin, the subcutaneous tissues, the fat. So I'm just trying to protect patients from what's going to be the most harmful, which is usually our skin bacteria or introduction of the bacteria in the wound. So that's literally the standard of care in the country. And every time you prescribe additional antibiotic therapy, you're acting like you don't care, that that's already been debunked.

Yeah. And I don't know why that is, but I have a lot of doctors in the family and they say there's always this fear of lawsuits. And so over prescribing is just a way of protecting their. Protect, protecting themselves. Hopefully that that'll change. But in the meantime, patients do struggle with.

Frustrating to hear that because you can't really take care of patients from like a place of fear. I know that's what that is about. Like somebody comes to see you and if they don't, you don't give them something somehow it's not been a worthwhile encounter or something. They'll go on the Internet and, you know, you know, be negative about you or what. And that's such a frustrating, you know, situation. Providers. I don't envy that. You know, I guess I'm old enough now, I don't care as much, but yeah, it's. That's obviously terribly irritating and Frustrating because it's not necessary.

Yeah. And especially when you see people struggling with, you know, this antibiotic resistant genes and struggling with things like diarrhea and bloating for months on end, their quality of life is so compromised. And I, that's the part that I get to see and it's very frustrating. Yeah.

Yeah. The, in addition to like all of the standard things that we run into, like you're in California and I'm in Texas and we're border states. So we constantly have patients going to and from other countries.

Yeah.

Whether they're on our border or in other, other continents. And they come back with obvious cases of travelers diarrhea.

Yeah.

And then they don't do anything about it. And then this kind of just goes on and on and on. And you know, the, the parasitic overgrowth you get from Intamoeba histolytica or giardia or whatever, whatever the bacteria is.

Yeah.

Or the parasite is, it's not serving you to have problems with, you know, absorption. And you know, those doctor that taught me was always, you know, so big on, you know, balancing out everything so the gut will work better and, and when you have those harsh, harsh imbalances and then problems with constipation and, or diarrhea, then absorption is affected and then the gut brain axis will get affected and all the other things associated with the gut will get affected because of the overgrowth of the, of the parasite. Maybe speak to that because I, I feel like that's just an underappreciated, you know, problem from traveling, which is a known thing. But it seems like everybody's just like, ah, it's fine.

Yeah, travelers diarrhea or montezuma revenge or deli belly, you know, whatever you call that, it's pretty real, you know, people. And the way I look at it is not everyone gets affected by the same, you know, the same travel, even within the family. You know, why is it. And the big question should be why is it that some people are more prone to it than others? And I think that comes from the, the basic, you know, gut microbiome being not resilient to it. So if you have the right kind of bacteria, bacterial balance or microbial profile, they fight your battles for you. So I, I am, I believe more in terrain building rather than just fighting the bad guys. You know, it's one thing to say, okay, I' going to go after these. I mean, it's one thing if it's giardia or something like that that needs to be taken care of. And then start building the terrain. But sometimes it doesn't make sense just because a test is saying there are like two or three different bacteria that need to be pathogenic bacteria to be handled. We have to look at the microbial balance, and that really comes from feeding them and decreasing antibiotic usage, spending more time outside exercising, sleeping really well, optimal sleep, all of these make a huge difference. And it can't be a one prong approach to microbial diversity and resilient microbiome. So even if someone has overload of pathogenic bacteria, I think at the same time, I propose that we feed the microbiome so we get back balance very quickly rather than just, you know, going after it. Because what is, I mean, the irony is like, if, if there's a problem, like let's say C. Diff, what are you fighting that with? More antibiotics? Right. So that's a little confusing for the patient too. Like, I thought this is, this was the reason I had this problem and now they're giving me more antibiotics. It's very frustrating.

Yeah, yeah. We have really not proposed fighting that way when something's encountered. We've worked diligently in a more natural way to help patients through the kind of obvious, you know, diet changes, additions and things to support detox, as well as try to, you know, highlight what are these things that have gotten into the system that we need to not have in the system, which is like a very lengthy discussion in the majority of the patients because they have just kind of dealt with. And that story that I was telling you that literally just was like, a couple days ago, someone came in and said, you know, I'm having all these problems. I can't even take the dog out for a walk. I'll get problems where I got to go and use the, the bathroom. Like, that's not normal. Like, how long has that been going on? And then you ask them and they'll give you all the information. If, in fact you ask enough questions and listen to what they're telling you, it's not going to be that hard to figure out. They went to Costa Rica on a retreat and, you know, she, this, this, you know, client of ours said, oh, the, the food looked great. Well, the food probably was great. The food prep with the water was not great because the water is the problem.

You end up eating street tacos. And, you know, and I usually suggest to my patients, just take some saccharomyces boular with you just to help you because it doesn't need required refrigeration. You can start on it right away. And especially for people who are like insistent about, oh, I don't want another dose of antibiotics, you know, they're really nervous about it because they've gone through it and they've seen the aftermath of it. So, yeah, definitely something like that. And really taking care of your gut before a trip is so important and it doesn't require a lot, you know, just.

No, but you have to be thinking about it all the time. You have to always be mindful of it if you're going to be somewhere. And you know, we talk about quality of water, quality food, quality of air, and those are, I know those, I know it sounds mundane, but it's like foundational for anything in terms of what we see as problems that you can address. You know, their modifications obviously like, and they're not like super complicated ones initially, you can, can start right away. You cannot drink out of plastic. You don't have to drink out of plastic. There's ceramic and stainless and glass as options over plastic. And don't reheat anything in plastic and don't buy a bunch of ultra processed garbage because it's really not food.

Plastic is such a flimsy polymer. I see this with people who are on weight loss with me that they don't know. I mean, they heat up their food and Tupperware and things like that and their weight loss stalls because it's a xenoestrogen and it can really, really affect your weight loss too. And I see this in practice, you know.

Yeah, that's a great transition too because, you know, patients, once again, from a literacy standpoint, don't understand how all those different things affect their hormones. And although we don't need to get in the nitty gritty, you said xenoestrogen. So maybe just for the audience say, okay, xeno is not your own estrogen, obviously, that's why it's called xeno. But what is it doing that can, you know, it's not so much help or hurt, but like, what's it doing? What role is it playing?

So in the, in your, your gut microbiome, they're also very adept at helping you recycle your estrogen. So there are bacteria that are called estrobolone that are really adept at that. So when we take in a lot of toxins through air, like you said, or through plastics and chemicals and preservatives, our gut, the microbes don't recognize that as anything like food. Like the ultra processed foods that we eat have a lot of preservatives and chemicals in it or artificial sweeteners. And now we have concrete studies that are showing that these are really causing havoc in the microbial profiles. You end up having a lot of pathogenic bacteria that have grown to metabolize these and produce more of these estrogenic qualities, and that can cause stalling your weight loss. And I see that a lot in my practice. Clients who come, they've been on restrictive diets to this whole concept of calories and calories out. Of course, the metabolism tanks. But beyond that, it is the, the microbial, you know, potential for a better metabolism is also compromised by not having enough of these beneficial bacteria going to bath for you. Ratios of bacteria could be elevated and that can cause weight gain. So there are many things that can happen just from. It's not just about, oh, don't eat food in a Tupperware thing, but it's the culmination of all of the things that we do. And unfortunately we, we are responsible for it because obviously the government is not doing taking that many, you know, things as far as especially processed foods. I mean, the food industry has a big part to play with it. I 100 believe that they know what's happening, you know, because anyone with a little bit of food science will know that if the food has protein and if it has fiber, whoever's eating it is going to feel more satiated. But that's not happening. We're having empty carbs and refined sugars in our food that's highly processed. So people go back and buy more. I mean, this needs to be fixed. And we can't really, like you said, it can't be. There's so much conversation around this. But. And how do we do it? I have no idea, Dr. Rob. I don't know how it's done.

Well, you know, we have this very simple kind of moment and I, I try to get people to be very mindful of this. Like, there is a lot of clatter, you know, discussion kind of disinformation, misinformation, whatever. We're gonna clutter. You know, there's just a bunch of confusing information. There really should be no confusion about, like what's food. Food doesn't have a, a label that describes the ingredients of the food.

Exactly.

Something that has an ingredient label is ultra processed. It's not food. So the, the adage of, you know, fruits and vegetables are food. Obviously sources of protein are food like fish and chicken and beef and, you know, your, your vegetables and things, like things that aren't food come in Boxes, bags and containers, typically. So, like, that's not that hard. And if you feel like you don't or can't get a handle on that, then there's little apps on your phone now that'll help you with scanning a barcode, and it brings up the thing you're reviewing, and it tells you kind of what's in it. Now, when they start saying things and.

Reading labels should be simple, right? I mean, you look at the first two, three ingredients, and they need to be whole. I mean, even with processing is foods, it can be like oats could be oat flour, and that's not so bad as having a bunch of ingredients that you can't pronounce. Those are all chemicals that are not really doing you any favors.

Right. Yeah. It's always the same, right. When, you know, there's this obsession with counting calories, like you said, there's this thing with weight loss that is still baffling to me. And then everybody's feeling that they have to lose this five or ten pounds. And, you know, I can, I can make anybody lose 10 pounds overnight. I can give you something and make you lose 10 pounds of fluid weight. And that's. Well, I try to tell patients all the time is if your gut is dysregulated, the largest amount of concentrated lymphatic tissue of the body sits around the gut. Yeah, it's called the Gault Gut Associated Lymphatic Tissue. Not a terribly great name, but it is what it is. And when you're inflamed, your and or GI tract is dealing with the inflammation, everything swells and you feel bloated, you look puffy, or you retain fluid. And I, I see these patients all the time, and I tell them, like, you're going to lose anywhere from 10 to 50 pounds of just fluid weight. And they're like, really? And I'm like, yes. Because your GI tract, so your liver works in constant concert with your GI tract, and when it can't, you have this imbalance and you can't eliminate waste, and you can't, you know, you. You get more swelling, and it's just a vicious cycle. And until it's broken, it's a huge problem.

Yeah, I mean, definitely. And I get a lot of clients who look thin on the outside, but they really have incredible amount of visceral fat and metabolically active fat, and especially minority South Asians, African Americans, who have been largely ignored in studies. And, you know, so I. We need to kind of reteach groups how to eat for Today's modern world. Just because our ancestors could eat a certain kind of food does not mean that we can because we don't live the same life. You know, they were farmers, they were doing a ton of work, you know, in the field. We don't do that. We're sitting here talking via zoom and spending a lot of time sitting. So we can't eat the same thing and expect not to gain weight. I think that is the biggest misconception out there. Like, oh, but it's an ancestral food, doesn't mean anything to us, you know, very different.

I, I've heard those terms, like you have, and they should be better for us, of course, because they're ancestral. So not to disparage those things because hopefully the quality of those is better on, on a whole. But it all works in concert with your sleep patterns and your other patterns of behavior, including, you know, like you said, you know, too much. Being sedentary or sitting too much or, or not moving. Movement is, is key. And you know, doing your. I harp on all my, my clients because I predominantly take care of women. Many are perimenopausal and postmenopausal. And you're trying to avoid osteopenia, osteoporosis. And those things are part and parcel to loss of hormonal balance and not enough resistance or exercise that incorporates movement and use of weight. So to your point, when we're all, you know, our ancestors all had to lead a much different life. There's a lot of work carrying heavy things, moving heavy things, because we didn't have all these devices and all this clever tech to help us get through our day to day. You know, we would have had to walk somewhere to sit down to have this conversation.

And I'm in Texas, my grandfather was a judge and he had to walk like 25 miles to get to work from his little village. So grandma would just pack a big bowl of fermented rice and then he would just polish it off, but he would walk it off. And if I ate the same thing, I would be definitely obese, you know, and I would be so insulin resistant because of the carb load. Right. You know, so you can't really eat and then expect, you know, miraculously that without, without the exercise, things are going to work. It doesn't.

Yeah, well, right, so that's, that's the thing, like, to your point, everybody's going to be extremely different. And that is, you know, I, it's the same thing when we talk about it to patients. You're like your own specific set of genetics exposures, experiences, diet, lifestyle, exercise, sleep patterns. All these things play into why you, you know, phenotypically express the way you express. And sometimes I get the light bulb goes on when I say that and a lot of times I get the what are you talking about? And what do you mean by that? That's everybo own. You can't compare yourself to someone else.

Unless you have a very bio individual thing, very unique to who you are. And I think you, you would probably agree with me that our patients or clients have an incredible power and knowledge about their own bodies. We can never know what it is to be in their bodies. It's just that there's a lot of confusion today. We're just so many things on social media that it's confusing the heck out of people. And I think things simple so everybody's on the same page and I think becomes our collective responsibility. And I think that's where podcasts like this, where we keep things simple and say, well, it doesn't have to be complicated. You don't need 150 different supplements.

Oh my gosh. You know, on the supplement thing. Oh, man.

Yeah, that is a very frustrating area for me because I see many patients come with a basket full of supplements and they have no idea the supplements actually working for them or not. And the whole thing is, well, I'm taking it because I was told to take it.

Right. So that ends up being a, the, the. And this is probably a good way to kind of summarize and, and we'll conclude with this because, wow. Whether it's skin care or supplements, two very difficult industries that I expose. As a plastic surgeon, I'm exposed to, you know, skin care a ton and get asked questions daily about this, that the other. And then as it relates to new drugs, like obviously GLP1 agonist. There's a big write up of this in an online forum and it got to a colleague in Europe and they sent it to me. So I did a video about ozempic phase and not ozempic face in older patients, but younger patients.

Oh, in younger patients.

So about a year ago I told my team, I'm like, the biggest problem with these drugs is they work. So now you're going to see this filter down to everybody else who wants this little bit of weight loss, these changes, because you have people who see themselves very differently when they look in the mirror. Some people see themselves and they're, they're like happy, they're comfortable, or maybe they want to work out more. Maybe there's some problem area, but then there's the person who sees a very different image, one that's very dysmorphic. When they're not happy with one that makes them upset, causes them anxiety or just being uncomfortable. And those folks are not served well by taking that medication to help them achieve something that is not achievable.

Correct.

And in the meantime, they're doing maybe lifelong damage to their fatty layer. Which the reason when you're younger and you look so different, especially around the eyes, is there's. There's something called the lid cheek junction. And when you're young, you don't really have a distinction between the lid and the cheek. And when you age, like me, I have a little bag under my eye. And so we have loss of our bony skeleton. That happens over time. That's part of facial aging. We have atrophy of the fatty layer, which is part of facial aging. And we have development of what we would term skin laxity. So there's ligamentous attachments, there's lack of collagen over time, lack of elastin over time. So that was going to happen anyway.

Yeah.

And now you just threw gasoline on top of a fire and lit a stick of dynamite and threw it in there. Because when you burn the fatty layer too fast now you've enhanced and sped up all of the skin laxity.

Yeah.

I don't know what it's doing to the actual bones because nobody does. So there's never studied for this.

Yeah. Muscle loss. Yes. Right.

Correct. But, like, this whole thing as it relates to your. I'm just talking about faces. So you're going to lose weight because those drugs work, and the newer drugs that are coming work even better.

Yeah.

And they're going to be focused solely on fat. One, in fact, in studies, has reduced the body fat by 38%.

Wow.

So if you do that to somebody who's seeing the wrong image of themselves, what do you think? You just made an even worse problem.

Yeah.

So now it's somebody who's lost weight too quickly. Now their skin is loose. So now they even have a worse potential body image issue. So it's a very complex thing. I. I don't.

Then what happens to the ethics issue? I mean, can everyone afford the drug? That's another big thing. And what happens when you stop? Do they have, you know, things in place to help them keep the weight off? That's another big, big thing. Concern that a lot of patients and clients have, like, I can't afford this. I Can't keep going with this drug. I need to learn how to eat better so I can keep this weight off. That's. That's a valid point, I think. You know.

Right. You would like to have all those things up front. Right. That's the way you should use the medication.

Exactly. I would say learn how to do it.

Right. This is the Pillshot Drug Society.

Exactly.

We have to do things in a accelerated manner because, you know, we got to keep up with everybody. But that's the kind of thing where you have to be, you know, always informing your, you know, patients, clients, friends, family. Because I get asked or told daily that somebody's now microdosing, because that's the thing to do. Microdose this. Well, there was no study on microdosing as you would imagine, because the FDA wouldn't have done a clearance for microdosing. So it's all off label.

Yeah.

And, you know, I understand and work within that space because everything in plastic surgery half the time is off label. So. Okay, that's fine. But if you're not teaching.

Yeah.

And explaining lifestyle modifications, food, air, fluid quality, you know, microbiome education. If you're not doing all those things, then you're not really serving the clients because they're just.

Because so many come with gut motility issues, gastric emptying. These are all real problems. Maybe the severity of it is not the same across the board, but everyone does experience it and causes a lot of anxiety in patients.

Yeah, yeah, I agree. I agree. Well, this has been a very, very good discussion. I hope y' all got a lot out of this. I certainly did with Anu. So, Anu, where can they find you? Learn more. And I'll put in the show notes and everything, but please just tell everybody where they can find and learn more and get your book.

Yeah, my book is on Amazon now. It landed a few days ago. It's number one on fiber, so I'm pretty excited about that category. You can reach me at 9Arms of Wellness on Instagram or my website is 9Arms of Wellness.com as well.

Awesome. Thanks for hopping on. I really appreciate it.

Thank you, Dr. Rogue.