Dr. Karan Rajan: This One Change In Your Routine Will Transform Your Sleep | Align Podcast #520
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Welcome back to the Lion Podcast. My name is Aaron Alexander. This is a place that we bring together the world's leading experts in all things health and wellness to help you optimize your mind, body, and movement. Today's conversation is with Dr. Karan Rajan. He is a big deal on the internet. He's got many, many millions of followers and subscribers. He is an actual doctor. He is a surgeon pertaining to things related to the gut in this conversation.

you will learn about why you don't want to hold in wind from your body, i.e. a fart, and what happens when you do. Also, what happens when you hold in pee, how to develop the perfect poo, what that looks like, what that is, some of the nutritional suggestions around that. We get into a lot of esoteric stuff around death and

and a lot of really interesting things. So this conversation I think is important. I think it's interesting. It's kind of like a magic school bus ride through the body. And I think her and Rajan is a pretty radical human, very grounded, very intelligent, and you're going to like it.

Um, thank you for subscribing to this for every list in this. Thank you for reviews. I read all of those. I appreciate them. Uh, jump over to the aligned podcast, YouTube channel subscriber there for a chance to win some sweet prizes at the end of the month. We announced a, our announced a winner at the end of each month to send you some cool stuff.

That's it. That's all. I hope you enjoyed this conversation with Dr. Karan Rajan. Do you do much breath work stuff? So the main kind of breath work I do is, you know, like if I've got something stressful, if I'm on call, if I'm about to do a big surgery and I feel some nerves, I'll just do a very simple four, seven, eight breathing, just focusing on that exhale just to calm my nerves and just to kind of steady myself. And

I do have family members who like practice yoga a lot. And I try to get into the kind of pranayama breathing and all these yogic breathing things. But, you know, it's a lot harder than it looks. And I never really could get it into my daily routine, but I'd love to. Cliche generic question that you've been asked already is the first question on my buddy Chris's podcast that I think is very interesting is starting off in relation to breath.

why is it valuable to not hold in a fart? In relation to breath work. In relation to breath work and in relation to stinky breath.

Well, if you hold in your fart, if you think about the basics of a fart, it's a gas, right? And gases easily dissolve through tissue. So all that gas that you're holding in, it's going to dissolve through the very thin tissue of your intestine and get into the bloodstream. And all the waste products that are dissolved in your bloodstream, things like carbon dioxide, CO2, that eventually goes all the way to the lungs and the lungs get rid of that CO2 and other gases.

Some of that gas will also be that dissolved fart gas that's into the lungs. And you literally exhale some of those dissolved fart gases. So it could contribute to foul smelling breath.

Interesting. Would that be actually measurable, trackable? If you're holding lots of farts in, do you think there'd be some way to actually have some quantitative data on foul breath? I guess there would be if you consider the stinky bit of the fart that we think of is hydrogen sulfide. If there was a way to track

If you had an above average amount of hydrogen sulfide being exhaled, maybe. I don't know who would fund such an experiment, but yeah, potentially it is possible. What is a fart, Curran?

Very good question. What is a fart? So it's a combination of things, right? People, it sounds like a ridiculous question, but actually there's a good science behind it. Some of it is swallowed air, right? Whenever you're eating food, if you're talking, we're swallowing air all the time. So some of that air goes down and it contributes to the gas component of a fart. The

The bulk of the fart is actually the breakdown products and the fermentation of food and fiber specifically by our bacteria. So most of the farts that we think of as our creation isn't really anything to do with us. It's our bacteria in our colon producing farts. So we are just the facilitator and the housing product for bacterial farts. That's all we are. And what about swallowing?

fart. Have you seen that? There's people that can actually do farts on command. Is there any like loose colon type scenarios or like flappy rectum situations that people could work on? I think it was in the sort of very late 19th century, there was a French artist called Lapitomène

Essentially, this guy could take things up into his rectum and also produce orchestral level sounds with his rectum. And he was known as like this performer who could create fart sounds. And he was a huge success. He went to the Moulin Rouge. He did all sorts of amazing things. So, yes, people have this ability to control their farts and fart on command.

Is there some way for one to regulate their fart output? Is there, so you're just talking about perhaps foods fermenting. Is that like a bacterial conversation? Is that something around maybe fermented foods, fibrous foods, excessive...

macronutrients or anything of that sort? How do we regulate our fart output? The higher your fiber intake, specifically soluble fibers, so you're thinking things like beans, oats, you will have more fermentation going on in your gut and more farts.

And if you wanted to increase the pungency of your fart, you're thinking of more sulfur rich foods, things like cruciferous vegetables, cabbage, kale, even things like eggs and meats, they have a high sulfur content. So that's going to get, you know, pretty spicy down there. This would be a really good for anybody that has any friends on OnlyFans. I feel like this would be like a really great conversation to share because I think there's a pretty significant market for that.

Have you seen that? The farts in a jar thing? Oh, yeah. There's a woman who's making a lot of money doing that. Yeah, yeah. It's big business. Continuing down the same track, because I'm joking and also serious, and I think it's actually really incredibly interesting.

uh interesting and valuable um the quality of one's poo uh I read in your in your book this book may save your life uh which I really enjoyed it's like a magic school bus ride through your human biology and human experience and even gets into like death and things of the sort so I'm very excited to talk about it um one of the things that mentions in there is the Bristol stool chart

and the various different ranges of your poo. So how can a person get to know their poos better and come in better relationship with their poo? And how can a person have the coveted perfect poo?

So, yeah, I think people don't examine their poo enough, right? There's this cultural taboo that we have that we don't want to look at our waste products. But actually, it's such a, you know, pun intended, gross indicator of our health. If we look at our poo, we can tell, is it floating? Is it smelling? Is there any blood? How well formed it is? What's the shape? What's the size? All these factors tell us about our internal health and our gut health.

So for example, the Bristol stool chart, as you referred to, it's a chart that was devised a few decades ago and it's commonly used in the NHS and probably other countries as well.

where your poo is graded like one through to seven, type one through to type seven. Type seven is like chocolate milk, right? I like to think about it in chocolate terms. And type one is like Maltesers, you know, round balls, like rabbit pellets. Type one rabbit pellets, you are very constipated because you are straining and pulling out tiny little nuggets essentially. And type seven, you have no control and it's just diarrhea.

And the kind of type two is still a little bit constipated. Type three, type four, that's like the optimum. It's like a sort of a Mars bar type shape or a crack sausage. And then type five, type six, again, you're going towards the constipated. So three to four is like the kind of ideal zone where you want to be, uh, having your poop look like, like a sausage slash Mars bar shape, well-formed with some cracks, uh,

And yeah, kind of that's what you want to check for if you're poo every morning. And you also want to look at other things like, is there any bleeding? Is it floating? Because a stool that's always floating on the surface, and that could be a sign that you're not digesting fats as well as you could be, could be a sign of some pancreatic or liver issue potentially. So I think people should be looking at their stool every time they go to the toilet. And how would a person...

devise the perfect poo? Would it be exclusively based off of the things that we're eating? I would imagine there's some microbiome conversation here. I'd be curious if there's any other factors relevant to developing the perfect poo.

So yeah, the perfect poo, there's a number of factors there. Like, in addition to diet, diet's one component, right? So we often disregard one of the main macronutrients when it comes to health. Like in this age, we're all rightly obsessed with protein intake and calories and carbohydrates. That's fine.

people tend to not shine too much of a light on fiber. And fiber is basically the food that drives your gut and drives the microbiome, which we're understanding is increasingly important and has a role to play in our gut's health. So making sure as the average adult, assuming you don't have any major gut issues, you are aiming for around 30 grams of fiber a day, combination of soluble fibers and insoluble fibers and resistant starches.

That's the dietary component taken care of. Another part of the perfect poo is routine and regularity. Now, people often talk about the internal or biological clock when it comes to sleep. You know, you've got this circadian rhythm where your body tells you when you feel tired, when you want to wake up in the morning. That little clock, you have clock cells in every, you have clocks in every cell of your body, including your colon and rectum and your stomach and your entire digestive tract.

So actually, your body likes timing. So if you go to the toilet for a number two every morning at 7 a.m., your body has queued all the hormones and enzymes and essentially neurotransmitters to make you go to the poo at that time in the morning. If you delay that by too much,

then you upset the balance, that orchestra of different enzymes and activity in your body. And you can actually affect your routine. And you can push yourself into constipation by not keeping that, you know, routine of going to the toilet. So that's another thing. And the third thing I would say is the actual physics and biomechanics of when you're in the toilet.

So you want to minimize straining because that can increase the risk of hemorrhoids and constipation and problems down below. So you want to try and raise your knees above your hips, either by leaning forwards, having some sort of something below, you know, your feet that just lifts your feet up slightly and actually minimizing the time spent on the toilet. I say no more than maybe 10 minutes max. So those three things, the mechanics, the diet and the sort of timing are the keys to having the perfect poop.

Yeah, the legs being up thing. It's like, it's pretty interesting that somehow we slipped away from being able to do a squat in the first place.

And the native or inherent mechanics of the body are devised such that actually opens up for defecation. So this is all stuff you're already well aware of, but there's the, it's called the anorectal angle, which is the angle of the rectum when you are taking a poop, when you come into a squat, the rectum opens up and there's a muscle called the puborectalis that wrecks around the front like a sling. And you relax that space and actually elongate the rectum

to create space for a healthy defecation when you go into a squat and when you're up raised onto a toilet, and you're in kind of that same position throughout most of the day, that 90 degree angle, you're actually kind of like clogging yourself up. Is that right? - Yeah, again, I don't know why we moved away from that. Probably the sort of Western toilet being,

- It's like notoriety in a way. It's like royalty, I sit on the throne. - Yeah, exactly. - Not the peasants squatting all the way down to the ground being healthy. - Yeah. So some places, the squatty toilet where it's a hole in the ground is still very commonplace. Parts of Africa, parts of South Asia and East Asia

they still have these hole in the ground toilets. I mean, when I go and visit some relatives in India who still live in the villages, they have hole in the ground toilets and you have no option but to squat and to use water to, you know, wipe yourself after you've finished. So, you know, that might seem barbaric, but actually it's in line with our biology.

I love a hose. When I go to Latin America someplace where there's like, you know, a dingy bathroom that's only meant for local people, it's like not for tourists. And you're like, ah, they've got this crummy little hose. You just fire it back there. It's incredible. What do you think of toilet paper? This is one of my greatest pet peeves as an American or just human being in general. What are your thoughts on toilet paper? Pros, cons? Are there any pros to toilet paper? Uh,

I think obviously convenience. So imagine you're wearing a full suit, you're in a business meeting, you just nip out to go to the toilet and you end up having a dump. And if you've got a hose or some sort of like water device, how are you going to wet yourself and then dry yourself and then not get your clothes wet? It could get quite tricky, right? So I think

toilet paper serves as a point of convenience in everyday life. But I certainly think in any 24 hour period, you need water in your ass crack. Oh yeah. You got sorted out. I like the analogy I have is like, if I were ever to get a little bit of poo on my forearm, there'd never be a million years that I would ask for a napkin. Yeah. It would never happen. No, no, no.

All right. That's very interesting. Is there any other stuff in relation to defecation and things of the like that you feel is like misconceptions? Like something else I think would be interesting, your perception of the carnivore diet. I know that that's been becoming a little bit of like an experimental trend for people and exploring. I know there's some transition in there. Yeah.

bowel movements with that. What are your thoughts on the carnivore diet in relation to bowel movements? Yeah, I mean, listen, if you look at the carnivore and keto diets, which are very trendy, very extreme diets and very restrictive diets,

People use them for weight loss, right? And increasingly, people are now claiming benefit of those things for other things like curing their autoimmune condition or helping their skin or whatever. And personal anecdote to find if someone finds that something like that helps them in some regard, and they find that they're not affected by it, and they can sustain that for years, which I'd be surprised with, great, go ahead and do that.

The thing is, most of the studies we have on keto carnivore, they're not very long-term studies beyond about six-month mark. So we don't know the long-term health impacts, like the real long-term health impacts of those sort of diets. All I can say from a microbiome GI point of view, the good bacteria that we have in our gut...

The vast majority of them are created and sort of their purpose in a way is to digest plant fibers. That's not me suggesting everyone needs to be vegan or vegetarian. I'm not vegan or vegetarian. I'm an omnivore. But we need an abundance of plant food to feed those bacteria. So definitely, I mean, I've tried keto before and within a few weeks,

I felt very constipated. And that constipation affected my mental energy levels, my physical energy levels, and even my skin health as well. So I don't know, like, if you're a meat eater, or a carnivore, or paleo or caveman, or whatever, you know, euphemism, you want to give that sort of restrictive diet, I think you should be having some sort of fiber supplement at the very least, you know, for your guts, even if you don't want to eat spinach, and you think it's poison, you need some sort of fiber supplement to help your guts.

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Another random question that I have in relation to gut health and digestion and such is I know some people that have been vegetarian or vegan since they were babies. So they're like people from like Hare Krishna religion or things of the sort like that, or they're just parents who are like yogis or hippies or whatever.

And one friend in particular, he was one of the guys in the Game Changer documentary, bodybuilder guy. He does quite well without eating meat and he's literally never had meat. Is there something that happens when you are eating meat, for example, or eating a certain type of food where you're actually taking in some of the bacteria from that food that would in turn be able to digest that food?

You know what I'm saying? Like, is there something with the, with the actual structure, with the biome of, of the gut shift in such a way, if it's been so long since they've had meat that when they go back to meat, it's like their body's actually not set up to digest it anymore. Or would that be something that the body will always have capacity to be able to digest inherently? Yeah. So I would say that someone who has not eaten meat for a significant period of time, uh, they would certainly, uh,

adjust their microbiome and their gut health and their body in such a way that they do experience a change in their sort of gut flora. Our, our guts are very responsive to anything, to antibiotic usage, to increasing fiber, all sorts of things. Like we know, for example, uh,

The Hadza tribe in Tanzania, they eat about 150 grams of fiber a day. They have bacterial species that you don't find in other populations around the world. So their guts have adapted to their high fiber intake. Similarly, someone who's not touching certain types of food, their gut bacteria will adapt in a way

In the same way, interestingly, Japanese populations who have a high consumption of sushi, they have a specific type of bacteria that's adapted to eat and digest the cell walls of red seaweed. You know, the nori wrapping of the seaweed? They have specific bacteria to digest that that's not found in other sushi-eating populations around the world. So there is that adaptation. That's not to say that someone can then...

reintroduce meat, and then they can go back to normal. That's absolutely fine. They will be able to do that. And in relation to this similar vein of like bathroom stuff, then we'll get off of this. What happens when we hold our pee in too much too long? Is there anything to be aware of holding in one's pee?

Yeah, I mean, we have an incredible capacity to hold in urine for long periods of time. As anyone who's been on long flights, long car journeys can attest to, that is possible. It becomes increasingly painful. But pain aside...

If you're holding in urine for excruciatingly long periods of time, there's a number of things which can happen. Number one, you actually increase your risk of bladder infections because urine is not sterile. That's the myth. It's not sterile. You've got all sorts of bacteria and fungi and whatever living in your bladder and in your urine. And number two,

Depending on the size of your bladder and how long you're actually keeping in your urine, sometimes the urine can go up the ureters, the P-pipes which connect the bladder and the kidneys. The urine can reflux back up towards the kidneys and potentially cause kidney-related issues as well. I think finally, continuing to allow that urine to build up without release, you eventually cause a stretch of the bladder. The bladder is surrounded by this muscle, the detrusor muscle.

And you are putting pressure on that muscle, just like you're putting pressure on a, um, you know, spring by stretching it too much. If you put too much pull on that spring, it will eventually lose some of its elasticity and recoil. The same thing can happen with the bladder. If you keep subjecting it to these high stretch forces, you do weaken that bladder muscle. So your day job is a, uh,

a surgeon specifically around how do you describe your day job you're a surgeon for the nhs you're in can you describe your day job please uh so i'm a general surgeon uh deal with all gut related issues um essentially my job involves me you know cutting people open cutting out cancers bad things

fixing hernias, removing rogue appendixes, gallbladders because of gallstones. So anything inside your digestive system, I probably have had a hand in getting rid of at some point. What is the experience of cutting someone's abdomen open? Like one of the things I read in your book was, which I didn't realize this was a thing, or at least it didn't in the name, but that the panprocto colectomy, is that right? Yeah.

What is that? What's it like? Can you take me through a panprocto-procto-colectomy and maybe say it the correct way as well? Panprocto-colectomy. Yeah. So, yeah, it's a bit of a long word. Essentially, pan means everything. Procto refers to the rectum. The colectomy or the coal bit of the colectomy refers to the colon. And the ectomy is removal of. So removal of the entire colon and rectum is what a panprocto-colectomy means.

And would that be because of cancer or what would be the reason for someone to remove the entire- Could be a number of things. It could be because of inflammation, because of a condition like Crohn's or ulcers of colitis, inflammatory bowel disease. It could be because of cancer. Sometimes it can be like a preemptive surgery because someone has like an inherited condition, which increases their risk of cancer. Like some people have these prophylactic

mastectomies because they've got a high risk genetic mutation. You can also get high risk genetic mutations for bowel cancer, you might want to remove the entire colon, it could be because of you've been in some sort of trauma incident where you know, you've received some sort of major injury to the intestines. So it could be a number of things. But yeah, it's a pretty major surgery.

Could you take me through the experience of what that is like from a surgeon's perspective? So in terms of complexity, I wouldn't say... All bowel surgery is complex, but I would say that specifically...

you're removing the entire colon. So actually, it makes it easier from that sense. You don't need to worry about leaving some behind, leaving whatever, leaving some potential cancer behind because you haven't removed this amount of colon. So you're removing everything.

It's mainly the time and keeping focus because you need to start from one side. And usually you start from the most challenging side, which is removing the rectum and removing the entire colon. So, you know, it's kind of taking a long time doing that.

Where's the cut or the cuts? Yeah. So people think like the intestines are just kind of hanging there like coat hangers, right? And you just make a couple of snips and you remove it. But actually they are almost welded into your abdomen, in the back of your abdomen. And you need to, first of all, you know, dissect the blood vessels free. Like all these intestines are

are, you know, they've got these feeding blood vessels. Before cutting out the intestine, you need to cut those blood vessels and they're like covered in layers of fat. So you need to carefully dissect those. Even finding the blood vessel supplying the left side of the colon could take like an hour, right? And you take the colon in different parts, like

Each part of the colon, like the left side, the top side and the right side, each have their own distinct blood supply and you need to carefully remove the blood supply from each part before removing the whole thing. So this operation can take upwards of six hours.

And are you cutting, is it something where you're going like intra-anally? Are you going like anteriorly through the abdomen or where do you actually make the cut? So a lot of this surgery nowadays is laparoscopic keyhole surgery. So you can go in through their abdomen and keyhole surgery, you can remove all of this. You can do a dissection and cutting and removal.

through that sort of internal bit. But when you remove the actual specimen, the entire colon, you need to make a slightly bigger cut somewhere, either sort of, you know, below their belly button, through their belly button, you know, like maybe a, I don't know, five, 10 centimeter cut where you remove the whole thing. And it's like kind of, you know, the sort of clown handkerchief thing where you're removing the entire colon like this. Jesus.

And then how, what does a person do from there? What's the healing process? How do they continue defecation? You mentioned in the book as well, phantom rectum syndrome, where they kind of feel like they have to poop, even though they have like the memory of the remnant of that, but it's not actually a mechanical thing anymore. Like,

What do we do from there? Yeah. So, I mean, so these patients will be left with something called an ileostomy, so a stoma bag. So all of their content will be coming out of their small intestine in a stoma bag, probably in the right-hand side if they've had this surgery. And yeah, I mean, if people still have this kind of major surgery where they've had their colon removed, if they've still got a small bit of their rectum left behind, sometimes

there'll be sort of some nerves still there at the end of the rectum, which sort of, you know, can still give some distorted phantom pain. Like someone has like a knee amputation, for example, the stump of their knee, there'll be these nerve endings, which have sort of, you know, fused together and still give this kind of weird pain that their limb is still there. Right. And it can cause chronic pain and all sorts and itching and whatever.

Same thing can happen in the rectum. Like you've kind of basically amputated the rectum and some of those nerves are still there and they sort of heal in a way where they can give abnormal signals. So you might experience sharp lightning type pain. You might even experience the pain of you needing a dump, right? And that's like a ghost poop, phantom poop.

And from how would one tend to said phantom rectum syndrome? Like I know if you're losing a limb, they can do like the mirror box thing.

technique, I think might be what it's called, where they actually put, they have the reflection of the opposing limb and you can kind of like almost massage out the limb where you're having the phantom pain where there's not actually a pain, but you're sending the signal to your brain that you're able to get some sensory motor relationship to it. And sometimes it can unwind that pain. Obviously I'm simplifying something that's probably incredibly complex. Is there any remedy for phantom rectum syndrome?

I wouldn't say anything that's well established. Usually when someone has like major rectal surgery or major pelvic surgery and they experience some neurological pain, that tends to settle with time. Sometimes you can get specific nerve injections. You can get sacral nerve stimulators, which might help.

uh you know sort of modulate this kind of pain tens machines uh trans electrical nerve stimulators there's a bunch of things you can try but nothing i would say that's guaranteed to eliminate this sort of pain but generally time does make it go away yeah yeah it's like a breakup um how so going into the the realm of pain you have another chapter in your book that that touches on that um

What is pain from your perception? I've asked a lot of the world's preeminent experts on pain, and it seems like there's a lot of different perceptions. And it seems like at the end of the day, most people are kind of like, you know, it's a very nebulous, complex topic that no one knows exactly definitively, objectively what the heck is going on. So maybe I'm like leading the witness a little bit, but what is your perception of pain? How does a person navigate pain within themselves? Like what's what's what is pain to you?

So pain, ultimately, what we feel is a product of the mind. So, for example, we can both get punched in the face by the same person with the exact same force. But that doesn't mean we will feel the exact same pain. Our experience of that punch in the face, the exact same force,

will be influenced by our past experiences, the kind of density of nerve receptors in the face, which will vary between yourself and me, and how we just feel about pain in general. For example, if you close your eyes and I open my eyes, I'm getting more of auditory stimulus of that pain. Like I know a fist is coming towards my face.

you've potentially down-regulated some degree of pain by closing your eyes. And there's even research which suggests that, for example, if someone is getting an injection or a vaccine, for example, in their hand and they look away or do something else to distract them from the pain, their pain sensation is reduced because the brain can sort of down-regulate or attenuate that pain level. So ultimately...

you know, whilst yes, cellular injury can cause pain, the intensity and the experience of pain is ultimately influenced by our brain, because that's where the sensation of pain goes to, you know, all the receptors feed into the brain, and then

our brain kind of, you know, does a little kind of, you know, automation, and then feeds the pain back and how you're going to feel it. So ultimately, if there's ways we can influence the brain, we can also influence pain. And this is why those pain regulation pathways in the brain is slightly glitched out and abnormal in chronic pain, where we don't sometimes know the cause.

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Get your money back. But I think it's worth giving a shot. 10% off. LeelaQ. L-E-E-L-A-Q.com slash Align. You're familiar with John Sarno's work, I believe. I've heard you mention, maybe not his name, but the concepts from him. Are you familiar with this stuff? Like mind over back pain?

No, not John Sarnas, no. Okay. Well, I've heard you mention the concepts of his work in another conversation. And a big part of it is essentially is if you explain or make a person understand their pain or the concept of pain, that can reduce the pain, probably because it creates some type of internal sense of control or certainty. Is there anything to that? Yeah, I agree. I think...

If someone understands where the pain is coming from and why, they often feel better about it. And sort of my personal anecdotes with that is if someone is suffering with pain related to gallstones, I often find when I tell the patients why they get pain, like biologically why it happens, what they can do to get the pain to go away, understanding something. And like you said, maybe that sense of control allows them to sort of deal with the pain better mentally rather than it being some unknown beast.

Yeah. As you were saying the thing with like closing your eyes, I would think that particularly if you like closed your eyes quite hard, that would get into, I think it's, I'm spacing it right now. I didn't get enough sleep last night. I think it's called sensory gating where your brain, you can kind of like offset a pain stimuli or nociceptive stimuli through movement. And so that's like, if you like burn yourself or, you know, stub your toe, you'll usually run around in a circle or go, ah,

You're like, you know, contract your muscles quite a bit. So you're actually like overriding that nociceptive pain signal with movement. Are you familiar with that? Yeah, exactly. That sort of pain gate theory, it's commonly applied to, you know, you sort of you stub your toe and then or you kind of get punched in your arm and then you rub your arm, right? The rubbing, that vibratory stimulus that you're applying with your kind of rubbing

helps to kind of distract your brain from that pain of the punch, for example. And yeah, like you can do other forms of distraction, like swearing. Swearing is a commonly used technique to downregulate the intensity of pain perception. And yeah, so that distraction does work. Oh, why swearing? I mean, I could take some guesses, but why would swearing reduce?

Again, I think it's a form of distraction. So you're swearing and your energy is high and you're thinking about something else. You're sort of giving anger to something else rather than just focusing on the pain at that moment. So again, it comes down to this sort of brain is the controller of pain, right? If you focus on just the pain, it's going to be a lot worse, which is why if you think about elite sports, why do elite sportsmen sometimes complain?

continue to play with pain. And then once the game is over, then they're like, Oh, God, I'm out for weeks, because this injury is terrible. Because at that moment, they are so focused on something else, their body doesn't have time to focus on that injury. So they just get through that pain. And you know, the adrenaline and all that, and then they sort of, you know, get injured.

The body is interesting in the way that it's, it, it has a certain level of like compassion and grace and kindness to the, you know, whatever the, the, the, I don't know,

spirit of the being that's holding holding that body like if you go through some type of traumatic experience your body will disassociate from itself for a moment and suddenly you'll drift off into the room and witness yourself going through that traumatic experience if you are a zebra and you're getting i just had robert sapolsky on the podcast recently who did the book why zebras don't get ulcers and one of the references in there is like if you're a zebra being attacked by a lion you're gonna get and you're kind of at the point where it's like oh like i'm

I'm out of here. You'll go through this kind of like, like ketamine, um, you know, opioid, opioid type experience where your body will release all these opioids and you'll suddenly have almost like this DMT trip where you turn into whatever the heck you turn into like a zebra white light, you know? And it's like, it's, it's very interesting that there's a certain level of like kindness and compassion baked into the, the physiological experience. You ever thought about that?

Yeah, I mean, to me, what I find most fascinating about the brain and the mind is how little we know about it. And the more we begin to appreciate how complex it is, the deeper the questions go. In your book, you mention the difference between I think it's like biological death and clinical death. And you have a chapter, I think, is it a chapter on death? Or is it just like a section?

Why did you include a chapter on death? And what did you gather from writing the chapter on death? So, you know, I'm in a very uncommon job in a sense of, you know, compared to the average person where I come face to face with death, not on a daily basis, but very frequently. I'm either, you know, delivering very bad news that is essentially sometimes final news for some people like cancer, right?

or, you know, dealing with things which might end in death, like major hemorrhages during surgery, or someone comes in following a major trauma accident. So death is a huge part of my day to day life. And the reason I included death in my book and reason I like to talk about it

is because I think there's lots of stigma and taboo attached to death. In the Western world, particularly, we have an aversion to talking about death. And I truly believe that if we can think more about death and be happy with speaking about death, not just in hushed tones, but in normal conversation like this, we can actually live life better. And, you know, it comes back to that old Roman phrase, memento mori.

you know, remember that you'll die, you know, that remember you'll die. And I think some of the great Roman generals, you know, of that age of ancient Rome, they used to have someone, even after they, you know, conquered some new land or won some great victory, they used to have,

someone just whispering in their ear all the time so they don't sort of get ahead of themselves just to say, remember, you will die kind of just to keep them grounded. And I think being reminded of death and your mortality allows you to live life more fully.

Yeah. Be good to have someone say like, remember you take dumps too. Yeah, exactly. Right. You know, I think that that's like a good, that's like a nice way to kind of like level things out. There's someone that you're really impressed by. So you're looking up to celebrity figure, whatever, you know, I think that would be a nice thing culturally if they would just put out a picture, public picture of them taking a dump, just kind of eat, like even things out a little bit.

Yeah. Ryan Gosling takes dumps. What are your thoughts on psychedelics? And, and because that's something that I think particularly in relation to death, I think, you know, we, we live in, um, kind of this like artificial world where we're very, um,

I think as in like in Western culture at least. And then I've never been to India, but I listened to a lot of Ram Dass and he talks about, you know, his experiences out there and, you know, bodies burning and it being something and also being a part of, of life because the grandparents live at the house. And so you're going to inevitably see death as a child or as an adolescent. And it's just a part of the experience. Whereas Western culture is,

Most people in Western culture probably have never actually been around death in their entire life outside of like roadkill, you know? And so like, like, like what's the value in coming into religion? I mean, I think you just, you just, you just touched on it.

So the original questions are your thoughts on psychedelics and then it just kind of opened up into general conversation around death and the potential of psychedelics may be being supportive to regain relationship with that. I think psychedelics, if you look at the research in psychedelics up to the 1950s, right? So Albert Hoffman, sort of, I think 1943, he essentially discovered slash invented LSD, which is a sort of ergot of fungus. And

Up to the 1950s, we had thousands of research studies helping tens of thousands of people with all sorts of problems from alcoholism, depression. You know, there was great research done on psychedelics.

And then the psychedelics got wrapped up in this sort of anti-war sentiment around the Vietnam War. The kind of governments thought that it was influencing society, which it was to a negative degree. And then there was essentially this kind of moratorium on psychedelic research and a ban on psychedelics, which was probably one of the worst censorships to happen in research, in advancing our medical research, clinical research, specifically when it comes to mental health, because we now know that

like a lot of the antidepressants we have, they are very life-saving and quality of life improving for a lot of people. But we also know that antidepressants do not work for everyone, right? It's not the best that we could have. But we also have evidence that

psychedelics like LSD, like ketamine, could be pretty effective in certain mental health conditions. In fact, there was a landmark study published in the New England Journal of Medicine not too long ago, which suggested that psychedelics, so something like psilocybin, which is found in magic mushrooms, with psychotherapy is as effective as traditional antidepressants.

And if you think about the difference between those two, the difference is the psychedelics act a lot quicker than antidepressants, which could take weeks to months to actually work. And the side effect profile of antidepressants, typically weight gain, sometimes like a numbing of emotions.

all those things are not typically present so much with psychedelics. And psychedelics allows a different way of thinking. They sort of attack the higher executive cortical functions of the brain, as opposed to affecting the emotional centers of the brain that traditional antidepressants do. So I really think there is huge potential that psychedelics could revolutionize mental health treatment, which is direly needed right now.

Yeah. And during that time, the Nixon administration, I think they called Timothy Leary, like, like America's greatest threat as though he was like a terrorist of sorts. And his whole concept was just like,

you know, tune back into yourself, you know, tune out of the media, tune back into yourself. And he's considered the greatest threat to the United States, which I think says a lot about the information that we get from the mainstream media, you know, it kind of brings back a little bit more invitation for agency and sovereignty. You're kind of like maybe ask yourself and people that you respect, I suppose, just like listening to whatever gets touted in the mainstream. Yeah. Agreed. Is,

Is that, is that something that you, do you ever talk about psychedelics within yourself? Is it something you've explored within yourself or do you, do you not communicate about things like this?

Yeah. So, I mean, with friends and with myself as well, I'm very interested in psychedelic research. So I'm definitely always doing research on it, you know, and seeing, looking at the side effect profiles, looking at how effective something could be, because, you know, I feel that there should be less taboo about these sort of things. The reason that things like magic mushrooms and psychedelics are seen as these kind of

dirty street drug, which only degenerates take. That's because of what we've been fed by mainstream media for years. You know, these have been used by our ancestors for centuries, you know, by sort of Aztec tribes in India, they've been sort of spiritual things, they've been healing things, you know, all sorts of things. So

you know, it's only like a 50 year period from like the 1950s to guess the 2000s, where these psychedelics have been seen as something poisonous, but they're not they are natural substances, which if regulated properly, and taken under supervision can be really effective. Yeah, where would you differentiate drug to medicinal substance, organic substance, because I think that that's a confusing conversation for anyone that was raised with like dare,

And within DARE, you know, the concept is pretty much like anything that's not whatever legal, you know, so cigarettes and I guess they're not really super pro cigarettes and alcohol, whatever, but still that stuff still like your dad, you come home, your dad's smoking a cigar and drinking whiskey and it's okay. Everything outside of that is drug.

do you have any sense of creating clarity around the concept? What would you put in the category of drug? And what would you put in the category of medicinal substance? I don't know how to say it. Anything which has an effect, a physiological, significant physiological effect on your mind or body can be classified as a drug. Like caffeine is a drug, right? It's a drug. It's an addictive drug. Nicotine, alcohol, all these are drugs. And what I find highly ridiculous is that

how much we regulate things and sort of illegalize things like cannabis, like psychedelics, but which things we know are harmful to the individual and society as a whole, like cigarettes, tobacco, alcohol,

They are freely promoted and advertised. And you start to think the reason behind that is not based on any scientific rigor, but it's based on politics and lobby groups of big tobacco, big alcohol, just giving money to politicians, greasing their arms.

I think the whole legislation around drugs needs a lot of work.

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And then that trickles into, I think the food conversation as well, you know, and, and, and the pharmaceutical drug conversation and just the things that it seems like we live in a culture that is, if you allow yourself to just be like dust in the wind of Western culture, you will be made sick. And then Western culture will, the same companies that made you sick will also provide you the solution to heal your sickness. And then you kind of get yourself into a cycle of,

of sorts and some of the pollutants that are coming off of the companies, you know, that are making their way in the water systems or into the, into the, the soil systems, or maybe into our homes or into our armpits with, you know, deodorants or perfumes or whatever. It's like, it's, it's really, um, it's almost like an episode of the matrix in a way, you know, it's like, and it's like to, to come out of that system. Um, what do you see from the food system that,

is kind of in a similar vein of like we're being fed misinformation and it would be supportive to for folks to kind of exit the exit the Matrix like is there some aspect in the food system where we're fed lies from your perception

I think the problem lies at a sort of government level when it comes to food policy, where we know that, yes, everyone should be eating more whole foods that's less processed and less ultra processed foods. We know that. OK, everyone, every single person knows that, you know, if you eat real chicken. Right.

right, chicken breast and you cook it yourself versus frozen chicken nuggets. One is obviously far healthier in terms of, you know, micronutrients and macronutrients than the other. But the problem comes with food equity and, you know, socioeconomic status.

Not everyone can necessarily afford organic chicken or whatever all the time. And sometimes they might need to order those sort of frozen items or chicken nuggets or whatever. And that now is a problem for the government. How do you make whole foods on process accessible to every single person, regardless of their financial status? Because ultimately, being healthy, the number one sort of factor that

correlates with health outcomes is your bank balance, ultimately. Because yes, you can go on the road and exercise for free and all these sort of things. That's not limited by your bank balance, but that's also dictated by your time. If someone doesn't have money to sort of sustain themselves, they might be working two or three jobs and might not have the time to exercise. Whereas someone who's got 10 million sitting in the bank, they may not have to work and can go to the gym five hours a day. So ultimately,

socioeconomic status is such a huge risk factor for health,

It's now up to the government to say, listen, let's make vegetables cheap. Let's make real whole meats cheap, not just ultra-processed packaged bacon and stuff like that. Have that cheap so people feel they can buy this instead of the expensive vegetables. And that's the problem. Yeah, and then that similar thing, like the socioeconomic, one socioeconomic position will be either...

will contribute to stress or alleviate stress depending upon where they're, where they perceive themselves to be. A lot of that's like comparison as well. Um, what are some factors that you've seen? There's a couple of chapters in your book where you talk about senses, uh, is where do senses come into the conversation of beginning to gain, uh,

regulation of one's nervous system. You have a chapter around vision in there, and I know there's a lot around our autonomic state tied to our vision. What are some things that people could be doing to bolster their physiology and the entirety of their nervous system through tapping into their vision in your research?

You know, there's this thing we sort of called, you know, introception, where we take a greater awareness of our internal cues. And, you know, like breathing, for example, that we did at the beginning of this podcast, that's a form of introception where we're more aware of our breathing, our pulse, our environment, our inner state.

And that has a direct impact on not only mental health, but also your physiological health as well. Like, you know, if you are meditating, controlling your breath, doing my breath work or, you know, any sort of physical activity that allows you to have a greater control over that physiology to a degree, or at least identify what's going wrong in your physiology. And that sort of gives you a greater connectivity to,

with your own sort of body systems and organs. And sometimes we can disconnect from that. And I think just having a greater awareness of our needs and things that we're good at is important.

- What is staring into screens do to our physiology? An excessive amount of staring into screens, chronically stuck in myopia. - Yeah, I mean, the myopia epidemic is huge. That sort of short-sightedness epidemic where people are just hooked on screens. And ultimately, if you're staring at a screen for long periods of time, that's sort of, you know, 10 centimeters from your face,

you will increase kind of the risk of headaches, eye strain, which can also lead to headaches. And also probably the position, the ergonomics, which we find ourselves in when we're looking at screens, punched over desks on laptops,

You know, screens when you're in bed affecting your sleep physiology. There's a number of physical effects it can have as well beyond just the eyeball and the brain. So ultimately, screens are a tool to connect us to other people in this day and age, which is great. You know, this podcast is us on screens and we have a great conversation. But also, you know, that should just be filling in the gaps. The kind of bulk of our time should be spent beyond screens.

With the vision, what are your thoughts on some of the kind of like nerdy exercises going through different visual exercises and such compared to perhaps just getting outside more often, looking up into trees, looking up into clouds? And also another thing, a lot of people, the percentages are pretty staggering, the increase towards myopia.

Seems like, you know, year over year. And I know that there is a conversation around that with just proximity, like, you know, being chronically in a contracted state to look at things up close. But then there's also a sunlight conversation to that as well. Are you savvy to any of that stuff? Have you seen any research? Are you familiar with any of that stuff? Like just the value of taking your body outside and your eyeballs outside? Yeah.

Yeah. I mean, ultimately, if you are being outside, we know that for all the evils that people proclaim about sunlight, it does increase the risk of cancer if you're chronically exposed to it without significant exposure. Great.

But also, yeah, we also do need sunlight for a multitude of things. You know, vitamin D being one, calibrating our circadian clocks and general body health as well. You know, when our eyes are like essentially the sort of precursor to the sleep cycle. You know, when we go out in the mornings and our eyes get exposed to that bright sunlight, it starts the timer for your sleep in the night, for good sleep at nighttime. So that's important as well. I would say, however...

If you're in prolonged sunlight for extended periods of time, it's probably advisable to wear sunglasses. And the reason is because just like your skin cells being exposed to UV lights and can sort of, you know, obtain this DNA damage from the UV lights, the same can happen to your eyes as well.

And if you're constantly out in very, very bright sunlight, although it's rare, you can increase your risk of, you know, ocular cancers, ocular melanomas and things like that. So wearing sunglasses is an important tool for things like that, especially if you have like very light blue eyes, which have less melanin and less protection against sunlight. There's another chapter you wrote about smelling. Are there ways to leverage the olfactory system to promote health that people might not be thinking about?

So our sense of smell is inherently linked actually to a brain regions associated with memory and learning. So like say breathing exercises, you know, that immediately helps with clarity of thoughts.

But also on the sort of flip side, one of a very underrated symptom of Alzheimer's and dementia is a loss of smell, which is not often picked up a lot. So our smell is inherently linked with other aspects of health. And we've seen also during COVID, for example, many people with the COVID infection had a loss of their sense of smell because that virus infected parts of their brain associated with smell, those sort of olfactory nerves. So although you can't

enhance your sense of smell in any particular way. There are certain things you can do to continue to, I guess, optimize your breathing and thereby your sense of smell, which can help with focus, clarity, and all these other things which are important. One of the questions I had that you have in your book is why we get runny noses. Sorry for these basic trite questions, but I think they're really interesting and I really enjoy asking questions like these. Can you talk about that?

A bit of like, what's like, what's going on with that? So, you know, there's different forms of like a runny nose, the simple rhinitis, if you've got an allergy or something like that, you know, that's a direct result of inflammation of the sinuses or the turbinates, the sort of, you know, essentially erectile tissue that you've got in your nose and your sinuses.

If you're crying and you get a runny nose, that's because the tears drain via the lacrimal punctum, little holes you have, you know, the inner ear, tiny little holes, and the water goes down that and comes in via your nose. So there's obvious reasons for that, why we get runny noses.

In writing the book, was there things that particularly surprised you or things that were, because you did, you must have done a tremendous amount of research for the book, like it would have been pretty immense. Was there anything that kind of things that surprised you or things that maybe changed belief systems or anything throughout that? Or what was the experience of putting the book together?

Obviously, I've covered a lot of areas which are not part of my day to day job dealing with cancers and bowels and things like that, for example, sleep. And, you know, the sleep chapter was, you know, very important to me, for a number of reasons, because when I first started my job as a doctor, I did suffer with insomnia for a number of reasons, taking work home with me stresses of the job, not having a great routine in general with sleep, and my sleep hygiene suffered a lot. And, you

a lot of that sleep chapter is based on my research and experiences of overcoming insomnia and literally pouring through evidence-based material. Like how do I fix my sleep? Because as a doctor, my sleep needs to be on point. So that was an ode to

to me overcoming my insomnia as a doctor. And that's how I positioned it as well. So for me, that was like a learning point in me. And, you know, a lot of these areas are based on my experiences, my research, and everything that's science based, because I don't feel comfortable talking about things, which don't have any real basis in science. Otherwise, you can't really justify telling other people about them if they don't have some molecule of truth.

how would a person begin the process of fixing their sleep? Is there any key takeaways? - So I think first of all, it's to expect that it's not gonna happen within a week. You're not gonna fix your sleep within a day, within an hour or a week. It takes several weeks to fix your sleep long-term. And you ultimately need to start by knowing this one thing, which was a game changer for me, is that if you're not tired and if you're in bed and you're tossing and turning for an hour,

You can't stay in bed. You need to get up, go somewhere and do something that's not too intense. Like, you know, go read a book, go listen to some gentle music somewhere or just lie down somewhere and be awake somewhere until you're tired enough to go to bed. So literally go to bed when you're tired and wake up when you feel tired.

you want to wake up you need to start listening to our body more that's part of the interception that we spoke about before understanding those body cues and i think that's really important that people don't appreciate about sleep would that be like because of an association type thing would there be like a like a resistance around placing the association of being stimulated

in the bed perhaps? Or would that be like acting on another system, just kind of tucking yourself out and kind of like what would be the reasoning for that? Our brains are very good at associating things. Like it's good at pattern recognition. It's like a survival tool that our brain has.

So if you're in bed and you're watching a scary movie and you're stimulated or you're eating pizza in bed, you're doing work in bed, our brain very quickly adapts to learning that our bed is a work environment. It's an entertainment environment. And so it no longer classifies it as just a sleep environment.

And so when you do try to sleep in your bed after eating and working and watching TV in bed, it's like, hey, this is not where I sleep. And actually, you've now trained your brain into not seeing this as a sleep environment anymore, as a rest environment. So it's breaking those cues as well.

Yeah. Is there any other takeaways you'd suggest for people listening on ways to improve their sleep? The thing we touched on earlier is it's a bit of a, I guess, a weird thing to say, but your sleep routine starts in the morning. And it's about exposing yourself to sunlight as soon as you can in the morning. That really sets up the nighttime because it's

It sort of gets rid of any remaining melatonin that could be in your system and really driving up the cortisol. And importantly, it starts the timer. That sunlight in the morning starts the timer and it shifts your sleep routine forwards. So actually you fall asleep earlier and you can wake up earlier. And if you are, you know, how we say a night owl,

The more early you wake up and expose yourself to sunlight, the more you shift your sleeping clock towards a sort of a morning type person. How many people do you think subjectively consider themselves night owl also, but actually just have garbage nighttime routines? Yeah, that's a really good answer. And

If we just look at a population, I would roughly like to say that people fall into thirds, like a third of people maybe like morning people, a third of people maybe night owls, and a third of people maybe sort of a mix between the two.

And I really don't know that as a society, because of social media and screens and electronics and Netflix and all these streaming platforms, have we set ourselves up for this sort of silent epidemic of turning people into night owls because of these electronic vices that we've surrounded ourselves with. So I don't know what percentage of people have maybe descended into night owlism because of bad sleeping routines.

versus what percentage of people were genetically night owls. And I think that proportion of night owls has definitely increased over the last 10, 20 years. Yeah, I think most night owls, for the most part, I'm purely projecting because I'm just speaking for myself. They're just distracted. Like I was in Peru for a couple of weeks, like a couple of weeks ago. And I was like living in like a hut, but it was a really nice hut. You know, it was like this great hut. And but there wasn't a lot to do after it got dark.

And so pretty much once it gets dark in that situation, I started to get tired. And I kind of like actually by the time night came, I actually like looked forward to going to bed because it was like a nice, pleasurable, fun activity. Whereas here in Austin, Texas, where I live slash anywhere, nighttime is just it's like a new chapter. It's like a new awakening essentially. Yeah.

And I feel like probably a good chunk of the world. What do you think that's doing to culture by having this new awakening called nighttime, pretty much since the invention of the light bulb? And then obviously, further deepening the hole with technology. Yeah, I think people feel that they're wasting time. It's probably part of this toxic productivity culture where people feel that

you know, still that rest shouldn't be just rest. We should be filling our time with something productive. We should be catching up on that movie that we miss. We should be doing some more work, creating content. And I think it's that sort of hustle productivity culture. And, and,

Yeah, people are distracted. People are bored. People want to fill their times with doing things. We don't like times without screens, without doing anything. And actually, yeah, people don't look forward to sleep. Like I love sleep. You know, I didn't used to love sleep. But actually, like you said, like you did in Peru, I love going to bed, lying down, maybe with a book, and just switching off. And I think people need to learn to, I guess, love being by themselves a bit more.

Yeah, right. Yeah, that's like the majority of paraphrasing whoever said that the majority of world's problems are rooted in a person not being able to sit alone with himself inside of a room, like feel content. And it's like when nighttime comes, that's I think when a lot of the demons start to surface. And you're like, oh God, there's no way to keep myself busy. And now suddenly I'm just, I'm here with myself, like you gotta get the phone, you gotta get the computer, you gotta get the Netflix. And it's just another distracted pattern until eventually...

life starts transitioning in such a way that forces a person to kind of examine themselves deeper or not, you know, just keep on running that way. But I think that a lot of, a lot of that probably has to do with that butchered paraphrased quote of much of the disease and issues that we experience is just not being able to sit with ourselves. That's my thought. All right. Thank you so much, man. I really appreciate it.

Getting to share this time with you. Um, is there anything else that would be relevant to share in relation to topics of conversation or things to, to, you know, I think your book is great. I really genuinely enjoyed reading that. Um, point people wherever best place to go from, from here is to learn more.

I mean, I'm pretty active on Instagram and YouTube. I sort of make deep dives into stuff so you can catch me there. And yeah, so I think that's probably the last thing I would say is, you know, although we've covered a lot of topics about health, ultimately it would be not to stress too much about these things. You know, let it happen. You know, you can't get things perfect from day one. And I think stress is probably the biggest thing.

negative impact on our health that we subject to ourselves, you know, and just in terms of sleep routine, just relax, you know, take a few weeks to sort it out. You know, it might be shitty for a while, but it does need to be perfect. Yeah. Awesome. Thank you so much, man. I really appreciate you. Thank you so much. That's it. That's all. Thank you all for tuning in. I'll see you next week.

Hope you guys enjoyed that conversation. I wanted to invite you over to the Align Podcast YouTube channel. Subscribe over there for a chance to win sweet prizes at the end of each month. We pick a subscriber to send you some dope stuff from various different sponsors and companies that we're a fan of here at the Align Podcast. Thanks for reviews. Thanks for comments. Thanks for shares. Thanks for joining you. I will see you next week.