EP 21: Lifestyle Medicine and a Change in Mindset

Episode Description:
In this Hope4Med podcast episode, we are joined by Dr. Richard Harris, a lifestyle medicine physician with a passion for empowering others to take control of their health. Dr. Harris shares his journey of experiencing and overcoming burnout. We discuss mindset as a key aspect to lifestyle medicine and how a change in mindset is the first step to optimizing your health and achieving a long health span.

Connect with our guest, Dr. Richard Harris:
Website: https://www.theghwellness.com/

Transcript:
[00:00:00] Dr. JB: For us, by us, and just for us. This is Hope4Med, med.

[00:00:06] Welcome to the Hope4Med podcast, I’m your host, Dr. JB, and today’s featured guest is Dr. Richard Edward Harris. Dr. Harris is a holistic lifestyle medicine physician that empowers individuals to take control of their health with lifestyle medicine and the health mindset to live with joy and purpose. Welcome, Dr. Harris.

[00:00:32] Dr. Harris: Yeah, thank you for having me on the show, Dr. JB, I’m looking forward to today’s conversation.

[00:00:37] Dr. JB: Yes, me too. Me too. So Dr. Harris, tell my listeners a little bit about yourself.

[00:00:43] Dr. Harris: Yeah, absolutely. I am an internal medicine physician by training. I’m also a pharmacist and I have an MBA. And if that seems like it’s all over the place, I am all over the place. I’m a part-time physician. I have a consulting company that does life science consulting for startups in the healthcare space. I also have an educational consulting company that does social, emotional learning and personal development for kids. And then I have some random other stuff, like I started a sustainable farming capital company where we invest in ventures that are prioritizing sustainability and social impact. And that keeps me pretty busy these days, but it’s a lot of fun.

[00:01:27] Dr. JB: You sound like you are extremely busy.

[00:01:30] Dr. Harris: I am, but I’m a workaholic so I have to be busy. I remember when we had a month off between residency and starting my first clinical position. The first week, it was great. Weeks, two, three, and four I was going insane.

[00:01:49] Dr. JB: Wow. You weren’t trying to get caught up with all of the sleep that you didn’t get while you were in residency?

[00:01:55] Dr. Harris: No, I, because I had nothing to do, right? This is the first time, that period is the first time for most of us that we literally have absolutely nothing to do, and there’s only so many times I can go to the gym and so many times I can play video games before my friends get off of work. So, I started just reading and learning and trying to acquire new skills and that’s the period that really sent me on the path that I’m on today.

[00:02:23] Dr. JB: Okay. So, Dr. Harris, let’s start from the beginning. So I understand that you said that you are a doctor of pharmacy as well as a medical doctor, tell us what came first and what made you decide to pursue both.

[00:02:37] Dr. Harris: So in high school– let’s go actually before that, when I was growing up, I was that kid who was reading books about whales and dolphins and sharks and dinosaurs while everyone else was reading Nancy Drew and the Hardy Boys and Goosebumps. And I read every single book in the library on those subjects and my parents had to find books for me to read that I hadn’t read before. And then I got into high school and my favorite courses were anatomy, physiology, and physics, and so I actually started college as a physics major. Realized I love physics, hated math. Switched into biochemistry, thought I wanted to do bench research, did that for two years on fetal alcohol syndrome, didn’t like it. I was about 20 or 30 credit hours away from graduating, had no clue what I wanted to do, existential crisis. And luckily I worked in the dean of the pharmacy school’s lab, he said, “Hey, I think you’d be a great pharmacist, come to pharmacy school.” I said, okay. I had no clue what a pharmacist did, no clue what pharmacy school entailed, I just applied because I didn’t think I had any other options and I had a great advocate on my side. Got into pharmacy school and it’s all physiology, absolutely loved it. And it was there that I started looking ahead in my life and I really sort of remember that I wanted to be a physician when I was a kid, and for about a month, I kept asking myself every day, if I don’t go to medical school, am I going to be mad at myself when I’m 65? And pharmacy school reinforced that desire for me to go to medical school because number one, I wanted to prove to all these physicians, what pharmacists knew. Number two, I like to challenge myself and, people always said medical school was the hardest thing that you could possibly do, and I’m like, perfect, that’s right up my alley. And that’s why I went to medical school and I’m so glad I did, because it allows me to see things from a different perspective than most physicians and most pharmacists. I can see both angles and see the complete picture when I’m taking care of someone holistically.

[00:04:50] Dr. JB: Okay. And so did you practice as a pharmacist before going to medical school or you just continued straight?

[00:05:00] Dr. Harris: Funny story, I worked for a year as a pharmacist at MD Anderson before I started medical school. I actually knew I was in medical school before I started work as a pharmacist, I got early accepted at UTMB, but I wanted to know what it felt like to make money and not have to study for awhile. Now, actually in medical school, I worked because my medical school was right across the street from MD Anderson, I went to the University of Texas at Houston, now called McGovern. And what would happen is I would get off work– or get off laboratories in the afternoon and I would walk right across the street and go work as a pharmacist, that’s how I paid for medical school. And I remember everything was fine until third year, and somehow someone told the administrators that I was working and they called me into the office, the associate dean called me in the office, and told me to stop working. I said, why? He said, because we don’t want you to get burnt out. I was like, my grades are fine. I’m performing, I feel completely fine. They were just so worried about having too much on my plate that they wanted me to stop working. I thought it was just comical, I laughed it off. They made me take an extra month off, delay the start of my third year rotations because of that.

[00:06:19] Dr. JB: But there was no sign that you were burnt out at all?

[00:06:23] Dr. Harris: No. And what happened was I missed a meeting before third year was supposed to start. I just put the wrong day in my calendar, simple mistake, and they flipped out. They were like, “no one has ever missed this meeting before.” I said, there’s no way in the history of this school that no one has ever missed this meeting before, this is complete hyperbole. And I told them I put the wrong date, I was working, that’s where I was. And that’s why they freaked out and made me take a month off.

[00:06:48] Dr. JB: Oh, wow. Wow. But with the start of clinicals, do you think that you would have been able to continue working as a pharmacist while doing clinicals your third year?

[00:06:58] Dr. Harris: I think so. I stopped before third year, but I think could have because some of the rotations, you got out of there earlier than others. And my job as the pharmacy was sort of PRN, I would just show up when I could work and be extra help.

[00:07:13] Dr. JB: Okay. Well, and that’s so interesting that they were so concerned that you were going to get burned out. So, did your medical school have any other resources in place to help prevent other students from getting burnt out?

[00:07:29] Dr. Harris: No, this was 2010, 2011, something around there and burnout back then wasn’t even on the radar for medical schools or residency or anything like that. I’m still not quite convinced we do a good job of handling that since we have burnout rates upwards of 50, 60% in internal medicine and ER and critical care docs. So, they never talked to us about it and I think the reason why they freaked out for me was because a couple years prior, a medical student at Baylor had committed suicide and that had put them on high alert.

[00:08:10] Dr. JB: Yeah. This topic of burnout and burnout starting early in medical school and suicide, suicide in medical students, suicide in residents, suicide in physicians, is a real, real issue.

[00:08:24] Dr. Harris: Absolutely. I had a, one of my students in residency committed suicide and that was really, really hard. It completely deflated the program, the next year and a half was completely miserable for, for a lot of us because we understood why, the pressure, the requirements, the patriarchal manner in which you’re talked to, you’re talking down upon, you don’t feel like a real doctor, the long hours, you don’t get any time off. You’re barely getting paid anything even though you’re working 17, 18 hours a day, it’s less than minimum wage if you average it out, you make like $8 an hour as a doctor, and they still expect you to show up, and if you take a day off, you’re hurting the team and you’re letting us down. And all of that environment is just very, very toxic. And then you get out of that and think things are going to be better, it’s not any better working for these large healthcare organizations and that’s been proven during this time period that they really don’t care about us. They don’t care if you put your life on the line, they don’t care if you’re burnt out, they’re just “show up, see your patients, meet your metrics, and be happy you have a job and you’re completely replaceable.”

[00:09:44] Dr. JB: Yeah. That “you are replaceable” is huge. I don’t know if you heard that, like this, this thunderstorm that just started right now. As soon as you said replaceable, there must have been like some lightning.

[00:09:58] Dr. Harris: Like Frankenstein is being created in the background.

[00:10:01] Dr. JB: And is like “preach it!”

[00:10:05] Dr. Harris: Right?

[00:10:08] Dr. JB: And that also is contributing to burnout. It’s you either suck it up or we’ll find somebody else.

[00:10:17] Dr. Harris: And if you challenge the status quo– so this is actually interesting, my last position I got fired from. And the reason I got fired is because I was working PRN, like I said, I’m not a full-time doc, I was working in the hospital and a freeze happened and they wanted me to stay overnight. And I said, okay, I’ll stay overnight, but I’m not a salaried employee, I’m an hourly employee. If I stay here, you have to pay me, and by government regulations, if I stay here for more than 40 hours this week, you have to pay me overtime. And they said, no. And I said, I’m not going to stay. They canceled all the rest of my shifts and then after that, about a month later, they said, we’re not going to retain you via email, even though I had been working at this place on and off for almost four years. And that to me just showed you how, how, even as a physician, you are the revenue generating portion of that business, but you are just a number and just a statistic, and if you don’t fall in line, they’ll just axe you without any second thought whatsoever.

[00:11:20] Dr. JB: And I can’t see what you said wrong in your statement, — you told them the facts.

[00:11:26] Dr. Harris: Exactly. I mean, this is not something that’s made up. If you know labor laws, this is a hundred percent true. As an hourly employee, if you stay from one 40 hours, you have to be paid overtime. I’m not salaried, I’m hourly, and if they mandate I stay on the job, cool, okay, I’ll do that. Just pay me for my time. Respect my time. And obviously that’s not something that happened at that institution.

[00:11:50] Dr. JB: Wow. And you were working there for four years.

[00:11:53] Dr. Harris: I started there in 2017 through another clinic that I worked at. We would take hospital rounds on the weekend, once a week, or once a month there on the weekends. And then once I started to realize that I wanted to be an entrepreneur, I took a part-time position there. So I’ve been there in some capacity for four years, almost four years.

[00:12:18] Dr. JB: So on going back to the topic of burnout, I know you mentioned that when you were in medical school, was that the dean that called you into the office and mandated that?

[00:12:27] Dr. Harris: It was one of the associates, yeah.

[00:12:30] Dr. JB: So the associate dean was very concerned about you being burnt out, made you take that month off before starting your clinicals. Did you at any point actually become burned out?

[00:12:40] Dr. Harris: In residency, yes, I was. I was really, really sure that I wanted to do critical care or oncology and in my second year, I just hit a wall. And after I got out of residency, I changed. I wasn’t the same person. And I don’t think any of us were the same people after we got our residency. Part of us became more jaded, more cynical, felt like we had less overall to give. And I was depressed actually, after I got out of residency, for awhile because of the lot of the things that physicians feel, they feel trapped. It’s not like another degree where you can just go work in a different field. If you’re an accountant and you’re working in oil and gas and you don’t like it, you can go be an accountant for another industry, or even you can do something else that’s not accounting. Maybe you want to be an actuary, maybe it’s management. These are things that you can easily jump to. It’s not that easy for us physicians because we have a very limited skillset and most of us have devoted so much time into developing this one skillset, that we neglected basic other skills, financial skills, management skills, leadership skills, and I didn’t want to feel trapped. And I was feeling trapped. And especially me, I’m more of a holistic type doctor, I don’t like prescribing medications. I’m a pharmacist I know how the meds work. Pharmacy school prepared me to better evaluate clinical trials on medicines, you know, I look at the number needed to treat, I look at the absolute risk reduction. I look at the number needed to harm whenever I see a new medication or something I’m frequently using. I look at that information. And then if you look at that, then a lot of it doesn’t add up.

[00:14:35] So, I felt like I was in a system that just was a quick fix. It was a sick care system and as an internal medicine doctor, I wanted to prevent disease. And this is what Z Dogg calls moral injury. I felt that. I felt like I had given so much of my life to something that was a pipe dream and I was making a ton of money and I was miserable. I was absolutely miserable. And it manifested itself as drinking all the time, hanging out with different women all the time, all of these, buying things I didn’t need for the status and to feel important. And it wasn’t until I had an incident out of the country that I had to change and I realized that I wasn’t me anymore and I had to get back to me. And I wasn’t going to find that working full time. And that’s when I got back to the church, started reading every single book I could read about personal development and growth and psychology and sociology, spent a lot of time in my own head figuring out what’s my “why?” What’s my value system? What do I really want out of life? And then once I got clear on that, I was able to create a plan. And then I said, okay, here’s what I want and here’s how I can get there. And that’s what I’ve been working towards since May of 2018.

[00:16:03] Dr. JB: So Dr. Harris, you know I’m going to ask this question. So what happened, if you feel comfortable talking about it, that made you really stop and say, I need to reevaluate my life?

[00:16:16] Dr. Harris: I was in Mexico and had way too much to drink and had a flashback of something that happened when I was in college. I got jumped by a two guys and I thought the same thing happened when I was there. And the people I was with thought I was crazy because I was like, you guys left me, you guys didn’t have my back, I can’t believe it. Like, how could you do that to me? And they’re like, “Richard, nothing happened.” And I was like, no, I was there, it happened. And then after a couple of days, I realized that it didn’t happen. I just had a flashback and I was like, what the heck is going on with me? And then that’s when I really realized that I was depressed and I, it was being hidden through alcohol consumption and partying and all these other trappings of life

[00:17:13] Dr. JB: And alcohol consumption is a huge thing that happens in healthcare and residency. And so this occurred post-residency, correct?

[00:17:22] Dr. Harris: This was post-residency, yes. Residency broke me and I, I just pushed through it. I have a strong family history of mental health and I’ve actually done my genetics; I have multiple mutations in the MLA pathways, MLB, and the COMT pathways, you know these are all things that are extremely important for our neurotransmitters and it explains why everyone in my family has mental illness and I wasn’t equipped and prepared with the tools to deal with the stress of residency and being a physician. I just wasn’t, and I almost broke. And luckily, I found church, I started learning about psychology, about myself, about my value system. And I started to put me first and a lot of physicians have problems doing that. And I’m going to tell you, there’s nothing wrong with putting you first. It’s common sense that when in an airplane, you put on your oxygen mask before you help somebody else because how can you help somebody else if you can’t breathe?

[00:18:29] Dr. JB: That’s correct. And that’s what this Hope4Med is all about. It’s about really changing the paradigm of medicine where our wellness as healthcare professionals takes center stage, because that’s not what’s currently happening? And for us to be able to function at our utmost, we need to be whole and we need to have the resources easily accessible to us to ensure that we are well.

[00:18:59] Dr. Harris: Correct. And it’s a system issue because I think the problem is a lot of these decisions are being made by people who aren’t physicians anymore. And how can you know the pressure of taking care of someone, of having a life in your hand, if you’ve never done it before? And it’s like, “oh, you’re only seeing this amount of patients, that’s not a big deal.” And you’re like, whoa, this is a very big deal. I don’t feel comfortable seeing these kinds of patients. How can I provide high quality care if I’m seeing 40 patients a day? That’s impossible. But they look at it as a cost-benefit analysis. Like, you know what, “we can squeeze in this many people and we know that there’s an X amount of side effects that are going to happen and we’re going to have to pay out X amount of money for that, but it ends up being a net positive for us so we’re going to do it.

[00:19:54] Dr. JB: So now that you have been out and you’ve been practicing medicine for several years now and you’ve had all these different experiences, if you were to reflect back on your time in medical school and your time in residency, I know there’s a lot of things that we wish we had known prior to coming in, starting with medical school or residency. What are some of those things for you that you wish somebody had told you?

[00:20:17] Dr. Harris: When you make an entry, plan your exit. And that’s something that I wish I had done and that’s having a contingency plan. What if this doesn’t work out? What if I don’t like it because it’s not that easy for us to switch careers in medicine? So I wish that I had thought about what happens if I don’t like this when I get out. That’s one thing. A second thing I wish I had known my personality type. There’s something that called DiSC, and I talked about this on my podcast, that’s a personality assessment. Once I learned my personality, I realized that I should not have become an internal medicine doctor. I don’t have the emotional capacity or empathy to talk to 25 to 30 people a day about their problems. I just don’t. It drains me, I’m exhausted when I get home, I’m barely functional for my wife and my dog I just don’t want to talk. I’ve used up all of my social capital and I realized that based upon my personality type, I should have gone into something that was more analytical and less direct patient care like pathology. I would have absolutely loved being a pathologist, because you just sit there in a lab, you solve problems, you talk to other providers and you go home and that’s it. So that’s also something I wish I had known. The third thing is you need to acquire skills outside of medicine because you never know when you’re going to want to make your exit. This goes back to that exit thing, and I wish that I had not taken biochemistry because once I got into pharmacy school, that biochem degree or biochem knowledge was worthless, completely worthless. It had been superseded. What I wish I had done was done finance or accounting or psychology or management, something that I could have used no matter what situation I’ve been in. And then the third thing, or fourth thing would be always protect yourself, because if you don’t protect yourself no one else will. And you have to be okay putting your foot down and saying, “I can’t do that.” And it’s okay to carve out a life by design. If you don’t want to work as a full-time physician, don’t work as a full-time physician. Nowadays, there’s more options than ever for us to find other ways to make an income besides seeing patients and that’s something that I’ve been talking to people about, I’ve explored, and I know several coaches that help people like us find a different way to make their financial goals.

[00:23:03] Dr. JB: These are all wonderful pieces of advice. In terms of realizing that oh, pathology is more in line with what would have suited you better in terms of your personality type. Would you ever go back to residency?

[00:23:19] Dr. Harris: No, there’s no way you couldn’t pay me. You pay me $10 million, I’m still not going back.

[00:23:25] Dr. JB: that’s one of the benefits I see in terms of a PA, if you’re a physician assistant, then you can switch. But I, I feel the same way as you, I survived residency, I’m never going back. So I’m either going to continue working as an emergency medicine physician or transition to urgent care or whatnot, but I will not go back to residency to switch it to anything else. It’s not worth it.

[00:23:52] Dr. Harris: Absolutely not. I couldn’t put myself through that again, that grind, that mental beat down, the anguish, the long hours.

[00:23:59] Dr. JB: Yeah. And so what did you mean by coming up with an exit plan?

[00:24:07] Dr. Harris: So that is– Here’s the thing about being physician, you will make the same salary if you work for a large practice or group that you will make at 60 that you made at 30. And it’s probably going to go down because a lot of specialties, their reimbursement keeps getting cut. Like I had a friend who did primarily EEGs, and I think it was last year that the reimbursement got cut by 50%. What other job do you know of that just overnight, someone could say, that’s not under your control, “hey, you’re going to make 50% less this year for doing the same job for no apparent reason.” And that’s happening all over, most of our salaries are coming down and– except for primary care because no one wants to do primary care and it’s really hard to get people to do it, so those salaries are coming up. And I think it’s the fact that as a physician, you have to work to make money. Most of us are very bad at investing because of domain dependence. We think we’re good at one thing, so we’re good at everything. That’s not the case. You can become good at it, but don’t just assume because you’re a great physician, you’re going to be a great investor. And you need to start early, putting your money to work for you, but so many of us are 200, 300, $400,000 in debt at graduate level loan at 7, 8, 9%, I even had someone who was 12%. Her loans were 12%. I was like, what are you doing? You need to, you need to consolidate this immediately because that’s hundreds of thousands of dollars. So I think this is a part of the problem and this is why you see so many physicians working in their sixties, seventies, because they literally can’t retire. They don’t have enough money, they don’t have enough savings, they have to keep working.

[00:25:58] Or the other problem is that their identity is completely being a physician. We are the only job that your identity is revolved around your job. No one says, “Hey, what’s up lawyer?” ” What’s up, esquire?” ” Hey, what’s up accountant?” ” How are you doing, engineer?” No. “What’s up, doc?” It’s your name, and your identity becomes synonymous with your profession. And for some people, that’s very hard to walk away from because it’s all they’ve known. And if it’s all you’ve known and it’s all you do, that’s going to be hard to walk away from. Even if you’re ready to walk away from it, you may not be able to because your identity is wrapped up in that and we will always go towards our identity. So that’s what I mean by having an exit, it’s a financial exit, putting your money to work for you, being able to be financially free and retire when you want to retire. And then also having something that makes it so your identity isn’t just wrapped up in being a physician.

[00:27:01] Dr. JB: I think those are extremely important. And when you mentioned graduating from residency and feeling stuck, that financial burden will make so many people feel stuck. You leave with half a million dollars in debt, what are you going to do to dig yourself out of this financial hole?

[00:27:22] Dr. Harris: Exactly, and that’s why people stay in stuff that they hate. But look, how many old ER docs do you see there? There aren’t many of them. How many old hospitalists do you see? There aren’t many of them. That’s a major problem. If there are– if you don’t regularly see people in their fifties and sixties, because the average physician is I think 56 or somewhere around there in age, but you don’t see them in our profession, what does that mean? It means they all got out. They’re all doing something else. And you have to ask yourself, well, why is that? And you have to prepare for that. And I wish I had started investing early. I wish I had learned about compound interest. It doesn’t take much to retire with millions in the bank, if you start early. Even just a hundred dollars a month and something low risk like a mutual fund earning, 4%, that adds up very quickly over time. I didn’t start investing until my mid-thirties because I never knew about it. It was just medicine, medicine, medicine, medicine. And in residency, they teach you, give your life to medicine. I don’t want to do that. Why am I going to give my life to a system that doesn’t care about me? Doesn’t care about my mental health, only sees me as a worker drone, “shut up and do your job.”

[00:28:34] And the other thing, I think that is toxic in residency, one of the infinite number of things that’s toxic, is they teach you that you can only be a physician at the bedside, that’s the only type of medicine there is. All the other types of medicine don’t matter, but what are we learning now? The socioeconomic factors are extremely important. Extremely important. Where you live, who’s on your street. What kind of trauma you had as a kid. Has that trauma been dealt with? Are you still acquiring trauma? All these things that when I was in medical school were soft, that wasn’t hard evidence, but we know that soft stuff matters in some cases a lot more than that hard evidence. And I think that we need to change the notion of what is a physician because I’m not seeing patients when I’m doing my podcast, but I’m helping people understand their health, understand how their bodies work. Isn’t that what a physician should do? Is educate and teach. If I’m consulting and working with these companies develop better ways for people to interact in the healthcare system or advancing personalized medicine where we’re doing genetic testing and metabolite testing and custom making a supplement based upon your body and its deficiencies, isn’t that medicine? Isn’t that helping people? So one of the things that I am so glad I did was I realized that there are other ways that I can be a physician and help people that are not at the bedside. And in fact, I can help hundreds or maybe thousands of people at a time as opposed to just one by one. And the one-by-one approach used to work, but now the default is disease. There’s more diseased people than, than healthy people in America, 60% of adults have one chronic condition, 40% have two. A Blue Cross Blue Shield survey from a couple of years ago shows that health really drops off a cliff past the age of 27. That’s young. And I’m sure you, as an ER physician, you see 30-year-olds with strokes all the time, 30-year-olds on dialysis, 30-year-olds with heart attacks. Never saw that 10 years ago. I see it every shift now. I mean, it’s just normal.

[00:30:45] Dr. JB: — we’re no longer having an emphasis on prevention, and it’s true what you said. We are working in a sick care system where most of the money is spent near the end of life and pennies are spent on preventative services.

[00:31:03] Dr. Harris: Yeah. And it’s really affecting everything. And then if you start to look at epigenetics, and this is the sad part, your decisions don’t only impact yourself, they impact your kids. And what we’re starting to see through the study of epigenetics is we are progressively creating more genetically fragile kids to where you’re seeing adult-onset disease in kids. And that kid never had a chance because the parents’ environment isn’t conducive to having a kid, that they have a kid and those alarm signals get passed on to that kid, and now you’re seeing kids obese at three or four years old. Kids with fatty liver. Kids having type 2 diabetes at four and five years old. And think about when that person decides to have kids, they’ve been acquiring injury and oxidative stress and genetic damage for 16 years and then they’re going to pass that on. And then the next generation is going to get more fragile and more fragile. And these are things that mainstream medicine doesn’t talk about, but there’s evidence out there and that’s why we’re seeing each generation get progressively sicker. And you’re right, we have to spend more money on preventative care, but I think there’s two problems, well two main problems with our sick care system. Number one is they don’t care about touch points outside of the office. It’s that 15-minute visit, let’s get reimbursed, and then you’re on your own after that. You didn’t take your meds, you have a bad outcome, that’s your fault as a patient. But we don’t interact with them where they live at home, we don’t see their environment, we don’t even ask questions about it. We don’t even have time in our visits, but that matters so much. The other issue is that there are effective modalities like health coaching, which aren’t reimbursed by insurance. The major problem with health in this country is behavior. A hundred percent behavioral. And we expect doctors to solve this. Well, that’s like going to an accountant if your car breaks down, that’s not their area of expertise. We’re not taught to be behavioral health specialists or behavioral change specialist. That’s health coaches, that’s their job. Why is this not being reimbursed?

[00:33:21] Dr. JB: So true. And so, going back to the whole epigenetics, is there a way to reverse the effects?

[00:33:31] Dr. Harris: Oh yeah, this is awesome. So I’m so glad you asked this because there was a study that came out a couple months ago and it looked at that. So there’s a couple of different ways that we can test our biological age, which is how much aging or how much damage or how old our cells are compared to our chronological age, what year we were born in. And one of these is a test called DNA age and what it looks at is methylation. Methylation is the way that we turn our genes on and off, we attach little carbon methyl groups to them and sometimes, depending on where it is, it turns things on or turns things off. And we know that there are certain areas that are synonymous with advanced biological age, if it’s a certain pattern or if it’s a different pattern, then that’s a lower biological age. This is why you can be 30 and look like you’re 70 or be 70 and look like you’re 30, because your biological age and your chronological age don’t necessarily have to be equal. So what this study did was they measured people’s biological age and they had the intervention group do four simple things, eat a mainly whole food, nutrient-dense nutrition plan, very similar to the Mediterranean plan, made sure that they got adequate sleep, made sure that they got exercise, I think it was five times a week in this study, and then they also instituted a mindfulness practice, I want to say it was five times a week for 20 minutes. And this was an eight-week study and in eight weeks, compared to the control group, that group’s biological age reversed three and a quarter years in eight weeks.

[00:35:16] Dr. JB: Oh wow.

[00:35:17] Dr. Harris: Astronomical change. There was another study that came out a couple of years ago that showed that if fathers who are trying to get pregnant started working out even weeks before they conceived, that there was a much lower incidence of cardiac birth defect. So, people tend to think these things take a lot of time because they’re looking at body composition changes, which do take time, but at the cellular level, we can see that these changes can start to accumulate and help people very, very quickly. And I think that’s so exciting because now you can do these tests on people in a couple of weeks. And so, hey, we’ve seen dramatic improvement at the, at the level of your cells, how your body’s functioning, in a few weeks. Now, imagine what’s going to happen if you stick to this plan.

[00:36:09] Dr. JB: Wow. That’s amazing. Eight weeks.

[00:36:14] Dr. Harris: That’s it. Just eight weeks of doing four extremely simple behaviors, they didn’t ask them to do anything complicated. They didn’t ask them to do things that most people have never heard of. It was four very simple interventions.

[00:36:27] Dr. JB: So, it’s not hopeless. Because initially when I was listening to you talk about epigenetics and oxidative stress and how it’s passed generation to generation, I was like, oh my goodness, like, painting a very hopeless picture, but it’s not. It’s not hopeless. Incorporating these lifestyle changes works. When people have new-onset hypertension or diabetes or whatnot, we always have this conversation about, lifestyle changes can prevent you from having to go on meds, et cetera, et cetera, but it actually works.

[00:37:04] Dr. Harris: And it’s virtually side-effect free. What’s the side effect of meditation? Well, you’re going to feel better, you’re going to feel more relaxed, you’re going to be smarter, you’re going to lower your blood pressure. Your brain is going to improve, your control over your nervous system is going to improve, you’re going to sleep better. I mean, those sound like side-effects that I want, give me those, give me those side effects any day of the week, I’ll take those. And you’re telling me, all I have to do is do some form of meditation or mindfulness or prayer or Tai Chi or yoga 20 minutes, three times a week? I can do that. That doesn’t, that’s not a big ask and it has all of those scientifically proven benefits.

[00:37:50] Dr. JB: And then in terms of sleep, do you know how many hours that study had looked at?

[00:37:57] Dr. Harris: Yeah, they want to get seven to nine. So that’s pretty much conserved all throughout the data that I’ve read, that seven to nine hours of sleep is the sweet point, 7.7 seems to be like the ideal area. And that helps as far as hormone control, as far as stress, as far as inflammation. There was actually a study that showed that if you get seven point, I think it was 7.5 or 7.7 hours of sleep, you actually decrease your calorie intake the next day by I think it was 400 calories because how sleep helps regulate our stress and our appetite control hormones.

[00:38:37] Dr. JB: So, a vital or integral part of any weight loss plan, is sleep. You don’t hear a lot of talk about that.

[00:38:43] Dr. Harris: No, it’s essential. People don’t realize, okay when, when you’re talking about– I don’t really like to use the term weight loss, because if I cut off your leg, you lose weight, but you’re not better off, right? And if you gain five pounds of muscle and lose two pounds of fat, the scale goes up, but your measurements go down, you’re feeling better, you’re more energetic, and you’re healthier, right? So, the goal is body composition changes, not weight loss. And it may seem like that’s semantics, but it’s an essential difference in how you’ll react. Because if you’re just chasing weight loss, you don’t care if you lose muscle, because the scale goes down. Well, you should definitely care if you lose your muscle. That’s one of the quickest ways that you can ensure getting a chronic disease is to decrease your lean body to fat mass ratio. And because this involves metabolism, which is exceedingly complicated, there’s lots of things that go into it. There’s hormone control, there’s sleep, there’s exercise, there’s stress management, there’s correcting nutrient deficiencies. There’s making sure you’re in a calorie deficit, but not too high of a deficit. A successful plan is all about finding that balance in a slow and steady approach. And unfortunately, we are a “get rich, quick” society and we don’t want to hear that. “Well, Cheryl lost 30 pounds in two weeks, why can’t I be like Cheryl?” You don’t have her genetics. You don’t have her environment. You don’t know how her body system works. She might have been able to do that because she has the right genetics that she can flip like that. Other people don’t. So we can’t expect someone else’s results because we don’t have someone else’s body, we don’t have someone else’s environment, and then you have no idea exactly everything that that person is doing. They could tell you, oh, I just started taking this green smoothie shake, but then they also started sleeping better. They also started moderating their stress better. They could have been doing a whole bunch of other things that they just didn’t tell you about and you just hear green smoothie shake, started drinking green smoothies, and you’re like, why don’t I get the same results?

[00:40:45] Dr. JB: So, all of these things that we’ve been talking about, is this what you incorporate in your lifestyle medicine?

[00:40:50] Dr. Harris: Yes, absolutely. I am a firm believer that lifestyle medicine is the most important aspect of medicine. What we do on a daily basis can either fight disease or fuel disease. And I like to tell people, listen, what lifestyle medicine is, is it’s literally putting deposits into your health savings account, which is your body, and making sure that throughout the day, we are putting more deposits into that than withdrawals.

[00:41:18] Dr. JB: And how does lifestyle medicine compare with functional medicine?

[00:41:23] Dr. Harris: That’s a great question. So, people get confused because they’ll hear the terms functional medicine, alternative medicine, integrative medicine, and not really know what the difference is. They can all be used for the most part interchangeably. Now, functional medicine focuses on using advanced diagnostic testing to get to the root cause of a chronic disease. There is a lot of really cool testing that’s available out there that can get to the root cause of things, that can get to why your stomach issues are there. What’s going on with all your hormones? How’s your gut function? Let’s take a look at your entire metabolism and see if you have nutrient deficiencies. Looking at oxidative stress and then certain markers that can tell, like B vitamin, do you have enough omega-3s? Are you getting too much of another type of fatty acid? Looking at your protein levels, are you deficient in certain proteins? So there’s a lot of really cool testing out there and that’s what functional medicine does. Lifestyle medicine on the other hand is more about mindset. It’s about the health mindset, because your body’s going to go as your mind goes. And in lifestyle medicine, we’re really focused on the behavior set that optimizes and ensures a long health span, because people talk about longevity, but we can keep you alive a very long time in disease. I don’t think anybody really wants that. What they want is a long health span, being alive for as long as possible and as healthy as possible. And that’s what lifestyle medicine helps us with.

[00:43:06] And then even if you have a disease, let’s say you have something, let’s say diabetes, and you’re drinking three sodas a day, eating McDonald’s or Burger King twice, you’re stressed out, you’re not sleeping. You’re taking your meds and you’re wondering why your meds aren’t working. There is no medication that can overcome your lifestyle. It just doesn’t work that way. And if you look at a lot of these medications, let’s just say statins for instance, statins, cholesterol medication. The data for primary prevention on statins has an absolute risk reduction of around 1, maybe 2%, depending on what study you look at. That means I need to treat about a hundred people, 50 to a 100 people, to save one. And mainstream medicine is okay with that. We’re okay saying, hey, if I have a number needed to treat of 30, which is the number for secondary prevention, people who’ve already had like a heart attack or stroke or something like that, if I treat 30 people and I save one, I’m okay with that. Now me as a consumer, I’m like, if you’re telling me your best shot is a 1 in 30 or 1 in 100 chance, I want something else. I’m not taking those odds. And if you look at medications, these are real-world numbers. And always, if you can look at the number needed to treat, look at your number needed to harm. How many people you need to treat before you cause harm and then ask these questions. Well, what else can I do? Don’t just rely on medication to get you through. The average 65-year-old’s on 12 to 16 medications. If the medications work like people thought, why would you need 16 of them?

[00:44:49] Dr. JB: Because they have side effects, so you have to combat the side effects with another medication.

[00:44:54] Dr. Harris: That’s so true. One of the first things I usually do is I just stop stuff. I just ask people, hey, is this working for you? And a lot of times people say, no, I’m just taking it because someone told me. Well, we’re stopping that. And then they’ll feel better because they’re just on certain medication to combat side effects of other medications. And then a lot of people don’t realize that these medications can cause significant nutrient deficiencies. If you’re on contraceptives, you need to be on a B complex. If you’re on Metformin, you need to be on a B complex and CoQ10 because it depletes these things. If you’re on anti-seizure medications, it can deplete folate. And these are key nutrients, if you understand biochemistry, that are going to help our overall function. Statins deplete CoQ10. And so you can have side effects from nutrient depletion from taking medicine. And I’m not saying, just stop your medications, right? But these are things that there are resources readily available that you can look at if you’re taking something, saying, hey do I need to supplement something while I’m taking this medication in order to make sure my body systems are in harmony?

[00:46:03] Dr. JB: So, question for you, in terms of learning about these effects of medications and their associated nutrient deficiencies, did you learn this in medical school or residency?

[00:46:15] Dr. Harris: Nope. Didn’t even didn’t even learn them in pharmacy school. This is all stuff that I learned afterwards, because I would look. Once I started doing the genetic testing and the nutrient testing on people, I saw a lot of people have significant nutrient deficiencies, and even the government estimates that 90% of Americans may be deficient in a key nutrient. And then there was a study that showed that I think 10% of people have a nutrient deficiency so severe that it’s causing a chronic disease. And this is something that I had to look at outside of medical school, because medical school teaches you about the most advanced of the advance, but it doesn’t really talk about the simple stuff. And if you don’t have the basics, the advanced stuff doesn’t matter. It’s like, okay, we’re going to build this really awesome house with this amazing pool, and you don’t lay the foundation.

[00:47:07] Dr. JB: So, it looks like there’s a lot of similarity between lifestyle medicine and health coaching.

[00:47:14] Dr. Harris: There is. So, in lifestyle medicine, a lot of us will have read a lot about coaching principles and psychology and sociology. In fact, in my lifestyle medicine course, I spend the first two weeks– it’s a five-week course– before we even talk about nutrition or exercise or sleep or avoiding toxins, we spend two weeks talking about mindset, because that’s how important it is. We talk about the growth mindset. We talk about willpower. We talk about values. So, I’m going to give your listeners a little actionable advice here because I’m big on action, I’m big on giving people tips. The biggest mistake that people make whenever they want to do something or change something is they start with action. Biggest mistake. The first thing that you need to do is get crystal clear on your values, understand your “why” for the action. It’s not enough to say, well, I want to lose body fat. Well, why do you want to lose body fat? Well, because I want to be able to ride bikes with my grandkids. That’s a really good “why.” That’s a very compelling “why,” I think that’s a “why” that most people would think would be admirable. So now once you have that “why,” then you form a new identity based around that “why.” And this is, for example, if you’re going to the grocery store and you’re picking up something and it’s Cheerios, you ask yourself, is this going to get me closer or further away from my goals? And in this case of riding bikes with your grandkids, those Cheerios is probably going to get you further away from your goals. And then because that’s your goal and now your identity is I’m someone who prioritizes my health because I want to ride bikes with my grandkids, now you’re going to put that box down and you’re going to find a healthier snack or a healthier breakfast item. So that’s the first step, is get crystal clear on your “why.” The second step is form a new identity around your “why.” And then the third step is do your research and prepare, don’t just dive in. You don’t learn to swim by jumping in the Atlantic Ocean.

[00:49:20] Dr. JB: These are all great advice. Because so many people just start, they’re so excited to start this new venture or this new New Year’s resolution and they just jump right in, and then a week or two into it, it’s a wrap.

[00:49:37] Dr. Harris: That’s because they haven’t found their “why,” they’re just doing it just to do it. They’re running off of dopamine. Dopamine is a molecule was, makes us want more, it’s always thinking about the future. And so if you’re just running off dopamine, then once you start doing something, dopamine gets bored and it says, I want something different, but if you’ve come clear on your “why” and your values, then that engages a different system, our serotonin, our norepinephrine, our endocannabinoid system, our endorphins, and then it’s more about the here and now and being present in the moment and enjoying the moments in your journey. And then when you enjoy the moments in your journey, guess what? You stick on the journey.

[00:50:25] Dr. JB: That’s true. And I wonder if there’s something to be said about taking it one piece at a time and prioritizing what you want to try to tackle instead of trying to tackle a bunch of things all at once.

[00:50:39] Dr. Harris: That’s exactly what we teach in our wellness course. I say, listen, you don’t learn to ride a bike by learning how to ride a bike and juggle and play the flute at the same time, but that’s how we try to attack behavioral change. We’ll say, okay, I’m going to get my nutrition and my sleep and my exercise, and I’m going to get it all right and start tomorrow. That is completely unrealistic. If you set unrealistic goals, you will fail. And so, we talk about setting smart goals and how you need to have a big audacious goal. You want to engage your dopamine and your here-and-now system together. You engage the dopamine by having a big audacious goal. Something that scares the pants off of you, but you break it down into small steps. That way dopamine’s excited because you’re reaching for something all the time and then you’re here-and-now system is excited because you get to celebrate small wins. And I tell people, focus on the thing that you could do the most. If it’s easier for you to start with nutrition, start with nutrition. If it’s easier for you to start with exercise, start with that. Or maybe it’s fasting, start with that. And then as you master that, as it becomes habit, ingrained in your routine, then you move on to the next thing. And then you figure out how to make that a habit and make that ingrained, and then you move on to the next. I practice everything that I do in my lifestyle medicine course, but I didn’t just wake up one day and started doing all that stuff. These are a collection of behaviors and mindset that took me months to years to develop, but it’s always something that I’ve been working on things one at a time, and then once I master it, it gets part of my routine, move on to the next thing. And I have a list of things that I’m working on and that I work on adding, and sometimes certain things will fall off depending on if I’ve accomplished what I needed to related to that goal.

[00:52:33] Dr. JB: And so how do you know that you’ve mastered it? Is it based off of a certain time, was it like three months of doing the same thing, like exercising every day for three months and now it’s a habit, or is it individual for each person?

[00:52:46] Dr. Harris: It’s individual, but again the easy portion of the thing to do there is ingrained as a, is a part of your identity. So, for instance, working out, I constantly tell myself, I am someone who works out, because everyone thinks that it’s all about motivation. “Like, well, I just don’t have the motivation that you do, Richard.” And what I say to them is, okay, you think I had motivation when I was a baby? Was I born with motivation? Have you ever seen a baby with motivation? Nope. It’s something that can be learned, but we’re not always going to have motivation, but what we always have is an identity. And when you have an identity around something, “I am someone who works out,” “I am someone who prioritizes my health,” “I am someone who takes health span very seriously,” whatever it is, you will always go towards that identity. So, I love working out, it doesn’t mean I want to work out every single day, but because it’s my identity, I will always get up and go to the gym even when I don’t want to.

[00:53:48] Dr. JB: So, what you’re saying is you need to make some space besides the identity of being a physician to make room for other identities.

[00:53:56] Dr. Harris: Exactly. Because I always tell people, listen, I’m not a doctor, as in, that’s not my identity. I’m just a person who has a particular knowledge in a particular skillset. But my identity is not a doctor. If someone asked me who I am, I’m not going to say I’m a doctor, because that’s not who I am. That’s what I do, but that’s not who I am.

[00:54:18] Dr. JB: Interesting because a lot of people say, “I am a doctor.” Like you mentioned in the beginning, a lot of people say, “I’m a doctor” and that’s it. A lot of people say, “I’m a doctor and I’m XYZ,” but you would not even say that you’re a doctor.

[00:54:30] Dr. Harris: It’s not who I am. It’s not, my identity is not revolved around this profession for sure. I was in trouble coming out of residency because it was. The moment I as a physician was the moment that everything started to change for me, because now I’m a person who has a lot of hobbies and activities and likes who just happens to be a physician, but that’s not my identity. It’s not, it’s not the essence of who I am. If I walked away from medicine tomorrow, I would stop saying that, when people ask me, “what do you do?” I wouldn’t say I’m a physician. People ask me who I am, I wouldn’t say I’m a physician because I’m not practicing anymore. And I’d be a hundred percent okay with that because who I am is I am someone who wants to leave the world a better place. That’s who I am. That’s the essence of me. And being a physician is a means to an end for me to do that because I get to help people with their health, with their mindset.

[00:55:32] Dr. JB: So, this change in your mindset, is that how you overcame burnout?

[00:55:38] Dr. Harris: Yes, absolutely. And I had to figure out how that I could practice in a way that I wanted to practice. And for me, that wasn’t always at the bedside, because again, I can’t, I don’t have the capacity to talk to 25 people a day. I just don’t. And so I need to figure out a way that I can make this work in a way that I wanted to. And being in internal medicine, we feel that we have to be great at everything, and I had to become okay with not being great at everything and figuring out what niche do I really want to serve? What do I really like doing about this job? And that’s when I started to look at things outside of medicine and I feel very fulfilled that way. I feel very fulfilled being a “physician-preneur,” that’s my job. I’m not even a physician, like traditional physician, I’m a “physician-preneur,” or I am an entrepreneur who helps people.

[00:56:40] Dr. JB: So, Dr. Harris, you’ve given so much wonderful advice during our podcast recording and I’m sure there are listeners who may want to get in touch with you to learn more about the services that you offer. So, if they did want to get in touch with you, how could they do so?

[00:56:58] Dr. Harris: Yeah, I’m very active on social media, you can find me at Dr. Harris MD most places. There’s also my website, theGHwellness.com. One of my businesses is called Great Health and Wellness, it hosts my podcast, the Strive For Great Health Podcast, and that’s the easiest way to get ahold of me actually, is to use the contact function on my website because it goes directly to my email.

[00:57:20] Dr. JB: Wonderful. and so that will be included in the description of today’s podcast. In closing, Dr. Harris, are there any words of advice that you want to leave with my listener?

[00:57:34] Dr. Harris: I think one of the things that’s the most important is that we shift our mindset and shift our associations, and one of the quickest ways that we can do that is have a gratitude practice. Wake up every morning, say three things you’re grateful for. Gratitude is immensely, immensely powerful, and that’s something that’s helped me out a lot. And the other thing real quick is just remove “can’t” from your vocabulary, because the moment you say “can’t,” that’s it, it’s a self-fulfilling prophecy. It’ll never happen. If you say can, you’re asking yourself now empowering questions, because if you say “can’t,” it’s, I can’t do this, I’ll never do this, I never was good enough, why did I think that, I’m terrible at this,” all negative, all defeating. If you say, I can do this, then those things become, how can I make this work? Who do I need to talk to? Is there someone that can help me with this? Maybe I allot this much time. Maybe there are books I can read. And you see the difference there? One of the lines of thinking is empowering, the other is defeating. And that’s the difference between saying “I can do this” and “I can’t do this.”

[00:58:41] Dr. JB: Yeah, who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.

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