Lunch and Learn with Dr. Berry

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Erin Boyd, an Emergency Medicine physician & former classmate to try and help us answer the question is there a cure for burnout. Dr. Boyd helps give her personal account on physician burnout and how she is able to navigate this world of being a physician when it has gotten harder than ever.

Hear how Dr. Boyd chooses to look after her mental health as an attending physician and why its important now more than ever to make sure physicians take care of the number one patient THEMSELVES!!

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Download Episode 129 Transcript

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Episode 129 Transcript..

Introduction

Dr. Berry: Welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com and CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and affirmation. This week we bring you a finale to our series on Physician Burnout. This has been a very telling and interesting look at the other side of our profession. First I have to obviously thank Dr. Nicole for starting these things off and helping us, educate us on what physician burnout actually is, just in the first place. And really spearheading the movement where we went back and said, you know what, let's look at what medical students go through. Let's look at what residents go through. And finally, of course, let's look at what some of the attending physicians who finished and look back and say, alright, this is what physician burnout is to them. And it's very interesting to hear the level and really the definition of how people describe it at these different levels depending on where they're at. So definitely want to say thank you to all who have been listening that's far for the podcast and for listening for this amazing series. Again please, if you've not had a chance to check out our prior episodes starting with Dr. Nicole where we really hit home what physician burnout was and is really started from there. So if you want, again, from a numbers standpoint, it is episode 124, right? 124 with Dr. Nicole and then just moving on in to this finale episode with the one person that I can't wait for you guys here. This is actually Dr. Erin Boyd, who is an emergency medicine physician. She currently works at a trauma center. Most importantly, she is a former classmate of mine, to Nova Southeastern University. She has really taken a mantle, especially when it comes to social media and just her story on physician burnout because that was something that she really wanted to drive home. And we'll talk about this today on a podcast about her personal experience with burnout and how she's able to dealt with it and how she's really used social media to get her out of the rut that the burnout usually puts a lot of our physicians and our residents in and now our medical students in. So I can't wait for you guys to this episode, which is another great one. Like always if you had not had a chance, go ahead and subscribe to the podcast. Leave us a five star review. Let us know just how much of an amazing job Dr. Boyd did, or just whether if you're listening to Episode 124 and just moving on up. Let us know how anyone has done thus far on the podcast with your five star ratings are greatly appreciated, especially if you're one of my Apple podcasts users. But if you're not, again, please subscribe, please download, please tell a friend or 10 to take a listen and get right on physician burnout. Like always, get ready for another amazing episode with Dr. Berry.

Episode

Dr. Berry: Alright Lunch and Learn community, you just heard another amazing introduction from a guest who, you has rights that a lot of people can't claim. She's actually a former classmate of mines. So I'm definitely excited to get her on and talk about a topic that we've been talking about for almost four or five weeks now guys. So I'm definitely glad to get this person on because this is the reason why I've been following very closely and been watching and seeing the growth behind what she's been doing and it has been interesting is because it's really been centered on this topic at hand. Dr. Boyd, thank you for coming on Lunch and Learn podcast. Talk to us. Dr. Erin Boyd: Thank you so much for inviting me. Much appreciated. Dr. Berry: Sure. So the question I ask, and I always asked my guess because what tends to happen is I give a little spill in my introduction and people fast forward, who want to go right to the show and they want to go right to the meat of the conversation. So I always asked, well, tell us something about yourself that we may not necessarily know because we're going to get into all your business, but we may not know just about Dr. Boyd. Who is Dr. Boyd and why are you so amazing? Dr. Erin Boyd: Well you know, I'm just one of those people that when I put my mind to something, I get it done. And I wanted to go to med school. It took me a couple of years, but I got in and I decided I wanted to go ahead and start my family in med school. So I did. I had my kids in med school. I had one in residency. So I'm just one of those people that wants to have a goal and I said it, I just get it done and I don't let anything keep me from that. So that's kind of a big part of who I am and that sort of thing. So. Dr. Berry: And I love that especially because you touched on a couple of topics that really hits home especially for women in medicine. One, the fact that you wanted to do it and no one was going to stop you from doing it. And two, family. Because unfortunately, again, I understand I'm on the other side of this double standard that's sometimes frowned upon. Just going into a career that you're going to be busy and wanting to actually have a family, an actual life. People think that it's actually a crazy thing which still boggles my mind today. Dr. Erin Boyd: You're absolutely right. Yeah. I mean, I didn't go into medical school saying, okay, I'm gonna have a family and do all this, just one of those things that hit me. And at some point, if you want a family, you have to figure out when that is. And sometimes you just don't know when the right time is. I've counseled on this with students and residents and even attendings. Now that they asked me, when do you start a family? And I just tell them it's when you're ready. It doesn't matter if it's before school, after school, during school, it's when you're physically, mentally ready because then you'll make it happen. If you feel like you're in the middle of medical school and it's time, then do it. You'll figure it out because that's what you want in your heart. But you're right, it is hard, as a woman because physiologically we're the ones that have to bear the children and that is what it is. Can't get around it. And if my husband would do it, that would be great. But he can't. So it's a factor that luckily women, we can do all sorts of things. So we've got to have the babies too. Dr. Berry: Yes you can. I love it. So we were talking about a topic which is really obviously now, especially when you turn on TV and you go to a website, you read a blog, has become extremely popular in the discussion of physician burnout. And I remember when I first started, this kind of series of discussions, I figured it was just going to be a one off discussion, just forgot what it is and then go away. And I remember being almost shocked at hearing just the level of death that it was really affecting so many different people and not just physicians but residents and medical, I was just so shocked. And that's again, that's why we started a series because I really wanted to hear everyone's really opinion on the subject matter. And then of course I obviously I know a little bit about you, our Lunch and Learn community may not. Talk to us about your familiarity with physician burnout in general. When you hear those terms, what does that actually mean to you? Dr. Erin Boyd: Well I'll tell you, I hadn't really heard this term. I don't think I remember hearing it in medical school. I didn't hear it in residency. And so I just started learning about, I think maybe the same way you described just through the grapevine here and there. Some articles come out and mentioned some little brief couple paragraphs about burnout and piqued my interest because it resonated with me so much. That's how I feel. That's how I've been feeling probably since, I mean probably, I mean medical school. Yes, but I really felt like second year of residency it really hit me and I almost felt like what did I do? I shouldn't have become a doctor. It got really bad just because I just felt spread so thin. I love medicine but it was hard to work those hours. It's hard to work 24 or 36 hours straight, come home, try to be a mom and a wife and just try to be healthy. And I didn't know what to do. I mean, but I haven't, I guess you just pushed through. I didn't know what else to do. I had to keep going and so I started feeling that way but I didn't really put a name to it. I never talked about it. I didn't tell my residency director, I didn't tell any of my other residents because I thought I was the only one. And I think that's the biggest problem. We all think we're the only ones that feel that way. And as physicians we are so afraid of messing up. We're so afraid of looking weak and we don't talk about it. And as a matured and grown in my specialty and I've been an attending now for five years. I luckily have had some close friends who are also ER doctors and we would start chatting and we would also feel the same way. And that connection that I made just talking about my feelings helped. And so I just think getting the word out and talking about it and letting other doctors know that it's not easy out there. We all feel this burnout stress and it's helped. And that's why I started my Instagram page. Honestly, it just was a way for me to connect, not just locally, but across the nation and even internationally. It's been amazing and it's been really great. So. Dr. Berry: It's definitely amazing, your Instagram page and we will definitely make sure that it's highlighted in show notes because I need people to follow you for a lot of different reasons. I'm definitely, I'm going to spend the time little bragging on you towards the end. So I just want to let you know, unless you're a little modest, I'm definitely gonna brag on you because you're definitely a person that I really admire and I like seeing you do well and do great things especially with your message. Because I know your message and like I said, we were classmates and it's definitely something that's always the sight to see when you're like, oh, I know that person. And it's so funny because we were just talking about this before we started recording. Just the amount of busyness that we deal with in our life as a physician that we've grown so accustomed to. I'm not sure if it starts in medical soon. Not sure if it gets hard and in residency and that we've grown so accustomed to that. It doesn't even seem abnormal to us. And I think you hit it right on the head. And I talked about this before in private previous shows that I think the biggest thing is that as a physician, we're so bad at telling people how we feel, especially our own colleagues. If I write a journal article, I'm going to tell every single person in the world, even if they don't ask me. But when I'm not feeling well, when I'm not 100%, when I'm not even physically, but even mentally, when I'm sad, for some reason we keep all of that in. And it something that just continues to build and build and build until we really have no outlet. My wife, she's not in the medical field so it's very difficult to have these conversations when you leave the job, right? Because for those who know I'm an internist, during residency, even now, a lot of my days usually may end up with someone not coming home. And that's really not a conversation start over dinner. Those are thoughts and feelings that you have to keep to yourself. So I definitely love that you hit home the fact that you were going through, what you felt was like, wow, this is overbearing, but you're looking around and it's one of those things where like, wow, am I the only one feeling this? Because no one else is verbalizing it. And I think that's what sometimes does a little injustice because no one else internalizes it. So when we're thinking, am I the only one who's ever experienced this? Am I weaker for experienced this? Will someone look at me in a different light if I finally say like, oh, hey, you know what, like I'm not feeling good either. And what was interesting, especially in a reason I really earmarked this conversation and earmark, wanting to talk to you, especially as an ER physician because we, especially within our profession, we know when we look around the different specialties and we talked about people, again, we didn't even know what it was, but I guess now we deem it as burning out when we look at, people were saying, you know what, I'm done, I'm quitting. I'm out of here. ER, emergency medicine has always been one of the top related physicians positions associated with that feeling. Is that something that, especially because you didn't know about it before, but is that something that you may have thought about? Is that something, even going into emergency medicine, because I always asked at my physicians' colleagues, why'd you go especially the women? Dr. Erin Boyd: I didn't know emergency medicine has one of the highest burnout rates going into it. I went into it legitimately because I enjoyed the action. I love seeing a little bit of everything. I can see kids, I see OB, I see geriatrics and cardiologists, see a little bit about everything. And I love that. I love being able to use my hands and do procedures. I love being able to make a difference, acutely right away. Somebody walks in and I can do something for them. And I love that. And I love being in the hospital setting. So I went into it thinking, wow, this is a great career for me. It fits me. I like to do shifts. So I go in and work 14 shifts a month or so, maybe a little more. I come home, on call. Perfect. Love it. But again as time has gone on, I think the stressors in the emergency department, I didn't really consider, because I just didn't know and nobody really talks about it. So it wasn't like I was interviewing and everybody's like, oh, by the way, 65% of your colleagues are going to stop working because they hate it. Nobody really said that. So I'm like, wow, I've gotta be the only one. Everybody must love this. But we see, the emergency department sees probably people on their absolute worst day. People are coming in, people are dying. We see people who are extremely sick. We see people who don't have insurance. And so they may have a lot of problems that I can't fix. I can't fix a lot of issues. And there's a lot of stressors from administration that I cannot control but I have extreme stresses to see patients pass, get them out of the emergency department pass with not many resources, not many nurses. And so there's a lot of pressures that I had no idea I was going to have to face. In a perfect world, if I can go in and help every single person that had, a true emergency, that'd be great. Probably 10 to 20% of what the… Dr. Berry: I heard that a lot too about the stressors that, not that sometimes aren't even in the clinical aspect on emergency medicine, physicians, but the social aspect, the administrative aspect, all of this is hitting you from, you can hit hard, hit face on the medical and the clinical, but you're like, whoa, I didn't expect this to hit, steamrolls. Dr. Erin Boyd: So true. I still love medicine. I remember, I've loved learning it and I like the medicine, emergency medicine. It's just there's so many more aspects to it I just didn't know. Just either, even if it's just irate patients or irate consultants or people yelling at me or administration saying you're not seeing patients fast enough when I'm seeing them as absolutely as fast as I can, but they don't give me C extra, CT scanners. They don't give me nurses. They don't give me beds to move patients into. Those are all things that have nothing to do with true medicine. But that's what probably frustrates me the most. And it may not sound hard, but it really takes away some of the joy of helping people. I think part of it, you don't have a lot of control over, it's my job, I can't really quit my job. So most emergency jobs are had the same thing everywhere, no matter where you go. So sometimes you feel a little stuck. And I think when you lose a little bit of that control, failing over, your career I guess or whatever that can make you also feel a little burnt out if you lose a little autonomy. And even doctors love autonomy. We like just doing what we think is best and doing what's best for the patients. But at that gets taken away from us or we don't feel like we can do that. It makes it tough. Dr. Berry: What's so interesting is that when, because we've talked to medical students, we've even talked to an ER resident and they, you can tell data, they're not saying it, but a lot of their thought process really deals in the fact that they're there. They're losing a bit of the control that they thought would have, as they move along their career. And I'm a hospitalist. For those who know that I work in the hospital city. So when she talks about time, you best believe the second I press admission, someone is clocking me and saying, when is this person leaving the hospital? And again, it is such a frustrating thing because you want to help those in front of you, but there's so many different roadblocks ahead of that quote unquote discharge time that stand in your way that for some reason we seem to be the only ones who can come to grips with it. Unfortunately, because we're the face of health care, unfortunately physicians are or fortunately depending on how would you, where you lean. We have to deal with the brunt of, the angry and the upset. And then bad publicity that's socially with it. Definitely, something that beats you up, at time and time again and just adds on to the level of stressors that just if you were just doing clinical medicine, you're going to have stresses in it of itself. But when you add all of these extra things on here, unfortunately it takes the cake. I gotta ask of course, obviously being in this position, as an attending physician now. Because it's funny because my medical students and my residents want to know, they want to know, hey, Dr. Boyd, does it get as get better once, I think a lot of us because we do this right of passage thing, which is, medical school and residency, uh, there are a lot of people who think that this is just what you're supposed to go through. And they think once you hit the promised land of the attending that it gets so much better. Dr. Erin Boyd: I will tell you my first year at a residency was probably one of the most depressing years honestly because I expected to hit the pinnacle of my career and it was going to be unicorns and rainbows and just, amazing. I get paid so much money and I'm just going to make all decisions and it's going to be great. And when I became an attending and realized that it's not, it's a lot of the same to be honest with you. I mean a lot of the same. You still stress out about making them right diagnosis like it did in residency and worrying about not missing something and making sure you're still the smart doctor. You still worry about that. And then in addition you're like, all the other stressors I just talked about come more into play as an attending. Because you learn about it in residency. But I felt like it definitely comes into play more when you get a real job and then on top of it I didn't have anything else to really work towards. So when you become a doctor, you're working for 11 to 12 years, whatever it is on this climb to this pinnacle of being a doctor and board certified whatever you are. And once you hit it, you don't have anything else to climb to. I feel like that was a coping, I could just keep working towards the next goal. They didn't really think about how I was feeling and until I just stopped and have anything else to really work towards. All of a sudden I was like, oh my gosh, what else? So what else do I do now? Dr. Berry: Lunch and Learn community you can't see me shaking my head, I'm just like, ah, she hit me. Dr. Erin Boyd: You almost have to find yourself. You're like, well, what are my hobbies? What do I like to do? I mean, I'm just so used to like 12 years of my life or whatever it is. 11 years of this constant pure, a hundred percent stress. And then you're an attending in, you still have the same stressors, but it's different and you still feel like you don't know who you are, I guess. You know. I don't know. That's how I felt. Dr. Berry: So what's interesting, I love that because when you're going through that climate, it's funny because you mentioned, what is my hobbies? But like a lot of times we don't even get time to do that when we're student in a residence. So for a lot of us, we really have gotten neglected the things outside of medicine, because we had to say, alright, I gotta pull all these eggs in this basket real quick, take care of my business here so I can get to that promised land of the mountain and then you get to that promised land the mountain, you're like, whoa, this is it? Dr. Erin Boyd: Oh, it was what I'd been working so hard for all these years. This is what it is? Dr. Berry: Lunch and Learn community I'll tell you this is a such a common feeling and thought amongst a lot of physicians and I think what's happening now, what you're seeing now is that we're being much more open, right? We're being much more like forthright and not keep it. We're not keeping it as a best kept secret anymore. We're saying like, and again, none of us are saying we don't like medicine. We all love medicine. It's all of these extra things that have infiltrated and been placed upon and been forced upon us during the process that's soured the taste. And when we do get now, we were at the top of the echelon and people are looking at us and they don't understand why we're not all golfing every weekend. Dr. Erin Boyd: Just swimming in money and stuff, it's not like that. It's just, it's not. And I don't mean to sound like it's totally the worst. It's just so nice just to say it. And so many other people feel that way. But I just didn't know nobody ever really talked to me about it. Dr. Berry: Oh no, definitely not. I do academic medicine and I'm even starting to tell my residents now like, hey, I know you think once you graduate, it's all gonna be, and I know you think money is going to be like the go getter and it's gonna make everything happy. But I'm promising, if you're not finding that outlet. And now if you're not finding it, the benefit of the why now of why you're doing this, you're going to be very sad and when they offer you crazy money and you're still wondering why you're sad. Was there anything like, especially as a first year attending your fresh out and then you're filling all of these feelings, what was there to help? What did you do to deal with the stressors and the feelings that you were experiencing? Dr. Erin Boyd: So I actually sought out, just like therapy. I just going to a weekly therapist and it was probably one of the best decisions I ever did because it was a third party person. It wasn't like my husband because after a while, sometimes your partner, sometimes it's hard to just dish on them all the time, all that negativity. So focusing on just my mental health, because I was depressed. I had clinical depression. I had anxiety that I didn't realize as I had. I didn't have time to even think about it honestly because you're just too busy. You're too busy to even think about how depressed and anxious you are. So I focused on me which I hadn't done in years and so that was the best thing I had really done to just working on my mental health. Because I think that's where a lot of this is, right? A lot of this is mental. You're physically tired but I think mentally you're exhausted. And the pressures of being a doctor, the pressure of keeping people alive. The pressure you can't miss a diagnosis. It takes a huge toll on you mentally. All the trainings that we do. And so that's just one thing I would recommend highly to anybody in the medical field is really take a look into your mental health. Because I think having somebody just to talk you about and learning, I didn't even know I was depressed until somebody told me. Dr. Berry: You're 100% right. We read the books. We read the books. We noticed signs and we were like, not necessarily. Yup, that's exactly what happens. I love that you say, you know what, I had to focus on me because I think that's a big thing too. Of course it may sound crazy that people, no, I know doctors are so centered. No, no, we're probably like one of the most selfless people and we probably, again, especially I did primary care medicine before I did hospital medicine and I know for a fact that doctors are like the worst patients. They won't come for the wellness, they're so terrible. And the reason being not because they would purposely doing it is because they want to take care of everybody else they usually neglect themselves for later. And what I love is that especially and I've joked about this before, as a physician, we're the one and only fields that has to be right 100% of the time. So think about that and then think about an emergency medicine physician. One of the fields, specialties that not only has to be right 100% of the time, but you have to do it much quicker than me. Like me, at least. I get some time. I can send some labs out and I can order a test. I can wait for some things that happen. You guys may have like 10 minutes, five minutes, your decision making has to be so quick and happens rapid fire. And again, remember we still talk about this clock right there. The administrators, they're still pushing this clock and they want you to ramp up faster and faster and faster. So just imagine that level of stress. Like I said, when you go to McDonald's and they mess up your order, no one gets fired or from it. But if we miss a diagnosis, grandma doesn't come home. If we miss a diagnosis, you may not see your mom or dad. That's the level of stress that physicians, especially emergency medicine physicians, like I said, that's why I love you, because that's the level of stress you gotta deal with. So that's why I always commend my emergency medicine folks, because I know, I know it's tough. Dr. Erin Boyd: Yeah. You're absolutely right. Because I think you're right. Physicians are very selfless and we spend our whole. Every single day we're at work, we're caring for every single patient, and I think majority of us do. We put our mind, our focus, our energy into our patients so we don't miss something. And then you've got to try to come home and then whether you have a family or not, you got to put your time and energy into your family. So it's just hard to, in order to be a good doctor in whatever, its taken time to learn because you have to figure it out. What fills your cup, what makes you feel strong, what makes you feel whole. Because you can only give so much to your patients and unless you fill up, yourself I guess. And that's how I feel like I can make the right diagnoses. Because even on the days that I've worked, let's say seven days in a row, I've seen probably, sometimes 30 to 40 patients a day, emergency situations, I may miss something just because I'm tired. I'm just tired and I might miss something for that. So if I don't take time, I can't do that to myself because then I will miss something. Dr. Berry: Very true. And they're not exaggerating when I say it again as a hospitalist, we have bad days where I may have to see like 25 to 30. But this isn't, they're seeing that many patients every single day. So again, like I said, that's why I really wanted to make sure that we had a conversation with an ER physician, because I know you guys get beat up way more often and much more frequent pace than others, in other fields. So that's why I wanted to make sure, if we're going to talk about burnout we definitely have to be talking to ER physician. I know they're the ones go through it. What I would say, especially now, this especially because we're about five years out from my attending status. If you had to look back and say like, hey guys, the feelings you're experiencing are true, are real, they're burnout. This is what I went through. But these are some tips, maybe not ways that preventing, because I've argued whether there's a way to prevent it. Well these are some tips that I would maybe give helps steer the ship away to help you out. What would you give to someone? Especially let's say that Dr. Smith, she's an ER resident, I think she's a third year and she's listening and she wants to know, talk to Dr. Boyd, how do I navigate what I know is coming to me? Dr. Erin Boyd: A couple things that I've starting to at least try to do is if you can work less, you should do it. I think again, as physicians we want to do, do, do and help out our colleagues and help out here and there. But if you financially or whatever can work less, you should not work the maximum out to make yourself crazy. So I've told my director, I said I've got to work less. Just even if it's two shifts less a month, it makes a huge difference. Just having some time off away from your job is crucial. You've got to have time to decompress. Just want one day off in between shifts isn't going to cut it. You need much more time to decompress. And that is the pet perk of emergency medicine as we do. 14 days a month maybe it doesn't sound like a lot, but some people work in 18 days a month or whatever. You don't get enough time in between those heavy days. I'm just saying no to extracurriculars if you can. So if you don't really want to do something, you just say no, don't do it. Whether it's a committee of some sort, even if it's just your friend wants to go out to dinner, just saying no and saying no, I don't really want to do that. If you don't want to, if you want to, great. But if you're just not going to fill you and fill your cup and make you happy, don't do it. Just find things that make you feel happy. Honestly, the Instagram page, I'm bringing that up again and again, it may seem silly, but it, it makes me happy. It gives me a hobby. It gives me connected with people, which I really enjoy doing. It's opened doors to talking with some of the medical students in the area. I've found some female physician friends that we have a group now. We've started through social media. So I've found something that I liked doing. So finding things that you like, whether it's traveling, working out, whatever. Those are some big tips. And then, I've already mentioned my mental health. I still had to go to therapy. I make sure mentally I'm in the right space. My mental health is very important and it should be for all of us physicians. Dr. Berry: Everybody. Of course and obviously I'm maybe biased because my wife is a mental health counselor. So she stresses and she jokes all the time that we physicians are so terrible when it comes to taking care of our mental health. So I've been a champion talking, talking, talking to someone, getting those feelings out. Because again, I wish I could say every time I go to work, it's a great day. It's not. I wish I could say every time I go to work, the person who I was able to admit is able to walk out the hospital. It does not happen. And it in a normal person shouldn't be able to deal with the level of mortality that physicians, especially those who work in a hospital setting, have to deal with. So if you know that's what you're going to, you gotta be able to like get your mental on correctly because it doesn't matter how smart you are, if your mental isn't where it needs to be, you're going to be lost and your patients are going to be lost. And the patients will always be the loser when you're not at your tip top shape. So I love those tips because I think it's not even specialty specific. It's really like, hey, you need to find out what you do well and sometimes you gotta do you alone. Dr. Erin Boyd: Absolutely. And this is on topic, physician depression, physician suicide, I mean it's higher than the general population. And again, this is not talked about. It's taboo. Physicians are medicating many times with drugs and alcohol and stuff like that. And it's not healthy. And we were losing physicians from our mental health because we don't take care of it. And I just like to stress that because it's helped me so much. And I know, I think part of that could be related to the burnout because we don't take time for it. So anyway. Yeah. I just wanted to add that. Dr. Berry: I honestly, I probably going to, I think that's where I'm hoping this conversation of burnout eventually leads us. Because now it's very popular to talk about physician burnout, moral injury and all of those things under the sun. But we don't really talk about that suicide aspect yet. (Yeah. And I think that's what comes down to it, right?). We don't really make it the hotbed we should, and again, what's worse is we're looking back, just like when we looking at this physician burnout thing, these are physicians who been out 15, 20 years and they're like, oh, you're tired. No, no, no, no. These are resident physicians who are just gaining out of practice maybe less than 10 years. These are resident physicians who are still in residency because our medical students who are still doing medical students stuff and they're committing suicide. And that's a very scary topic. But if you don't address it right, if you don't even mention, it's like Voldemort out here, that's where the problem is. I love that you touched it because I really think and I'm hoping that this is where we eventually go. We start saying physician suicide, physician suicide, physician suicide. Just as much as we're casually saying physician burnout. (Yup). I think there's like an ICD10 code now for physician burnout. So you have to understand like, no, it's leading to a place that we need to be able to talk about right now. Right before our physician colleagues get there.

Dr. Erin Boyd: Yap. I agreed. Dr. Berry: So before I let you go, I got to brag on you. So we again, classmates. Shout out to Nova Southeastern University. As a person who's been doing social media for, since probably since medical school. But I've always been enamored with social media and to the point I remember I used to get called in the office and hey Berry, make sure you don't do nothing crazy on HIPAA. HIPAA was always a big thing. I remember you joining Instagram specifically. First let's tell Lunch and Learn community how can they find you? What's your Instagram? Dr. Erin Boyd: Okay. Its @er.doc.mom Dr. Berry: Alright. And remember Lunch and Learn that will be in the show notes and you definitely need to follow her, like as you're listening to me. Go ahead and go follow her. (Thank you). And I remember when you first joined and I remember watching a video of yours and you were just saying like, hey guys, I'm just here because I just want somebody to talk to. And I remember being like so enamored with that because it was one of the first times I could see like, oh wow, this is a person who is really open and really open with what's going on and okay with being open. I think social media gets such a bad rap, especially in our healthcare field. It's getting better for sure. It definitely getting better, especially when I see what medical students are doing now compared to what we used to do when we were medical students. So definitely getting better. But when I see you, I'm here, I have this page, I'm going to be talking and follow me. And I was like, yes. I'm definitely in following because I got to see. And it's been such an amazing treat just to see your journey now. Was Instagram something that you would, was it just one of the platforms you happen to like? Was there a reason why you chose Instagram as a primary source? Dr. Erin Boyd: I've always enjoyed just the format of Instagram and in my back of my mind, I wanted to maybe do some sort of blog sort of thing, but I'm trying to make a website and everything just seemed annoying. So one of my friends was like, why don't you just do it on Instagram? Just do like a mini blog. I guess I just found it easy to do, just started doing. And format just seems to work well. And I didn't really know there was actually a lot of physicians on Instagram, that I had no idea. So there's a great community there for advice on all sorts of topics. And so, yeah, I just found Instagram just to be easy to use, user friendly. I like the pictures and I can make post and just talk about whatever I want. And it's pretty cool. So. Dr. Berry: What I love is that not only do you do that, but you also take the time to educate as well. You also take the time to say, hey, this is who I am. But hey, by the way, and you know what, let me do some education right here. And I get asked, as a person who does some blogging, does some podcasting, does some videoing. Person who does all of these things. I just love that when I see people, especially my physician colleagues, because I'd be begging, I'd be like, you don't know how many times I have to begged on my physician colleagues, I was like please just open up one of these accounts. We need you out here as we could probably talk about this all day, I'm not gonna keep you on. Just the misinformation that's out there. I need people like Dr. Boyd say like, no, this is what emergency medicine is guys. I don't know what you read. I don't know. Like stop reading what you're reading. Don't read it off student doctor dot net. This is what emergency medicine is. And I just love that. And like I said, that's why I highlight, I make sure like you're even on my notifications. I always know when you post it. Boom. All right. That would that because I need, because I want to know that, oh, where's she teaching us today? So I just wanted to take the time and highlight you and thank you for all that you're doing on this, that on the app and really all that you're doing for people that you may not even realize you're doing it for. And I know you said you've been connected with a lot of people, but there's a lot of people who may not like press that DM, but they're following you and they're saying like, yes, hello with Dr. Boyd. I'm glad she's doing it and I'm going to keep moving along. So I just wanted to take the time and say your efforts and highlighting your struggle is definitely appreciated, especially from one physician to another. Dr. Erin Boyd: Well, thank you. I'm very honored that you said that. Thank you so much. Dr. Berry: So you're on Instagram. Are you on any other social media platforms? Dr. Erin Boyd: I'm on Facebook too. It's the same thing @er.doc.mom. You can find me there too. Dr. Berry: Perfect. The last one, not least, I'd always ask my guest this, how is what you're doing helping to empower others to take better control in themselves especially us physicians? Dr. Erin Boyd: Building a community on social media where we're open and we're not afraid to tell you how it really is, has been extremely powerful. Just the connection, I've made with students, premed students, regular students, resident, it's been invaluable to me and I think also to them just being open and honest, not afraid to tell people that I sucked today, I missed the diagnosis, I'm tired. I don't feel like doing, I'm just being so open and real with people on a big social media platform like Instagram. It's just building a great community that I'm really proud of. And I hope it continues because it's great. I wish I had this when I was going through school. Dr. Berry: That's where I really want to hit home the point and there are people who are watching you who are feeling the same thoughts but are jumping for joy because now they know they're not alone. So Dr. Boyd thank you for really helping us enlighten Lunch and Learn community, especially from in the eyes of emergency room physician who I know takes a hit left and right and still, for some reason it keeps going back to work because you love what you do. Dr. Erin Boyd: I know, right? Somehow still do. And we appreciate y'all hospitalists because I know we beat y'all up a lot of times. We appreciate you guys. I couldn't do my job without my wonderful hospitalists so thank you. Dr. Berry: I call it the transition of care. Thank you for letting me be a part of this patient's care. I appreciate it. Dr. Erin Boyd: Yeah, sure. Yeah, good. Good. Dr. Berry: Dr. Boyd thank you and you have a great day. Like I said, appreciate all that you do and all that you do for here on the Lunch and Learn community. Dr. Erin Boyd: Alright, great. Well, thanks so much for having me.

On this week's episode of the Lunch and Learn with Dr. Kristyn Smith an Emergency Medicine resident in Philadelphia to give us some amazing insight on the feeling of burnout at the level of the resident physician. Dr. Smith's current interest include health disparity reduction and cultural & linguistic competence for healthcare providers.

As we have heard already with our two previous podcast episodes (125 & 126) featuring medical students we know the effects physician burnout has at their level but it was great to hear Dr. Smith talk about how being much a resident is affected. She also does a great job providing actionable tips to help residents from all specialities manage burnout during training.

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On this week's episode of the Lunch and Learn with Dr. Berry I decided to follow up last week's discussion with Aprylle Thompson with my own personal experience as physician burnout.

Over the past three weeks we have heard from our guest discuss not only what physician burnout means to them but also how they have personally been affected. I didn't plan on jumping in the mix for the series but I after hearing these two amazing medical student's stories I figured to add my own experience to the mix.

No one is immune the effects of physician burnout and it wasn't until I finished residency that it began to takes it toll. Listen to this week's episode to find out how I overcame it.

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On this week's episode of the Lunch and Learn with Dr. Berry we follow up last week's discussion with Kessy Joseph with another fourth-year medical student, Aprylle Thompson, MS4.

Aprylle was born in Jamaica and decided to pursue medicine after her aunt was diagnosed with the crippling disease of Creutzfeldt-Jakob Disease. Today she talks to us about how her experience with burnout has affected her as a medical student & offers tips not only for medical students but physician as well.

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Download Episode 126 Transcript

Episode 126 Transcript... Introduction

Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and affirmation. This week we bring you an episode with student doctor Aprylle Thompson who's a fourth year medical student. She again continues this discussion that we have on Physician Burnout and really more aptly medical student burnout. And she was very poignant during her interview just talking about some of the trials and tribulations that she had to face as a medical student. Some of the expectations of a medical student that I think she will agree with me as well, is really at a line for what we shouldn't be expecting of medical students and she really asked the question, why don't we include medical students in this discussion of physician burnout. The discussion that is definitely had when we're talking about attendings that people who are in their career. About feeling signs of being down at a price where for some reason we don't have this discussion when we talk about the medical students and she really wants to make a point and what I love about her interview today is that please think about the medical students again and remember that we're all human. And if we're all human, understanding that not only are the distressors that the residents and the attendings are going to feel, you best believe the medical students have their own pervasive feelings of concern. So I want you to again, check out this week's episode with Aprylle Thompson, a fourth year medical student talking about medical student burnout. Let me know what you thinking. If you have not had a chance remember subscribe to the podcast. Leave us a five star review and tell one friend to tell a friend about this amazing discussion we're having here on the Lunch and Learn with Dr. Berry.

Episode

Dr. Berry: Alright Lunch and Learn community just heard another amazing introduction for a number two, so this is actually gonna be our second medical student on a topic at hand that is extremely important. That is extremely, I guess becoming very popular now with this discussion of Physician Burnout. And because of the matter at hand of how we started a series out, we really wanted to make sure we reached out and not only talked to just physician, but we wanted to talk to residency medical students. So I'm thankful that we got a chance to talk to Aprylle Thompson today, who is a fourth year medical student who's going to be gracing us today in helping us with our discussion. Aprylle, thank you. Aprylle Thompson: Glad. Thank you for having me. Dr. Berry: So Aprylle, I always did the introduction. I have a lot of people who love to skip right to this portion here. For someone who skipped through and they say you know what, who's this Aprylle Thompson? Tell a little bit about yourself that may not even be typically in your bio and always ask, especially since you're a medical student. Let's talk about your motivation for going to medical school, your career aspiration goals and all that good stuff. Aprylle Thompson: Well, I'm a fourth year medical student from Ross University School of Medicine, which located in Barbados. My interest in medicine started from my junior year in high school. The reason being was because my aunt was unfortunately diagnosed with Creutzfeldt–Jakob disease. So my family had to care for her around the clock and as she deteriorated she became more dependent on us. And we have to learn about the process and what to do. And because of that, my interest was piqued and I wanted to learn more about medicine and treat patients on a more intimate level. Dr. Berry: I love that. And it's so interesting, especially for a lot of us who get into the field that a lot of times our first experience of medicine is a family member who really makes us appreciate the system at hand and really helps put us in that situation where like, you know what, I can be like that doctor. I always tell people about Dr. Gaston who was my pediatrician growing up. And I just used remember thinking like, oh my God, one day I want to be like that Dr. Gaston because I just seen the hearts he was able to touch with just his interaction of being a physician. So we were talking today about Physician Burnout, which is again, especially for those who are in Lunch and Learn community. A topic that's getting much fanfare as of recently to the point where they're even classifying it as ICD 10 codes and all of these things there that are really trying to make it seem as popular as it is. And when we had Dr. Nicole on the podcast, she talked about how this phenomena isn't like a new issue. It's just gotten came out to light with that aspect of people were really being concerned about the onus of being quote unquote burnt out. And what I want to talk about today is really like how are not only physicians, but really how are people who are on the front lines, which our medical students. What's that onus like? What's their thought process? I like to start out just talking about as a medical student, what are some typical stressors that you face on a day to day, month to month basis just being a medical student? Aprylle Thompson: I believe the few stressors that we usually have, well number one is we have to impress everyone. By can go for the CEO of the hospital down to the garbage man. Not just that, as a medical student, sometimes we don't feel as if we know enough material to impress people. So we have that battle that we deal within ourselves. And then we have to also learn how to balance everything. Connect all the pieces together. So what I like to say is that we feel as if we really want to be at the table with everyone, but although we have the knowledge to get close enough, we're still not there yet. And then when you put in the hierarchy of medicine and what goes on in medicine, it just complicates everything altogether.

Dr. Berry: And what was very interesting about that was, especially those who may infer, when we talk about the physician who is typically one who, again I say this all the time, that they're in a job where they're supposed to be correct 100% of the time. But a lot of times people, people don't realize too, to get to that point we face almost a daily struggle of I don't know enough. And I think and you said it right on the head, it's really bad in medical schools where we, I always say especially in on in a GME side, we train backwards, right? Where if you're a second year medical student, I start pimping you on stuff that the third year medical student knows. And if you're third year, I started pimping you on stuff for the fourth. For some reason, every time you get to a certain level, we expect you to know a level higher than you're actually at. Aprylle Thompson: Yeah, I've seen that. Dr. Berry: So question, as a medical student, and even when you're in the premed stage where some of the stresses that you've been facing, where they expected? Were you like, yeah, I'm probably going to have to deal with this type of stressors? Or was there anything like, whoa, I didn't realize medical students had it like that? Aprylle Thompson: Honestly, before I started medical school, I thought it would've been a walk in the park as ludicrous as that sounds. I thought it would like I would wake up every day. I'll go to the hospital. Helps sick patients. Get them back to their normal baseline and then go home happy. That's what I thought. I didn't understand that some days when it rains it will pour. And my thought process, what they're being sunshine and roses everywhere was obviously wrong. Dr. Berry: That's so true. Do you have any family members in the health field prior to pursuing it? Aprylle Thompson: No. I was the first one. Dr. Berry: Same here. It's funny because most of my family, they all went like the business route and manager route. I was literally the only one who was even on the premed side. Didn't have any mentors on that side. I think it's so true that when you don't know what you supposed to know, sometimes kind of walking in the dark. I mean, a perfect example, I didn't realize until I was a, let's say a sophomore and somewhere undergrad. There was this test that you had to take before you went into medical school. I remember just walking into the career center and when Ms. Anderson, shout out to Ms. Anderson at Florida State. When she asked me, hey, what do you want to do? I want to go to medical school. Oh, have you been studying for MK? I'm like, what is that? Just to give people an idea that it's not uncommon for people who want to pursue a goal, but because they don't have the mentorship dare that they need to really be walking into, almost like the firing squad, but it kinda is. Especially in our system where we don't like to talk and we'll talk about that later too as far as how older physicians and people who have kind of been there, done that, don't really reach back enough to like say, hey, you know what you're going to get in medical school and you're going to have to deal with some of these issues that you may not be ready for. So we just want to give you a heads up. Aprylle Thompson: I think apart from that, with my id of the walk in the park, I think it's also the fact that TV shows don't do it justice either like Grey's anatomy. You think it's so happy and it is fun 24/7 but it's really not like that. Dr. Berry: Grey's anatomy, Scrub, ER, all of these. Yeah, trust me. Yeah. And they still funny. My wife can't stand watching those times shows with me because I'm like, I guess it was like I didn't need mumbling under my breath and I'm like, okay, alright. Sure that's how it goes. For some of the stresses that you know that the typical medical student faces and then I asked especially because Ross University is an international medical school. What was that experience like? Not only going to medical school but going to medical school in an entire different country. Aprylle Thompson: It was honestly a great experience. But I think I have a little bit of leeway because I was born in Jamaica and my family is from Jamaica. So I felt like I was at home. I was in paradise. Dr. Berry: I love it because when you hear of the international medical graduate, I know a lot of times they're saying, well you're going to a medical school outside of the country, because we'd had even taken the fact that there are people weren't actually born in a country who are also going into that school as well too. So that definitely, I love that aspect of it. Now, as a medical student, what were some of the stresses that you typically faced? And just going from first year medical student all the way up in your last year now? Aprylle Thompson: Correct. My biggest stressor would have been balance. I mean, while I was in high school and college balance was a lot easier. But in medical school you have to learn that people will not spoon-feed you. You have to learn how to grow up and figure things out. And I had to learn how to balance my friends, my family, my social life and of course medicine. I believe that being a medical student or even a physician, it makes you realize that having just 24 hours in a day is not enough because everyone is pulling you in different directions and you're only one person. So you have to figure out how to break that up and split that up amongst everyone. Dr. Berry: I love about that. I think sometimes and it happens a lot, especially when you're a medical student, and I say, I always use a term like life be lifeing. Stuff is still happening, but you're in this, almost like this cocoon of being in medical school and having all of the pressures or responsibilities placed upon you. Sometimes you can't even really enjoy the typical experience of someone who normally would, you as a 21, 22, 23, 24 year old, in that range, especially in your 20s. I tell people my twenties were gone. My twenties were highlighted by me studying. And just what it is when you decide to embark on this journey. For sure, I think as a medical student, just having those pressures, not only the inside pressures that the school itself, places on this. But it's the outside pressures of friends and family and just life in general, that are still going on because unfortunately they don't pause while you're in it. Now would you say, especially with some of the stresses that you had to face and some of the stresses that medical students typically have to face, what would you say, from a preparation standpoint, what was the position of your school? And the reason why I ask that is because when we speaking with Dr. Nicole, she talked about the fact that as a physician, as an attending physician, the systems are in place for us to deal with physician burnout. So, now that we bring it all the way back to the medical student, I wonder what that situation is like as well too? How well would you say you were prepared for some of the stresses that you had to face over your time in school, by your school? Aprylle Thompson: I believe my school realized that burnout was increasing amongst physicians as well as medical students. So the clinical student affairs at my school, they promote something that was called a self-care day. And with that, that's what made the day, students are able to focus from their clinical rotations as well as within the classroom. They're able to take that day off and they can work on their mental health, emotional health, and even physical health. So that's one way my school did it. I know other schools love to incorporate therapy in which students are able to have maybe 30 to 45 minute sessions with a therapist and talk to them about what's bothering them and ways that they can plan to help improve burnout or whatever issues the student might be facing at that moment in time. Dr. Berry: I love that especially because it seems like it's coming from the top above where they're recognizing like, hey, our students are being affected by the pressures of burnout. And I talk about burnout a lot when we do this general discussion. When you say the Self-Care Day and you're able to decompress and you just get away from it. How was that one day like for you? Did you feel like it was enough? Do you feel like it was a start for things that come? How would you grade the actions of your school? Aprylle Thompson: I believe it was very beneficial because usually it comes in at the right time. Usually the day before I'm at the peak of my stress. And just knowing that the following day I can stay home, sleep in and relax or even just go to the gym. And I could just figure out ways how I can start my week or what I can do differently to help decrease rate at which I'm burning out. Dr. Berry: Now I got to ask, especially being in this stage of a graduate medical education director and really an attending in itself. Was there ever any time where your attendings either notice or even worse, probably didn't notice some of the burnout associated symptoms in the medical students? Was there something that essentially had to come from the top? Ross essentially had to say like, hey, give these guys a day off because you guys are at work. What would you say in that matter?

Aprylle Thompson: I believe students spoke to Ross about it because sometimes attendance can be very oblivious because if faculty have to deal with their own issues and what's going on with their patients, sometimes medical students are overlooked. But luckily for me, my program at Ross University, they're able to identify the issues that we have and whenever we speak, they listen. So I've been very fortunate to be a part of this institute that really cares about their students to help fix the problem that's on arise. Dr. Berry: I love it. And we hedge that a lot. But when you hear the term physician burnout and understanding that you're a medical student. So you're, a few months is about to be a physician who I guess walking into this field where this aspect of physician burning out is very real. What do you think about it when you hear the term? Aprylle Thompson: I believe the term physician burnout, it's very synonymous to the word overworked. So when it happens, we don't perform our best and when we can't perform our best, we're not able to treat patients to the best of our ability, which will increase the rate at which medical error occurs. Dr. Berry: I love it and I think you really hit it on the head because again, like I said not I have a problem with the term physician burnout, but I do think it's something that's masking problems at hand. And sometimes I feel like, especially when you tie the phrase of physician burnout, you're putting the onus on the doc. But not putting the onus on all of the other factors that got the doctor to that point. It just like, oh well, Berry burnt out, that's holidays. Berry burnt out, not realizing, well Berry burnt out because the hours are too long. Very burnt out because he couldn't take care of his patients the way he wanted to take care of his patients. Very burnt out because the frustration of maybe not getting paid enough will continue to grow, all of these different reasons. But when it's titled Physician Burnout, all you hear is the physician is the onus and the physician is the responsible party associated with it. I'd definitely for sure love that definition because I think it's so true and it really cast light on a system that again, it has seemed to now trickle down and I'm not sure if it's was purposeful or I'm not sure if it was just a cumulative effect. But something that's kind of purpose all the way down to now the fact that you could be in training and still experiencing these symptoms of a burnout. Now as a medical student, I asked, you're a fourth year, you're about to be out of here. But was there ever times, especially in the mid before to self-care days and those things in that regard, there ever times you're like, yeah you know what? I'm feeling it right now. I guess this may be a little too much for me at the moment. Aprylle Thompson: I believe that time for me was while I was studying for my board examination specifically step 2 CK and while I was studying for my boards, I was also working in the ICU. So as you already know, the hours are very long.

Dr. Berry: When you say ICS, oh alright. Aprylle Thompson: Yes, very long hours. So I had to balance trying to impress my attendance because as a medical student you want to be on the forefront. You want to show that you know your stuff. Apart from pressing my attendance after, make sure I impress my residents, whether that's just, I don't know, doing scutwork for them or being around the patient 24/7. Reporting back to them as soon as possible. I have to always be on my tip toes to make sure that I'm viewed in a positive light. Because as a medical student, your residents are usually they advocate for you. So if you impressed them, you can work your way up. And while trying to do that, I had to also learn as much as I can in the ICU. Because ICU is a whole another world, a different ballgame in medicine. And then when I left the hospital and I went home at about 8:00 or 9:00 PM, I had to still pull out my book to study until about one or two o'clock in the morning and then go out by four or 4:45 AM to get to the hospital by six o'clock and that cycle continued. And after a while I started to feel myself burning out and I couldn't really tell my resident or my attendant because as a medical student, we're not allowed to feel that way because we're not officially doctors yet. And while I was feeling burnout at that stage, I didn't even in the fact that I still had to eat, I still had to cook my meals for the week. I still have to go to the gym, do my laundry. But with everything like that, it's very tough to talk to people about it. Dr. Berry: And most importantly, you still got sleep. And especially Lunch and Learn community, I really want you to have to really pay attention to this story because it is not an uncommon story. First of all, again, I'm an internist. I'm a hospitalists. I take care of patients all day in a hospital. But I 100% agree when Aprylle talks about the fact that ICU is a, just a different ball game, a different beast, a different mindset that it takes to really take care of the sickest of the sickest patients. I can 100% agree with that. And just this understanding, and she touched on a couple points where she talked about one, the hierarchy aspect of it, where the attendings who are there, you have the residents who are there and then you have the medical student who is there and understanding that the work that you have to put in to impress not only the resident but also the attending, on top of juggling effect that this is I'm assuming this is your first time in ICU, right? Understanding that I'm having to learn on the fly while impressing all of the people who are above me. And because I may quote unquote medical, I've got to say quote unquote, but because I'm a medical student, no one recognizes that I can also be burnt out. Is definitely a quandary that a lot of our medical students I realize are facing, in this aspect of quote unquote training. And again, we shouldn't want to train our physicians to have to deal with that level of burden or stress. Because trust me in a light that when you're an attending, I could tell you wholeheartedly just so you can see some type of a light at the end of the tunnel. That level of work isn't there, but it's a different type of stress that you're going to be walking into. Aprylle Thompson: Yeah. You guys live the good life. Dr. Berry: Right. So it's one of those things where I'm becoming very keen now, especially with physician burnout, being discussed on a more and more aspect of it. Understanding that yes, as a physician. Because again, I used to be naive, I used saying, well when they talk about physician burnout, it was people who've been in the game, 10, 15 years and they were just tired. But then when I started walking around and I'm at a residency, let's see, five years now. So I'm five years out of residency and I'm seeing colleagues who are around my age exhibiting and talking about they're tired and done. So you can be five years out of training and already experiencing those symptoms definitely something needs to occur and change. When you're doing the ICU and you are recognizing like hey, I'm not sleeping. I'm not eating. I'm not, you're just probably not talking to friends. I'm not doing the things I needed to do to take care of my own. The support system that was there. Can you talk a little bit about it? Is this where the self-care day really came into play and really helped you or what was happening during that time? Aprylle Thompson: I believe I've been very blessed to have a big support system, specifically my family. From the moment I told you I wanted to go to medical school, they've been there with me from day one, whether if I had a bad day, if I had a happy day. For me, whenever I leave the hospital, the first set of people I call are actually my parents. We talk about my day, I try to replay how did they went. If it was good, they're happy. If it was bad, we talk about ways in which I can improve it tomorrow. And apart from talking to my parents, my fiancé has been a great support system as well. Whenever I've vent my frustration to him about what's going on in the hospital. He listens and he listens very closely and he helps me think about ways that I can distress ways that I can improve myself for tomorrow. So in that way, I don't bring the low from the previous day to the next day and it makes me feel 10 times better when I'm able to vent to my parents and my fiancé about what happened. Dr. Berry: Talk about this especially I want to hit you a follow up question. Is your fiancé in medicine or health or outside of it? Aprylle Thompson: It's funny you asked me that. A lot of people love to ask that. No, he's not. Dr. Berry: And the reason why I asked especially because you talked about how understanding he was is that sometimes a lot of our friends outside of our bubble don't really comprehend. The level of stress that we're dealing with. I definitely want to say you're very fortunate to have that person who can understand like hey, nope, she's on ICU this month. Yeah. I'm probably not gonna see her as much as I want this month. I'm not gonna make her feel guilty for not seeing her as much as I want this month. Those types of things that can build upon a relationship or hurt a relationship when there is that communication disconnect. And especially having parents as well too. Like I say, because having someone to say like, oh my God, today was crazy. And just to be able to talk about it is definitely something. Because one, our typical conversations. We just can't really have all willy-nilly. Unless you're in the field, no one's gonna really understand. I had to see 40 patients a day and being served for 10. Then I got really understand it. But if they're able to be sympathetic to the thoughts in feelings, it really helps you and really helps leave this stress that is usually there when you walk into that building. Whether it's a clinic, whether it's a hospital. But be able to go home and have that stress behind. Aprylle Thompson: Exactly and that's why I think it's great that he's not in the medical field as well because when I bent my frustration to him, I just vent. And then that's that. I don't have to bring work home every single day. Dr. Berry: I love it. We talked about just the system in general, of just our medical training. And again, I have some personal thoughts about just training and especially in only being, going through the process of being a medical student and a medical resident right now and attending, but also now being decided where I'm also training as physician, be attendings as a program director. What do you think about just our system in general? Is it our system that's really set up for people to burn out? And especially when we talk all the way down to the medical student, is it just set up so that people are gonna burn out just because the way we do our things? Aprylle Thompson: I believe so because in this system with medicine, not all position, but a lot of physicians, medical students are taught by intimidation and sometimes we're not allowed to feel tired or we're not allowed to know something. And if that happens, sometimes we can be scrutinized by physicians. And the culture of medicine with that, I hope it changes sooner than later and students overwork themselves because you want to impress everyone. So we sacrifice our mental health, our emotional health, and even our physical health just to prove a point that we are good enough and that we are equal to everyone else. Dr. Berry: I love that. I can tell you that's going to be a quote somewhere. We're going to definitely quote something up somewhere. I love the word intimidation because it is such a word that unfortunately does not stop. It's one of those things where I remember being a premed student and feeling like if I'm studying with this person next to me, this person may be able to take my spot in medical school. So I had to be fierce, be tougher to try to get that quote unquote last spot. And then it's the feeling that does not change when you get to medical school. Where not only are you feeling the intimidation from your colleagues and I always joke this because especially in medical, I used to think we're going to be colleagues, I'm not your like enemy. They still bring those kinds of same types of feelings into, that atmosphere. And then you walk into a system, especially for those who may know Lunch and Learn community, what typically occurs depending on the school, but some schools differ is that your first couple of years of medical school, you are essentially doing a lot of the bookwork, laying down the foundations from a basic science aspect. And then your last couple of years you're actually in the hospitals, in the clinics and awards, seeing patient direct patient care on a more, a full time basis. And for those who may not know Lunch and Learn community. But what happens is once you get into the latter years where you're a lot more direct patient care and then you're having to deal with residents or medical attendings who were either brought up differently or brought up in a certain way and don't really know how to get their point across without making you feel like you're lesser. This is a very common problem for a medical students. And again you talked about the pressures, not only the pressures of board exam, but the pressures of oh, if I don't perform and resident don't liked me, they gave me a bad grade and they tell the attendant to give me a bad, all of these things here that they have to perform on a day to day basis, 24/7. And that's a pressure that I always tell people most career professionals do not have to deal with the pressure that the physician has to deal with. So just even make that micro and think about the pressures that the medical student has to deal with and understanding every single day they feel they're being graded and if one day right, they're human. Because I think that sometimes gets lost. If one day they're human and aren't as enthusiastic as they were the day before yesterday, they can be docked points for it. I think especially when it comes to physician burnout, because I think a lot of times I tell people when you have a physician who's burnt out and understand that they're not just gonna flat out quit, they're going to keep working. They're going to keep seeing patients, they're not going to do it effectively. But they're going to keep on doing it. So when we talk about physician burnout and then what it can ultimately lead to, I think a very important topic and one that really I think probably should get much more fanfare than it is just the aspect of the physicians even committing suicide. And the fact that we don't have many people who are going into medicine as much as we did any more. Just this shortage that's around everywhere in that regards. What do you think about just those aspects of physician burnout, physician suicide, which is extremely high and as well as just the overall aspect that less people are going into medicine? Aprylle Thompson: Well, I believe in the rate at which physician suicides occurred. It's definitely at an all-time high. But I think for these people, it crosses the line of abuse. Reason being is because some people don't know how to distress. They don't know how to take what they're given, switch it up, and then find a way to relieve themselves. And that's because in the culture of medicine, we can't talk to each other because we're seeing as if we're less than or we're not able to keep up with the rest of the crowd. So because of that, we keep everything bottled up until we can't take it any more than fortunately some people they commit suicide because of that, because that's their way of getting away from all of the stress that they're dealing with within the workplace. Dr. Berry: Very poignant. I think you hit a home on another point. I mean, is sad is that physicians, we don't really talk to each other like that for that fear of being seen as less capable to do. And again, if you took the physician title away from us and someone just told you like, hey, I'm feeling down, I'm feeling bad about myself, I'm feeling depressed. People would automatically know, okay, this is the type of steps you need to do. But people wouldn't say that, okay, you're a less of a blank because of it. Well, for some reason when it comes to physicians and the feel that aspect of burning out, right? That automatically goes to the top of the head like oh, people are gonna think I'm less of a physician and I can't take care of the patients like I used to be able to take care of because of, I'm actually acknowledging this issues that I'm going through. Aprylle Thompson: It's funny you say that because I believe as physicians, sometimes we dub ourselves as being super human because even the burnout could just be from ourselves too. Because we actually look at one another as if we're greater than thou and we're not allowed to not know something. We're not allowed to feel tired. Because even sometimes the outside world, they don't see that. But we put it on ourselves and maybe if we can change that where it's okay to not feel fine, it's okay to let loose a little bit. Maybe that can help our culture a little bit. And the rate at which physician burnout occurs. Dr. Berry: Amazing. For the medical students, because again, you're almost added there. But if you could look back and say like, hey, if you want to, and I hate to say avoid it because it sounds like the system that we're in is going to be very difficult to avoid it. But if you want to be able to deal and manage some of the stressors and the symptoms of medical student burnout. Because I think that's the term that we need to really call it. What tips would you give to say like, hey, if you could do this and if you could do that, that could help you in the long run? Aprylle Thompson: Well I have a few tips. For one is, destress as much as possible, however you want to destress. If it's going to the movies or even a book, do what makes you happy. Secondly, I believe exercising is very important because as we all know, you'll have an increase in endorphins which will make you very happy and if you eat healthy, that can also change your health. And it can also make you feel better about yourself. Funny story is, I'm actually someone who loved burgers amongst other people. And after a while when you keep eating that you don't feel your best. But then whenever I changed my diet and I incorporate more fruits and vegetables, it's amazing how much clarity I have, how it improves, how I feel much happier. And I'm able to focus more. So if we're able to just exercise and maintain a healthy diet that can really help in the way that we react to burnout and how much we're able to tolerate before we get to that stage. Dr. Berry: Amazing tips. Before I let you go. Before we get you out of here, first of all, it has been absolutely amazing and your insight has definitely been something that I think is needed. Because I think is eye opening. I think as we continue to really highlight this phrase physician burnout, I think we need to make sure that we don't just start looking for problems once they become an attending and understand that a lot of these issues and a lot of the lack of support for these issues are happening as early as the second we start being a medical student. Before I let you go tell us about, especially because you're a medical student, so I love to hear about just your plans. What's about to happen? Where are you trying to match? Let's give all that stuff there so we can make sure we're on the lookout for you. Aprylle Thompson: So currently I'm applying for the 2020 match. Going through the hectic motion of getting my application done before September 15. I know a very big day. So I'm from Orlando, Florida. I hope to stay home, be with my family, but if I get matched anywhere else, I'll happily take a position there. So I love all aspects of medicine and as of right now, I'm loving internal medicine as well as general surgery. Dr. Berry: Okay. That's as interesting. I could tell you, I'm an internist right? You don't want me to know OR and I realized that very quickly that you want me nowhere near to OR. I just didn't have the mindset of a surgeon. I just knew it. One of the most important things that I tell anybody is just knowing yourself. Understanding like, oh, I like medicine, but that's not just have medicine I like to be. And so very interested that internal medicine or surgery still in the bread basket for you. So as a program director, I obviously definitely wanna wish you good luck on this upcoming match. I hope you get to whatever this by you're going to get. Like I say, it's a very different, internal medicine or surgery so hope you get to wherever you want to get to. But I want to thank you for sobbing vital podcast and really helping educate Lunch and Learn community on all your endeavors. From a social media standpoint, where can people find you, follow you, track your journey if they wanted to track your journey? Aprylle Thompson: So you can follow me on Facebook at just my name, Aprylle Thompson or on Instagram @cheecah_med. And you could also follow me on Twitter. I don't tweet as often as I should @ Aprylle Thompson. I don't have snapchat though. Dr. Berry: Sure. Okay. Alright. Appreciate it. Remember Lunch and Learn community, we always put all of these links in the show notes so you don't have to write anything now real quickly. We'll make sure it's in the show notes so that you can just click and then go right to Aprylle s page. Aprylle again, thank you for joining the podcast today and you have an amazing day. Aprylle Thompson: Thank you for having me. You have a wonderful day as well.

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On this week's episode of the Lunch and Learn with Dr. Berry I sat down with Kessy Joseph, a fourth-year medical student from Ross University School of Medicine. To continue last week's discussion on physician burnout with Dr. Nicole we are going to get the perspective of a medical student on their perspective of the important discussion.

Kessy has career plans to pursue Internal Medicine, studied Health Education at the University of Florida and her research interests include the cultural views affecting health outcomes/decisions and food access in diabetes management. Kessy also discusses that in her free time she enjoys the sport of boxing and cooking.

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Download Episode 125 Transcript

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Episode 125 Transcript...

Introduction

Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and affirmation. This week we bring you a guest medical student. She's actually our second medical student on the podcast who talk about physician burnout. Maybe you've not had a chance, please check out last week episode with Dr. Nicole Washington, Board Certified Psychiatrist who really breaks down the foundation of what Physician Burnout is. She helps explain that it isn't something that just happened within the past year, even though the news may make it seem that way and we really lay out the groundwork of what these next series of episodes is going to be like here on the Lunch and Learn with Dr. Berry. So we are going to have a chance to talk with not only other physicians, but we're talking to resident physicians, those who just got out of medical school but aren't official attending status yet. And now we're even going to be talking to medical students because we realized after our discussion with the physician burnout that this isn't something that happens right when we're done at a residency. No, like we're getting hit over the head very early. As early as in our medical school days. So we have Ms. Joseph here who's in fourth year medical student. She's at a Ross School Medicine and she's going to give her encounter on what physician burnout means to her. She's going to talk about some of the instance that she faced personally, how she was able to get over it. So I'm very excited for you guys to get ready for another amazing episode and listen to her words. Again, whether you're a medical student, physician or whether you're a patient. And again, you're not going to be a doctor. Understand, and I talked about this last week, that if you don't think physician brand now affects you because you're not a physician, you are going to be sadly mistaken. Because physicians who are burning out aren't just quitting on a spot. No, they're working for a years on in within a depressed state, in the least effective state that they can be. And they're having to take care of your relatives and you don't want that to occur. So you want to know if your physician's experiencing some signs of burnout. That way they can make sure that they're taking care of you correctly. So like always, if you have not had a chance to make sure to subscribe to the podcast, leave us a five star review. Whether you're on Apple podcast, Castbox, Google play. I think Stitcher lets you do comments as well. So wherever you can leave comments and if for some reason a podcast app you listen to a podcast doesn't allow you to leave a comment, go ahead and come to the website LunchandLearnpod.com and leave a comment there. Just let us know how we're doing on the podcast. Remember to rate five stars and let's get ready for another amazing episode here on Lunch and Learn with Dr. Berry.

Episode

Dr. Berry: Alright Lunch and Learn community just heard another amazing introduction. And this is a topic and again, if you caught last week's episode with Dr. Nicole, we are going to be starting a series of a serious topic, especially for not only you guys, the patients, the one who gets taken care of. Because this is really affecting the people who got to take care of you, which we kind of alluded last week. Again when we talk about Physician Burnout, it's not something that the physicians feel it and then they just go away. No, they still keep taking care of people, which means taking care of you, taking care of your mom, taking care of grandma. But with the energy that we got from last week's episode, I excited to expand it and really talk to all different kinds of stages of the physician. And this week we have a guest who's a medical student. And it's so funny because again it wasn't too long ago that I was a medical student but I was surprised just by talking with Dr. Nicole the fact that now we have medical students are starting to feel that pinch, starting to feel that burned and those symptoms that really is a problem. Because if they're feeling it early what happens? I mean they want to quit early. So again Kessy thank you for joining today's podcast here on the Lunch and Learn community.

Kessy Joseph: Yes, thank you Dr. Berry for having me. I'm really excited to be here.

Dr. Berry: So I gave them a little bit introduction of your bio in the beginning portion. But tell them, just to listeners, because I got listeners who love to skip, go right into the main talking points where I tell them something about yourself they should know by now. Your motivation, even let's say you are regular now. Why are you going to medical school? All that good stuff there. Because I think that really ties home the fact when we talk about Physician Burnout.

Kessy Joseph: So essentially just give a little of my background. I'm Canadian born, patient breed, Florida raised. There was a lot of different influences that happened throughout my life, but the most prevalent influence was definitely medicine because of my family background and just like the people I was raised around. But I didn't really want to go to med school until I hit about grad school. That's where I really started working in the whole clinics and seeing all the different populations and the management of different chronic diseases and I really piqued my interest and I was like, whoa, I think I want to be a doctor. I want to be the person that they come to help with their health conditions because I feel like once they start getting referred to like diabetes educator or the nutritionist, they is kind of get lost in the system. They don't really follow through, so why can't I be that person that can do all of that for them? As long as their primary care physician.

Dr. Berry: I always ask my doctor friends, but especially medical students, if it wasn't medical school, what would you be doing? Because me, I always tell people my plan B, I probably would did something like on a computer side and you know, some engineer, something. It would just, it was either physician or I'm going in this direction here. Would you have still stayed in the health realm or what was the..?

Kessy Joseph: I was thinking, at that time I was really into the whole health education behavior, like diet, nutrition, like community health realm. So that's really what I was interested in. But at the same time I also want to go to culinary school at the same time. So I don't know where I would've been right now.

Dr. Berry: Okay, cool. I like that. Okay. We had Dr. Lauren on here who's culinary physician as well too. So I love that aspect of it. As I stress especially for physicians, I think a lot of times when we go in this route, sometimes we forget about our second and third passion because we think we can only focus on physicians. So definitely we want to make sure we still encourage, especially if you still like culinary and food and stuff like that, that we still go in that direction.

Kessy Joseph: Right. For sure. I definitely agree. We'll get into it later, but that's definitely something I use for my therapy.

Dr. Berry: I love it. Okay. Alright. So let's talk about it. Because I think when we speaking with Dr. Nicole last week, she talked about the aspect of the fact that medical students are facing a lot of stresses. And again, I'm act like I didn't, it's about eight years now. So it's been eight years since I've been in medical school. And I knew there were some stresses there. But let's talk about some of the common stresses that typical medical students are facing these days.

Kessy Joseph: I would say there's definitely different stressors depending on the type of medical student you are. For me particularly, I'm considered an international medical student because I went to Ross University. So there are some stressors that aren't as prevalent as in the U S med students. But I think it still can be understood and related to. For everyone, I definitely think one of the main stressors is workload for sure. We have to commit so much time and energy this making sure we have this large breadth of knowledge. And then not only that, a lot of this knowledge is put on us on our own. We have to teach it to ourselves so that can result a lot of sleepless nights. A lot of…

Dr. Berry: I remember those, we used to camp out in the library for hours. Even when I think about it now, I'm like, wow, I used to really stay in a library for like 12, 14 hours.

Kessy Joseph: I just remember sleep, staying up all night before an exam the next morning. It's rough. It's definitely rough. And then is this like the succession of exams that we have every two weeks, every month, it's like never ending. And not only that, the step one and then the shelf exams and then the step two, step 2 CK, step 2 CS, it's like it never ends.

Dr. Berry: And you talked about it because especially, I got a lot of friends who went to international medical school, especially Ross as well. What are some of that extra that being an international medical student, it weighs on you as well?

Kessy Joseph: Wow, there's so many. Firsthand, just the fact that we had to go to school in a different country. We had to relocate our entire life to a country that's not as industrialized as the United States. So we had to pretty much adapt to sometimes not having access to water or electricity for a couple of days.

Dr. Berry: Wow. Okay. Alright. That's definitely a stressor.

Kessy Joseph: Yeah. And then also it's in the Eastern Caribbean. So hurricane season, definitely a tough one for us to the point where in 2017 our entire school was relocated to another island because it was damaged to that extent. So that's just some of the stresses. Is this the fact that after we do leave the island for clinical rotations we have to relocate from state to state, go into different hospitals just to complete all of our clinical requirements.

Dr. Berry: Very interesting. I'm definitely glad you touched on it because I especially I love that the Lunch and Learn community understand that when your physician is standing in front of you, most times they have went through a lot of trials and tribulations just to get there. So we really need to, and again, I think sometimes of course I think I'm biased, right? I think sometimes the physicians don't get the amount of respect and credibility that they deserve. Because I don't think a lot of people, and it could be partly our fault because a lot of times we don't really tell our story. But I don't think a lot of people understand like, hey, during school I went out without water. That's a story that if my physician tells me that I'm definitely gonna make sure I listen to exactly what they're saying because clearly they did what they needed to do to get here. Definitely, thank you for that aspect there. Now let me ask you, before you started, I know when you made that transition, I want to go to medical school and before you actually got there, were some of the stressors expected where they're any new ones that you're like, oh I didn't realize it was going to be like this significant. Was there something that threw you for a loop?

Kessy Joseph: Well, I definitely knew about the whole workload. I went to grad school. I knew a little bit about that already. But I was expecting having to be up all night studying this, studying that. So that was okay. But ' Very hard to the point where you let yourself go. You stop caring about your personal grooming. You don't eat. I just remember being on the Island, I lost probably like 20 pounds because I just didn't care. I'll just see you whenever I can.

Dr. Berry: And again, Lunch and Learn community I'm telling you this is not a unique story. Because again, we're really not exaggerating. You're spending majority of, if you're not sleeping, the majority of the day is spent studying something. So when you think about those extra maybe an hour or two or three that you have outside to not be studying or not be sleeping. Social life really doesn't shoot up to the top because lifestyle happens, family. So there's a lot of things I still got to occur. Again, I'm nodding my head because I'm like, yap, she is hitting it right on the head.

Kessy Joseph: Yeah. I missed so many weddings, so many birthday parties, so many events. And it's hard because people just don't understand when you tell them, Oh I can't make it because school are like what? You weren't at University of Florida, you can make things, why can't you make things now? I don't understand.

Dr. Berry: It's a different type of pressure. And what was funny is, especially when you're talking to other physicians, you definitely don't even have to explain us. If I'm talking to another physician, they're like, yeah, I can't do it. Okay. Alright. I understand. Usually the people on the outside who don't really have the insight in, for them it is perplexing. You don't have time. Yes, I actually don't have time. I'm being dead honest with you.

Kessy Joseph: Right. To the point where they think you're just lying. No, I would love to be there.

Dr. Berry: I wish I could be there. Dr. Nicole says something about that last week where we sometimes even demonize our medical students sometimes when they ask for like, hey, is it okay if I get off early? Is it okay if I take off to go? There are attendings out there, my colleagues and I get on them all the time for it who are like demonized students for wanting life to still be happening while they're a medical student. Because again, it's one of those, oh, when I was your age, I had a walk in the snow backwards. BS, do you think that that school prepared you to face some of the stressors that you did ultimately face?

Kessy Joseph: Not at all. They have their little lectures where there's this like, Oh, you know, if you ever need help or you're ever feeling any mental, like mental instability, we have resources for you. The whole spill. I feel like it's more to cover them. They never really tell you how to prophylactically prevent burnout from happening or what to do to make sure this burnout doesn't happen. Or is this like, oh, once you reached the edge of the cliff and you feel like you're about to fall off, reach us, contact us, we're here for you. So I feel like that's a little too late.

Dr. Berry: Yes. And it's so interesting because your story isn't unique. I wish we could say it too. Even unfortunately, again, I'm in graduate medical education and we have these same things or like, yeah, we've got wellness programs and we offer this, we offer that. But again, I sometimes feel like it's window dressing as well. We're offering it so someone can't say we didn't offer it more than the active approach. Actively making sure our students' wellness and wellbeing and mental health and self-care. We don't do any of that. And especially when I was in school we have to do it. There was like a month break and then after that we did a test every single week. It was midterm, final, midterm, final. Every single week, which is crazy when I look back at it. It's crazy that that's the system that medical school has really enacted and unfortunately I think it's a big reason why the trickledown effect is starting to occur. Because when I talk about burnout, when we talk about burnout just in general, I used to be naive. I used to think it was something that only happened to, you know, docs who've been around for 10, 20, 30 years. But as I got out and realized this was happening much sooner, much more of my friends, I'm like, okay, this is weird. Why are they starting to experiencing things and now we can see where some of the groundwork is being laid. And now the medical students, y'all can't even get out of school before it starts hitting y'all over the head. Knowing all that, how do you typically deal with just stress in general? Because I know medical school stresses a heap, but just stress in general.

Kessy Joseph: I think really what helps me personally is because of my background in health education and behavior. So I do understand the different facets of overall health. The social, the mental, the physical. You have to make sure every single corner is pretty much covered. And for me, I just like to do things that make me happy. So I enjoy cooking. I enjoy baking. But right now I try to stay away from that because I usually results negatively for me as in weight gain. So I change it to a little bit of exercise. I started boxing. It's really fun. (Oh wow. Okay. But what got you into boxing?) I actually always wanted to box since I was a teenager because my dad would always watch boxing and I thought it was a really cool. I see boxing as an art. You gotta be really skillful and it's really cool sport in my opinion. And I'm also really into gardening. I think watching something grow from nothing is the most beautiful thing. So this producing fruits and vegetables from this water and sun and soil is so relaxing. It's like making I guess your own little children. And I'm always so happy with the products that I produce. So it definitely makes me happy. And then just traveling and exploring and doing outdoor activities, being involved in my community. So this really getting myself outdoors and involved in things outside of medicine because I feel like people in the medicine field always are focusing on medicine and sometimes you just need to step away from that and clear your mind and see other things. It's not always medicine. There's other things in the world.

Dr. Berry: I love that you said that because I think it is definitely something that I know a few of my colleagues really have problems with getting away from medicine. Because Lunch and Learn community I just alluded earlier, medicine is busy enough that you can't really consume a lot of your life if you let it. So I'm definitely glad that you're able to experience some of those outlets. And is that something that you had to learn to expose yourself outside of medicine? Was there something that you tried to incorporate even in your early stages of being a medical student?

Kessy Joseph: I think this was subconsciously instilled in me by my mother because she always used to say like, don't stress yourself out because you know what, if something were to happen to you today, they'll find someone else to replace you.

Dr. Berry: That's so true. The reason why it hit me is because I remember vividly, when I became an attending and there was a doc out of that hospital, he had been there for maybe like 10, 20 years. And he passed away. And I remember he got two emails, like literally just two emails, one email say, Hey, this person passed away. And another to say, hey, this is where the funeral was at. And that was it. You didn't hear anything about, and this is a doc who really put his time and effort to that hospital. And I remember just two emails was all that he got. Didn't get a party. Didn't get anything. So it's so true that if you don't expose yourself outside of medicine, because of the way the system is, they'll just plug someone in behind you and act like you didn't put in all of the amount of amazing effort that you did.

Kessy Joseph: Exactly. So that's why I always feel you've got to put yourself first before you can put any patient first. (I love it). You are just as important as this patient. If you're not functioning at your prime, at your 100%, you can't serve your community. It's important for you to just realize that.

Dr. Berry: Very great point. Especially because I think sometimes we as a physician, we get in trouble because we think that, at the patient, yes, Lunch and Learn community, the patients, we understand that. But if the person who's trying to take care of you, isn't that their best? They can't effectively do it. So you have to take care of yourself for it. Just like when you're in an airplane and they tell you, you gotta put your own oxygen mask on first. It's the same premise. If you yourself isn't taking care of, to the ability you need to be taken care of, how do you expect to take care of others and in the most efficient way? When you, especially as a medical student, when you hear the term physician burnout, as a medical student, how do feel about that? How do you feel especially because nowadays where I think has become such a popular term for some reason now and a lot of people, more people are bringing it up. A lot more articles are being published. When you hear the term physician burnout and you're about to walk and especially because it's not like you're on the outside looking in. You're on the inside. You are medical student, graduated, about to become one of physicians and you hear this term burnout. What does some of the thoughts that go through you?

Kessy Joseph: I mainly think of it as this physician can no longer perform at their best abilities and this results in them jeopardizing the patient care. So essentially this physician no longer cares about what they're doing and there just there to be present because it's compulsory. So it was just like I'm here because I have to be here, but my mind's not physically here and I have no desire being here.

Dr. Berry: And as a medical student, was there especially because when you talked about some of the stressors and you definitely had a lot of stressors to deal with as a medical student. Was there ever any times that you felt that you were at that point?

Kessy Joseph: Almost definitely.

Dr. Berry: Felt like, oh, is this hitting me too?

Kessy Joseph: I was hit real hard during surgery. My surgery rotation, for those of you who don't know, surgery rotation surgeons in general is a very tough field. They wake up at ridiculous hours and they leave the hospital at ridiculous hours. They basically live at the hospital. I just remember it was the middle of my surgery rotation. I just moved to New York. So already that's a stressor in itself because New York is a crazy city and I was waking up at 3:30 AM every morning to get to the hospital at five and I would be in the OR all day just standing there, because medical students don't really do much in the OR. So just imagine standing in the OR for hours and hours and hours and then I wouldn't get to leave to go home until six to 8:00 PM. So I get home at eight to nine. So do the math. If I get home at nine and I have to wake up at 3:30 I typically would what like go to bed at like 10-ish. So I would get like four or five hours of sleep every day. So that went on for three weeks straight. And most days I didn't eat. I remember one time I stopped to think about something and I realized, oh my gosh, I haven't eaten an actual meal in 36 hours. (Wow). That's insane. I'm literally running on a banana and Graham crackers from the patient pantry room. What is this? This is not okay. So that went off for three weeks straight and then right from there I went into an emergency medicine rotation and those shifts are 12 hours long. Four consecutive nights or days. And after my first week in the ED of four consecutive 12 hour shifts, I was done. I started feeling like I had no motivation. I had no interest of going to the hospital. I just couldn't. I was rethinking the whole medicine thing.

Dr. Berry: Right then and there. Yeah. Lunch and Learn community, the two specialists that you just named are two of the specialties that suffer a lot from burnout. So again, she was a medical student. She wasn't even, it's like, so just to understand just how deep and pervasive that the feeling and association is.

Kessy Joseph: It's rough. Very rough. And I just remember telling myself, whoa, what am I? No, I can't do this. I cannot do this. I literally wrote an email to the coordinator and said, I'm taking a week off. I can't do this. My mental health, I can't see myself going back next week and continuing to do this or I'm just gonna like slowly degrade and crumble into pieces. So I took a week off for myself, for my mental health.

Dr. Berry: Now how was it? I guess the question is what was the initial response from your email?

Kessy Joseph: She was actually very supportive because I have a good relationship with her. And also my school recently at that time was this launching a new initiative for mental health. So I guess it worked in my favor as well. So she was accepting. She's like, okay, that's fine. No worries. I'm happy you're actually taking the initiative to take care of yourself, your mental health, and I'll let the attendings know that you would like to change your schedule around and it was fine.

Dr. Berry: What I love about that is she recognized that you are human. And I think that sometimes gets lost in the training of our medical professional that we're humans who are stepping into a field. And I tell everyone who listened to me that we want in a few fields that we're required to be correct 100% of the time because if we're only correct 99% of the time, that could mean your grandma does not come home. That could mean your dad does not come home. So when you're dealing with that level of pressure on a day to day basis and it's not being recognized that you're dealing with that much pressure on a day to day basis, you can definitely will. So I definitely give props to, it was an advisor? Who that was? (The coordinator). Coordinator, yeah so definitely props to who recognize like, hey, what we need to recognize like, yes, the mental health is going to be important if we want her to actually succeed. So definitely shout out to her for sure. And then during that week, what did you do? Was it just like you just disconnected or what was the?

Kessy Joseph: So I had a ball. So I called, I had my boyfriend come down in New York. We traveled to Canada. Went to go see my family. We went to the zoo. We went to museums. We went out to restaurants. It was great. Like I just decompressed, enjoyed life basically. It was nice. It was definitely like me hitting the reset button and it was definitely needed.

Dr. Berry: I love it. When you came back and the button was reset, were you completely like, I'm ready to go now. Was still some lingering effects? What was that feeling back that first day?

Kessy Joseph: It was weird. I actually felt like I wanted to do medicine. Like, yeah, okay, I'm ready. Let's go. Let's start at least seeing these patients. I'm happy to be here. Let's save some lives. That's the attitude I had. It was great. I was really excited to be there versus a week ago where I didn't even want to get out of my bed and go.

Dr. Berry: That's amazing. Amazing to hear because again and that's what we want. That's the scenario that we want to see when our colleagues. Because again this is something that I have to tell my attending colleagues all the time like, hey, you didn't realize this is going gonna be a colleague and like a couple of years. Sometimes I think we get so hierarchy and the way we look at medicine is that we don't recognize like, hey buddy, you are actually a medical student. Whatever years ago you were like there's no way you could become a doctor without becoming a model student. So understanding like yes, this person needs to breed. This person needs to relax. They need to be able to have some mental clarity. It's definitely an important so definitely love the fact that you were able to reset. One, you're able to recognize you needed to reset. And then the opportunity was there and it was given to you. So definitely thankful for that aspect of it.

Kessy Joseph: I'm just very lucky the fact I had the support system and the faculty that actually supports us taking care of our mental health. Because I feel like if I had attendings who were like, Oh, suck it up, just keep coming. No, you can't have a day off. Then you do realize most medical students won't finish medical school. So you have to be supportive. You have to show that you care about our sanity essentially. So you want us to become these great physicians, so you have to support us in taking care of ourselves to be great physicians. So I'm happy that I have attendings like that, but I know everyone's not as fortunate.

Dr. Berry: Now a question that was post by Dr. Nicole was the aspect of the burnout we're experiencing. Is it a rite of passage? Is it a form of abuse? What's actually happening on such a level that when you tell your story from Ross University, I can relate your story from Nova, Southeastern University. From a systemic standpoint, why do you think so many students are really just experiencing these signs of burnout?

Kessy Joseph: I feel it's difficult to say because I know for some students, they do get the whole abuse aspect of being in medical school while they're in clinical rotations where attendings are like pimping them from left to right, degrading them saying, oh really? That's the answer you're giving me. You're wrong. Go look it up. Blah, blah, blah. But personally, I've never experienced that. But I would say systemically it's really the fact that a lot of people who do go to medical school or kind of type A perfectionist. So whenever we do make a little mistake or whenever we do forget a fact or not know something, we beat ourselves up and forget that this is a learning process. We can't know everything. We were expected to make mistakes. So we can't just keep degrading ourselves and not being confidence within ourselves while we're on this journey to becoming a physician. And I think that's really one factor in this whole process of physician burnout.

Dr. Berry: That's so huge and so key because it may hit it right on head the fact that a lot of us are such perfectionists. I always equate it to when like athletes go to college sports and in their homes, in their home towns, they were the man. They were that elite person. And then you get, go to college and then you're in a room full of other elite people. And you realize like, wow, my eliteness isn't as elite as I thought it was. And again, sometimes you get a reality check. You get that bad grade on that physics exam. You get bad grade on anatomy physics. You started getting Bio-Chem and all these things are happening. And you're like, your armor that you've been able to build up because you've been the elite of the lead as an undergrad, medical students just begins to get chipped away. And a lot of us have not been prepared to deal with that. We just have not been prepared to deal with the strife that comes with not being a hundred percent perfect. So I definitely think that's, I mean that's really hitting right on the head. Why I think some of them are medical students are really starting to feel some of that burn. Again, and it does worry me because especially, I know you're a medical student, but I can tell you as a resident you're going to feel different levels of pressure. As an attending, you're gonna feel different levels of pressure and stresses. So I'm glad that you had that opportunity that I kind of face a little bit in, in your medical student career, in NOLA. Hey, these are ways that I can work my way through it because unfortunately, and I'll let the cat out the bag. You're going to experience more. You're gonna experience not to say it, it's going to be worse. It's just going to be different. So having the tools to cope with it now are extremely important. So that definitely, I think you're doing an amazing job. Like I said, it's one of those things where sometimes you do have to go through it to see yourself on the other side and you already done that. But if you had look back, especially you're a spokesman now. You're at in your last year and you're looking to get out, what tips would you give to help students behind you either avoid if they can or I say deal with, I probably mean the better manage the medical students burnout?

Kessy Joseph: I think as a medical student you need to manage your time and prioritize your time. Yes, you can take all the hours in the day to study. But trust me, those two hours that you decide not to study and do something else for yourself won't change your grade. You won't learn any much more.

Dr. Berry: Yes. Talk about it. Lunch and Learn community I know it sounds like crazy, but trust me, I've got colleagues right now who are attendings right now who never could learn that concept. They felt that if they weren't studying to the last second to the last T they were going to miss the one question I was going to make them pass or fail the exam. Because that's just the thought process that was there. So again, even though we say like it's real real how some of the medical students feel.

Kessy Joseph: I have yet to this point studied at the last minute and actually been questioned on any materials that I read the last 24 hours. It's only things that you know from months and months and months of studying that you're assessed on. So that I just really think people need to prioritize their time and also learn yourself. Learn when you're starting to not be yourself anymore. If you're always, if you're typically known as the happy go lucky, like really friendly person, always wanting to go to work, always wanting to see the first patient of the day and then all of a sudden you realize, oh, it's hard to get out of bed. You just want to sit in the clinic, not see any patients. There's something wrong with you. You're not yourself. Maybe you need to step back and take some time for yourself and reassess everything. See what can change in your daily routine to make you feel better essentially. So that for sure is how to just to manage the burnout. And avoiding the burnout, I don't know any prophylactic measures you can take, but maybe integrate some exerciser activity or hobby you can do every week or spend some time with friends or family every week. Don't isolate yourself. I feel a lot of medical students isolate themselves. They just go to the hospital and then go home, sleep, go to the hospital, go home, sleep. Forget, they don't do laundry. They don't cook. They don't take care of themselves. Try to do something for yourself. I think it's important. Try to still humanize yourself.

Dr. Berry: I love it. Before I let you go, I always ask my guests, especially because you're doctor now, right? You're my colleague. How can what you do really help empower others really just really take better control of their health. Right? Especially us the medical students, who really need to hear your work.

Kessy Joseph: Wow, that's a good question. I've never really thought of how I can empower others, but I just think my words, seeking support and help from other people that's been through what you're going through. Really that's pretty much it. Find people you can relate to.

Dr. Berry: Amazing. And where can others find you? This is actually a nice little side question. Because I think in this day and age where social media is extremely prevalent, this is just from a general social aspect. Because we talked about making sure we don't disconnect from people. As a medical student, understand that you're about to be a, you're a physician in a few months and understanding that your words, even though it may not seem like it now or are extremely powerful and people are going to want to hear or see or reads this kind of stuff that you do or follow. Are you on social media? And when I say on social media especially, I mean in your moniker of as a medical student about to be a physician.

Kessy Joseph: Not necessarily, but I do. I mean if you want to see how I live life to be my stressors, I am on Instagram. Look at my great traveling pictures and all that great stuff.

Dr. Berry: What's your Instagram so we can follow you, what's the Instagram?

Kessy Joseph: Its la.kay.jo

Dr. Berry: Okay. Alright. Lunch and Learn community that will be in the show notes that you can follow the soon to be Dr. Joseph. And again, I joke because I always talk about as, I remember when I was doing my blogging as a medical student, social media wasn't really the thing that people did. So it was always very weird because I've been calling myself Dr. Berry Pierre since a medical student because I was like oh that's a foregone conclusion. So sure. So I had already skipped the student doctor moniker because I didn't need that attached to me anyways. One because I didn't want to have to switch all my stuff out when it came around to it. But I was always talking about health and always and people follow me for again almost like eight to 10 years now under that moniker. So I always encourage my medical students to get out there and show yourself and let people know who you are because especially in this day and age where as a physician, you need to do things that help you stand out amongst the crowd. Because I always encourage all my medical students get a social media page, obviously one that you liked, right? If you like Facebook, get your Facebook. If you like Instagram, get your Instagram. If you like Twitter, whatever you like and understand that you're about to, you're a role model now as a medical student. Because I'm pretty sure you already getting those medical questions like, hey, how you do this. So I've already shared the questions already happened. It's like I say you might as well just go ahead and establish yourself and establish who you are as a brand as well.

Kessy Joseph: You have a good point. And it's interesting because to be honest, as a medical student, I really haven't done as much social media because of time. There's really, I don't like to use my free time on the computer or on social media because I rather experience the outdoors.

Dr. Berry: But take the picture of outdoors so we can see what you're doing. I want to see the cooking. I want to see where you traveling. I want to see all of that.

Kessy Joseph: Okay. I'm gonna take your advice because I have more free time now. I think I'm gonna rev up my social media footprints. Is that what we call it?

Dr. Berry: Oh yes it is. Yes it is. So again, first of all, I want to thank you. You are actually my second medical student on the podcast. So definitely shout out to you, especially because the journey that you're about to commence, because in fact we got time now, let's because you're in the process of the match, right? Let's give people a little inside look of what it means to go from medical student to resident. How are you, as far as that's concerned, where are you at? Just so people can know that they look out for you whenever that time comes around.

Kessy Joseph: Alright. So my primary specialty of choice for this upcoming match is internal medicine.

Dr. Berry: Yes. Ladies and gentlemen obviously I'm biased, right? Because I'm internist as well too. So I love when the medical students want to be an internist.

Kessy Joseph: And obviously, like I said, I'm South Florida race so I'm looking to go back home. (Perfect). Really, moving forward I really want to focus on like conducting and doing research on community health and especially focusing on certain populations, different cultural beliefs and how that affects their health outcomes. That's definitely some of my career interests, but I'm all about primary care and that's the goal for me. And hopefully this upcoming match season goes in my favor.

Dr. Berry: Especially as a Program Director, I know you've plan on applying towards Ontario region. Again, we would definitely love to see you there. So again, we're putting those positive affirmations out there and again, I always tell even if you don't want Wellington, at least as long as you match and get to where you get to. I'm happy because again, I love the journey of the medical student. I love the journey as a physician in general and I wish more people knew about the journey and knew what the journey took. Because I think it would really give people a lot more appreciation of just how hard it is to become a doctor.

Kessy Joseph: It is hard. Very hard.

Dr. Berry: So again, Lunch and Learn community again, we want to thank MS4, soon to be Dr. Joseph for blessing us, really with educating us on what the burnout process is for a medical student. We appreciate your kind words. We're sending nothing but prayers and wishes on your journey up in this up and coming match and make sure you lane at the destination that God puts you in.

Kessy Joseph: Wow. Thank you Dr. Berry. Thank you so much for having me. Thank you so much for your kind words and your blessings and everything and positive energy. I love it. I thoroughly enjoyed speaking to you and being on your show. I hope to see you again. (Yes). Possibly. (Yes. Alright). It was definitely a pleasure.

On this week's episode of the Lunch and Learn with Dr. Berry I sat down with Dr. Nicole Washington (For the Second Time - check out episode 62 to talk about a very serious topic of Physician Burnout. It is one that affects physicians at all levels of training and no one is immune.

If you think this is some new topic, Dr. Nicole wants you to think hard about saying that is your final answer. We talk about the history of burnout, common symptoms associated with physician burn out and why our medical system may be to blame.

This was an amazing conversation as we got to talk about what physicians need to do TODAY, if they want to prevent becoming the next victim of burnout.

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Download Episode 124 Transcript

Episode 124 Transcript...

Introduction

Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and empowerment. This week we bring you a repeat guest with Dr. Nicole Washington who is Board Certified Psychiatrist who focuses and specializes in a treatment of high performing individuals and helps provide face to face services in the state of Oklahoma. But she also does some psychiatric services at Georgia, Louisiana, South Carolina, Texas, Virginia, Tennessee. So she's pretty much where you need to go and where you need to find her. And I bring her on the podcast this week to talk about a very important topic and I want to especially the listenership to understand that a lot of times we talk about the mental health and focused on the mental health and that focusing on the patient. But now we have to focus on, well the person who's actually giving the advice, the physician. And unless you've been under a rock, you've probably heard the term Physician Burnout. Whether you read it, where you saw it in a blog, where you listened to it on a podcast and we're going to be doing a nice little dive into the psyche of physician burnout. Why it happens, where it happens, when it happens, and how you can actually deal with it. So again, this is an amazing episode. I was glad that she, I must've did something right because she came back for another go around for another talking with us. Again, if you don't remember, she was actually on Episode 62 of us. Can you know the link drberrypierre.com/LLP062 if you want to check out that episode. So check that episode out. But after you do checking this episode out about physician burnout, and this is going to be the first of a series of episodes with different physicians and colleagues just talking about what physician burnout means to them and their personal experiences. So like always, if you have not, and this may be your first time. But if you have not subscribed to a podcast, make sure you subscribe to the podcast whether it be Apple podcast, Google podcast, Spotify, iHeartRadio, Overcast. We're pretty much there where every podcast outlets are. Go ahead and subscribe to the podcast. Leave me a review wherever you can as well too. Just let us know how we're doing. Let Dr. Nicole know how she's doing well on this amazing episode. I know you guys are in for a treat. So like always, you guys have a great and blessed day. And again, I'm going to see you on the next amazing episode here on the Lunch and Learn with Dr. Berry.

Episode

Dr. Berry: Alright, Lunch and Learn community. Just heard another amazing introduction on a guess who one is kind of funny because not only is she a repeat guest but she was on episode 62 which she is a repeat guest 62 episodes later. So ladies and gentlemen, take the time to give a warm welcome back to Nicole for again blessing our podcast audience with a very significant topic that especially if you do a googling or you just watch TV. It's getting so much more I guess fanfare these days. Again, Dr. Nicole thank you for joining us on the Lunch and Learn with Dr. Berry.

Dr. Nicole Washington: Thank you for having me.

Dr. Berry: So we had your bio. We read your bio out. I got a lot of people where my listeners who like to skip the bio, go right to the main episode. So even if someone did read your bio, what is something that they may not be able to know about you that just happens to not be in your bio? Tell us something about yourself.

Dr. Nicole Washington: I am an advocate for mainly people who just don't consume services on a regular basis. So whether we're talking about people with severe mental illness like schizophrenia. We're talking about people of color who have all kinds of barriers about accessing services or even professionals. Because I think a lot of people think that because you are a doctor or a lawyer or whatever you are, that you've achieved that space. So what do you have to be stressed about? What do you have in need? What could possibly be going on with you that could be interfering with your mental health? You're making good money. You got a good family. You live in a nice house. People have a hard time with that.

Dr. Berry: Trying to coping with that reality. What was so funny, especially when you say that, I see that happen more often, especially the cases of suicide, right? Especially witnesses like a celebrity suicide, death and everyone's almost like, oh my God, I can't believe that happened. How did it happen? Why did, it's like, it's almost a shock because people feel once you've meet a certain level of credibility or statute and for some reason those same things that happen to you when you're not at that status can happen to someone else.

Dr. Nicole Washington: Yeah. And it happen that you make or where you live or any of those things.

Dr. Berry: So I want to talk today about a very important topic. I teased it in the introduction, about Physician Burnout. And it's a phrase now, which interestingly enough, it almost has its own like ICD-10 code now. Because it has gotten such fanfare. But of course being on the front lines, as a physician, as a practicing physician, I really wanted to delve into these, especially these next few episodes on our series, just what is it? Who is experiencing it? Where did it come from? You being in the introduction, which again, I'm so thankful for. I would definitely like to start from there. Let's talk about physician burnout. And just in general, what is it? What is that term we're hearing all of a sudden now?

Dr. Nicole Washington: So the term burnout, even though it seems like it's become very sexy here in the last year. So it is a term that's actually been around since the early to mid-seventies. There was a book called Burnout: The High Cost of High Achievement that was written in 1974. From that book is where this term burnout came from. Herbert Freudenberger was the author's name. So he defined burnout as the extinction of motivation or incentive. Especially where one's devotion to a cause or relationship fails to produce the desired results. (Okay. Alright). I must say that again, extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results. And that is burnout. So you were once very motivated. You had a lot of incentive to do to be devoted to your field. You got a medical school. You had all the motivation and incentive in the world. You wanna help everybody. And you start to lose that motivation and you start to lose that incentive and then because you failed to get the results that you want.

Dr. Berry: Oh, that's deep. Remember Lunch and Learn community anytime a guest mentioned a book or anything, we'll make sure it is in the show notes so you can read that as well. When we talk about, especially in a sense from the physician standpoint, what does that even look like? A physician who's unfortunately losing their sense of self, I guess?

Dr. Nicole Washington: When you start to experience burnout, it comes in different ways. So there's physical symptoms of burnout. You may have headaches or GI issues, muscle aches. You may notice tension, neck, shoulders. Sometimes people are emotionally exhausted. So you listen to everybody's stuff all day. Everybody needs you. Everybody's pulling on you when you're burnt out. You just don't handle that as well. So you're emotionally drained and when you're emotionally drained, it takes away from your personal life. So it's then not just your day to day. It interferes with your ability to be empathic with your patients. If you're emotionally drained from people pulling on you and then it also affects you when you get home because you can't be a good friend, wife, husband, mother. When you just are drained, you can't take anything.

Dr. Berry: That's very interesting point because I think a lot of times, especially when we talk about the physician burnout, I think a lot of times people think that it only, it starts when you clock in and it stops when you clock out. So as I loved that you had touched on it, that even outside of your work space, people are affected or your world just gets affected from what you're experiencing within the workspace.

Dr. Nicole Washington: Yeah that's true. And then also with burnout, you can feel disconnected from your job. So you ended up having just this increasing sense of frustration and cynicism. So you just find yourself getting frustrated with patients about stuff or staff and making negative comments. You dread even getting up and going into work in the morning. Some people just go through the motions. They feel numb. And they have a hard time connecting with their patients in that way. That we did, which is for most of us the reason that we went into medicine because we liked that connection with people in that being able to help people and when you're burned out from your job, it's hard for you to remember why you loved it so much.

Dr. Berry: Wow. That is a powerful words. especially in in the sense of a physician who tends to deal with, and I know you work with a lot of high level professionals, so in the case of a physician who tends to deal with that scenario where people are asking, asking, asking. I don't want to say taking, but again there's saying like, hey, let me give you my emotional burden. Sometimes let me give you the physical burden and please help me get this off of me. When you have a physician who that's really their job to deal with that, when do these issues start festering up? Is this something that 10 years down the line, 22 years down the line? When should physician actually should start being concerned about something like this? Dr. Nicole Washington: In med school, before med school. (Wow, way before). Yes it should happen in medical school. You should learn how to handle it because there are some of us who have really high stress jobs but then always lead to burnout. So it may be, for some people it is a reflection of how well they manage the stress that they're under. So if we learn how to set good boundaries with our careers. If we learn how to do great self-care and I mean real self-care, not like a spa day once a month. Because that's great. I mean, who doesn't love a good spot day? But real self-care. Consistent care about making sure that you're nurturing everything that you need to function well. So if we can teach that early, I think we do a better job of handling just the everyday stress that comes with our careers because of stress.

Dr. Berry: Especially if you're a medical student having to learn to deal with, I guess what you're saying is the reality. The reality that yes, you're going to be in a stressful job. Yes, people are going to push and pull at you, but you have to be ready for it. Is there things that work better than others when you're first in that beginning process of trying to say like, okay, yeah, I think I do need to deal with something that's eventually going to come about?

Dr. Nicole Washington: One of the problems that interferes with us in medicine, and I can't speak to other industries, but medicine for sure, we have a little bit of a disconnect. I guess we have a lot of a disconnect between what we are taught to teach other people to do for themselves and what we are allowed to do for ourselves.

Dr. Berry: Oh, I like this. I like the direction we're going right now.

Dr. Nicole Washington: I think it's our field that needs a revamp of how we look at our role and how we look at what we do. I mean, I can recall interviewing for residents, after residency, for jobs. And I interviewed with the CEO of a facility and he was going, you can make this much and then if work this many weekends you can make this much extra. And then if you take extra call you can make this much extra. And I said, if I don't have to work weekends, I can probably be okay with not making that extra money. I feel like that's not, I'm good financially. That is enough money. I don't need to keep chasing. I'd prefer to spend time with my family. And he said, well, I just don't know. These young doctors, kind of joking, but kind of not. You younger doctors, the old doctors would work 60, 80 hours a week plus, and they work every weekend. And I said, yeah. And they were all irritable and burnt out and their families hated them. The kids didn't like it. A lot of problems came with that. So I think the expectation has always been that you give 100%, the medicine and then you just figure it out where the rest of your life fits in.

Dr. Berry: Wow. What I love about that because it's such a, I mean I'm a program director so I work with residents and I'll sometimes hear other attendings, these young doctors just they don't want to work as hard anymore. I understand especially if you're not in Madison, right? Our regulated work week hours is making sure that my residents don't go over 80 hours and I'm pretty sure some of y'all like 80 hours? So yes, they can go over 70 and be okay. That's how we typically look at it when you're in a residency. Again, I don't know these other industries. But in, I want to say the real world, it shouldn't be that way. So I definitely agree that medicine has definitely skewed our way of thinking. And unfortunately the teachers, the one who were supposed to be passing down good skills, good knowledge. Because they're still relying on that old ways, they do downplay the efforts of newer and younger physicians. Because newer, young physicians aren't about that life. They don't want to have to work a hundred plus hours just to please somebody.

Dr. Nicole Washington: And I think that's great for them. I mean I think that's fantastic. Thinking about even I used to work in an academic setting and how difficult for a medical student to say, I know this is my third year in psychiatry rotation Dr. Washington, but my sister's getting married in Arizona, can I go to my sister's wedding? And I would say, absolutely go to your sister's wedding because I think that kind of thing is important and part of self-care is nurturing relationships outside of your career and being available for your family. But I also have heard other attendings and other departments say, oh they want us to go to their best friend's wedding. And I thought, well why not? I would want to go to my best friend's wedding.

Dr. Berry: Right. If you weren't in this field, it would seem common sense. Of course you want to attend that wedding. But in our field is like, huh. They don't want to stay for 12 hours taking notes.

Dr. Nicole Washington: Because to ask if they could go to a family reunion. Yes. They have the audacity to ask if they could go to a family reunion. They should go to their family reunion. So those are the kinds of things. And even simple stuff like how many doctors do you know who make regular annual exam appointments or take care of their own things because they have the patient's scheduled and it's an inconvenience and they have to fit. It's just so much that goes into Madison that you end up totally losing and putting everybody else before your own basic needs.

Dr. Berry: Do you find the physicians who tend to err on that side where they're really gung-ho when it comes to medicine, they really do a lot of work in that field tend to have these same types of traits where the burnout comes a little bit earlier?

Dr. Nicole Washington: I think a lot of it is just based on who you are and just your priorities and how you manage stress. I know doctors who work tons of hours, but they do so well at setting boundaries when they're not at work. And they exercise regularly and they take care of themselves. And they seem to do pretty well. But there are those of us who are not doing as great a job of managing our stress well and setting limits and boundaries. So I think a lot of it is personal characteristics that play a part.

Dr. Berry: Especially with burnout, especially with our system of medicine. And we touched a little bit on it, how it is almost status quo to overwork yourself. And you almost seem like your outlay when you don't want to. What is it about just our system in and of itself that I guess takes away the fire that a pre, we'll even go down to our pre-medical student, right? That pre-medical students who all they could think about as one of the save lives. You know the personal statements, right? Take care of people, take care of people, take care of people. And then sometimes they're not even getting out of school before they're starting to say, I don't know. I don't know if this is what I really want to do. What is it about our system just in general that continues to fester that?

Dr. Nicole Washington: Yeah, it seems like we do a really good job of just beating people down in general. We just crush everybody's spirits up front. I mean it's hard. I definitely know people and med student, being in academics and medical students who by the end of med school didn't even know if they wanted to even practice. And I have seen, a handful of students not go on to residencies because they said this four years of medical school took me down. I don't think my mental health, I don't think I can handle this as a career. This environment is so cut throat. So we talk about burnout on one end because just the job itself, just always having people lean on you and just the pressure of everybody's looking at you and then you have the Internet and anybody can make comments about you on the Internet.

You can't defend them because you know. There's all these things that just come with, even if the job is going well, but then you add in the negative cultural stuff and it just takes them down. I look at it a little bit like I'm not making light of anybody who is abused and going through an abusive situation. But I think if I have a person standing in front of me who is dealing with significant abuse, whether it be verbal, physical, whatever. And then in my treatment with them, I only focus on them and coping skills and let me give you an anti-depressant and let's work on your coping skills. Well, yeah, that person needs good coping skills. We all do. But I need to be focused on this some toxic environment that they're in that is abusive to them.

Not telling the lady who's abused. Well, we just need to work on your coping skills if you just had better coping skills. How about you do a spa day once a month? How about you make sure you turn your emails off at night? That's not going to change the fact that that environment is so toxic and some of our work environments are toxic. Not every environment in medicine is, but some of our work environments are so toxic and almost abusive to the people that work in them that talking about the regular burnout stuff, about self-care and all that, it's a moot point. Because I can go to spa days every day, but it's not going to change the fact, in this toxic work environment.

Dr. Berry: I love that. Especially because I'm hearing it. And I'm thinking about, as a program director, I, being in the graduate medical education side, even now when I tell you that the burnout has gotten so, such a, and I don't wanna say popular, but because more people are talking about it, what's been happening now is this push on wellness. And I think it's so funny the push on wellness like, oh, we got to make them well. We gotta make sure doing real well. We gotta make sure you're getting sleep because it seems like no one really wants to talk about what, hey, your system is causing this, right? So, yeah, you can have a thousand different wellness efforts, but if you, if you don't have a thousand fixes to your system, especially. And again, I can talk candidly because I'm in GME, right?

If you don't have a thousand fixes to your system from that aspect of itself, it doesn't matter how many wellness retreats they go to. It doesn't matter how much sleep you give up. It doesn't matter how much hours they work because they're not happy. I guess that's really the crux of it. So I love that aspect because sometimes I think that's, and again, it's easy, I think when you're not in the zone, right? Quote unquote you're not in the club, right? When you're not in the club, it may be easy to focus on. I'm like, oh well, you know, they're just not coping well. Right. Oh, they got so much money, what they worried about? And I love how you talk about like, no, no, we gotta look at this system itself.

And I think that's something that really people don't really talk about when we talk about burnout. Because most of the burnout focuses on the physician. Why isn't the physician happy? Why isn't the physician deal, they got all the money, why can't they just cope how they need to cope. What did a quote unquote sad about? But I'd love that aspect of it and I can only imagine it. Like I said, I'm in GME. I used to be in private practice I guess in private practice stories as well too, they gonna see where that goes.

Dr. Nicole Washington: Absolutely. My time in academics was very interesting because I do think that's where you make change. We make change with creating systems for our trainees so that when they get out and get into leadership systems, they will demand basically. I think a lot of our trainees, you know, millennials and people give millennials a hard time and all the millennials don't want to work, all that. I get it. I cannot ever blame somebody for saying I don't want to work 80 hours a week. I get it. I don't want to work 50 hours a week. How about that? If I don't want to work, I give you 40 that sounds good. I'll give you 40.

Dr. Berry: Can I go back and forth? I've thought 40 was the norm.

Dr. Nicole Washington: I can't blame younger physicians for having those expectations. And I think the culture will shift hopefully as we have these younger physicians taking over leadership hopeful that we will see changes that really changed systems and not necessarily, like you say, I focus on physician wellness and 15 minutes once a month in a lounge.

Dr. Berry: Say hi and then keep moving. What's usually, especially because when we were talking about medical students at first too with the burnout aspect, what are they learning? What are they learning that's already giving them that idea? Oh this is probably gonna be that rough. And I think it goes back to the expectations that they had. Could someone argue like, well, Dr. Nicole, maybe they should change the expectations.

Dr. Nicole Washington: I do think that's part of it. I think when you go into any situation with unrealistic expectations, it can be difficult. But we also still very much having medicine, even at the medical school level. You have your gunners and you have this culture of kill or be killed. And there still may not be this collegiate relationship among the students because they're all vying for, I need to do better than you because I want this spot. And then you create, now we have students coming in who have the pressure of knowing that we're no longer at a place when you and I were in med school, when there were spots to scramble into and there were extra residency spots that went unfilled. And so we knew we can probably find a place somewhere. It may not be, you think, okay well might not be my number one or two, I could probably find spot somewhere. But these students have the additional pressure of am I even going to be able to find a residency spot? So you hear all of that, so there's that stress from day one and the culture at our medical schools is still very old school. It's still very kill or be killed and it's still very, very competitive.

Dr. Berry: You touched on it because I didn't even think about that how competitive it was when you are, I didn't even think of, I forgot about how competitive you had to be a and I hate to say you had to be it, but you had to be when you are premed and you are in those undergrads and you studying to get, you studying those MCAT four questions because in your mind you felt like if I missed this one question, that person next to me may get the spot that I want. And you are right, I think a lot of us forget and I don't want to say forget cause maybe we're never encouraged to do so, but I think a lot of us never turn off like, oh hey by the way guys, we're here now.

We're in the school so we probably don't need to fight because again I went to NSU com, they changed the name. But in NSU com and we had 200 plus in our class. But still, even with that 200 plus, there are some, like you said, there's some people who they kept in themselves, they stayed by themselves. They didn't want anything unnecessary do with the majority of population who might been more, collegial and just kinda like buddy-buddy and together because we were like, we felt like, hey, we were already here. We don't need to work hard, let's work together. So, and then I think that process starts right over again when it's time for getting on, getting residency interviews and getting residency spots and then that process, when you become a third year resident, you're doing it all. So yeah, we do that even in premed.

Dr. Nicole Washington: Yeah. And has met so many students, the medical students are concerned about not having enough residency spots to fill into.

Dr. Berry: Can we show our, we're building a new medical school everywhere you turn, but…

Dr. Nicole Washington: And we're not creating new residency spots to match the number of students they were turning out. So somebody who's going to be left without a spot. So then that creates even more competition.

Dr. Berry: Yeah, wow. I didn't even think about it. Oh yeah. Okay. So our system, the way it goes, it's going in a direction where the spotlight is now kinda highland and like, hey, something is wrong. If you had to focus on and we've talked about different levels, if you had the focus on different levels of weights to correct, would you be more on the after their physician side and working in the medical system? Or would you be during the medical school aspect of it or even in the premed aspect to say like, hey, this is some of the reality. You're getting into, so please be prepared.

Dr. Nicole Washington: I think I would hit the trainees, I would hit med students and residents. So I think for medical students, one of the things is, and I mean you could think back to your training. I know most med schools haven't changed. We don't do a lot of talking about the business of medicine and that side of medicine and we talk a lot about treating patients and we talk about, this is what you should do and this is what evidence says you should do and we need that foundation. I'm not saying we don't, but then as a student you don't have a good feel for what is the business side of medicine. What is the reality of what I'm about to jump into? What does it mean I want to do family medicine? What does that mean? What does that mean for me? Does that mean I'm going to see patients there in 15 minutes and they going to have less as long as the arm and is that what that means? Am I going to constantly feel like I'm not making a different, what is that going to look like for me? And I think we don't do a good job of pairings students with necessarily mentors who actually are out practicing in the fields they think they're interested in for them to really get a feel for, okay this is what it's really like. But somebody who's not going to scare you and say get out while you can. Somebody who's gotta tell you the really bad things.

But these are the really good things and this is why I keep doing it and this is why I love it still. You need balanced people to give them realistic expectations and to learn a little bit about the business of medicine. For residents, I think the focus should be on just life and just living. What does your life look like? Because I think you're laying in residency a foundation of how I'm going to practice for the rest of my career. So I think they should focus on not only making sure they get the knowledge they need and get the patients numbers and I get all that, but how do you live life? How do you nurture your personal life in addition to your career? Because you have to have balance and the people that don't have balance are in trouble. They need balance and to learn that as a resident because that's really hard after for three, four or five years, depending on your specialty. You literally cut off our relationships with people you love and care about and you don't talk to your best friends and your family and you don't hardly go to church and get all fat because don't work out.

These things that all of a sudden you're on a 10 day and it's like, okay, go figure it out. Go figure out how be a normal person again. (How to reconnect). Yeah, go reconnect with people you've ignored for five years. No, it'll be fine. I mean you just have to I think help them and help them too with the expectations of what it's like to practice in the community. I trained in a program that we didn't have our own university system so we had to, we did all of our rotations mostly in community systems. And so we learned a lot about how that worked in reality but people I know who worked in closed systems, it was a false sense of what it's really like when you're out having to deal with managed care and having to deal with community based systems. And it just takes a lot of adjusting and getting used to and people think well this is not what I signed up for. This is not how I thought it would be because we don't train the residents a lot in the business part of medicine and how to function outside of resident.

Dr. Berry: What I loved especially because we mentioned the business part of medicine. I've seen people, I think I saw the meme the other day where they talked about just the growth of administrators versus the growth of physicians in healthcare, especially in regards to salaries. Because again, when we talk about physician, we don't think money is evil over here. We like money too. And they talked about just the amount of costs as that's going towards the administration aspect, the business of medicine. But then you see the growth of physicians, not even a sliver of the mountain and I 100% agree teaching the business at multiple different levels will go so much further. Because I think sometimes a lot of times of, I don't wanna say sometimes but I don't want to say a lot of times, but sometimes the financial remuneration that they were expecting isn't there because they're not seeing that many patients. So you alluded to the 15 minute and I was once, I always like talking about the 15 minute because a lot of times people think, well my physician doesn't care about me.

They try to get me in and out and I promise you is not that physician care about you, is just that they are in a system that unfortunately rewards seeing more people. And if I have to, if I need to maximize my hour that I'm seeing, I'm going to try to see at least four. So I say 15 minutes where I'm really thinking 10 because I'm hoping I can get it in and out your room in five minutes because I did outpatient medicine. Honestly we had full disclosure, we had a person who came to our office who timed everything we did in a day. So they would time how long it took a person to come to the front desk, sign in and when they sign in how long it took them to get to the back from my inmate to see him. And then how long it took from my MA to see him from an MA put them in a room. And when they may put it in the room, how long it took for me to go to there and then for me to get out of there and then for never go to the front office and then for me to finish the note.

They time every single thing to the point where they even recommended switching, like how the room was set up because they're like Dr. Pierre if your chairs on the opposite side of the door and you got across your patient, I know it's crazy, right? If you had across your patient, they may ask you another question, that may take a couple of minutes. So you imagine that a couple of minutes times 50 patients, right? You could have seen 10 more. So I'll just like wow. So and when we talked about the business, there are people who really focus on a business aspect of medicine unfortunately at the demise of the physician and at the demise of the patient themselves.

Dr. Nicole Washington: Absolutely. And I think the business and for the students and the residents, I think so many of us are made to feel guilty about being concerned about the money. And so they're labeled as not caring and we get labeled as being money hungry and all about the money. And they just want to turn more patients out so they make more money. They don't care about us. And that's not true. But I think in any of us, no matter what you do, you want to make what you can make and you want to be able to make for your industry what is a good living. And I think a lot of us are made to feel guilty in medicine. We shouldn't care about how much we make because we should just do it. And I think people have a false, so for students and residents I think is helpful to make that a little more normal or of conversation and understand that that's part of it. This is your career and that will play a huge part in your satisfaction in your career and your burnout. I mean that will play a huge part in all of that.

Dr. Berry: I was reading some article that talked about how the businesses, the businesses at hand, hospitals, health administrations, because they know our love for the patient, right? Because when we talk about physician burnout, yes, the physician loses, but the patient ultimately loses as well. So when we talk about this, our love and care for wanting to take care of people, sometimes they use that against us and that's where this talk of all that doctor cares about his money comes from, it usually comes from people who are making money off the doctor. And they're like, well, you shouldn't be focused on that. And, and they know that because we love our patients, we care for our patients. We'll go the extra mile for our patients. We'll spend extra time for our patients. We'll stay longer. We'll come in earlier. We'll do all these things that are unfortunately detrimental to us because of the goal of taking care of our own.

Dr. Nicole Washington: We will not spend time with our families in the evening because we're charting from the day of the people we saw because we didn't have time to see all the people we needed to see, give them the care that we felt was really good care and chart at the same time.

Dr. Berry: First of all, amazing episodes. Before I let you go though, is there any, especially for, let's say you've got a physician right now who thinks like, hey, you know what? I think I may be burning out and I think I feel like I've read enough articles, I listened to enough podcasts. I've seen enough videos. I think I may be ready. What do you tell them? Especially because again, you tend to deal with so many more high level professionals. What do you tell them? What can you say at this point?

Dr. Nicole Washington: So I always call it crispy. For my own self, when I say oh, I'm feeling a little crisp. A feeling things are getting a little hard. I'm hard and on the outside. I need to do something. So the first thing is just being okay with it. Recognizing that you're human and recognizing what your signs are and what you need to do. I think I recommend that people take their vacation regularly. I think that helps. I worked at a job once where I had 330 something hours of PTO racked up because I never took leave. Because it painful for me to take leave because I would either pay for it on the front end or back end. Because I was either going to have to see extra patients before I left or when I came back.

So I just didn't take leave. So 300 plus hours, that's insane. Somebody should've said, girl, you better take leave and take care of yourself. So I would say make sure you force yourself to take your vacation regularly. Schedule time off, even if you don't go out of town and doing things fancy, just take some time to reset. So I recommend doing that for prevention and maintenance kind of stuff. But if you feel that you are getting there, I think you have to be very intentional about recognizing your burnout sides because mine may not be yours. I know mine are, my personal one is I get a little snippy with the people in my house and normally I'm not. And so when I, the people in my house, my husband will say, hey, hey, hey now you know, I didn't do anything to you.

And I go, oh my God, you're right. That's how I know when I'm getting to that point. And so when I am getting to that point, I take extra steps to do things during the day to pull back to give me chances to reach ours. I go outside and walk around. I make sure I take lunch away from the building. I do things, just little things to help me kind of decompress. I focus a lot more on my gratitude. Sometimes I get lax and I don't do my gratitude work like I shoot it. But at the end of it all, if that, if those little things don't work for you and go talk to somebody. Realizing that going to talk to somebody or doing therapy does not set you up for a lifetime of going to therapy.

Dr. Berry: I think that's always people fear. If I got to see him one week, on my, I got to see him for the rest of my life.

Dr. Nicole Washington: Yeah. And that's not true. I mean you can do brief therapists with people. I've seen physicians for very short periods of time. They had a bad outcome at work and they just needed to debrief through it is that we also don't do, which asks our burnout rate. You work with people. You lose patients, they die. You have to deal. Don't even get me started on people's secondary trauma associated with ER docs and child abuse pediatricians that are pediatricians and you just carry all that stuff. I mean that's a lot. Sometimes you just need to talk that stuff out with something and maybe that's once a month, maybe that's once every other month. Maybe that's just a standby on call. I had a bad case. I need to talk this out with you. But don't be afraid to link with a mental health person. It doesn't mean you have depression or bipolar and anxiety. It doesn't mean any of that. It just means you need a little help, which we all do from having.

Dr. Berry: I agree. Before I let you go, I always like to spotlight our guests and make sure whatever they were doing, working on, the Lunch and Learn community can be privy too to try to help connect then. And like I said, we had you on episode 62. This podcast is definitely changed over the 62 episodes. We've definitely grown already 62 episodes. So we're so appreciative that you came back and touched out. And is there anything going on with Dr. Nicole that we should be looking out for. Any things you're going on, courses, books, whatever. Please let us know.

Dr. Nicole Washington: Yeah, I guess since I have been on the show last, I have jumped into the podcast world and my podcast is called The C-Suite Confidant. So it is all about a c-suite executives, doctors, lawyers, high performing folks and the stresses they deal with, whether it be occupational, personal, and listeners have the ability to go to my site, drnicolepsych.com. And you can go to the podcast and you can leave me a question. So if you have a work issue or there's something going on and you go, I want to know what the psychiatrist thinks about this that's going on. And you can leave a voice message on the website and I will respond to people's questions on the podcast.

Dr. Berry: I love that. Okay. Alright. And remember links we'll definitely be in the show note because that's a very interesting thing. I actually, I need like hop on your podcast so we can talk about the life of an internist program director and the stress they got. Let's make that, I'm putting it out on air right now so we can make that happen. (Absolutely). Especially sometimes you got to say it out loud, right? Beause when we talk about affirmation, right? You keep an affirmation inside so you don't try to disappoint yourself. But as long as you, if it's blurted out of there and now you got a whole bunch more people disappoint and you don't want to disappoint nobody. (Absolutely. Absolutely). And last question, how is what you're doing right now helping others, especially other physicians like really empower themselves to take better control of their health?

Dr. Nicole Washington: I am all about us just taking our life back and taking our mental health into our own hands. I think we have just for so long worked really hard to pretend like we didn't have issues because how can we help people and have our own issues and that is super flawed thinking. But I just work through my practice, I work with physicians who are having untreated mental health disorders. I mean you mentioned physician suicide earlier, we think we lose about a physician a day in this country to suicide. But those are just the ones we know about. And those are just the ones that we lose. What about the ones of us who are out here suffering and depressed and anxious and every day they think, I wish I wouldn't wake up tomorrow. And those are the ones, because like you said earlier, it's not just about us, it's about the care we give to patients. And if you're impaired, you can't give the care to other people. It affects your patient care. So through my practice, I work with doctors in seven states now, South Carolina, Tennessee, Virginia, Louisiana, Texas, Georgia, Louisiana, Oklahoma. And I can work with them on addressing and a previously not dealt with mental health issues.

Dr. Berry: Love it. What's the website again so people know how to find you? Where can they find you in any social media outlets

Dr. Nicole Washington: I am on every social media platform at @drnicolepsych and at the website drnicolepsych.com and there's podcast, clinical services information there and so all you can find everything you need to know about what I have going on through that site.

Dr. Berry: Dr. Nicole thank you for really enlightening the podcast audience to the topic that is very serious. Again, I know it's getting a lot of fanfare now but it's because it is extremely important and patients, especially those who are listening don't think that is just effecting. Because again, these physicians who are burning out, burnt out, still going to work. And they're still taking care of your mom, your dad, your grandpa, your grandma. So again, do not think that this is just a physician only problem. Please. Thank you for joining the podcast again.

Dr. Nicole Washington: Thank you for having me.

Download the MP3 Audio file, listen to the episode however you like.

On this week's episode of the Lunch and Learn with Dr. Berry I sat down with Dr. Phillippe Douyon. Dr. Douyon is a board-certified neurologist and the Founder & CEO of the health, wellness, and technology company, The Inle BrainFit Institute®. Dr. Douyon is the first neurologist we had on the show and we talked a lot about the number one organ in the body, The Brain.

This was an amazing conversation as we got to talk about why he became a neurologist, how his initial encounter with the healthcare system has shaped his mindset on taking care of patients and his approach on improving brain health.

We also got a chance to talk about his book Neuroplasticity, his institute, and his app. Before the end of the episode, you will see why One Brain, One Body is more than just a catchy phrase.

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Download Episode 123 Transcript

Episode 123 Transcript...

Introduction

Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy. This week we have an amazing guest, Dr. Philippe Douyon, who is a Board Certified Neurologist. He's actually the first neurologist that we've had on this show and he definitely set the bar because we got to talk a lot about the brain and nutrition and just overall health. Which you know when you think about it, you don't really put too much onus on it. But after this episode you are really going to say like, you know what, let me make sure I'm taking care of my brain because I only have one. And that's something that we really drove home during episode.

The fact that we only got one brain. It's probably, if you asked me the most important organ of the body. But if we don't take care of it, if we do things that in our teens, in our twenties, in our thirties that does not help it, then we're going to see problems when we get 40, 50, 60. It's not going to be surprised when we run into these medical related problems associated with neurological health. And that's really the theme I want you guys to get from here. We talk about health a lot. We talk about diabetes, cholesterol, blood. We talk about not smoking. We talk about all of these different things here. But understanding that neurologic health is extremely important. And that's why I love this episode because Dr. Douyon, who you know has already wrote a book. He has his own wellness institute that incorporates his neurological practice and he even has his own app in the app store or Google play, whatever that the android storage.

He has his own app there as well. You're going to get to hear a very well rounded individual who is a physician. Who really wants to put their patient care at the forefront, especially when it comes to neurological health. So, again, like always, if you have not had a chance, go ahead and subscribe to that podcast. Let me know what you think about this episode. Shoot me a five star review if you must. And you know, tell a friend and tell a friend. That's really the goal of every week. Just to tell one person. You don't even gotta tell 50 people. Just tell one person and then that's good for me. So you guys, you're ready for another amazing episode with Dr. Douyon.

Episode

Dr. Berry: Alright, Lunch and Learn listeners. You just heard that amazing introduction from a guest. I'm very interested for you guys to hear because it's something different. We actually haven't had someone not only from the show, from the specialty that to kind of talk to you about health in general. So definitely excited. Again, Dr. Douyon, thank you for joining today with the lunch and learn community.

Dr. Philippe Douyon: Well thank you for having me. This is exciting to be on your podcast and I'm looking forward to this conversation.

Dr. Berry: So I gave them your bio. First of all, amazing bio. But if someone, because I got some Lunch and Learn listeners who like to skip the intro. I don't know why they do it. They like to skip the intro and get right into the meat and potatoes of a show. For someone who skipped the bio. But maybe they read but they kind of glossed over it. What is something that isn't in a bio that someone may not know about you, but you would feel, you know what, if they walk away from this episode, at least I hope they know this.

Dr. Philippe Douyon: Yeah, I think it's probably that, I would say that my goal is to really get people to reach their full potential. Especially their full neurological potential. I feel like that we have so many limitations that we put on ourselves and that we put on our patients in medicine. And I'm just really trying to empower people to live their best life and to get as healthy as possible.

Dr. Berry: And you know what I love about is because I've had quite a few guests on the show. But I've never had one who really stressed the importance of the neurological potential. So I'm like very excited to get into that aspect, especially when it comes to health care and how that helps overall well-being. So definitely excited to get into that. So what made you, because again, I'm an internist. So what about neurology say, you know what, this is the field for me. What was it?

Dr. Philippe Douyon: So it's a couple of things. I think my first experience with neurological disorders was that I had a cousin growing up who had epilepsy. I had a grandmother who developed Alzheimer's. So I got to see the impact that neurological disorders have on people's lives and their families. And as devastating as it was to see neurological disorders have a different impact than others diseases. I mean, it impact who you are at every level, the way that you think your strength or your ability to function throughout your life. And so I always found that fascinating. But I also grew up, I was born and raised Catholic and I probably don't track this as much analysis as I probably should to my parents. But you're taught that you are created in the image of God. And I think for us, the parts of us that are most God-like are our spirits and our brains. Our brains are capable of creating. Creating our external environment, our internal environment. Creating our lives.

Dr. Berry: Obviously some of the history of they may not know is you've been well in tuned with the medical system in and of itself. Right? And it isn't as if you became a physician and that's when you kind of get enamored with it. You are on the other side as a patient and let's talk a little bit about that. And then really lead into how that's played out in your career thus far.

Dr. Philippe Douyon: I think people when they first see me, they're like, oh, doctor neurologist, epilepsy specialist, author creator of this app. But what they don't know is that I've been a lifelong patient. I've been a patient since I was 18 years old. So my entire adult life, I'm now 40, so more than half my life. So I've gotten to see things from that perspective. And being a patient I think has made me a significantly better doctor. When I was 18, freshman in college a couple of weeks into my college career and I went to college on a tennis scholarship. And so to a play for the team then you have to undergo a physical. And so when I undermined that physical, they found something wrong in my urine. Initially they ain't clear me to play on the team. But they did a couple of weeks later and we go on our first trip to go play at a tournament out of state.

And during that trip I'm playing my match and my entire body goes into one large crap and I just cannot move around and I can't move any muscles. And I ended up having to be rushed to the hospital. And probably about a month after that is when I was diagnosed with kidney failure. At the age of 28, eight days after walking across the stage at Carnegie Hall to get my medical degree to get my diploma. I walked into the halls of Columbia Presbyterian hospital here in New York to have a kidney transplant. And so I have been a lifelong patient and that I said, has made me a better doctor. It's influenced the way that I practice medicine. It allows me to relate to my patients much better because I understand what they want. I know what it feels like to have to face your mortality. I know what it feels like to take medications that don't make you so great. I know what it feels like to look in the mirror and not recognize yourself.

Dr. Berry: And the reason why I love about that is that I think a lot of physicians, especially the ones who haven't been in a position where they've had to be on the patient's side. I think it does lose a lot, right? I think there's even they could be as empathetic as they want because they really haven't been there. Sometimes it is difficult for them to make that extra leap go that extra mile for their patient because they've never experienced it. So I was definitely interested because I know something like that right is going to help shape the career. I know something like that is going to help shape your want for your patient. And especially when you talk about making sure that you improve that neurological health, which is something I think a lot of people downplay unfortunately.

Because one, it's not something that you, you physically can touch. It's not sexy. It's not something that gets an entire month. In a different, it's not like that level of, I guess, "popularity". Because that occurs, I think a lot of people downplay its level of importance. But again, I'm thankful that you're on the show today because I really want you to get the listeners together so they understand how important it is to really make sure you're optimized from a health standpoint, specifically neurological. It's has so many devastating affects when you are not. What are some of the things that you do that helps people improve from a neurological standpoint? When someone says like, yeah, I'm a neurologist, you have gone to neurologists, what do they typically do? So, because that way I want people to be in that driver's seat when they hear neurologists. What is, he's a brain doctor? What does that even mean? What is that?

Dr. Philippe Douyon: So I take care of people that have a whole host of brain and spinal cord issues. So they can have strokes, epilepsy, seizures, multiple sclerosis, Parkinson's disease, headaches, back issues. And one of the things that I realized pretty early in my career and I've been attending now for about six years, is that the biggest impact that I had on my patients wasn't in prescribing medications or taking them to the operating room for epilepsy surgery. It was really when I got them to think very differently about their health, their life, and even whatever neurological disorder was going on. That's where you truly empower people. And so I think in terms of taking care of our neurological health and really reaching our full neurological potential. There things that we can do that we'll certainly talk about. But the first thing that we need to do is to change the way that we think on a regular basis.

Dr. Berry: I love it. Let's talk to them. I love the mindset. Let's go.

Dr. Philippe Douyon: So every thought that you have gets wired into your brain and the more you continue to have those same thoughts, the more hardwired it gets into your brain. And whether those thoughts are positive or negative. And for most of us, we've got a default mode where we get a lot of negative thoughts throughout the day.

Dr. Berry: Why do you think is the defaulted that way? Is it just nurture? Is it just, what do you, if you had to…why?

Dr. Philippe Douyon: There's a couple of things. So I tell people all the time that the primary role of your brain is twofold. One, it is to keep you safe and it is to get you moving. So let's talk about the first one to keep you safe. So in terms of keeping you safe, it means to minimize your risk. It means to minimize the potential that you're going to face danger. And for a lot of people, that means doing the things that they are used to doing because they know what the outcome of that thing is going to be. Right? So even when you talk about careers. People will stay miserable in a job forever because they have the security of that paycheck that comes in every couple of weeks. They have the security of whatever benefits that they get. Instead of really following what they are passionate about. And part of that is because they're trying to minimize their risks.

Dr. Berry: So your brain will essentially say, you know what, I don't want you to try this new thing because I'm not sure what's over there.

Dr. Philippe Douyon: Right. And we see that play out all the time. People take the same way home every single day from work. So the point that they can't even tell you how they got home. They went to sleep while they were driving which is potentially dangerous. So people do that in every aspect of their lives. They stay in relationships that are not healthy because they are scared of being alone. They're scared of potentially not being able to find somebody else. So people operate from the perspective of fear often. And so it's really about changing the way that we sing and recognizing that the best thing that you can do for your brain is actually just switch things up from time to time.

I'm a big believer in that you need to reinvent yourself every five or six years. I was giving a talk at a conference, a neurological conference about two weeks ago in California. And one of the speakers got up and said how he's been working on the same research for 50 years. And I thought to myself, oh my God, like you have been doing this same thing for 50 years. Oh, how incredibly boring and unstimulating and unchallenging does that. And I think when people make the same decisions every day, they take the same actions every day. And what I find most interesting is that then they turned around and asked, why is my life not changing? They have the same thoughts, make the same decisions, take the same steps every single day. And why is my life not changing?

Dr. Berry: You know I love that because I think a lot of times people think that it's just a "self-conscious". But you're breaking it down to the point that, no, this is like hard wired in. This is down to the tissue saying no, chemical wise, no, this is why you're doing the same thing over and over again. It's not a lack of willpower. No. Your brain is literally saying like, nope, you're not going to go that way because you don't know where that way goes.

Dr. Philippe Douyon: Right. And when we do new things, that's when our brain actually makes new neurons, makes new nerve cells, makes new connections. That's when we truly expand on the potential that our brains have and that our lives have.

Dr. Berry: And I love that of course I'm probably on social media so I know a lot of times you'll post a video where you're just in different scenes and you tell the viewers just focus on the scene behind. Don't even really like look at me, just focus on what's going on back here, just to generate new processes going on. So I guess, I'm definitely with you as far as this process is concerned. Now is that something that ledger path as far as the motivation? And the reason why I ask, especially Lunch and Learn listeners who may not, most physicians, we're pretty mundane. We're pretty boring. We pretty much do the same thing. Go to work. We prefer, we're hardwired to do that as well. You're in a situation, especially as a neurologist, which is very interested in, you do a lot more different things that I would expect from a neurologist. So let's talk about The Inle BrainFit Institute. I want to talk about that motivation. What was that about? Because I'm always enamored when I see physicians go a little bit different direction. Usually because their colleagues don't go, they get looked at as weird. What was that about?

Dr. Philippe Douyon: So I think part of it kind of hit the nail on the head as doctors. Even though people on the outside would say, oh, you know, their jobs are so intellectually stimulating, they're making decisions that impact people's lives. All which is very true. But I find that us doctors, we actually don't learn new things. And often that thinking that we do right is billions of dollars that goes into research that you can deduce just by logical reasoning. And oftentimes they do the same research over and over.

Dr. Berry: Lunch and Learn community, remember you can't see me but I'm literally shaking my head and I'm like, yup, yup. You're right. Yup. Yeah.

Dr. Philippe Douyon: So we fool ourselves into thinking that we're learning new things even though that we're not. And we're not learning anything that's going to impact the lives of our patients today. If we're lucky, maybe it's used from now. And what I had realized was, like I said before, it was really where I had the biggest impact, was about getting people to change the way that they think. And getting people to exercise on a regular basis, say eat right, to find ways to minimize their stress, to constantly learn. Those were the things that when I was talking to patients about, that worth having the biggest impact on their lives. Because for most diseases out there, there are no cures. And we did debate why there are no cures for a long time. So we'll leave that for another topic though. But there are no cures.

But you can make symptoms better with a lot of lifestyle changes. And even if you couldn't with lifestyle changes, just by changing the way that we think about whatever disorder or disease processes affecting us can have a significant impact. And I know that both personally as a patient who's had kidney disease since he's been 18 and I know that as a provider. So for me, when I was first diagnosed with kidney failure, when I first had a kidney transplant, that was a really difficult time. I mean, I was angry, I was frustrated, I went through the why me, I did everything right. How could this happen? For a while my identity was wrapped up in my diagnosis and it wasn't until I started changing the way that I thought about myself and what was going on with my body that my life started to change.

And so, well, you know, I'll very openly say yes, I've had a kidney transplant, about kidney disease. There are times there are bumps in the road. And I sort of have to go back in for some maintenance work. But my identity is not wrapped up in that. That is just part of my story. And it's getting patients to see that for them also. Their identity is not wrapped, in whatever disorders affecting them. That's just part of who they are. And it can be a small part or it can be a large part. It's really part to that. But getting them to see that there's so much more to who they are and the only limitations on their lives is the limitations that they place on themselves.

Dr. Berry: I love it. Especially shout out to the osteopathic physicians where I think A.T Stilll talks about, not defining your patients as , oh this is my diabetic patient. No, this is a patient with blank. And understanding that they are still a person. Because you're still a person, you know, you still have the issues going on here. You just happen to have whatever disorder you happen to have. So I definitely love the fact that you're able to even, especially at that age. Because you said at 18, right? And usually that's not an age where you're thinking that way. You're usually thinking of other way where you're angry, you're questioning, you're wondering why me. Usually that's the normal mode. Because I've got some older adults who I still can't get them to break out of that mode. So I definitely commendable that you are at least able to mentally make that mind shift that said, you know what, this is…

Dr. Philippe Douyon: Process. That is doing some hard work and realizing wait a second, my life is not what I wanted to be. And recognizing that the problem is not necessarily everybody else around me. It's in the way that I'm thinking about what's going on in my life or whatever my life circumstance has happens to be in that moment.

Dr. Berry: And as far as your institute, when did that come about? Why did it come about? Because again, the concept is what's so interesting to me because again you're I guess putting the brain first. Which is something you would think, but it doesn't happen unfortunately.

Dr. Philippe Douyon: Yeah. So the wishing that came about is actually pretty interesting. Because I was two and a half, three years into being an epilepsy, attending of private practice. And I had grown my practice part of the practice significantly large. So the practice is like a tristate area practice, 20 epilepsy specialists, full of neurosurgeons and neuropsychologists and I was really one of the more successful doctors. Probably in the top two, top three successful doctors. The only one that was consistently more successful than me with the owner of the practice who started in the 1990s. And so they didn't really care for the direction the practice was going and was kind of like, is this it for me? Is this what my life is going to look like? I was watching some of my older colleagues at the time and seeing what they were doing and was like, I just can't see my life for me in this direction. Something needs to change. So I actually resigned, on the spot. No plan.

Dr. Berry: I bet your brain was like, what are you doing? What are you doing?

Dr. Philippe Douyon: My brain was like something, you should change it. And it was like slow down, you know? So the owner of the practice came to me and said, doc, even if half your patients go with you, it's so many patients that it's going to kill our practice. And he didn't know it was, I had no interest and at that point continuing to practice like a regular doctor. But he said to me, what is it that you want? And so I said, well I want the ability from a legal perspective to be able to open up my own neurology business. And so he said, fine. And he said, look, you do the epilepsy for us. And we continue to pay full salary pay benefits. You can open up your own neurology business and we'll even refer you patients. (Wow). And so I was like, alright. And I knew, I didn't want your typical neurology practice where patients come to see you for 15 minutes. You up their meds and you send them on your way. So I've created a program where we create individualized exercise regimens for patients based on their medical and neurological needs. One of my offices at the time was right next to a health spa. So worked out a deal with the health spa where my patients did work out. They're underneath my direct and indirect supervision and I would just program for them. That's how we got started and since then have been able to move it to online.

Dr. Berry: And what have been some of those benefits? Because I'm pretty sure as a neurologist, people are looking at you funny when you're saying no, no, no, I want to incorporate more than just the medications. I wanna incorporate a mental, their physical. I wanna incorporate all of these things while also dealing with the neurological thing I'm dealing it. What was that initial reaction from your colleagues?

Dr. Philippe Douyon: I think a lot of people were skeptical and they were like, you know, what is he doing? He does so well in this arena. Why would take this kind of risk? But I was seeing the benefits in in my patients. I mean there were patients with refractory epilepsy. Seizing on three or four different months and you get them to eat healthier and you get them to exercise on a regular basis. And their seizure frequency would go significantly down. I was able to take one person off their antiepileptic medications than just control it with diet and exercise alone. Their anxiety and depression would significantly improve. Headaches would go away. And so I was doing the research, checking the literature, and with every neurological disease, exercise is really important and exercise makes these diseases and disorders better. And I started to learn more and learn a lot more about neuroplasticity. Exercise is the biggest promoter of neuroplasticity there is. That is our brain's ability to adapt, to learn and to heal. And so exercise should be at the foundation, I think of any medical issue. I mean, when we think about the diseases that have gone up in the last 30 years, it is sedentary lifestyle, obesity, diabetes and Alzheimer's disease. I mean these are all lifestyle disease.

Dr. Berry: What I love about this is, and I think we would definitely want, I want to kind of dive deep in because you even wrote a book, right? Again, Lunch and Learn community members, I'm promised you this isn't your typical neurologist, right? This is the one who again, that's why I was like, wow, okay, hey, I think we need to like have him on the show. Because not only did you do that, where you started realizing I need you to incorporate the whole person. I need to incorporate how much activity are they doing, what they eating, when they're eating. I need to incorporate all of those things if I'm going to adequately treat my patient. You said, you know what, I need to do that. And then you wrote a book about it. Right? So, and then you alluded to it. Talk a little bit about this neuro-plasticity and the effects of exercise and everything else. And then let's talk about your book in general. What motivates you write a book? Because I know most of us position, right? We've got no problem writing journal stuff all day. And I joke to my colleagues all the time, I say, you know, all those articles, you write a great but your patients aren't reading that.

Dr. Philippe Douyon: Right. I don't know. It's very rare that I read an article in any journal where I'm like, oh, there's articles about say saving life. And maybe I'm just a little jaded, but I just feel like it's rare that that happens. I think it's more for intellectual curiosity than it is the actual curiosity. We used to think that our brains, we were born with our brains and our brains never changed over our lifetime. That if anything it as we got older, maybe that these age-related changes, some degeneration or some neurological disorder would take hold and that would have a negative impact on the brain. Or we have some trauma that would have a negative impact on the brain. But now we know differently. We know that our brains are constantly evolving, that they are really dynamic. We know that our neurons and nerve cells that were capable of making new neurons in their cells throughout the life. And that's really what neuroplasticity is about. It's about the things that have a negative impact and positive impact on the brain. The things that cause our brains to make new neurons, things that cause our brains to lose neuron causes dysfunction of neurons. And a lot of those things are within our control. There are things that we do on a daily basis.

Dr. Berry: What are some things that we do that benefit that and what are some things that we do that may cause some problems?

Dr. Philippe Douyon: Exercise has huge benefit. Being sedentary, not being physically active actually kills our brain cells.

Dr. Berry: Wow. Okay. Alright.

Dr. Philippe Douyon: Oftentimes when I go and I'm giving talks, I'll give the story of a sea squirt, which is sea squirt when it's born, it's a fully mobile tadpole. And it's got a full functioning nervous system, brain and spinal cord. And within the first 72 hours of its life, its primary goal is to find a place that it can park itself and never move again. And when it does that, its body releases chemicals that cause its brain and spinal cord to dissolve. And it's eventually left with like this rudimentary nerve cell as a brain. And we see the same things happen and people let me stop moving, everything start to shrink, start to atrophy. And so exercise is really important to combat that. And I've seen 90 year olds who are physically active who eat well, minimize stress. So those are a couple of things.

Stress is a big one. Stress kills brain cells, especially in the part of the brain responsible for memory. And so people will often come to me and talk about how they're increasingly forgetful and when you talk about the things that are sort of going on in their life, they are under chronic stress. And we're all built to have to enjoy a short burst of stress. Chronic stress is not good for any aspects of our body and certainly our brains. It doesn't allow us to make new memories and all that cortisol and junk and adrenaline is also killing neurons. That's another thing that's really important. Constantly learning. Doesn't matter how old we get. You need to be constantly learning. I've seen so many people, we've had the same job for the last 50 years, right? And they can be physicians, they can be four years they've been doing that same thing. They've done a great job in their field. Most people would tell you that they are brilliant. But they retire from, what they were doing and three months later they are like completely demented. Because their brains never had a significant amount of reserve. They weren't actually learning new information. It just got really good at doing what they had always been doing. And once they stopped that, it was like they just fell off a cliff.

Dr. Berry: What I love about this is because you're not mentioning like the alcohol and drugs, because that's what people always think. Which we know that it would cause problems too. But the fact that you're like no being sedentary, not exercising and being super stressed causes problems too. So I love that you're hitting home on those points. Because I think some of our Lunch and Learn listeners need to hear that. Because they need to hear like, no, no, no. Just because you think you avoid those couple things don't mean that you're not in trouble.

Dr. Philippe Douyon: You need to avoid those things too. Those have a negative impact on the brain. Alcohol and drugs. But yeah, other things that we do on a daily basis. I tell people all the time that we need to have different conversations with different people. If we always have the same conversation with people who I think the way that we do, that's not good for brain health, either. That's not going to solve any issues in our life. We don't necessarily need think with everything. But that perspective is invaluable. It gives us a different way of thinking. And because of that, that causes the formation of new neurons and new connections. So that's really important. And one place where we see that not having conversations with people who think differently from us, the negative impact that that has, that's in our current political system, right?

Dr. Berry: The first thing I was like, the folks who…

Dr. Philippe Douyon: The Republicans. They sort of stand their ground in whatever their ideology is. They don't talk to each other. So therefore there's no new solutions to any problems. So talking to people who think differently from us is incredibly important as well.

Dr. Berry: Talk about the book. What was your initial thought process? What was your goals when you first decide and say, you know what, I'm going to write a book. I'm gonna write a book. Because of this theory, but not really theory, just practice of action. Like what was that like? Especially as a physician because I'm always intrigued at my physician colleagues who go out the box because I know what it takes to do that.

Dr. Philippe Douyon: So for me, the inspiration for the book was definitely the patients I take care of. People that I serve in general. And when you think about neurological disorders and the devastating impact that it has on patients and their families. But I've spent the last, I don't know, maybe 10 years, 11 years when you include my training. Seeing how people with devastating neurological injuries have risen up, that they have fought for their life, they've fought for their independence. A lot of them have not let their diagnosis sort of define who they are. And so they were really the inspiration. It was the patients that were doing the work every day to change the neurological destiny. To change their life and to create their own life. And so, they inspired me to write this book and it was about why the things that they do have, the impact that had has.

Dr. Berry: And for a person who is going to be going to be picking up this book, what should they expect to get out the book? In your mind when you were writing it and you're finishing it, if you had to point to one goal from the book, what would you say that would be?

Dr. Philippe Douyon: First of all, I would say this, that one of the things that I've learned in writing a book is that a book is never actually finished, right? I mean, there was actually supposed to be probably another 10 different sections to this book. But when you're talking about things that have to do with the brain, for a lot of people, that's scary and that can be complicated. And so you don't want this massive book that people are going to be like, oh my God, I can't be that. Because book is never really finished. It's just when you decide, okay, this is it for this part, yeah, I'm going to put this part out first or if a publisher comes or whatever the case. But the thing that I want people to really take away is I want people to have a completely different relationship with their brain than they've had before.

I think for a lot of people, they don't give their brains much thought until something goes wrong. And our brains are like our muscles. If you want it to grow and evolve, you have to stimulate it. You've got to do so in different ways. You've got to take care of your brain. And my sort of tagline for my company, it's on all our t-shirts. It's actually on this t-shirt and our wristband, it says "One brain, one body". Everything that your body, the way that you treat your body impacts your brain and everything about your brain impacts your body. And people don't necessarily realize that that is the case. A lot of physicians don't realize it either. So I'll get call it to see somebody who's had, whether it's high blood pressure, diabetes, Alzheimer's or disorder for years and that'd be like, oh, they're having some issues with their brain. And it's like, yeah, because this high blood pressure, diabetes or inflammation not only impacts their body has a significant impact on their brain and it's been damaging their brain this entire time.

Dr. Berry: So the segue, when we talk about bringing health, and I'm such a big fan of physicians who go a different direction. You have your institute where you focus on the overall wellbeing of health. You have your book where you actually wrote a book, because most physicians don't write books unless they're writing it for boring conferences that none of our patients actually go to. But then you went the next step and say, you know what, I'm going to create an app as well. Tell us the motivation behind the app. And ladies and gentlemen, the app is absolutely amazing. Is an IOs, is on the android platform. Please download it. Of course the links will be in the show notes for you to get that. Give it to your kids as well too. This isn't just an adult app. Kids can play in this app too and have just as much of a great time. So talk to us about the app.

Dr. Philippe Douyon: Yes. So the book is called Neuroplasticity: Your Brain's Superpower. The app is called Dr. Douyon's Brain fit. And believe it or not, actually I don't play games. But I wanted a really fun way to teach people about how to food and exercise and other lifestyle choices impact your brain. And I thought a game would be a really great way to do that. Especially because everywhere you look, people are on their phones doing something. Either in the bus, they're on the train. They get a minute of free time, they're on their phones. And so I wanted to meet people where they were at. I wanted to find a really fun way to teach them, to influence their health and just get them to live, sort of help you lives. And I've used this app as a learning tool where I'm teaching students. So kids like elementary school kids, high school kids, and even full-fledged adults went on when I'm talking to them and everybody seems to really enjoy it.

Dr. Berry: What has been some of the results? Is this something you incorporate as an overall process from a treatment plan with some of your patients? Is this something where you say, you know, I think you would definitely be much more apt to kind of going this route and using the app and kind of using that I guess the part of the brain to learn and to build up your brain? Like we exercise and we build up muscle when we're gaining weights, building up the brain is just as important.

Dr. Philippe Douyon: I think games serve different functions and I think games are very much like books. You have different genres of games. And so this game, this app is definitely a puzzle game. It's a matching game. So you get to match healthy foods and healthy activities and as you match and as you go through the levels there questions that come up related to that particular level of that particular disease stages. People learning about that disease and how exercise impacts those diseases. So you know it's not necessarily. I don't make any claims like, oh this is going to improve your cognition, it's going to improve your memory here or anything. I prefer to think of this like, you know, when patients come to us and maybe you give them material to take home or even better than that. Patients come to us and we're educating them in the office.

But we are educating them about their diseases or their medications during a very stressful period where they are stressed out about what they are going through and how this is going to impact their life. Oftentimes a lot of physicians will use a lot of medical jargon and people in general don't understand healthcare with the way that they should. They're sort of healthcare illiterate and by no fault of their own, the system is sort of designed that way. So I think with the game, you meet people where they're at and you allow them to, when they go home on their own time, on their own terms, they're able to go back and access information that's going to effect the potential disease that they may encounter. And so the levels to this game includes sedentary lifestyle, includes hypertension and diabetes and works its way up to things that we think of as primary neurological diseases and the last level, level 40 is Alzheimer's disease. And the entire time they can just go in there and about how different foods and exercise and stress has an impact on all of this.

Dr. Berry: I absolutely love it. So before I let you go. I like to call this my promotional period. Because we highlight so many different physicians like yourself are doing so many amazing things like yourself. I want to make sure that I allow that time to say like, hey, what are you doing? How can people get in contact you? How can they get into your world? So let us know, is there any more books? There's any more courses? What's going on? And how can someone be intertwined with you?

Dr. Philippe Douyon: So this book that just came on in April, Neuroplasticity: Your Brain's Superpower. The game Dr. Douyon's Brain fit that actually came out in November. I'm currently co-authoring another book now about perception with actually as a psychiatrist. So it's written from the perspective of a neurologist and a psychiatrist and it's about how we perceive the world around us and what influences our perception. I am working on creating an online learning platform for people so they can learn about their health and all the different things that impact their health. And so we've got a couple of couple of big things in the works. And The Inle BrainFit Institute, what we do is we create individualized exercise programs, continuing to grow that so people have all of those things to look forward to.

Dr. Berry: Perfect. I absolutely love that. My last question I always ask my guests before to get out of here is, and obviously you hit home a lot of the points throughout. But how is what you're doing helping to empower others to take better control of their health?

Dr. Philippe Douyon: I think our current healthcare system is a very passive one. I mean, people come to see us, it's like, alright, take this pill. They don't really have to do anything but take a pill. And we know that at best it's a Band-Aid approach. It's not really curing the underlying disease process or it's like let's take them to the OR. But it's not anything that they're actively doing themselves. And I think when you get people to move their bodies and get them to exercise, when you teach them about food, when you teach them how to minimize their stress, because they're learning, because they're actively doing, then you're truly empowering them. And I think when people aren't empowered, they can reach their absolute potential. They certainly can reach them neurological potential. They get a lot more creative. They sort of take their lives by the horns. And so I think we're really teaching people just how truly powerful they actually are. I get to see the brains of people from all the world, all religions, all cultural background. Everybody's brain looks the exact same way. And I think what that means too is that we are all capable doing really great things. All we need to do is remove the limit, the limitations that we put on ourselves and that society tries to put on us. And once we do that, I think yeah, we're capable of being truly great everywhere.

Dr. Berry: Absolutely love it. Absolutely love that answer. Phenomenal. How can others get in contact with you? What are your websites? What are you links? What are your socials? What's going on? How can they reach out to you, follow you and go mission with you?

Dr. Philippe Douyon: They can reach out to me through email. So [email protected]. They can reach out to me through my website, www.inlebrainfitinstitute.com. All one word. They can find me on Instagram. So they look me up. Just look at my name, Philippe Douyon, and they'll find me on Instagram. At Twitter, its @PhilippeDouyon. And they can also find me on LinkedIn and Facebook.

Dr. Berry: Love it and again, members and listeners, all of these things will be in the show notes so you won't have to go far. And he's definitely, again, I know you guys thought, what is the neurologist going to tell me about my health? And clearly there's a lot, right? And I absolutely love that aspect of it. Even down to the neurological fiber, if you don't take care of yourself and especially from an active approach, if you aren't actively doing something, problems can and will arise and are rising because we aren't doing it. So Dr. Douyon, thank you for really helping the Lunch and Learn community members turn another chapter in their pursuit of learning and I'm helping them understand that from a neurological standpoint we stood out a lot of work to do, but we can do it.

Dr. Philippe Douyon: Absolutely. And the power to change our lives is certainly within ourselves, within the way that we think. And our brains are capable of a tremendous amount of greatness and creation. So you gotta make sure we take good care of our brains.

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On this week's episode of the Lunch and Learn with Dr. Berry I sat down with Dr. Cecily Clark-Ganheart. Following up last week's episode, we have Dr. Cecily's story who like many has had trouble with weight issues after childbirth but found a way to change her lifestyle for the better. In the discussion of healthy dietary change, the topic of Intermittent Fasting has become increasingly popular. With the popularity of a "new" lifestyle, we need expert opinions on what is safe & what isn't so Dr. Cecily has taken the time today to educate the Lunch and Learn Community.

By training Dr. Clark-Ganheart is certified both in Maternal-Fetal Medicine and Obesity Medicine and once she was able to incorporate Intermittent Fasting into her lifestyle and lost over 50 pounds. During the episode, we talked about all of the common misconceptions about intermittent fasting, who would benefit the most & who should stay away from the practice. You also find out how many hours does Dr. Clark-Ganheart fast (you won't believe it).

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• Furmili S. ER, Ramos M., Fung J. Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. BMJ Case Rep. 2018.
• Varady KA, Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Haus JM, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12(1):146.
• Eshghinia S, Mohammadzadeh F. The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women. J Diabetes Metab Disord. 2013;12(1):4.
• Dunlop EA T, AR. mTOR and autophagy: a dynamic relationship governed by nutrients and energy. Semin Cell Dev Biol.36:121-9.

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Download Episode 122 Transcript

Episode 122 Transcript... Introduction

Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and promotion. This week we are talking about intermittent fasting and have amazing guest, Dr. Cecily Clark-Ganheart, who is Board Certified in Maternal Fetal medicine, Obesity Medicine Specialist. And she's going to talk to us about how to incorporate intermittent fasting in your nutritional lifestyle change. Guys remember the theme for the past few episodes has been about nutrition and making that nutritional transition in your life, to live a longer, healthier life. Because that's always the goal. And I wanted her to come on this podcast because I have a lot of guests who have inquiring about intermittent fasting. Some of the pros, some of the cons, some of the benefits associated with it.

So I said, instead of me just telling you what I know from an internist standpoint, let me tell it from someone who's actually in the trenches physically. Actively doing it as we speak and having so much success to the point where she's lost over 50 pounds incorporating the lifestyle of intermittent fasting, low carbs. And guys, she fast for 18 hours a day. So again, first of all, full disclaimer. You do not start going all the way to 18 hours fasting. You have to work to get there and we're going to talk about that mental process and that mental transition of working up to get to the point where you can actually fast for 18 hours a day, lose 50 pounds, still incorporating a great diet. Things going to be another one, things going to be really highly requested because of the amount of gems that gets dropped during this episode. You guys are definitely in for a treat. Of course like always make sure you subscribe to the podcast, especially if this is your first time listening. Again, appreciate you listen to the show today. But if this the first time listening, subscribe to our podcast. Leave five star review. Four star review is okay. With five star review, letting us know how we did about today's episode in our discussion on intermittent fasting. Again, you guys have a great and blessed day.

Episode

Dr. Berry: Alright, Lunch and Learn community. Just heard another amazing introduction from a guest who I'm actually very interested to talk to, especially for us subject as when we talk about nutrition that we've been doing for the past couple of weeks. I get a lot of questions about fasting and is it safe and what can I do to better my chances. So I say, you know what, let me get someone who, this is what they do. This is the expert. This is their field per se. Let me have them answer it and see if we can get there. So again, Dr. Cecily thank you for joining the podcast and getting ready to enlighten us because I know you're about to do that. Again, I'm excited. Like I said, you've been highly recommended. I just want to say I have had a few people are like, no, no, no, no, you gotta give a passing doctor on the show. That's what it gets.

Dr. Cecily Clark-Ganheart: I'm happy. I'm excited to be here. And I love talking all things intermittent fasting and just how it pertains to health. I think it's a tool that people don't really think about and it's highly underutilized and it can make such a big difference in health. Dr. Berry: I love it. So we did a little bit introduction on your bio, but I do have listeners who like to skip passing, get right into the meat and potatoes. For some of who may have read a bio and then they are like, that's great and all that. What is something that may not be necessarily in your bio, but you want people to know about you and your journey?

Dr. Cecily Clark-Ganheart: So what's probably not in my bio, my bio does talk about, and I won't rehash, it talks about my own health journey and things of that nature. How I got into intermittent fasting. It was basically the only thing that I hadn't tried before in order to lose weight. And then also combine that with the lower carb approach. And so for me, I found it worth very well. It was the first time that I had long sustaining weight loss without feeling like I was on some strict regimented program where I had to count calories or worry about stuff like that. And so for me, I think just in general there's a lot of misconceptions about intermittent fasting and I'm sure we'll get into some of those later. But it really is easier than I think what a lot of people make it seem like it really isn't that complicated.

Other things that I encourage people to do and that I've gotten into myself that's not in my bio, I think you also have to pay attention to the role of gut health. Just overall in our physical health, the gut microbiome. Some people say, our GI tract is like our second brain. There's so many different disease processes and signals and changes that all start in the GI system. So I think doing other like healthy eating habits to support a good micro biome is also important. So for myself, for some examples, I like to do fermentation and I like gardening and I ferment my own stuff at home. One, it's cheaper. Two, it's better than taking a probiotic because the probiotic can't compare to what you're getting in a natural from it for people used to eat all the time. And it's really easy. And I encourage people, once you start refining your nutrition, I encourage you to look at some other more quote unquote ancestral ways of eating and just see what people did before industrialization because all of the diseases that we are treating now in the medical system really are modern diseases. They're diseases of industrialization. So we used to die of different things before industrialization. (I love it). Now we're dying from a whole host of different things that have just been created by us thinking that we were outsmarting nature.

Dr. Berry: Well especially because it's so interesting because first of all Lunch and Learn community, I need you to follow her Instagram because she actually will show you the fermenter process. So this isn't something that she's just talking, she shows you, oh see this is what I do. Now of course when you first look, that's interesting. But when you just listen and understand the process, okay. Because I think that's what always gets people anytime they have to make any type of change transition. Just that newness of it is very difficult for people. So when we talk about just fascinating, and even though like the fermentation and all that, when you hear those words, they're like, what does that mean? You mean I can't eat? That's always a big thing, right? I can't eat. So for a person who says, you know what, maybe I'm thinking about your intermittent fasting, but what is it? What would you say to that person?

Dr. Cecily Clark-Ganheart: So the easiest way to describe intermittent fasting is just, it's a period of gut rest. It's a period where you are not intaking any food. You can drink water, but nothing with the caloric content that just allows your system to reset. That's how I like to describe it. Now, there's several different things going on when we say you're resetting your system. But it really is just simply, you just not eating for a period of time and you pick the period of the time. That's the beautiful thing. You decide how long you want to go for without eating. And that's why it's different than starvation because when you're starving, you don't get to choose when you eat again. You're praying that food comes around so you can eat it. With the intermittent fasting, you can eat whenever you want. You're just making a conscious decision that you know what, for 12 hours, for 16 hours, for 18 hours, whatever you set your schedule to. I'm going to allow my body to actually have time to repair itself, to lower my insulin levels, to do some other beneficial things that my body's not able to do if I'm constantly eating every two to three hours all around the clock.

Dr. Berry: What's interesting, especially when people hear about the intermittent fasting, the time is always one of their biggest markers. It's usually how long I gotta do it and what can I eat when I'm not like or drinking on that process. Do you have any, especially when we talking about the different types of intermittent fasting, is there any pros and cons one way or the other in terms of if someone's a beginner or someone's on late stage? What would you, especially in the beginning stages for sure?

Dr. Cecily Clark-Ganheart: Yes. I think if you're just starting off, probably the easiest to do, especially if you are used to a lot of nighttime eating and again, if you're a constant grazer, honestly starting off with just like a sunset to sunrise fast might be the easiest place for you to begin. Because I think it's intimidating for some people to hear that, oh my gosh, I have to go 18 hours without eating. One big thing to keep in mind is that sleep counts is fasting. So sleep! Use that time to not eat. So that's saying that you're going 18 hours starting at 8:00 AM. Do you know what I mean? All while you're working in things, if you stop eating by 7:00 PM and during the summer hours and early fall, it's still going to be light outside. That counts is eating. Getting your last meal in before dark.

So if you just did 7:00 PM to 7:00 AM that's 12 hours and you'd be surprised how many of us don't even go 12 hours without eating. That seems that should be natural. But if you are eating at nine, 10, 11 at night or say you ate at 8:00 PM but before you go to sleep you have to drink, name some sugary beverage, that's not fasting. It's your drinks too. If their calories in it or artificial sweeteners, all of that is not counted as fasting. So for a lot of people, if they can just begin with not eating after dark and waiting like even an hour or two after waking up in the morning before eating something, especially if you're changing your nutrition, you're going to see benefits. And so then after that, if you start with that as your foundation, then you just basically start extending after that.

So if you ate at 7:00 PM the night before, instead of eating at 7:00 AM the next day you push that back a few hours. That's how you're going to get your 16 hour fasting. And then keep going from there that you can get up to your 18 hours. There's all sorts of different terms. There's one meal a day. There's people hear about the five two diet, which is just a play on intermittent fasting. There's several different things that you can do, but I would say rather than getting caught up in which method you're doing, just start with 12 hours and then as you noticed, you're not hungry. The next thing I tell people, if you're not hungry, don't eat. So don't eat at 7:00 AM just because it's been 12 hours.

Dr. Berry: Because it's like the clock watching and in a second… (Exactly). 7:01, alright I will not going to eat.

Dr. Cecily Clark-Ganheart: Exactly. But then I would ask you before you do that, are you hungry? Because if you're not hungry, why are you eating? And that's the whole thing. You have breakfast, lunch, dinner, two snacks and I got to eat on clock. Oh it's time to eat. Whoever told us in nature it was, this position of the sun is time to eat. You ate when you were hungry. So I think by starting just with that concept and getting to know true hunger cues that's going to help you just become a natural, intermittent faster.

Dr. Berry: What I love that you talked about is, because I think a lot of times people will say, well I didn't eat anything. But then they'll neglect the fact that drinking soda, I was drinking juice, I was maybe I had a nibble here and there and we don't really realize how much we're actually eating and drinking after seven before seven. So I think sometimes is having that eye opening experience, wow, I'm really eating a lot after the times where I probably really shouldn't need to eat. Because I know a lot of my patients that was always that big, oh, I gotta have something before bed. I gotta have a snack, I gotta have something. It's something that they, quote unquote had to have that we'll tend to get them in trouble. So I love that aspect of just starting when the sun goes down, when the sun goes up, this kind of seat. That way they're not clock watching per se, because again, like I said, that tends to happen. The second they realize 7:01 hits, all of a sudden they're running for a meal. And I asking themselves that question, I wasn't actually hungry or was I eating because I'm quote unquote allowed to eat.

Dr. Cecily Clark-Ganheart: Exactly. And so that's the thing. I mean it's about getting used to your true hunger cues. The other problem is because of a lot of the sugary-refined processed carbohydrates our hunger cues are truly off. And so I do this with my kids a lot too. They'll run up and they're like, I'm hungry. I'm like, okay, here I have like the fish that we made and Broccoli, there you go. Oh I don't want that. All right. I guess you're not hungry. Because if you're hungry, you're getting eat what is in front of you. Right? I know when I'm hungry, maybe I would have preferred a salmon young for dinner. But you know what? That cabbage right there looks good too. And that's what we have. Somebody eat that, you'll eat when you're hungry. And so I think if you can get up or if you're picking at something and you're like, blah, blah, blah, or if the phone rings and now you're distracted for 45 minutes and now you're no longer hungry, you realize that that wasn't a true hunger cue either. And so what I noticed a lot for myself and people that I work with is that when they start intermittent fasting, the thing they say is, I thought I would be starving at the end of my window and I've actually not. And so that's when we start having that conversation. What do you want to go longer? Because if you're not hungry you don't have to break just because it's the time. I'm giving you a time just because a lot of people do better with goals up front. Something very finite, but it's people realizing that once your insulin levels are coming down, once some of these other factors that mediate hunger, like growing, you know, or decreasing and etc. You don't have that urge to constantly snack either. And a lot of people are surprised by that.

Dr. Berry: It was interesting, you talked about hunger cues. Does the fasting help modify them or does it, are we able to bring it to light and say, well see, were you actually really hungry or is because you're fasting now as you're hungry. How would you say that the hunger cues are affecting? And we'll even go back a little bit further. For Lunch and Learn community, you may not know, what are hunger cues and what are some of the things that you've seen, especially with the clients that you work with and even self as affected in one way or the other?

Dr. Cecily Clark-Ganheart: Yeah, so I think the hunger cues, when we go back and we're talking about the gut, there's a lot of signals and different hormones that originate the gut that then provides feedback back to the brain to mediate hunger or not. I think of the famous experiment with the dog and the bell where it's like every time you were going to feed the dog, you ring the bell. And so then all of a sudden all the same physiologic processes would start happening if you rang the bell but didn't give them food. And that is an example of how our hunger cues can get intertwined with things that are external cues that aren't necessarily your body truly saying, I need to eat right now for nourishment. So it's just time or think about other things like stress.

Stress eating is a big thing. But you're not necessarily hungry when you're stressed, but you may eat when you're stressed because it either gives you relief, it either pacifies you with sugary food. Again, stress eating, usually you're not stressed eating out on Brockway, right? You're doing it on high. I mean probably not. You're better than me. That's not what I should say. You're stressed eating on things that are typically poor quality nutrient foods that have a high glycemic index that are very sugary and sugar triggers a reward response in the brain. So this may be getting a little too geeky, but I mean there's a chemical called dopamine. And so if that is stimulated that its makes us feel good, we feel better. So sugar can do that, but then that feeling goes away and I'm stressed again.

Okay, now I feel better that I had that piece of cake. Okay. But I'm still stressed, better than I had that extra. And so it can become vicious cycle like that. So there's so many other external stimuli that we are either getting rewarded from or mistaken as hunger. And unfortunately they tend to be the foods that are not the best for us. Then if we're talking about internally, some of the things that intermittent fasting can help do over time. We've already talked about insulin and that's also the same premise behind lower carbohydrate way of living or Keto in general. If you're not having to stimulate your insulin as often, you're going to have lower levels of that in the body. Insulin in itself, it signals storage so you can have a hard time getting rid of that or different things like that.

If your insulin levels are chronically high. So with intermittent fasting, if you're not eating, those levels are coming down. In turn, those work with other hormones in your body that when they're high they tend to produce hunger or produced cues to eat. By lowering those, because you're not eating as frequently. That's why we think any way people are not having that constant feeling of hunger because people will tell you the longer they fast, the longer they practice intermittent fasting consistently. Also if they are improving their nutrition, I still think nutrition is important as well in all of this. Over time they're less hungry and that's just uniform around the board.

Dr. Berry: It is very interesting because I just recently myself went to a low carb Keto lifestyle type and you hit it right on it because really thought like I would be, because we ate a lot of rice versus everything else. I don't eat that no more. I really thought I'd be starving, but I get that's really not the case. Which is still surprising to me that I'm like wow, I guess I'm not as hungry as I as I though because I would remember the opposite where I'd feel like, oh I didn't have a meal. My meal wasn't quote unquote complete if it didn't have rice, especially rice. I always felt like, oh this meal, I'm not even quote unquote full yet.

The fact that I essentially token out away and that felling is in air. That was definitely a very interesting point as well. Because there's always gonna be attracted, right? Regardless of whatever lifestyle change you have. And I'm pretty sure you heard every reason in the book at hand. But I always get people when we talk about anytime we change it, is there any evidence behind it? They don't really read them but they always want to know of this type of evidence associated with fasting. I want to talk about your personal journey just in general just so we can kind of get that out the way.

Dr. Cecily Clark-Ganheart: In terms of the evidence, so there is a lot of evidence for intermittent fasting. And so when we say intermittent fasting, again the research has looked at different fasting protocols. So for instance, you have animal models. Sometimes people are like, oh that's in rats and I'm not a rat. And I get that you're not a rat. But I mean also you don't necessarily want to start testing out something on six week old infants either. Right? So you got to start in the lab somewhere. I mean it's for human safety. But looking at the animal models, several studies have shown when you do kind of like the Ad Lib Diet basically meaning kind of how most of us prior to intermittent fasting kind of function. Ad Lib meaning you eat whenever you want and what you want as much as you want.

And so for some reason you decided to stop. So mice will do the same thing. So if they have chronic access to food, they've looked at their metabolic changes versus when they intentionally restrict the periods of time that the mice can eat. And so that's where they first started seeing some of these improvements in micro neurologic function in terms of rats that were showing maybe some signs of like Parkinson's disease and other neurodegenerative diseases weren't showing it as much as the rats who ate all the time around the clock. Looking at different inflammation markers that are associated with condition called metabolic syndrome, which basically several different conditions. They were showing that those inflammation markers went down, that they were having less visceral fat, which is basically fat around your abdomen. Central obesity as well as what we also call it. Those studies have shown that there are at a cellular level. There is something going on with the intermittent fasting.

That's where some of this research and at term or concept called autophagy has come into play, which is a basically a self-healing mechanism that the body uses to remove damaged proteins. Well, the body can only do that when it's not overloaded. But if we're eating all the time, the body is spending all its time in the feed state processing, so you're not able to get those levels. So that's where they think some of the therapeutic benefits of fasting come in. While this is not, I guess, science, if we just look at human culture throughout the ages, every major religion has fasting as a part of their dots. If you're looking at, I'm not gonna promote, tell people one religion versus the other, but I'm just saying if you look at religion in itself, a commonality is fasting and prayer.

If you were ill, you needed to fast for a while. We're now starting to see some of that adamant, you're a level, why that doctrine actually does make sense to have a period of time. And you'll see people quoted through history, Benjamin Franklin, one of best medicines, rest and fasting. I mean, people would set this off. This is not anything new. It's just we forgot, because we were more sophisticated now, whatever. And we have access to a lot of foods. So then to take it out of using that as a bridge to get into. You have human studies as well. One of my favorite ones, and I'll send you the link for it, talks about intermittent fasting in normal weight people. And so even though you know the clientele I've worked with, my patients are going to be overweight or obese.

I like this study because there's this concept that once you hit goal weight or normal weight, whatever that is for you, now you stop fasting. Because if you fast at a normal weight, now all of a sudden you have an eating disorder. But if you're heavy, it's okay because you got to get rid of that fat. But like once your BMI hits normal, why are you fasting? So this study was actually done in people of normal weight or who were just slightly overweight and they did a variation on alternate day fasting and they saw improved metabolic markers still because just because you look a certain way, does it mean that your metabolism and your inflammation markers and all of that are where they should be. It's just manifest it how I might manifest it. So for me, if I go back to eating very high sugary foods, I can put on 30 pounds easily. That would not be difficult for me. Other people just they don't gain weight but they still could drop dead from a heart attack. And you're like why? What happened? Because it doesn't mean that you're metabolically healthy just because you look skinny.

Dr. Berry: That's always so funny because I think a lot of times people are like almost perplexed when they see on the outside looks fit, look skinny, that has all of these other hypertension, diabetes, all these other medical record. For some reason it should be that to the obesity aspect. Oh, that's why you have that. But when a person is an obese, for some reason, I can't explain why.

Dr. Cecily Clark-Ganheart: Exactly. And so that showed improvement in health markers for that. If we're looking at diabetes, granted it's only a study of three people, the reason the case series is impressive is because they took people who I belonged standing type two diabetes. So they were on insulin for years. And traditionally a lot of people are like, oh my gosh, what if I get diabetes once I go on insulin? Like that's it. It's just a matter of years before the amputation hits or before whatever hits. It's coming.

Dr. Berry: That's so funny. Because I don't know how many times I heard that. That is…

Dr. Cecily Clark-Ganheart: Yeah, it's just like people are like, oh well, all right, I gotta take this insulin now. I mean you might have to seek it for a little bit, but come on, let's look at your nutrition. So they did combined a low carbohydrate approach. So they weren't Keto per se, but they reduced their sugary intake. And then they did varying fasting periods and it was like, I think within nine months or something like that, I can't remember the exact time frame. Most of these people were off insulin and they were on high doses. Some on like over a hundred units a day. And they were able to come off insulin using a combination of a lower carb approach and intermittent fasting, which then goes challenged that dogma that once you have, and I'm talking about type two diabetes. Type one diabetes is a different thing that's a whole different mechanism.

But, so if we think of a type two diabetes is more of a lifestyle disease. They were able to show through changes in lifestyle that you were able to reverse that. And then there's several other studies that go over again, like autophagy and it's applications and potentially cancer therapy and protecting against some of the adverse effects of chemotherapy. So there's a lot of work in this area. And so I think to, for people who are referring to it, just as a fad. One, you haven't looked into it because it's not. There's actually evidence behind it.

Dr. Berry: What led you on the journey where you realize that you know what, intermittent fasting is for me or that's a way I want to go? And let's talk a little bit about your regimen. Because when I had Dr. Lisa Folden, she's been on the meal prep. And when I asked her, what are the issue that thing happens with meal prep. Is people, they Google and they see these images. Or they Google and they read stuff and they're like, oh, I can't do that. And that's always a big thing. Oh, I can't make my foods look like that. Oh, I can't stop eating for 12 hours. What was some of the events that led you on that path? What's your day to day now with that process?

Dr. Cecily Clark-Ganheart: So what led me down that path was, when I had my second son in 2014. At the time of delivery, I was around like 260, 264 pounds when I had him. And so I was like, okay, I had been diagnosed with metabolic syndrome after all of that. And so I was like, all right, well I need to do something differently. Okay, I'm pre-diabetic. So we already know where this goes.

Dr. Berry: Insulin, amputation.

Dr. Cecily Clark-Ganheart: So I was like, okay, that's where I'm going. So I need to, I'm only pre-diabetic right now so I can get a hold on it. So that's what led me realizing I needed to make a lifestyle change. The problem was after that I did more of the same thing because I really hadn't heard of intermittent fasting yet at that point. So I mean, I did lose weight. I started like your traditional calorie counting, working out, running all of these things. And so gradually I was able to get down to just around 200 pounds and then the weight just started coming back. And so I was like, I was doing everything that I thought I was supposed to be doing and then I'm gaining weight again. And then I was like, well, if I'm just gaining weight then why am I even doing this?

I gained more weight. So around that time in 2017 though, I was like, okay, really though I need to figure this out. And on the chat board actually is where I heard about a book called Obesity Code and that's by Dr. Jason Fung. So I pick that up and read it and it actually made sense as to what he was talking about. And so I said, okay, well I'm just going to give that a try. And in his book, it's not his focus really. He talks about nutrition a little bit. That's not the main focus. It's to get you to understand the mechanisms of intermittent fasting. So I started with that, but then subsequently read a book called Deep Nutrition by Dr. Cate Shanahan that discusses more ancestral ways of eating. And so in a more ancestral approach is going to be lower and refined carbohydrates. So it kind of all still goes together. So that's what led me to it. And then I was seeing results. For me, my typical regimen is closer to like an 18 hour fast each day. But sometimes I go longer or sometimes I go shorter. But that's typically what my period looks like. And then during my eating window though, I also don't snack or keep snacking to a minimum. So can I say I never have a snack? No, I can't say that, but I certainly make a conscious effort then if that day's going to include eating lunch and dinner to really mainly just eat a good lunch and a good dinner and not stack in between that. Because what we're thinking is if we're thinking that insulin has a role in obesity, and obviously there are other hormones, nothing's like that simple where it's X plus Y, you know?

I definitely admit that we're probably over simplifying some of the explanation. But at the end of the day, this is the premise of it. Every time you eat, you spike insulin. So insulin in itself, the insulin you make in your body is not a bad thing. It's just when you have it in excess. Because we need insulin to live. If not, that's where you start getting type one diabetes, right? So I mean, you do need it. But the problem is when you're needing it and increasing amounts, increasing amounts, and if you keep stimulating it all the time with frequent snacking, without doing gut rest, this leads to just higher baseline levels of insulin even when you're not eating. And so insulin signal storage, so signals fat storage, but it also can play into other signaling for inflammation. And then your high blood pressure or polycystic ovarian syndrome. I think of that as a disease of androgen. Excess meaning too many like meal steroid type hormones, which yes, but also insulin excesses at a key in that as well. So there's so many other things that insulin influences where it works in perfect harmony when your insulin levels are regulated and normal. But in excess, anything can be bad. Why? I still try not to snack during my eating window per se because I don't just want to keep. I don't want to do that.

Dr. Berry: Is there any issue during your period as far as foods you try to stay away from, during that period as well too? Or is it because it's my period and I can go and I can go in blank?

Dr. Cecily Clark-Ganheart: Agree. I still try to stay away from refined carbohydrates during my eating windows. So things that I'm going to eat are pretty much stuff that either grew from somewhere, or it's an animal, something like that. I've really tried to stay away from package food. And also I think a big misconception is that, diet pop is fine. No, those artificial sweeteners we see can stimulate worse than what just regular sugar would do. So it's not been saying, well I'm not eating. Because it says zero calories, but it still has that very sweet taste. I try to stay away from juices. I am not at my brother and I go back and forth on this all the time because he just lost his eyes at me. But I am not a fan of smoothies that you can tell me you make them however any kind of way.

Especially if you're buying them at a juice bar or something like that. Have you ever just blended pure Kale doesn't taste good. If that taste good, they have put something. I mean this is the thing or what I tell people is, think about an apple. So I don't know if you're having like a green apple smoothie or something like that. In a day, it is probably very difficult for any one person to eat five or six apples in a day. I eat one apple. But it's going to be difficult just for you to sit there and say, I'm gonna eat five apples. You could easily have apples in a smoothie. So again, I think there's a misconception that just because the sugar is natural, that it's fine. I think when we're eating fruit in its whole form, there's only so much of it that you're going to be able to eat. So you're still naturally limiting how much sugar you're taking in in a day. If you're eating it, you have to process all the refuge with it. You know you're going to get cool. But once you blend something, you can easily have two smoothies. Well how much went into that?

Again, I'm not saying have I not ever had a sweetened beverage, have I never had a pop since I've started intermittent fasting? No, that's not true. But I can tell you prior to intermittent fasting and changing my nutrition, it would have been nothing for me to have three or four diet drinks in a day. Thinking I was doing well because I was only having a diet drink and all of that stuff messes with your insulin. So on a day to day basis I try to stick with water, plain tea or coffee as the beverages I drink. I do brew my own Kombucha at home so I may have like a little bit of that here or there. I try to stick with real natural foods stuff not made out of a factory or plants.

Dr. Berry: I love it. Because I think you answered my next question as far as different types of lifestyle adaptions you can also apply while on the intermittent fasting. Because I would assume especially with the clientele you work with, when they initially start it's the time factor. The hurdle that they go over. I'm pretty sure you probably do just as much as education when it's time to go when it actually is time for them to eat. Okay. That is time for eat. I need you to kind of look at the type of foods you're eating as well too. I'm not sure if saying it would offset their fasting is correct. I guess that's probably a good question. Can you have a bad faster who may go 12 hours, 14 hours, but because of what they do with the rest of the time, it offsets some of the benefits?

Dr. Cecily Clark-Ganheart: So I think initially you'll probably see some improvement even if you don't change your diet right away because you're going to eat less of those sugary process carbohydrate foods. Usually if you're increasing the time between meals. So you may start to see an initial benefit. But I think we're, a lot of people hit plateaus from, because they aren't realizing, okay, now I need to focus on my nutrition. The other thing is because I see a lot of people who are hoping to become pregnant, we don't recommend intermittent fasting during pregnancy. So my thing is you gotta get your nutrition down because when you're pregnant, your nutrition is all that you have to control how much weight you're going to gain during pregnancy. Contrary to popular belief, we're all not supposed to gain 60 to 80 pounds when we're pregnant. You're having a seven pound, eight pound baby, where did 70 pounds go?

I was like that too. I gained like 60 pounds with my son who was only seven pounds, two ounces. Like, okay. Clearly he didn't use all of that 60 pounds that I gained. So the thing is, I think we need to also focus on nutrition because that there's so many other benefits to having a nutritious diet rather than thinking of intermittent fasting as a mechanism that you can eat whatever you want. Honestly, I don't even have people do extremely strict carbohydrate moderation. I think people automatically assume, because I'm seeing lowering your carbs. I'm saying, you can never have another carb again. And I'm like, that's not what I'm saying. I have people who do fantastic on 20 grams or less of carbs a day. And they might love it and they feel great.

I have other people who come to me and the first time I see them, they're eating 400 plus grams of carbs a day. I am not going to get someone in a week to go from and sustain because again, this is about sustainability. I'm not going to be able to get them to go from 400 to 20 grams all in a week's period. So what I find is that even just gradually reducing it and people, a lot of people are shocked. They're like, oh, you have people who really eat, a hundred, 150 grams of carbs a day and you add intermittent fasting and they lose weight. I'm like, yes. And they're like, but you have to do, I'm like, we took away a lot of the processed stuff they were eating and now we added periods of gut rest. You would be surprised.

The next thing I'll hear people say is, well, they possibly can't be in ketosis if they eat a hundred grams of carbs a day. Well, if you're 400 pounds and you add intermittent fasting and you're eating a hundred grams of carbs a day, I can pretty much guarantee you are in Ketosis, right? Because it's this state relative to each. By everyone body compass. So I think we get into a lot of things and that intimidates people where it's all of these rules. And I just go back to, if we kind of simplify it, I tell them they can still have carbs, but I want their carbs primarily to come from vegetables that are in low glycemic index. Then I want their dessert now to be fruits. So think of fruit as dessert. To me, dessert is not something you have to have every day. That's just me.

So if fruit is now becoming your dessert, you can still have it, but you're not doing that every day. And then you're adding a period of gut rest, which is forcing you to mobilize your own fat stores. And I think just doing those different things, people actually see a lot of difference and they're surprised that how much a change they can note without feeling like restricted.

Dr. Berry: Especially with some of the clients that you worked with, I think when you Google you hear some of the common questions and even better misconceptions and we've talked about a lot of them, but are there any others that you hear questions even sometimes bother your mind like huh?

Dr. Cecily Clark-Ganheart: I know. So we already talked about the starving misconception. The thing that I find most interesting is the conception or question I get all the time. Can women fast? Women's shouldn't fast? (Interesting). I don't get that. But yeah, men fast and, but then women can't fast. And I said, well that's very nice that in caveman days the men would give all their foods to the wife. Probably not. I'm sure they were both not eating together, but women can fast. I think the issue is that we are equating fasting to an actual state like Anorexia where we see when people have true Anorexia, you can have irregular cycles. It's the same question I've heard people say, well can women do Keto? Because don't women need carbs in order for their cycles to… So people will ask that too. No. Again, people are thinking that you're taking something, you're mistaking fasting with a medical condition and they're different.

So there may be, you'll see people who do intermittent fasting along with a more real foods, whole foods diet approach, who talk about this is the first time in my life that had normal cycles. Because they're self-healing their self correcting some of those issues. I think as with anything, and I don't think fasting is not any difference. If you take fasting too far to where you are now nutrient deprived. But again, most people, if you're still eating two meals a day, especially in the U.S. you're not going to be lacking calories. That's why I think we have to, we're not in the desert, you still have food. So you really don't, in my opinion, have to worry that you're not getting nutrients if you're really just cutting down from three meals a day to two meals a day. There are now hopefully better nutrition quality than what you were eating before.

Your nutrients should be fine. But yeah, if you take fasting too long and you're doing regularly 20 day fast or something of that nature, yeah, you probably will see a change in your menstrual cycles after doing that chronically. But with 16 hours of fasting a day, 18 hours, even one meal a day. If you're eating nutritiously during those periods, it really shouldn't be an issue for most women. So yes, women can do intermittent fasting. Women can do low carb. You can do both eating before you work out. So there's this concept that you have to have that free nutrition, before you go lift weights or run or if you work out in a fasted state. You will be surprised at how much better you feel and the results that you've noticed actually.

Bodybuilders tapped into this a while ago. Think Terry Crews. He lifts fast and when you are in the fasted state actually working out, you have the higher levels of growth hormone, which not to a point where it's going to be detrimental, but it actually preserves that muscle and makes it more receptive to during that recovery time period. Within, you may go and have your meals so you don't have to eat before you work out. Remember there's something called like fight or flight or adrenal access. So if your body is sitting there trying to process food while you're trying to divert. You're having competing processes going on. So you can work out fast and a lot of people, I prefer to work out fasted and I just feel better when I do it. Other people say fasting will slow your metabolism. It doesn't slow your metabolism either.

Just think about it again, fasting, we're now using it for therapeutic purposes or for weight loss. The fasting was just a period of people's lives because again, they stopped eating after dark. And then when they got up in the morning, they were either tending to work outside or doing something like they didn't eat as soon as they got up. So just by virtue they were fasting. If you go 12-hours without a meal and all of a sudden your body starts to shut down and go into some hybernation state, the human race would not be here.

All of these things that we think need to happen for survival. We've been surviving for years without doing all of these things that now all of a sudden (Feel we have to do) every two to three hours. So I think those are the biggest misconceptions that I see. And I think people really just have to realize, you will not die if you don't eat for 12 hours. You really well.

Dr. Berry: I know you talked about pregnant women avoiding intermittent fasting. Is there anybody else who should maybe stay away from this type of?

Dr. Cecily Clark-Ganheart: I would say during pregnancy we already touched on stuff. The time also with breastfeeding, that's not the time to try to do 16 hour fast or anything like that. Eating disorders. So if you have a history of eating disorders, you really want to work with your physician prior to doing that to make sure your issues surrounding that have resolved. Because again, especially if you may have had like anorexia or something like that in the past, we don't necessarily have data either way to say that it's going to make that condition worse or it's going to make it better. But I think you need to make sure you're being monitored by someone so that if they see that you're starting to develop those habits again, they can help get you into therapy or whatnot.

So I personally wouldn't recommend it for people with a history eating disorders. We talked about the case reports with diabetes and how it's used as a treatment. So it's not that she can't fast if you have diabetes. But again, you need to be monitored by a physician if you're doing that because you probably need medications adjusted. You don't want to go hypoglycemic. So the interesting thing is, and this concept I find interesting because when you do have studies of people who do prolonged fasting and maybe like an extended fast for like 48 hours or you know, whatever. If you look at their glucose levels, they actually are pretty low. Where if you were getting a lab result back, it probably would deem it as a critical lab value that their blood sugar is hypoglycemic. But you don't have symptoms of hypoglycemia because your insulin levels are low.

So if the insulin is low and your blood sugar is low and you're producing ketones, your body runs off of the ketones. This is also why a lot of people who are strict Keto will notice that they have natural low blood sugar levels because your body is using the ketones. So the same thing with fasting. So you're not going to be hypoglycemic or have symptoms in someone who is adapted like that. The problem is with intermittent fasting and a diabetic who has not adapted to having low insulin levels is now all of a sudden you think, okay, well I'm going to fast, but I'm still taking my same dose as the insulin. Now you have low blood sugar, high insulin, that's a different state. Your problem. Now you have symptoms of hypoglycemia, so you really do need to work with your doctor. It's the same way though, like when you start reducing your carbohydrates. I tell my patients, especially during pregnancy, if they're on insulin, I'm like, hey, if you have a change in your diet, I need to know that because I need to change your insulin. Your insulin prescription is based on your diet, so this is why we really shouldn't be surprised that changing your diet can read your need of insulin because I am prescribing you insulin based on what you're telling to eat.

Dr. Berry: A lot of time, I think especially my diabetic patients, they know sometimes we have to get on them. That a lot of times I'm not even necessarily prescribing it for the weight base, which is should be. When I'm prescribing it because what you eat and I got to come back your mouth and that's why you're on the dose that you're on.

Dr. Cecily Clark-Ganheart: Correct. And so it's one of those things, it's like, well if you are going to start, I would say the same thing with low carb. If you are on hundreds of units of insulin and now all of a sudden you're like, okay, I'm going to go low carb. I'm not saying you shouldn't go lower carb. You need to call your doctor because that same insulin dose now is going to be probably not appropriate because now you've made a lifestyle change. So that's what you have to be careful about. And then especially type one diabetics because type one we've already discussed, you need insulin as a type one diabetic. You don't make it. So you really have to be cautious. That needs to work with the healthcare provider on that. And never would say anyone who's taking just general medication stuff. Sometimes we don't think about blood pressure medications, but there's some several different classes of blood pressure medications and some of them, not all of them, but work with making you urinate more, go to the bathroom more because you get rid of excess fluid.

When your insulin levels lower, that acts as a natural diuretic as well. You will notice lots of people who do intermittent fasting initially because eventually it equals out. But who lose a lot of water weight. They're diuresing extra water. So again, your health care provider needs to be involved in this because they may need to adjust doses of medication. They may need to do different things. So it's not that you can't fast per se. And I know a lot of people are like, oh, I don't want to talk to my doctor about it because they'll tell me not to do it. But I mean go talk to them. Because the thing is, they may tell you not to do it, but if you tell them you are doing it, then they will adjust. They'll document all in the chart and you know, whatever. But at the end of the day, you need someone to manage your medications. The other thing I would say is that this goes back into misconception time. But people get so worried about, oh my gosh, I'm taking my medication. Is that breaking my fast? If you are prescribed a medication, assuming that it doesn't say don't take on an empty stomach because you do have some medications which should not be taken on an empty stomach. Ibuprofen should not take in state on an empty stomach. Regularly you're going to have a GI bleed. So there there's some things that shouldn't be taken but I wouldn't worry about unless you're drinking your medication with a smoothie about your medication breaking fast.

Dr. Berry: Good old green apples smoothie.

Dr. Cecily Clark-Ganheart: Because eventually I'm never going to have a smoothie company endorsement. Losing my endorsement potential. But there a water company. That's what I need to find. I think a water company. That's something too, again, before you are playing around with your medications and not taking something or doing this or the other. You you really need to talk to your healthcare provider because that in itself can be dangerous not because of the fasting. It's because you're self-adjusting medication. And so that's something you need. And obviously this is not medical advice for you to go start doing anything. You should talk with your healthcare provider, but these are just some cautions that you should keep in mind.

Dr. Berry: Always talk to your doctor. Especially I think in this day and age where there's so much information out there that could have some good effects or also some bad effects. Always want to make sure you're talking to a professional to make sure you get yourself in order before causing any problems. Before we go, I do love the aspect of highlighting my guests and all of the amazing things that they do. First of all, congratulations. I know you recently, just got certify Obesity Medicine Specialist. Definitely congratulations on that aspect as well. I like to call this like the Promo period where any books, any courses, any clienteles or anything that you wanted like say, hey like this is what I'm doing right now. Please feel free. Because I think when people hear this and they get enamored by the guests and sometimes they want to follow up and see what else guests can all kind of offer them.

Dr. Cecily Clark-Ganheart: I think the easiest way to find me is my handles the same. My websites the same just across all platforms. So if you go to my website, it's www.thefastingdoctor.com. I'm also thefastingdoctor on Instagram and thefastingdoctor on Facebook. And I have a Facebook group and a newsletter so you could sign up for either, or. I'm going to this fall actually start launching two different programs. One's going to be like small group coaching for people who feel like they want a more personalized kind of approach. But also just a large group forum where we'll have basking schedules available and then host weekly Q and A's. So if you sign up for my newsletter or follow me on Instagram or on Facebook, any of those sites, once that's available, all the information will be there.

Dr. Berry: Before I get you out of here, I always ask my guess this, how is what you're doing helping others to take better control their health?

Dr. Cecily Clark-Ganheart: So I think how it helps it just realizes or helps people recognize that the weight loss and being healthy says it's really not some magic kind of thing where you, you need something super complicated to do. I think if you just focus on periods of gut breasts and trying to eat whole foods, things that are not in a package, I think those are the easiest places to start. And then in terms of adding physical activity, it could be as something like walking 30 minutes a day. You don't have to join a gym. I mean, not saying you shouldn't, I'm just saying though that people will have all these reasons like well they are able to lift weights five times a week, they have access to a trainer and they have access to this. And it's like you don't need access really to any of that.

You need access to quality foods and you need to give your gut a rest. And while quality food can be expensive, if you save the money from that one meal that you skipped, you probably then have more money available to buy more nutritious foods. So I think that's the take home. That is my message. I just want to realize and empower people to know that health isn't just for a certain group of people who have access to wealth or whatever. Health really can be for anyone. And probably some of the most healthiest people in the world are the people who actually have access to police.

Dr. Berry: Very good point. I love it. I want to say thank you for joining podcast and really helping to enlighten on a subject that is gaining, I guess traction per say in just the everyday talk when people are making the transformation, transition to one, be more nutritious and they want to think of different ways to do it. This is definitely one of them. Again, thank you for taking the time out and much appreciated. Like I said, we will definitely be looking out for the program, for the groups. And again, remember Lunch and Learn community, all, every book, everything, every link she noted. We'll make sure it's in the show note so you don't have to write anything now. We'll make sure we get that to you.

Dr. Cecily Clark-Ganheart: Thank you.

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On this week's episode of the Lunch and Learn with Dr. Berry I got the chance to talk with Dr. Lisa Folden. I love her story as she is a physical therapist in training but soon realized the importance of nutrition and the lack thereof was having on her practice as well as her personal well being.

Dr. Folden has her own practice Healthy Phit Physical Therapy & Wellness Consultants where she marries the art of physical fitness with nutritional behavior. She is on this week to talk about one of the most commonly noted but overlooked aspects of lifestyle modification which is meal prepping.

As I have made lifestyle changes of my own, I know how difficult it can be to not only make the change to better eating but then to plan out those better meals but Dr. Folden does an amazing job giving us easy & actionable tips to get our journey started. We also got a chance to talk about her book "Healthy Made Easy: The Ultimate Wellness Guide for Busy Moms" and her upcoming book on meal planning.

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Download Episode 121 Transcript

Episode 121 Transcript..

Introduction

Dr. Berry: Welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and promotion. Today we have another amazing guest on the podcast. Again, the theme this month is nutrition. And I thought, what better place to start when we talk about nutrition is meal prepping. Again, if you Google nutrition, you Google trying to lose weight one way or the other, you're gonna come across a blog post or a page or a video that talks about the importance of meal prep. And I get this question a lot. Honestly, I'm in the process of trying to be more diligent when it comes to meal prep and myself.

So I figure, let's talk to someone who's been there, right? And really speaks about wellness and nutrition as a whole. And really is trying to hit it home. Out the park. I mean, when it comes to meal prepping and meal prepping for patients and her clients. This week we have Dr. Lisa Folden. She's a licensed physical therapist, naturopathic lifestyle coach. She's a movement expert, women's health advocate, and she works to educate the general population on exercise safety as well as other aspects of physical wellness. And I thought it was very important to have her on the show because not only does she talk about the aspect of physical wellbeing. And obviously her being a physical therapist that makes a way, that may just as obvious, right?

But she understands and she had almost like an epiphany that because she was dealing with just one side of the table, she was only doing half the job.

When she wasn't educating her patients and our clients on the actual function of nutrition and how nutrition plays such a big role on the physical aspects of health. She knew she had to make a change. And right now she owns healthy fit physical therapy and wellness consultants in Charlotte, North Carolina where she works with clients of all ages, recovering from orthopedic as well as neurological injuries. She's also been featured on the Oprah magazine, Shape magazine, Lift Strong, bustle, because she's a writer as well too. She loves writing and she actually has her own book Healthy Made Easy: The Ultimate Wellness Guide for Busy Moms that we get the chance to talk to her about that as well as well as an upcoming book focusing again, hint on meal prepping.

So again, I definitely decided for you guys to catch this episode. Again, like always, if you have not had a chance to go ahead and subscribe the podcast. At least leave us a five star review. Let us know what you feel about the podcast. Let us know what you feel about the episode. And then, tell a friend and tell a friend as always go. Again, I don't expect you to tell 50 people, but as long as you tell one person, that's all I can ask for. So again, get ready for another amazing episode here on the Lunch and Learn with Dr. Berry.

Episode

Dr. Berry: Alright, Lunch and Learn community. Again you just heard another amazing introduction. You know the theme this month, we're talking about nutrition. We're getting ourselves together when it comes to the subject of nutrition. And of course you know I ain't the expert, right? So I bring experts onto, you know, now kind of get you guys to get myself right as well too because I learned just as much as you do. So again, Dr Lisa, thank you for joining today's podcast.

Dr. Lisa Folden: Thank you so much for having me.

Dr. Berry: So Dr. Lisa I got a lot of my guests and a lot of my listeners who like to skip right past the introduction. They like to fast forward, past stuffing. They like to go straight to the meat and potatoes, given the pan, right? If they just missed your bio, let's say to even read your bio, what is something that made me not be in your bio, but says, you know what? This is what really kind of expands the person who I am as far as Dr. Lisa is concern.

Dr. Lisa Folden: Yeah, well, being in the health field, I obviously have a passion for helping people. I think most people in our professions do. But for me personally, I'm just so passionate about health and exercise and making things fun and making nutrition and life manageable. So some of the things that don't go on my bio, a little tidbits about me. Number one, I love to dance. Like I could dance all day and if I thought that, if I had a little more confidence in myself as a dancer, when I was younger, I would probably not be a physical therapist. I'd probably be a professional choreographer or dancer. Because it's something I love, I incorporate it into my fitness lifestyle because I enjoy it. But yeah, that that's, you know, one of my things, I'm a neat freak doesn't have as much to do with nutrition necessarily, but I like to have things organized. I read organizational books and I follow organizational logs. And I'm the type of person that gets really excited going to the container store. You know what I mean?

Dr. Berry: Wow. Okay. I love this. Okay that makes sense. I didn't even know there are organizational books, but now I'm even more intrigued by that aspect. And again I think it calls to the discipline and I'm pretty sure, and we'll talk about it. I'm pretty sure you understand how important discipline is with the subject of nutrition and getting ourselves together. For those who may not know or still may be just kind of coming into their own, when we talk about nutrition and its overall benefits to our health. What would you say it is? The grand scheme of things?

Dr. Lisa Folden: Well first I'd like to say I don't consider myself a true expert on nutrition. My education and physical therapy, we have some nutrition training, but it's not, I definitely, I'm not a nutritionist by any means. So I never like to tell my clients or my audience people that I'm working with that I am the authority on nutrition. But I have a good grasp of it. Just from my work experience and history. And then of course living my own life and trying to figure it out. So what I have learned is that nutrition is so much more important than we were taught growing up. It's probably, as it relates to weight loss or weight maintenance, it's probably 80% honestly. And that's hard for me because I'm like an exercise and like I love to work out. So you know, you get in that mindset for a long time like, oh I'll eat that, but I'll just work it off.

And that is no, not how it works. And I learned that the hard way for years and years. So I just think nutrition is, it's really primary. What you put into your body is, you're going to be a product of that. So it's, it's really important and it's hard in this country to find the right stuff and the good stuff. And sometimes when you think you got the right stuff, you read an article on Google that says not the right stuff. So it can be very confusing and very challenging. But it is very important to put at least a decent amount of effort into defining a nutrition plan and program that works for you, your family, your lifestyle.

Dr. Berry: And what I love, and I think this is especially because we looked at it, you touched on it in the beginning is I think a lot of times, especially in when it comes to health and just health care in general, really just knowledge in general is that a lot of times, we kind of attribute the aspects of like, you know, having some type of degree or paper and at like sponsor us as experts when we all know job applications all day. Talk about what is your experience associated with what you're trying to do. And here, like especially in health, I see it all the time and you already know, it takes someone, they do a couple months of training and all of a sudden they propound themselves as this the expert de facto, right?

Unfortunately, there isn't. If someone follows them and someone believes they are the expert, that's where it is. So I don't think, I never put too much, I put some on this right. And onus of meeting certain degrees certificates or something like that to say like, Oh, I'm an expert. But I always put more focused on like, oh, are you in the trenches? Are you getting down and dirty when it comes to it? Because that's the person I want to listen to you. I want to listen to the person who's had struggles. I want to listen to the person whose hats assessors. I want to listen to the person who is then able to initiate and then pass that knowledge on.

Especially in Lunch and Learn community, I think that's always been a big thing for us, is understanding that those paper degrees is fine. But tell me what your life is about and that way. Because unfortunately most people are more likely gonna follow that type of person. A person who got whole bunch of degrees on the wall but don't talk about nothing, can't talk about nothing because they can't teach us. And I think it's interesting because you talked about the fact that you had to go through your own aspect of learning that, oh nutrition actually is the real deal. It was it because you are so active and you were able to balance it out. Was that someone you kind of leaning on the fact that you're so physically active and you are able to kind of get away with, maybe some of the nutritional discretions in the past?

Dr. Lisa Folden: Well, I think it's probably most of us when you're an adolescent and you're exercising and moving all day and your metabolism has not yet come to a bit of a halt. You can live a lot more freely and do a lot more of whatever you want. You don't see the repercussions of it and then you're not even talking so you're not even thinking about it at that age. So for me, I was always very athletically built. Always very athletic in regard to the activities I chose. I ran cross country. I was a dancer in high school. So when I went into college, I think that was, that first shift, they talk about the freshman 15 and this and that. But I think that was my first shift and seeing like, oh, my body is changing a lot, growing up.

But also based on the foods that I'm eating. What was accessible to me, with a lot of stuff that I don't think I normally ate. And so I saw changes happening. Wasn't able to pinpoint exactly what to do about it at that point. But that's when I became more aware. And it wasn't until I got into physical therapy school and I started learning a little bit more that I started to understand, oh, okay. But even still, I mean that was like 15 years ago. And you still, because of you know, the way that you grow up sometimes you still have this desire to like, okay, I can just work it out. So I played that game for years and years and I think it was probably starting to have children and then seeing real changes. It's like, oh, okay, I cannot eat the things that I was eating at the rate and the consistency that I was eating them before. If I want to be healthy and be able to function and not continue gaining more and more weight.

It all came to a halt I think with children. So I leaned on my youth and yeah, my activity level and then just not really understanding what was happening all the time. I did put on a little weight, which is fine. And I like to mention that I don't do a lot of heavyweight focused in my practice when I work with people for wellness needs. If you have a goal of changing your weight, I'm cool with that and we'll work with that. But I try not to make the primary focus to do with your weight because it can be so misleading. Some people are just naturally thinner, naturally smaller, naturally, way less. And it does not speak to their health as far as what they're putting in their bodies and what their body is able to do, what their lab work would say. So I don't focus heavily on that, but sometimes, oftentimes, weight is the most visible descriptor of what's happening as far as what you're eating. So for me, yeah, definitely seeing changes and fluctuations in my weight and then also when some activities that I could do before it became more challenging. And it's like, hold on what's going on here?

I don't remember needing this much water in a day. But now if I don't get my 64 to 98 ounces, something is wrong. You know what I mean? So yeah, just being more aware of those changes and seeing being their effects on my body.

Dr. Berry: And when I look at, and I know you talked about being a physical therapist. I'm pretty sure with a lot of just on that aspect of your work and in seeing where you know and if a person's nutrition, isn't optimal. And makes that side of the job part of it as well. What were some of the things that kind of led you to say, what I think I want to take a more proactive role. Not only in myself but in others when it comes to nutrition.

Dr. Lisa Folden: I was working, let's see, I graduated in some so long ago, 2007 from physical therapy school and I started out doing contract work. So I would just work at a location gym for 13 weeks or so and then move on to another. And I enjoy that because I have a tendency to get bored. So it's nice to kind of switch up my environment, switch up my caseload. I got to see adults and children. So I have a pretty wide spectrum. But what I noticed is when I kinda got into the field of and staying more consistently in a location, it just became like the same thing over and over again. So and so need for this. Run them through a program real quick and then six months later they're back for something else.

So I started to feel like a factory worker and I was just kind of repairing the same people over and over again. And it dawns on me, and this was around the time that I started contemplating starting my own practice which I eventually did. It just dawned on me that we spend a lot of time on rehab and no time on prehab. So I started… (Oh, I love that. Hey, alright, okay). It goes with our American system, right? We're not necessarily a healthcare system, we're more of a secure system. And so it became annoying and frustrating to me that I could probably instill some knowledge and people that would prevent them from having these injuries over and over and over again. And a lot of it, a lot of the injuries is of course related to weight or just poor nutrition in general.

And so that's when I contemplated to start more practice a few years later. I did and I immediately my practice is like wellness. We're going to do physical therapy, absolutely. You get injured, I'm happy to help you. We're going to do wellness. So almost all of my clients know that we'll be finished healing their injury, the very acute thing that's happening in them. We moved right into, okay, what's next? It's like alright now, now the core is strong. How are we going to keep it that way? What are we going to do? So I just make that, my focus now is really getting people to consider how they don't want to come back for the same thing or deal with the same issues. So how we can sort of revamp what you're doing. And I do that a lot with my moms. I have a fit mom program that I work with and I help women, especially after babies. It gets real challenging. Your whole world gets kind of turned upside down. And I have a heart for that because I've been through it myself three times now. And so I work with them on their nutrition and making things very simple, easy, creating some grabable meals, things that are healthy and fulfilling to their bodies that they don't feel like they're in the kitchen, slaving over, for hours and hours and hours. So, yeah, I just, all of that, you know, that whole experience and seeing people do the same thing over and over again, and me being there to facilitate it, it was like, this is insanity. Let me, let me figure out a new plan here. So.

Dr. Berry: And I love that especially because the fact that, and I think a lot of times when we hear of nutrition, people always go to a weight. If your nutrition is bad, your healing's bad, right? If your nutrition bad and mentation is bad. There's so many other things associated with nutrition that like weight becomes more of a byproduct more than the actual targeted aspect and goal. And so one of the reasons why, I definitely want to highlight here, is because obviously in this day and age we're in August, right? I had a previous guest tell me 80% of people who had new year's resolutions have already kind of failed and dropped them right in. They're already thinking about next year's resolutions. (Yeah. Unfortunately). One of the big things, especially when people start thinking about, trying to get better as far as with their eating right, is the onus and is the practice of meal prepping. And again, full disclosure, Lunch and Learn community members, I am going to be like kind of taking down notes as well because I have trouble with justice. The just getting behind the mindset of it. Let's talk about meal prep and why is this such an important aspect? Because I know you're big on it as well too.

Dr. Lisa Folden: Yeah. I spent a lot of time meal prepping and revamping my meal prep process because it is more than a notion. I always tell people start small because it takes some effort and some energy and some thought. But I like to look at the idea of meal prep like this. You know, if you fail to plan, you plan to fail, right? And you have to take that same thinking into your food. If you are just going to fly by the seat of your pants. And that works for some people. So I don't, not the process. You have to find your own process. But most times if you're going by the seat of your pants on your eating, then you're not going to be eating good. And that's just the bottom line. If you're not planning out what are going to be my breakfast options this week, my lunch, my dinners, then you're likely ordering fast food, carry out, going out to lunch multiple days a week, or eating a bunch of snacks.

We're human, right? And that is usually what it lends itself to. So for me, the construct of meal prep starts in the mind. It's like, all right, let's think this through. What do I know to be good for my body? How can I incorporate as much of that into my daily eating as possible? How can I avoid spending my money and eating things that are probably made from mostly, not great products and putting them into my body every single day? And so I look at it from that standpoint and then I create affirmations around it.

Dr. Berry: We love affirmations out here. We love it.

Dr. Lisa Folden: Right now on my bathroom mirror, I have like five or six affirmations associated with my eating. And one of them is my taste books are not more important than my physical health. Right? So sometimes I want some cheese cake or some Oreos and those things are fine in moderation obviously. But I know myself, I have a moderation problem.

Dr. Berry: I love that. See, we're right here with it, right? We know that we can't even, like now we can't even go to, because we just don't stop.

Dr. Lisa Folden: I can eat a whole, like a whole row of Oreo. So for me, I don't bring it into my home. Now from out somewhere and there's a cookie, oh, I'll take one, that's fine. But I don't bring those foods into my home so that my whole concept of meal prep just revolves around that idea that my being healthy and eating fuel and food that is good for my body and it's going to make my body work better is more important than that temporary satisfaction of a taste. And so I plan for it, I create affirmations around it. I write out a menu, I shop forward, and I meal prep and I go from there. And when I do step outside of it, because I'm meeting friends for lunch or dinner or whatever, it's not a huge deal because the vast majority of the time during the week I'm sticking within my plan. So that's how.

Dr. Berry: So what would you say and you talked about preparation. What other benefits are really associated with those who are looking to get into meal prep, or doing meal prep or are in that process like you know, a lot of times, for us, we gotta mentally kind of put ourselves in that process first before we can take that.

Dr. Lisa Folden: Yes. As you should. I suggest that because like I said, if you just, sometimes when you jump into it, it's like overwhelming and it's too much. But the benefits of meal prep, I mean they're numerous. Number one, you're more aware of what you're eating, right? So you know what's going in your body. If you're a calorie counter or someone who likes to be very mindful of how much they're eating. You plan it out. You literally portion it out. You size it out. You make sure you're getting the right serving sizes. Number two, of course you save tons of money. I don't even like to do the math sometimes. If I'm all not doing my meal prep, I check my bank account and I see what I've spent on carry out and like a week or let alone a month. I have a family of five so it gets real bad.

Dr. Berry: Same here, same here. I got two twins and an older daughter. So we just can't just go out.

Dr. Lisa Folden: It's depressing to the bank account. So what I do, obviously you saved a lot of money when you meal prep. To me like I said, it just keeps you organized and you know, that speaks to my inner organizational person. I love the idea of knowing, all right, here's the kid's lunches. These are my lunches. These my husband lunches. Here's the freezer prep for the next four meals. It saves time. Meal Prep can take you several hours obviously, but it saves you so much time during the week when you can come home, get off work and all you have to do is throw your dinner in the oven. You know what I mean? It's so easy if you can get up in the morning and get your kids off to school or wherever they're going and all they do is grab their already premade lunch out of the fridge.

It free up so much time. And for me the personal benefits are when you free up that time, then you get to do more things you love. Like spend time with your family, go figure right or shoot, lay out on the couch and watch TV if you want to. You know what I mean? It gives you the ability to spend more time doing things that you enjoy because now you're prepared and your week is set as far as your nutrition goes. So, of course the weight benefits, the nutrition, making sure you're eating good foods, all of that is there. But saving money and time and restoring memories and things that you don't always get to make because of our busy, busy lives. Those are the big benefits to me.

Dr. Berry: I love it. I love all of them. But Dr. Lisa, you already know, and I'm pretty sure you probably ran through most of them. You going to have people, going to hit you with the excuses. (Yes). What are some of the more common, I'll call it misconception, but you know really what are some of the common excuses you hear for people who say, Oh, I can't, I can't do that.

Dr. Lisa Folden: Oh, there's so many. Let me pick out my favorites. First, let me say, excuses are tools of incompetence. (Let's talk). Okay, so the reality is this, if you want something bad enough, you're willing to work for it. And I take that into every aspect of my life. Period. Family, schooling, education, career, nutrition, health, fit, all of it. It goes into every category. The most common excuses I get are time. It takes too long. I'm not interested in that. And I respect that one because time is valuable, for me too. And so for people like that, I suggest we take a small. Maybe instead of meal prepping once a week where you're spending three or four hours, maybe you meal prep twice a week. So maybe on Sunday you meal prep, a few things to get you through Wednesday and then maybe on Wednesday you meal prep, a few things to get you through, you know, Thursday, Friday or the weekend, whatever. I also suggest that people take time off. Like sometimes meal prep, it can be a lot when you're doing it consistently every week. So to give yourself a breather, take a week off. That week, just make sure you shop for things that are healthy and grabable. And then you plan your curiosity around sort of your healthier food options in your neighborhood or wherever you work or live. So there's ways to get around it. But that's the biggest excuse that I don't have time.

Another excuse I get is, their families. People who have like picky eaters with kids and I have a whole chapter in my book about that, so I'm ready for that one too. And it's just sometimes people don't, you know, we'll Google everything, right? I got a scratch on my arm or let me look this up. Sometimes people forget when it comes to meal planning and recipes and things like that. Use the internet, use Google, find some things that sound attractive to your kid. Find ways, if you know what your kids like, find ways to incorporate things they like into the meals so that you're not, you know, meal prepping and basically being wasted. So picky eaters can be tough, but there's definitely ways. I hide food, hide vegetables inside of food all the time. My kids have no idea. You can say, my kids don't eat vegetables. I'm good for making them like a cheese and chopping up fine, yellow bell peppers and they have no idea, that way it blends in with the cheese. I'm all for that. I'm all for problem solving. But yes, picky eaters. And then I say the third most common meal prep excuse I get is, well, two, one people think it costs too much, which, you know, I can totally refute that it does not your fast food and your carry out is way more expensive.

Dr. Berry: Way more. Quickly too. At least for me, I know one session and then I'm like, oh my God, what are we doing right here?

Dr. Lisa Folden: Exactly. But that one is easy to get rid of. But the other one is for people who are single and you know, live alone or just don't feel like, oh, I don't want to eat that. I don't wanna eat the same thing all the time. Or I don't want to cook all of that food. And I totally get that. But I think that the single person, the person that just meal prepping for themselves has a great advantage. You have the opportunity to really switch your stuff up because you're making such small portion sizes and grocery stores have gotten real hip now. They got a lot of single serving options for you. So to me it's not really a reasonable excuse anymore because there are ways around it and there's ways to take a meal prep it, just pull out a couple for your week and then freeze the rest. And that can be a prep for later in the month or whenever. So there's ways to get around all of that. So I'm ready for all the excuses. But those are probably the top three or four that I get.

Dr. Berry: It's a little incompetent. I love it. I love it. When you started and you made that transition where nutrition was important, where meal prep, was this like a tag team combo where like when you were making the nutrition turn, you said I need to do it while meal prepping or did that come at a different timeframe?

Dr. Lisa Folden: That's a good question. They came very close to one another. Yeah. I think within the month or so of me feeling like, hey, I need to really step up my nutrition game. I think I was like, yeah, meal prep is just a natural part. It was sort of a natural progression to me. Because it was like for me, I'm a planner anyway, so it's like, okay, if I'm going to eat right, how am I going to make sure I eat right? It' I can't just rely on what's here because we're always gonna go for what's quick. So I may have all the healthy ingredients in my cabinets and refrigerator. But when I get off work and I'm literally exhausted, I don't want to make that. I don't want to stand in the kitchen. So I will order food. Post mates has been seen like the best and worst creation ever because I will post mate in a second. All of those. So for me, they came very close to each other because I realized even though I want to eat better and I know a little bit more about how to eat better and I shop a little better. If I don't have stuff already prepared, I'm going to still reach out to the stuff that's not great for me. So yeah, so they were close. They were close together.

Dr. Berry: Now of course the minds are gonna want to know, what is Dr. Lisa eating when she's meal prep it, right? Like what? Because you do these Google searches, right? They got these immaculate looking meal.

Dr. Lisa Folden: Let me just say a little disclosure here and people who will follow my Instagram. They already know this. I wrote my book last year and it's called Healthy Made Easy: The Ultimate Wellness Guide for Busy Moms and I touch on meal prep and exercise and tons of things in there. The sequel to that book, I guess in a way, and this was by popular demand, was a recipe book. And let me just say, I am about three quarters of the way through the recipe book that was supposed to be released in May and it has been more than a notion and it's because of just what you said, it is so hard to put out a recipe book that does not look like the stuff that you see when you Google. And I'm like, so it has been a huge stress to me to where I've been contemplating whether or not I'm going to release it. But yes, it can be overwhelming when you see these great looking whatever to flay.

Dr. Berry: They have it lined up and some got chicken. Some type of protein, red meat. Then you got your asparagus you got, and I'm looking like, I look nothing like that. What am I? Okay. Alright.

Dr. Lisa Folden: Well here's the thing. Neither do I. My stuff is simple. For the most part, I pretty much, I have this go-to garlic and herb seasoning that I use on almost everything and it's literally like I just buy it in bulk at this point. Because I can, I do not have time to be doing like 15 ingredients dishes. Now there's times when you want to splurge and go crazy or I saw this cool thing, I want to try it, but my regular, no. So my things are simple. At least two weeks out of a month. I am eating egg muffins for breakfast. It's so simple. I literally cracked 24 eggs in a bowl, sprinkle some pepper, and then I make a decision. Is it going to be bell pepper this week? Is it going to be a little Turkey or chicken sausage? What am I going to put in this egg? I scrambled them up and I pour them into a muffin pan, two muffin pans, and I bake them for 20 minutes on three 50. I throw those in a Ziploc bag and my kids and I and my husband, we grab them every morning for bread. I don't even want mine up. Super simple. So everything I do, I try to keep it very basic. When I step outside of the confines of basic, I typically find myself annoyed or frustrated. So I put myself back in.

Dr. Berry: Because it takes a little bit longer or is that the?

Dr. Lisa Folden: It takes longer. The stress associated with it. It's like, oh I want, you know, you see this on Google and its like, oh this is a beautiful, I want to do that. And it's like, you know, it doesn't have to be that way. Just make some food that's edible and tastes decent and go for it. I tell my kids all the times, we are not living to eat. We are eating to live. Okay. (Yes). So everything is not going to be the very best thing you've ever tasted, but we're going to get through it. I try to make my food tastes good just as a disclaimer. So I try to keep it very simple dinners. I mean we tip, I don't do red meat and it's really just been a preference since I was like 12 years old.

So I don't eat red meat. I don't eat pork. But we have a lot of chicken dishes, a lot of ground Turkey or Turkey breasts, dishes, and then a lot of fish. So we do a lot. We have one fish meal at least every week. So this week we had a shrimp stir fry that was so easy. I literally bought the frozen raw de veined and unsheltered shrimp from my local BJ's and then I bought a couple bags of frozen stir fry vegetables. I put them in a Ziploc bag together. I sprinkled some low sodium soy sauce on them. It's my famous garlic and herb seasoning. A little bit of olive oil. I kind of wish the bag around, throw it in the freezer. Yesterday when I came home from work I threw it in a pan and we ate it. It was so easy.

Dr. Berry: I love it because you keep knocking down now, time, come on.

Dr. Lisa Folden: It doesn't take time if you do it wisely. It doesn't take a lot of time. Some people love cooking. So some people meal prep is cool. It's like an expression of their art and they don't mind being in the kitchen for a long time and making fancy stuff. And I'll say more power to you. I'm not that person. I cook because I have a family. If I did not have a family, I'm sure I will be ordering like hello fresh or one of those. And I often recommend that to people. I'm like, I meal prep. I think it's the best thing ever. But you know what, it's not for every single person in the way that I do it. So if you can afford it and fit it into your budget, order from a digital delivery service that you have researched and found their ingredients and their options to be healthy. Do it that way. And a lot of those, you still have to do the cooking and they just give you the fresh ingredients kind of prepped. So whatever works, I'm here for whatever works for you. And you know, everybody.

Dr. Berry: I love it. I love it. I have to make that. Mentally, I see myself, I just haven't made that leap where I got in. Of course, but those who may not know. But you should already know. Like I'm dealing with the fact that like I'm still in my rehab process. I'm only got one leg. I'm just willing around in places, but like I already know mentally, once I get on my feet and figuratively, that's definitely gonna be the direction I want to go and go there. Because it makes so much sense and aware of it, if you prepare. And I love that I'm still thinking about that one line.

Because we got to eat. We know we eat. It's a surprise that I'm going to be hungry Wednesday night. I'm going to eat Wednesday night, so if you're going to eat, why don't you just go ahead and prepare the food now and not have to spend that money going out and eating and I'm 100% I here for that and we got here on record that she's going to be finishing her recipe book soon. So we're gonna keep pushing it. My friends know me, I will DM every week and like, hey, what's going on? How's that book going? Everything alright? We waited for the book to come out. So I am going to be on Lunch and Learn community. You don't have to worry about and that you gotta get that book out of it because it I think is definitely needed. Especially if people asking for it. You gotta give it to them.

Dr. Lisa Folden: I will. I definitely will. And I appreciate the accountability. So I will. I will get it together.

Dr. Berry: Especially in your line of work, when you're working with people and you're working with the whole aspect of wellness, whether it be planning and goal setting. What has been some of the benefits and what has it been some of the successes that you've seen thus far and the whole kind of onus of it?

Dr. Lisa Folden: Oh, I mean, it's so many things. A lot of my clients who make the decision to transition to a lifestyle where they're just being accountable and being knowledgeable about what they eat, planning for and things like that. I mean everything. From the very obvious weight loss, inches lost, fitting into clothes they hadn't before to more internal and personal benefits. I have clients that are like, I couldn't walk from the back of the parking lot before, you know what I mean? Or I couldn't do the stairs without my knee rubbing or I couldn't even see myself getting back to the gym. So tons of tons of things when people make a decision that they're gonna change and do something to better themselves no matter how hard it is, that's the key.

We've got to get over that hump apart. Because most of the stuff that's worth having is harder to do. So once they get that mindset and we sit down and we set a plan, the positive results are just so many. There's just so many good things. And it'll be like, because everybody is not like, oh I need to be a size five. I got to lose this weight. Some people are very, very genuine about like, I just want to be able to chase my grandkids around. I don't want to be out of breath. You know what I mean? I want to feel better. I don't want to be sleepy every single day, all day. My clients come to me dragging sometimes. You know what I mean? I'm exhausted. I was up to two in the morning working.

I didn't have breakfast. I didn't go extra. It's like Jesus, I can't live, that's enough pressing way to live, for so long. So it just so many benefits to just getting that action plan set, getting your life in order. And it translates to everything we do. Every single thing. You are going to be a better worker, you're going to be a better husband, father, wife, friend, everything. You're better when you're taking better care of yourself. And it's a big part of the self-care journey, so big on that.

Dr. Berry: I love it. We love self-care here. A love affirmations. We love preempting the inevitable and that's where the meal prepping and Prehab and everything else kind of comes in. And I know you talked, especially with your practice where you focus on you, obviously you have patients you know who have some physical ailments that you take care of and then you kind of deal with the ones. Do you also just take care of patients on just strictly who may not have physical ailments but like, oh I just need to get my wellness together?

Dr. Lisa Folden: Absolutely. So I offer just straight wellness. Several people, they will contact me and they will say I want to get into the gym but I'm uncomfortable. I don't really know what to do. Or maybe I just lost a lot of weight and you know, now I want to kind of tell but I don't know where to go or what to do or how to keep it off or you know, I get all kinds of stuff. So yes, I take people straight for wellness. I also offer kind of a newer service is called a Mobility Visit. And this is a whole separate podcast, I'm sure, but I have a true passion for teaching people the benefits of stretching and mobility in their body with regard to the muscles and joint and, Oh God, I want to say maybe 80% of us like don't stretch unless we're maybe about to do something.

Dr. Berry: Again, Lunch and Learn community, we do full disclosure here. I had to go to, I went to Disney with the kids, right, because that's what got to do. I'm in Florida. There's one of the rides or that wasn't even a ride. It was just some session that we went to. Where you got to sit like Indian style. I couldn't even sit Indian style. I didn't even know how hard it was to see. I'm like, oh my, I used to be able to do this. And mind you, I'm going to the gym and I thought I was doing something but clearly I wasn't working the right muscles because I tried it and I couldn't do it.

Dr. Lisa Folden: Some of the most athletic strong aesthetically perfect looking people are the tightest and never stretch. It's amazing. So I spent a lot of time offering a new service called the Mobility Visit where you literally come in, have 45 minutes, but I'll do a very quick assessment. And then I take you through guided stretches for every major muscle group in your body. And then we end with a little bit of soft tissue work just at the base of the skull, right in the neck. And people get up and they literally feel like a new person. And it's like this is something you could have almost all done on your own. But it's a service I've had to offer because people don't know how to stretch. They don't know how long the whole stretches. They don't know what position is best to stress stretch particular muscles. So that is one of the wellness services I offer. It has nothing to do with physical therapy or injuries necessarily. It's not a service that they can necessarily cover with their health insurance. But it's a wellness service that I offer.

Dr. Berry: Clearly needed. I had to put my leg, let us stretch one leg out because I couldn't not do that any side. I'm like alright, okay.

Dr. Lisa Folden: It's very common though, especially among men.

Dr. Berry: I said okay, I got to get myself, need to get this type of some type of yoga, someone need to teach me how to stretch. That's what it was. That like someone just probably gotta like try to do that like some online thing like you gotta probably like formulate like some a video step process. I think that would definitely do well for you. Before I get you out of here. Because again I'm very nosy. (Me, too. That's fine). Let's talk about healthy made easy and I want to talk about all of your business ventures because I'm always impressed by my guests and all the amazing things that they do. Like I said, they helped motivate me, they kind of get me together. Let's talk about that first book, the motivation behind that first book and obviously, and they were going to kind of spill the beans on every, again you talked about the mobility. Let's talk about everything that you're doing. So the people who are listening can know, where you're from here, location wise?

Dr. Lisa Folden: So I'm originally from Detroit but I have been living in Charlotte, North Carolina, eleven years. So that's where I am and that's where my practice is.

Dr. Berry: Okay, perfect. So what made you write the book? What was the driver forced, you know what, I need to get a book out here.

Dr. Lisa Folden: Yeah. It's so funny. So a lot of things. I blog a lot, I write a lot. I've always been into writing, but usually short little things, essays. So what I was finding in my practices, I was repeating a lot of the same information, especially to my moms, to people who were trying to sort of organize their life and combat that primary excuse for healthy living right time. I don't have time to work out. I don't have time to go to the gym. I don't have time to meal prep, my kids this and I do this and work in that and that, dah, dah, dah, dah. All of that sounds like, you know what? I started jotting down some thoughts and I was like, you know what? I need to write a book. So this was maybe early 2018 and put it off, put it off, and then I finally just went to town.

I think I wrote the bulk of my book proudly in a two month timeframe because I was literally coming home from work just I was typing on my phone in between patients, you know, so it's called Healthy Made Easy: The Ultimate Wellness Guide for Busy Moms. And I say that, mom's a big market, but it's really for busy people. I mean honestly it's anybody who has a lot going on in their life and doesn't feel like they can make time to exercise. So I have a chapter on meal prepping where I talk about how to make it easy, what to do. I recommend some websites for recipes. I have a chapter on incorporating your children and your family into your new lifestyle, especially when you have picky eaters. Talk about ways to, you know, hide foods and make the meals attractive to children or to your spouse or whomever.

I talk about social eating. People don't recognize how challenging it can be to go out with your friends or family when you're trying to eat a certain way. And so I give some very, very simple tips for that. I talk about that. That's mostly the part of the book on nutrition. Second half of the book is all about exercise and fitness. So I have workouts in here, sample workouts for when you're taking your kids to the playground or you have your kids at a sports practice, give suggestions and tips and things you can do. I try to, I have a chapter talking about incorporating fitness into your everyday lifestyle, like making exercise double as family time. So you guys all go for a hike or things like that. Everybody involved because it's a lifestyle. Right? And if you go to my Instagram, you'll see my kids are on there with me exercising all the time because they see me do it and it's just a normal part of their lives.

I talk about having navigate gym equipment and I have some very unpopular thoughts on the unpopular opinion on some of the equipment at the gym. I'm more of a home workout person myself, but I do appreciate the gym but only for certain aspects. And then, the last chapter in the book talks about focusing on your fitness without comparing your journeys to other people. We so often, especially as women, and I think men do it as well. We see someone else and it's like, well I want to do that, I want to look like that. This is your body and your process and you need to want to look like you. And whatever byproducts of being healthy and fit is for your body will thankful for that. But trying to formulate a plan to look and be like, someone else is always wrong.

So I talk about that in the book. But I'm very proud of it. It's available on Amazon and through my website. It was my little labor of love and it took me a little under a year to complete. So that a good tool for people but especially for women, people with children, pets, if you're taking care of elderly, family members, you got a lot on your plate. It's a good book for you to understand you're making time for your fitness. My practice here in Charlotte, it's called healthy fit, physical therapy and wellness. And I have a little spell fit, the normal way. It's actually spelled P, H, I, T and that was just a play on words, the P and the T for physical therapy. So, but yet we see clients literally ages zero to a hundred.

I see pediatrics adults. I consider myself a generalist. Though I do have a lot of work in the pediatric world as well as low back pain. That's a very, very, very common diagnosis that I get. So I do a lot of lumbar stability and core strengthening, things like that. And I'm here for all of it. I refer out if I feel like you know, what you got going on is a little bit more in depth than I feel like. So have some people I refer out to, but in general I see most patients. So if you go to my website, www.healthyphit.com. You can sign up for my mailing list and I have a free posture packet that you will receive via email. And that's been really good for people because most people don't really know what good posture is. When I see a client and I tell them to, let me see your best posture. What I typically get is some exaggeration of that posture.

Dr. Berry: Yes. Lunch and Learn community, I can't see, but mentally I was actually, once she said that I was actually about to sit up. Oh she looking at my posture? I don't know.

Dr. Lisa Folden: Whenever someone says posture, I'm like whoa. So I usually see some exaggeration of good posture where they're like in that military stand or you know.

Dr. Berry: Is that even a good posture though? Is that? Okay.

Dr. Lisa Folden: It is not. So I send out to sign up for my mailing list, I send out sort of a sheet that that shows you some of the common poor posture positions and then the best ideal posture. And the goal is to get as close to that as possible. Our bodies are our bodies. Everybody's not going to be the exact same, but just some general ideas and then some information about areas of back pain and what might be causing themselves. I like to share that information with people for free and that also have on my website, if you go to our shop tab, I have a couple of trainings. I'll have some more up. I have one that I'm working on now that is for like managing chaos in your life. Simplifying and making things smoother. But right now what I have on the site of training for people interested in physical therapy.

So I kind of go through that whole process of initial interests through school and then journey into private practice. And then I have another one. Yeah, that's a good one. I was fortunate enough to do a presentation for the North Carolina health occupation, students of America, their conference here. And so I basically did that presentation. So I just rerecorded it, kind of condensed it a little bit and offer it for people on my website, for a much reduced amount. And then also because I do a lot of writing and I have been very blessed to be featured in a lot of great places. Some of my tips on health and fitness. I have a Webinar that is up on my website right now recording that is for people who are interested in that. So if you're interested in having your blogs or you're just your writing featured in major publications like Oprah or shape magazine or Reader's Digest.

Dr. Berry: Drop the names on it so they know you're not playing out here. Because I read the bio, they might've skipped the bio. Let folks know what just some of the places that you've been in so they know.

Dr. Lisa Folden: Thank you. Yeah that webinar is for people. It's just five steps to getting your writing speeches but yes, I have been fortunate enough to be featured in the Oprah magazine. I was a big one for me because you know is Oprah is Oprah. I've been teaching in shape magazine. I've been featured on livestrong.com, Bustle, She knows, oh, there's so many. I mean I don't have my list in front of me, but I love writing and that is why I love writing and it's so cool because I'm writing about health and fitness related things and exercise. And so literally, I mean the topics from, I got emailed an article today from, what is it? I can't even recall, but I was talking about foam rolling. So I love to put my 2 cents out there about some of the latest health trends and give people tips and tools and things from someone who has some experience, with those things. So yeah, if you want to be featured and do that type of work, I have a webinar on that and yeah. And I'll have more, I'll be loading more as weeks go by just having to sit down and make times for recording.

Dr. Berry: Too busy. I hear we gotta to get you like a VA or somebody to have direction.

Dr. Lisa Folden: Just had that conversation. I totally need one of those. Put that in the show notes. Dr. Berry: We need. Because we can get the second book. You don't free up some of her time. So we need to be able to try to free up some of your time to get the second book out here. Love it, love it, love it. And you talked about the second book so this is going to be essentially a kind of a recipe book just based off the meal plan. Okay.

Dr. Lisa Folden: Yap. So it's going to be just basic recipes that I'm going to right now the format I have is sort of a set section for breakfast, recipes, lunch, dinner, and then I'm going to have sort of a bonus section for kids' lunch ideas. Because I tried to get very creative with my kids because I'm not really the sandwich maker. I get very bored with that. So I try to get creative with their lunches. And so sometimes when I post them to Instagram I have people like what is that? How'd you do that? So I'm like, you know what, let me just throw a few. So I'm thinking maybe five to seven kid lunch idea. So you guys have some options for that too. Because sometimes it's nice to make their stuff fun. You know, we'll do like Turkey dogs skewers with like piece of Turkey dog, some string cheese, Turkey dogs, cool stuff. You know, it doesn't take long. I'm not that mom, I don't have a whole lot of time. But sometimes I try to give them little cutesy ideas for that. So yeah, we're working on that. I'm gonna maybe if I say it out loud, I'm gonna set a tentative deadline of. (Let's go, let's go). December, by the end of the year.

Dr. Berry: Alright. You heard it here and again, I'm one of the best accountability partners. I'll be in the DMs. I'll be in the comments like, Oh hey, Christmas is coming around. That'd be an amazing Christmas gift.

Dr. Lisa Folden: I'm going to get it and I'm going to send you one, that's what I'm going to do. That gonna be Christmas present from me.

Dr. Berry: I love it. I love it. Before I let you go, I always ask my guests, how is what you're doing helping to empower others to take better control of their health?

Dr. Lisa Folden: Well, what I hope and what I believe based on some of my client feedback and see that I'm leading by example. You know, I'm not just sitting here giving you a list of impossible things to do that I have not done or tried myself. But I'm actually being very honest. I'm being tried to be very honest about my own shortcomings and my own struggles with this whole journey of wellness and nutrition.

Dr. Berry: It is a journey. I think that people need to realize that this isn't like a stopping go. The journey contained some ups. It does have some downs as well.

Dr. Lisa Folden: Absolutely. And it's ongoing. So my goal is to just be authentic and transparent and open so that people can see that I'm doing this with them and leading by example. And I'm trying to do my part because my goal is to provide some level of inspiration. If it's just enough to get you at the starting block. We're doing something, we're going somewhere. But I teach people to be accountable for themselves and to recognize that your happiness, your joy, your health is only your responsibility. These kids that we love so much, they will drain every ounce of your energy and they don't care what you eat, okay? They'll find if you eat cheddar cheese popcorn all night and hang out with the people in your life that love you the most, are not necessarily checking for your health and it's your responsibility all the time.

So I just try to, I put it back on them. This is your life, your body, your health. You only get to do this once, right? As far as we know, at least in this space. So you gotta do it right? You're trying your best to do it right. And that does not mean perfect. Like I said, we all fall short. We all have tough days, weeks, sometimes a month, right? But the point is you get back up, you keep going. So that's my goal and I hope, you know, and I've had some people say it, but I hope that I continue to inspire people to do this on their own and just and take the reign and say this is my life and I don't have to be governed by what I was taught growing up or what I saw growing up or what the people around me are doing. I can carve out a plan and a direction for my life that I think is better for me and that's it. And I'm not better than the next person because I'm doing it. I'm just trying to be good to me. So.

Dr. Berry: And where can people find you? Where can they track you down working stock and make sure when that book comes out, they know where to purchase. And again, remember Lunch and Learn community, all of this information, it will be in the show notes so you don't have to like write it down scurrying down. Now it will be in the show notes. But wait, where can they find a website? All that. I know you said it before, but for our late stragglers.

Dr. Lisa Folden: So I love Instagram. I tried to limit my time on there, but I am on Instagram all the time. So that's at healthy phit. H. E. A. L. T. H. Y. P. H. I. T. That's me on Instagram. I'm also on Facebook. I will be honest, I do smaller interactions on Facebook, but everything that I post to Instagram goes to Facebook so you can see my posts there as well.

Dr. Berry: Just go to Instagram. Some great pictures.

Dr. Lisa Folden: Thank you. And Twitter is the same way. I don't really spend time on there, but everything I say that I can get to my Twitter page goes there as well. So everything is at healthy phit. And then, of course, my website, which is healthyphit.com. You guys can email me if you have questions. [email protected] and yeah, join my mailing list cause I send out my blogs, which is also on our website and I send out specials and you guys are the first to know and when I do release something or when a webinar's available and things like that. So.

Dr. Berry: I love it. I love it. Dr. Lisa, again I want to, and I thought we'd talked earlier but I do want to show the graciousness of being able to take time and get me together. I get our Lunch and Learn community members together on a topic that is so important. Once you Google lifestyle changes, you know, meal prepping, nutrition is such a big thing that pops up and just the fact that you're able to simplify it and really give that personal touch. We really appreciate me taking the time to talk to us today.

Dr. Lisa Folden: Thank you. I'm so glad you had me on. I appreciate it and I love your podcast. I will be a continued subscriber and listener.

Dr. Berry: I love it. So you have a great day. Again, thank you. And again, guys, remember, she said December. So we gotta, we'll plan a campaign around November time frame to start like just dropping comments, and so we can get a good little Christmas gift like that. That's going to be us. We want that Christmas gift. We want, we want it the book to come out and again, again pick up the book is as on your website now as well as Amazon? (Yes). Right. Okay. I always tell my listeners if you can get a chance, always get the books off the person's website, right? Because Amazon, you know, they try to take all that money, right? Like so you can get the book off the website first, right? If you have to, right. If you gotta get it kindled out, whatever, that's okay.

Dr. Lisa Folden: I understand. We don't care how you get it.

Dr. Berry: Just get it. That's probably the goal. We don't care how you get it. Just get it done. And you know, we're gonna appreciate you for it. Thank you again for joining the podcast.

Dr. Lisa Folden: Thank you so much.

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On this week's episode of the Lunch and Learn with Dr. Berry I am back to start off our next round of podcast episodes focused on the topic of nutrition. At the time of the episode, I have currently made the transition over to a low carb ketogenic lifestyle and what better way to start the nutrition discussion than to tell it from a personal view.

Learn why I made the transition over to the keto lifestyle, why I hate referring to lifestyle changes as "diets" (Even though throughout the episode I still had trouble not doing it) and what the goal for me is.

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Download Episode 120 Transcript

Episode 120 Transcript...

Introduction

Dr. Berry: And welcome to another amazing episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and promotion. Today we bring you Episode 120 and it is a solo episode with yours truly and we are moving along with our theme related episodes and for the next few weeks we're going to be talking about nutrition. Because for majority of my listeners, the majority of just patients out there in general, it is a huge topic. It is a huge area of concern, especially when we talk about controlling our health and getting our health together. And we're going to start off with a solo episode because I want to kind of talk about some of the things that I've been doing pretty recently.

Depending on when you're listening to this episode, as far as nutritional changes in lifestyle changes. Because again, it is not a diet. We're not talking about any diet related strategies. We are talking about nutritional and life base changes that need to occur to make sure that we have a very fulfilling and a sustainable approach to our health care. So we're going to talk about my transition to the Keto lifestyle, which again if you're listening to this in the month of August, just happened pretty recently. And it was something that I was always thinking about something that I was always contemplating, but it was with the issue of me going into the surgery and not being able to have any ability to exercise. It was going to be even more important that I stress my nutritional habit, which was bad of course, which is something I wanted to make sure I addressed before I can get back to the gym.

So again, listen for another amazing episode. Like I said, we're going to have a great slew of episodes coming up in the next few weeks. Hope you guys are there again and appreciate all the new listeners who have been recently following and subscribing to the show and sharing. And letting friends know and your parents know and your relatives know that being healthy is cool. And again, stick with me. Then remember, Empower Yourself for Better Health, that is the model here on the Lunch and Learn with Dr. Berry. You have a great blessed day and let's get ready for another amazing episode.

Episode

Dr. Berry: Hi everybody, Dr. Berry here. So today we are having an episode that focuses on nutrition and I think for most people, especially those who follow along with the podcast. You like to hear a lot of the personal reflections every time we talk about the stories of, really important to get the personal standpoint from it. So today we're talking about my journey with nutrition and we're going to be talking about the ketogenic lifestyle. Which is again, I don't like to call it diet. Because diets aren't long lasting and they usually don't give us the result we want for a long period of time. So, and in here we always try to focus on very evidence based medicine related to a lot of the topics we do and ketogenic diet definitely happens to fall under one of them. So just a quick little recap of everything that's been going on does far.

As a person who has been working on losing weight. That was my goal in the beginning of 2019. It's still my goal towards the end of 2019. I definitely thankful to still be kind of on that track. In Dr. Brad's episode where we talk about the fact that 80% of people by this time have kind of fallen off on their new year's resolution. That has not been the case with me. So I'm definitely glad about that. But what occurred was the aspect of, and I've talked about this before, how important diet and exercises to losing weight. But then what happened a few weeks ago for those who may know or may not know. Again, if you don't know, you're going to know now. I recently had an injury where I actually had to have surgery and actually had to be non-weight bearing for four weeks, which essentially means that I'm not going to be able to exercise and do that level of physical activity for at least four to six weeks.

It really actually longer because even once I'm actually becoming weight bearing, because I broke my fibula. I can't even wear sneakers for another two more weeks after that. So at least six to eight weeks before I can even put sneakers back on before I can get back to kind of working out. Right? So here was this onus where we know the equation, especially when we talk about losing weight is diet and exercise. But now I've taken that component pretty much out of equation. So now all I can do is really focus on my diet to help me lose weight. And I'll be honest, and then this happens for a lot of people who do did an exercise combo. For a lot of us who do it and kind of do it frequently enough. You kind of cheat on the diet side, even though I know someone's going to hit me with the diets are made in the kitchen.

Yes, I know that. But like if I exercise enough, I don't have to worry about eating really bad that one day or two days. And that was occurring throughout this process. There are some days where I wasn't as efficient as I needed to be on my diet. Again, that just happens to everybody. The goal is when you have these trips and these obstacles and these bumps in the road that you know how to get past it, right? So I was very fortunate enough to be able to work out, to balance those issues and allowing the weight to still be decreasing. But now I've taken that aspect. I can't work out and all I can do is focus on my diet. And there's a wide range of different types of diets related options.

Again, like I say diet, but really is the lifestyle changes that need to occur and understanding, where I was at and what needed to be changed. I am Haitian, so growing up most of my meals were rice and something. And when I look back, the amount of carb load that was associated with my diet was so crazy high. It was a wonder that I lost any weight, right? Because carbs are such an important staple of my diet. So when I was looking to see, okay, what type of lifestyle change can I make that I think would have the biggest impact on me. This is when the ketogenic diet to shot up to the top. Because the ketogenic diet for those who may not know is a low carb, high fat, high protein diet. And it has lots of different benefits. And we're going to talk about some of the benefits at hand. But it was one of those things where I said, you know what, if I know my bad issue, is the carbs, right? Why not go to a lifestyle that reduces that? Right? And Ketogenic Diet pretty much did what it needed to do, right? It said, hey, I want you to decrease your carbs and I want you to just have more proteins and more fats, which again was pretty obvious in nature here. And for a ketogenic diet, again, for those who may not know, those may remember of the Atkins Diet. That famous diet that people were essentially having almost a zero level of carbs and just like eating bacon and grease and all that. That's not the Ketogenic Diet. The Ketogenic Diet does take into account that just you're going to increase your fats. Yes, you're going to increase your proteins and have lower availability of carbs, but you're not going to be having those drastic amounts of fats.

Because again, there's all types of fats, all types of proteins. There's good ones and there's bad ones. Right? And what happened for a lot of people, especially when the Atkins Diet was very popular, was everyone was eating really the bad related types of fat. They weren't really eating any of the good related oils and fats that needed to be added to their diet. So that's why we had so many problems back then. So I think that's why the Keto lifestyle has took a center stage at this time because it's been more perfected. A lot of the related ill effects that you used to occur with that type of diet with the Atkins Diet does not necessarily happen, especially if you follow a good regimen.

So I want to take you what happened. So again, here I am, I can't have any of my typical o's I normally eat, which essentially was rice and something. That's essentially gone. And there was a lot of change over. Because again, I had surgery. I couldn't move anywhere. I couldn't do exercise. So I had to decide, wait, what am I going to start this diet? Hey, I might as well start at like right now. So once I started, once I made the change, it was pretty drastic, especially in the household because most of our meals consisted of that carbs. And I'll be honest, I was not a big vegetable eater, even on fruits are kind of, you know, sketchy. Especially, because I don't know if a lot of us realize how high carbs some of our fruits are, but fruits was kind of sketchy as well.

So I had to decrease some of my fruit intake and really increased my protein and my vegetables. Which was something that I needed to do anyways, but just never had. And again, I think I was going off some of the benefits of, the fact that I worked out a lot more than I needed to be. And there's different types of ketogenic diets. There's your standard diet, which again, from a percentage standpoint. And again, I don't like, especially for my listeners who may be thinking about starting on your nutritional support. Obviously, make sure you follow up with someone, make sure you have some professional help to get you over the hump. We're talk about percentages. When it talks about percentages, a lot of people have about, 20 to 30% of their food or proteins.

Again, a good 60 65% of their food, are fats, and then less than 10% is carb related. That's just in a general sense of things. And again, for most people who don't understand, why keto works? Our body typically breaks down our three, we have three types of nutritional support. Proteins, fat and carbs. Most of us have a pretty high carb diet. Most of us take in enough carbs. So that's what our body tends to use. So our body needs this nutrient, which is carbohydrates to energy. Really to make the body work, make the brain work. But if you're in a state where you're taking in a lot of carbs and you're taking a lot of fat, your body does not have to break down any of that fat for energy.

Because why? Because you're giving it enough carbs. So that's what tends to occur. So imagine you're eating enough carbs, you're eating enough fats and you need to work out. You need to do something. Your body is going to break down those carbs first and leave those fats alone. So what tends to happen over time is that you have this fat stores that continues to occur, continues to build up because you're giving it enough carbs that your body never actually has to go down to the fat. That's why when you go on these treadmills or these bikes, they usually have different settings, one for a carb and one for fat burning. Because it's a different level of energy needed to get to the fat burning. It knows it has to get through all of your carbs source first before it can even think about getting to the fact because your body just won't allow it for you to do the Keto Diet because that's essentially reverse.

Essentially I'm saying, hey, I'm going to give my body the bare minimum of carbs to use energy and burn off. Your body has no choice but to go after the fats much sooner. And for most people, that's where the weight loss occurs. Because not only are they usually, because they usually have a lower intake from a total calories standpoint. So they have a lower intake from a calorie standpoint and then because they have a lower carb intake, your body is having to go after the fats that are in their system much quicker. This is why you see a lot of the weight loss occur in patients on the ketogenic lifestyle because your body says like, oh I got nothing else to burn but fat. So I'm going to burn fat because I need this energy. And that's where a lot of that's where you see a lot of the success and results for people who are on this lifestyle losing weight.

That's the crux of, right? Again here at the Lunch and Learn community, we don't want to try to hit you with the grave details. Because that's not really important here. You want to understand why something is working, why something helps. Because that's really the name of the game. Why does this thing work? And that's really the reason why. Because your body is now forced to break down that fat that it was not forced to break down no more because you're going on a low carb diet. And there's a lot of different things that have been shown to help. For patients who are diabetic or pre-diabetic, because you're having less carbs that means you're having less of your insulin that's needed to be used.

So we've seen some benefits in our pre-diabetic and our diabetic patients. There's been studies that's shown that there's changes that improve for patients with epilepsy because of the ketogenic state that happens in your lifestyle. Patients of course had to be concerned because remember we're talking about increased fats, we're talking about increased protein. So you have a history of high cholesterol and stuff like that. You definitely have to be very mindful when you're on this type of a diet to make sure you don't really cause any problems and headache. Because again, like I said, every lifestyle comes with changes that need to occur. So again, I'm not telling you to eat nothing but bacon grease three times a day, but I am telling you, you have to be very mindful of what you're doing and what you're eating to make sure that's not an issue. So again, I'm just going to list a couple of other things that, again, these are evidence-based things that ketogenic lifestyle has been shown to improve. Again, it helps improve the risk factors of heart disease. Again, because you're losing all of this weight, are you dropping your blood pressure down? There's been signs of that some cancer, has been shown to have a slower growth rate because of. And we know cancer is a very nutritional base. Again, not to say that nutrition causes cancer, but we know that there are some nutritional diets that can help at least slow the process down. Patients with Alzheimer's disease, I talked about the epilepsy, Parkinson's disease as well, brain injuries, acne. So again, a lot of these things that are nutritional and hormonal related. We do see some benefit associated with the ketogenic diet. So here I was, because again, back to me because we get up to the big thing. So here I was saying like, yup, I want to make this change. It's going to happen right now. So what did I have to do? So question RSE is, well Berry, what did you have to like avoid? What was your big things? For me, big things were rice. That was always a big thing for me. First and foremost, I was a big fruit eater as well and that was probably some of the bigger things. And again that occasional fast food. But these are some of the things that, again, some people would go look in your cupboard right now.

Just to list some of the things, I've had to avoid that, you're going to have to avoid, if you want to partake in this ketogenic lifestyle type diet. Sugary foods, soda, fruit juice, ice cream, candy, your breads, your pastas, your cereals, get a lot of your fruits are very high in carbs. Again, you could still have like berry, blackberries, strawberries, but you have to do it in moderation. Again, with everything is in moderation. So you have to do that in moderation. Beans, potatoes, sweet potatoes, carrots, any fast food, fried foods, get that out of there. A lot of your condiments, that's just no good. Some of your unhealthy issues, fats, vegetable oils, corn oil, canola oil, mayonnaise, ketchup, all of these things here that are high in carbs are high in sugar was a big thing.

Of course, I'm not a big alcohol person anyway, so alcohol, one that had to get out of there in that case as well too. So there's a lot of different things that, again, I don't suggest. Again, and we're like, we always do right. Always follow professional. I give you advice here but you know the terminology, you know the legal is, right? Don't follow me. Act like I'm not a physician and always follow up with some professional that can follow you along in that process. Again, these a lot of things that you have to remove out of your diet. If you really want to partake in this type of lifestyle. So again, this isn't an easy process.

This isn't an easy transition. It's probably the reason why it took me so long to make that transition. I really had to kind of be forced into doing so. Because again, I love my rice. I love rice. I can't, ugh, it hurts me. It hurts me when I can't have rice. It hurts me when I can't have bread. But because I understand the long-term goal of where I want to go with, that's kind of direction I'm willing to take. So what are some things bread that you can't eat? And again, a lot of this stuff I was already eating in the first place, Meats of course, red meat, your steak here, your bacon, your ham, those Turkey chicken. That's still on the horizon. I used to always tell my diabetic patients, what gets them in trouble. Make it have a plate, 12 ounce New York Strip. And that's not the problem when it comes to their diabetic.

It's that roll on the side. It's that mashed potatoes on the side. That's what causes your sugar to raise. Again, your steak could be as big as your plate and that's not causing your sugar levels to shoot up. But that roll and that mashed potatoes that you have on the side is really, really the problems. Fish is definitely what, so what are foods that are good to eat that we can't eat on a ketogenic diet? You know, again, I hate to say diet, but whatever. Needs, we talked about fish, eggs, butter, cream, cheese, there's some nuts or say almond walnuts that are available. Healthy oils, virgin oil, avocado oil, coconut oil, avocados. Some, I love avocados that was definitely a good thing.

Most of your veggies are going to be in line and then a lot of your condiments. Again, I know you can't have like ketchup and stuff because of the high in sugar, but there's a lot of sugar free related stuff that you can have. Salt, pepper, all that stuff is still on brand to have. So again, yes, there's a lot of foods I can't eat, but there's still a lot of great foods that I can eat. So isn't that something that like, Oh woe is me, how Berry gonna survive because he can't eat his regular food. That's definitely not the case here. There's a lot of great nutritional support. But I think the most important thing, especially for person, in my case, a person who decides, this may be a lifestyle that I want to think of.

There's pros and cons with it and understanding what good can happen, what bad can happen. There's always something you always think about. Understanding longevity. And this is where we're going to get on the soapbox aspect of this show. Understanding that when you're making a lifestyle, whether it be you're going to exercise more, whether you'd be, you're going to change in nutrition. Like I said, there's a whole bunch of different types of a lifestyle changes. Like I said, over the next few weeks, you're going to hear some various aspects of a nutrition. Because I want you guys to get a full picture of how people are doing it differently. Again, this isn't the only way to help lose weight. This is just one of the ways to help lose weight. Because again, at the end of the day, the equation is simple. If you take in less calories. If you burn off less calories that you take in, you're going to lose weight. That's just the simple mathematics of it all. The question is how do you go about doing that? That's really the most important thing. You could be on this ketogenic lifestyle, but if you're eating, 3000 calories of stuff but you're not really burning off that many calories. You're going to have some problems. That's not a good aspect. It's all about making sure your nutrition is adequate and really adequate for you. Make sure that you, it can be in what, in three months, in six months in a year, still be doing that same process. Because that's where, again, Dr. Brad talked about it, right? Eight months later, you want to be eight months later still being able to say, yes, I'm still on that type of lifestyle.

And I've had people who, again, there's various different ways to do the ketogenic lifestyle. Some people do it where they do it for five days out the week and then two days they kinda quote unquote recharge their battery as far as the carbs are concerned. You could do it that way. But again, just like we've talked about, especially with Dr. Bollie, right? We talked about these cheat day, right? Don't cheat yourself. You can treat yourself but don't cheat yourself. Don't think that you can be very good Monday through Friday and just go crazy Saturday and Sunday and then it all kinda starts over again. We don't want that. That is not healthy way of doing things.

And again, like I said, I can only imagine some of them. I've been doing it for probably like at this time recording about almost three weeks now. I'm definitely noticed a difference. I definitely noticed I'm not hungry anymore. I definitely noticed some changes that I think are positive benefit of minds. So I know its works. So again, in which was never the problem. It was never an issue of does this thing work. The question was, is Berry Pierre, in the mental mindset? Again, all last month, we've talked about getting into mindset ready and getting our goals. Why Berry in the mindset to do this? And I can tell you a few months ago I was not, but over time and you know I kept saying, I kept saying that aloud to the point I didn't want to call myself a liar.

And I finally did it and that's why I'm definitely happy. Like I said, I'm definitely excited to see over the next few months, especially once I get back to working out again. You know, what type of positive benefits we're going to see here. Because again, it is a transition. Like I said, every time I go on my kitchen like I almost like have to close my eyes because I see all of these things that I used to be able to eat that I don't eat no more. Right. All of these things that I used to be able to enjoy that I just don't enjoy anymore. I can't enjoy anymore. I w what I and that's really where a transition occurs. Right? Once you mentally make the decision like I want to make this leap in this direction. Right. You just got to do it right. And there's a lot of support groups.

Like I said there is a lot of different aspects especially for those who may be interested in the ketogenic lifestyle. There's a lot of different ways to do it as a lot of different supplements. Again, if you have any questions, concerns or you want to make the leap, make sure you drop a drop a note in the comments, make sure you go them a website, make sure you follow along. Because I'm on my socials everywhere. Instagram, Facebook, Twitter. I'm all at Dr. Berry Pierre, all of them. So follow me, drop me a message if you have any questions or concerns along with that process. If you are in my Facebook group as well, that's another place that you can ask your questions as well, especially if you have any questions regarding at least to ketogenic lifestyle and what the process is going through at this moment here. And like I said, I'm hoping. I'll say it on the prayer out loud and maybe with answer. I'm hoping to get it one of the foremost maybe like a ketogenic expert on this. Everyone, when you're an expert, it just means that you've done it longer than everyone else or you just read up on it. So I hoping to get an expert on Ketogenic lifestyle, maybe like a dietician on here to kind of talk to us about that aspect as well too. Just so you can kind of get a little bit more of a formal approach. But I really wanted to give you a personal aspect to kind of start the month. Because again that's one that seems to translate well with you guys.

You guys like to hear the personal stories, which makes sense. You want to make sure that the person who you know is up here, expounding knowledge, actually has some sense, isn't like a robot doesn't follow their directions. So again, love everyone for their support of the podcast. You guys have been absolutely amazing over this past year. Continue to listen, continue to share, to subscribe and leave your ratings. I love those ratings. Like I said, I love when you guys show that I'm actually doing a good job. Because sometimes you never know when you're up here talking into a microphone by yourself. So you guys have a great and blessed week. Like I said, I'm excited for the next month or so as far as some of our podcast guests, and I think you guys will be excited as well. Have a great and blessed week and see you next week guys.

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