Small Changes Big Results with Dr. Ron Sinha

The life of this Georgina time is right. welcome today’s guest strong, powerful. Dr. Ron Sinha. Dr. Ron, are you ready to do this?

Unknown Speaker 0:22
I’m ready. Let’s do it. All right, let’s go.

george grombacher 0:25
Dr. Ron is a Senior Medical Director of employer strategy for Sutter Health. He’s the Chief Medical Officer for the Silicon Valley employers forum and he’s the author of the South Asian Health solution, a culturally tailored guide to lose fat. Dr. Ron excited to have you on tell us a little about your personal life some more about your work? Why you do what you do?

Unknown Speaker 0:46
Yeah, absolutely. So I am an internal medicine physician and practicing right now in the Bay Area. So you know, I started off doing primary care medicine, which is many of you know, deals a lot with chronic health conditions like blood pressure, diabetes, etc. And the way my journey sort of started, and I’m kind of fast forwarding, because I’m not going to start with my childhood and things in life that’s relevant later on. But but the way I kind of started my journey is when I came out of medical training, there was a certain vision I had of individuals that have chronic health conditions, just based on case studies and things you learn in medical school. But when I got out into the real world, I realized that boy, this is a very different world, especially coming to the Bay Area. And seeing a lot of young entrepreneurs, techies, software engineers, and folks developing chronic health conditions that I would have expected developed, you should develop decades later. So to be more specific, seeing 30 year olds with their first heart attack, or having a diagnosis of diabetes very early on. In the beginning, I was pretty startled by that. I was like, Okay, there’s just must be anomalies. But as I looked at the research, especially in specific ethnic groups, I realized that these are conditions that can start very early on in life. And it really changed my lens. The other thing that he actually taught me was, not everybody with heart disease, or condition, like cancer is a smoker that eats red meat, a lot of these folks are folks that are actually doing a lot of exercise, eating a relatively healthy diet. But honestly, it is your sleep schedule, it’s your chronic stress, all these factors that are not traditional risk factors for heart disease that you learn about in medical school, that are really manifesting in this sort of intense Silicon Valley environment, which can be extrapolated to really any intense work environment. And really fast forwarding to now, especially after the pandemic, I’m finding a lot of those factors have been magnified even more with work from home, and all the stress, we’re dealing with even more sleep dysfunction. And really, now that I’m even seeing older teens, in my practice, seeing things like high blood pressure and teenagers that are applying for college, you know, like things that I’d never come across before. So, you know, my passion based on that has been to really create health education resources, go out and talk to Silicon Valley companies, and really educate the public about what are the things that they need to focus on, as employers, What do employers and HR leaders need to focus on because their employees clearly, you know, companies care about their employees, but they also care about the bottom line. And if they’re paying for the health insurance of their employees, and they’re developing heart disease and diabetes risk in their 20s, and 30s, that’s gonna be a big issue. So so that’s what really motivated me to create the book, create the programs that I’m doing. And then I do have a clinical practice a couple of days a week, where I’m seeing patients individually, and just learning about the habits that are really driving a lot of these chronic health conditions. So so that’s kind of a high level deserve a lot of the work that I’m doing.

george grombacher 3:35
Nice, I appreciate that facet, awful, slash fascinating, running into young people who are who are struggling with these. And trying to figure out, take a big step back and change that lens and what is what are the causes of these? How can we start to work in to prevent these? And then what are the habits, and certainly companies, you know, I’m assuming that companies want the best for their employees, but they also want to make money. So we need to optimize these folks so that they are showing up 100% and leading happy and healthy lives. Exactly. So how do you start to crack that nut? I mean, individually, as a human being I need to, you know, attend to all these things, but how do you how do you work with a company and say, Okay, let’s let’s push this out in a way that’s actually going to be absorbed.

Unknown Speaker 4:30
So, you know, a lot of folks in these companies and not just focusing on tech companies, but many of us are really driven by metrics and numbers, right. And the problem right now, George with the traditional health care system, is the way we identify disease. It’s a very downstream process, right? So we’re gonna wait for your glucose numbers in your a one C two enter range called pre diabetes or diabetes before we act upon your health. And one of the tricks here is that the earlier we can identify and enter Being on signals that the traditional health care system is not emphasizing. That’s when we can really reverse health conditions. So I typically see a lot of patients, for example, from Asian backgrounds where diabetes is rampant in the family. And they literally feel like, genetically, they’re just predestined to get diabetes. But I will sit down and teach them, how do you actually interpret your cholesterol panel in a way that can actually for diabetes later on, and to give you a very specific example, because I want to make this practical for your audience to is, instead of waiting for your blood sugar to get into the pre diabetes range, there’s a couple of early signals, you can tell that might put you at risk for heart disease. And again, these are my individuals that had early heart disease, even with that having diabetes. So for example, if the waist lines a little bit beyond the limit that we would set for somebody and to be very specific, you take your height in inches, and you divide that by two. And usually that should be the upper limit of where your waistline should be some very waistline focus, because total body weight is very misleading. I have patients that are elite athletes and bodybuilders, they’re going to be above the body mass index threshold, but they have a lot of lean body mass and low fat. So weight doesn’t is not very useful. On the other hand, I have very slender skinny patients in my practice, that a heart disease in their 30s and 40s. So their weight is normal. But if you look at their body composition, they have very little muscle, and they have a little bit of belly fat around their stomach. And that’s enough to trigger disease. So really being aware of what is healthy body shape is one important thing. The second thing just to throw at you too is when most of us have hopefully had a baseline cholesterol panel, the cholesterol doesn’t have blood sugar in it. But if you’ve got issues like slightly elevated triglycerides, low levels of healthy cholesterol, what we call HDL, those are very early markers for future diabetes and heart disease risk that actually happened even 10 to 15 years before your blood sugar goes up. So really educating the public about what are early markers that you can track. And you know, act upon now, because it’s so much easier to reverse this condition when it’s in the pre pre diabetes stage than when you develop full blown pre diabetes or type two diabetes. And then if you track those numbers, and most doctors are willing to get your labs checked, instead of waiting three years, like the standard guidelines, say, let’s check it in four months or six months after you make X y&z changes, and then see those numbers move. And metrics are a big motivator rather than giving general guidelines on Hey, eat less and exercise more. That mantra has been around for decades, we know how effective that has been in combating diabetes and chronic health conditions. So knowing those numbers is really critical part of how I approach it. And that’s the message I ticked employers. And that’s why they love my thoughts. Because I approach it, I tell them, I’m going to teach you about the operating system of your metabolism. And here are the metrics we need to aim for to really improve your health and well being that’s kind of the approach that I take.

george grombacher 7:49
That makes a ton of sense. And I certainly think it’s the right approach and the belly fat is belly fat, the worst kind of fat? Dr.

Unknown Speaker 8:01
Yeah, you know, it’s a waistline fat. So there’s two different types of fat in the body. So the belly fat is what we roughly talk about. It’s the visceral fat, it’s the fat that lungs or organs. So when you’ve got that extra belly fat, that is the one that releases chemicals that can drive heart disease, cancer, and even Alzheimer’s risk. Then we have the subcutaneous fat, which is like our arms, legs and thighs, and that contributes to the total body weight, but it tends to be more inert. So there, for example, patients in my practice women that have a lot of subcutaneous fat that they clearly want to lose their visceral fat is not necessarily as high relative to subcutaneous fat. So their overall risk is really not as bad. Now, one thing I do want to highlight is there’s a lot of, you know, news around belly fat, and it can actually drive people to be very obsessive, like I have men and women that come into my clinic, they’re like, unless I have a six pack, you know, it’s like, I’m not going to be healthy. And reminding them that this is one metric. And for a lot of patients just losing an inch or two, and bringing their triglycerides and blood sugar back down to normal. That’s all they need to do. Because otherwise I have a lot of busy entrepreneurs that have become body obsessed with intermittent fasting and government intensive keto diets, which can be helpful to some degree, but sometimes they’re developing borderline eating disorders. So I do want people to be waistline focused but not waistline obsessed, especially given the constraints of their lifestyle in terms of what goal they’re reaching for.

george grombacher 9:25
Yeah, that’s a that’s an interesting and fine line of being a healthy, functional human being that has a sustainable that has sustainable habits and I have a legitimate eating disorder and some some form of body dysmorphia.

Unknown Speaker 9:43
Exactly. Right. Those are the perfect terms for that exactly. Right.

george grombacher 9:47
So and then it’s going to be how important is it to to, to consistently do that blood monitoring, I’m not going to get the term sheet Like How valuable is it to to to do like a glucose monitor to know, this is how my body is actually responding to the food I’m putting in it.

Unknown Speaker 10:10
Yeah, great point. So in a traditional healthcare system, so So first of all, when I see individuals and we get a baseline, cholesterol panel, blood sugar testing done, many individuals have perfect numbers. So it’s not like I’m going to, you know, prick them and get a blood check every three months or every four months, you know, sometimes it could be even twice a year for patients that look metabolically healthy. So that’s the great side of the spectrum. But then there are individuals that are already developing chronic health conditions, or they might have borderline conditions. And in those patients, I tend to be more aggressive, it might be every three months, it might be every six. But initially, I want to keep them really motivated. Because you know, if they make very simple changes, for example, some of them breakfast is a killer meal. It’s like they’re eating a lot of carbohydrates, and bagels and what they think are healthy breakfast cereals. And I’m like, let’s just change this breakfast. And you will see your blood sugar and triglycerides improve within four to six weeks. So if I can give them some literally some low hanging fruit, where they see some metrics that are beneficial, that gets the momentum moving. Now they’re like, Okay, Dr. Ron, I’m ready to do the next thing. So it really depends on that now, what you brought up is an interesting piece of new technology that I do use in my clinical that continuous glucose monitor CGM. And these are actually game changers. Because right now, when you go to a doctor’s office, they’ll check your blood tests will say, you know, eat healthy, exercise more, and come back and see me in three, six months or a year. And sometimes patients won’t come back for another two years. And in between, they don’t really know what’s happening to their body, because you’re not getting real time feedback, you’re going to come back. And maybe that lifestyle experiment worked or didn’t work. But continuous glucose monitors are sensors that you literally put on you use an applicator you attached to your arm, and you can in real time, see what’s happened to your glucose and form food experiments. So these are a lot of the programs that I run and what I do in my clinics, because now we can see the individual variability. So for example, oatmeal might be great for your blood glucose, it might destroy my blood glucose, you know, certain specific foods that are, let’s say, low carb, or keto friendly, it’s amazing how some of those are raising more blood glucose in my patients and others because, you know, food manufacturers have now glommed on to keto, and low carb dieting, and they’re finding ways to manufacture foods that have that label. But when you see the glucose response, often it can be astounding, these protein bars are these high protein shakes. Now if you go to a market, everything’s about protein, right? 25 grams, protein, protein chips, protein cookies, and people think, yeah, I’m doing so much good to my body, I’m gonna build muscle by having Protein Chips, but their glucose is just haywire as a result of his food. So I hope one of the things I’m pushing for all of these glucose sensors to be a mainstream part of the practice, because right now, they’re just approved for people that have insulin requiring diabetes. But that’s why we’re launching some pilot programs for Silicon Valley companies, where anyone can come into a program and get a glucose sensor prescription. And then they’re often running to understand what is food stress and sleep and activity doing to their blood glucose. And these sensors, by the way, are over the counter in Canada and Europe. And I hope they’re going to be over the counter as soon just like getting a Fitbit or wearable where you would need a little bit of physician insight or somebody knows how to use these. But But I think this is going to be the next generation hopefully, of health and wellness is using these centers more broadly

george grombacher 13:25
out of sleep impact my blood glucose, you would

Unknown Speaker 13:28
be shocked. I mean, I have individuals that are doing everything, right. And I’m somebody who is very sleep sensitive. What I mean by that is these are individuals that are doing everything right from an exercise and nutrition perspective. But because your sleep is lower quality or a little bit disrupted during the night, or they’re waking up prematurely, they wake up with a blood sugar that’s almost in the diabetes range or even pre diabetes range. And they tell me what the heck’s happening. I’m doing 16 Eight fasting, I had my I finished my dinner at 6pm. It was keto. There’s no carbs, where is glucose freaking coming from. And this is unbelievable thing about the body. Because when you go to bed, in a state of high stress, your liver can manufacture glucose out of anything, you know, because it’s literally trying to protect you during the nighttime it needs to give you an energy. So cortisol levels, which is our stress hormone, when they go up during the nighttime and especially in The Twilight Hours, they can cause a surge of glucose in the morning. And I would say having a little pulse of glucose in the morning is fine. It’s like your body’s already pouring breakfast in your blood system. So you can have some energy to do your workout. You can do cognitive tasks, so it’s not that dangerous. But if you’re consistently seeing spikes, I tell people listen, don’t go lower carb. If anything. If you’re too low carb before bedtime, you’re sending even stronger signal that this person has low glucose stores and then the liver will do everything he can to spike glucose. But that’s the beauty of the program is it’s actually motivated a lot of entrepreneurs to really take them they’ve read all the headlines around sleep, but until you see the impact of poor sleep on glucose, you don’t really believe it in that really teaches people to really perform better sleep hygiene around. The second thing on that note I want to mention is the impact of emotional stress on glucose is ridiculous. Like, you will not believe until you see what happens after conflict, what can happen to your glucose level. So somebody from my team, I use this as an anecdote, one of my programs, she had the most shit, unbelievable. Yeah, she’s young, beautiful blood sugars all the time. And then she basically noted in her diary, a conflict with her in laws, and her glucose went up to like 171 80 Never had gone that high before. And she literally afterwards did some breathing, she went outside, she came back, she had chocolate cake with her in laws, and her glucose did not go nearly as high for eating chocolate cake. So I wrote a blog post saying your in laws can be more dangerous and chocolate cake when it comes to your glucose. But it gives you a sense that these things like sleeping emotions, boy, can they have an impact on your glucose and, and we use that as a hook to really get people to focus on sleep, hygiene and mindfulness. All the things we know intuitively are good for us. But when you see the impact on glucose, it’s very powerful.

george grombacher 16:04
That’s fascinating. It’s not interesting to me that my in laws can make me unhealthy.

Unknown Speaker 16:09
Luckily, I’ve got great in laws. But yeah, all of us have those problematic folks in our lives that we have to really learn how to deal with in a better way.

george grombacher 16:17
And then mindfulness and some kind of a mindfulness practice, and it’s meditation can actually then reduce that, is it?

Unknown Speaker 16:25
Absolutely. Yeah, I agree. So if you start off the morning, with some sort of practice, you know, whether it’s mindfulness getting out doing some breathing, it could be mindful walking, like, you know, my routine is I take the dog out for a walk, but many of us take our dogs out for a walk, but our brain is buzzing around conflict or what we have to do during the day. But for me, that’s an opportunity to just focus on my walking, and I literally try to get inside the head of my dog, like, I see what my dogs do. And we’re like, really trying to be mindful during that walk, just so I can start off in a state because I do tend to wake up very sort of ready to go, you know, which is good for some things, but I know my battery’s gonna run out if I start off screaming with my battery running full flood. So you know, for me, it’s really doing something, some form of exercise where I’m focused on that task, and then really resetting and coming into you know, the rest of the day in a smoother way rather than starting off to activate an agitated so

george grombacher 17:20
it seems so obvious when, when, when we’re talking about it, the the, what we’re focusing our attention on, also has an impact on what’s going on in my blood sugar and everything else. So Right. Yeah, absolutely. Is it possible to get too much sleep?

Unknown Speaker 17:35
Good point. So so when you look at sleep data, when you start going up into the eight, nine plus hour range, it looks like that’s associated with poor health outcomes. And it’s not necessarily that physiologically that amount of sleep is bad for the body. But it often reflects either individuals that might have other health issues like for example, some people with mental health issues like chronic depression, they can sometimes be oversleep or they just don’t have much motivation, their cortisol levels which we should have some stress for when to activate us tends to run low. So Audrina li Fei TKE people that are not producing cortisol, they might be oversleep errs. So so it is something to be wary of, and even people that have sleep, disordered breathing, sometimes they’re not oxygenating very well during the nighttime, and they’re sort of hungover and sort of drowsy during the morning, and they’ll end up over sleeping as an effect from that. So definitely oversleeping can be a signal of something else going on. But there are also some folks that do get eight to nine hours of sleep and they function fine. So so how your mood is and how you’re functioning during the day. That’s a rough surrogate marker of whether you’re getting enough sleep, you know, if you’re consistently getting sleepy during the daytime, especially in the mid morning, the early afternoons with no reason for that to happen, and you’re driving to work, you’re getting drowsy. Those are signs that you’ve really got to see your doctor and maybe get a sleep study done to make sure you don’t have a sleep breathing disorder or something like that. And we’re seeing a lot by the way, the trends in sleep disordered breathing are going up like crazy. So many of my patients, when they get a sleep test, they’re not oxygenating their brain properly, and even slim folks again, in med school, we learned that these sleep issues are and people that are very overweight with thick necks, but chronically stressed at women entrepreneurs, I see so much sleep apnea in these patients. I’ve done some blog posts and podcasts on it but but you know, we have to be aware of the fact that if we’re definitely not getting adequate sleep during the night time from poor oxygenation, it can lead to a lot of daytime fatigue. So and glucose elevations is a result of that.

george grombacher 19:32
Everything is killing us.

Unknown Speaker 19:36
No, but you know, yeah, maybe I’m painting a bit of a pessimistic picture you are right. But you know, it’s more I think we don’t have enough awareness of what the risks are going on. We go through the day. We’re just trying to get through in basket. So we’re not even aware of the fact that some of these things were unconsciously happening. So once you open that up and see the signals whether it’s you’re aware that your breathing is changing while you’re checking In emails, or that your glucose numbers have trend in the wrong direction, it doesn’t take a lot of effort to make these changes for a lot of my patients, it’s like after you’ve had two or three, back to back meetings, that’s a really good time for you to step away from the screen for at least 10 to 12 minutes, and just do some breathing, go outdoors and then come back in, you know, because otherwise, we have this approach to health and wellness, it’s, you know, get a fitness trainer, you know, burn 1000s of calories, you know, do all these extreme things fast for 18 hours. And I’m not saying those are not good things to do. But some people are either doing that, or they’re doing nothing at all. And there’s so much in between stuff that we can do to manage these things. But that awareness and that’s my job is super, even through this interview, is to create that self awareness. I’m not saying everybody has to get a glucose sensor. But if you know that back to back to back meetings and breathing improperly is not good for you. Can we step away and do things a little bit differently? Can we integrate even five to 10 minutes of mindfulness while I’m showering or having my breakfast? It sounds so like, it sounds like how could that help me? But we see the metabolic numbers and impact it has. It’s super powerful. And hopefully that leads to a chain reaction of some other behaviors and habits we can integrate into our daily life.

george grombacher 21:09
I love it. Well, Dr. Ron, thank you so much for coming on. Where can people learn more about you? How can they engage? Where can they get a copy of the South Asian Health solution a culturally tailored guide to lose fat increase energy and avoid disease?

Unknown Speaker 21:23
Yeah, I’d say the central hub, just go into my website and my blog would be the best place and for that you can go these if your URL is my name, so just go to run ich Sinha md.com. So that’s aro N E sh Sinha. md.com. And from there, you can launch into my program some more recently, the program that’s getting a lot of attention is a program called the meta program which you can link to and that’s at the meta program.com. And that’s literally where I teach busy professionals, how to integrate health and wellness into their days like during zoom meetings, how do you get stronger physically and mentally. So I think going to that website would be great. And if you are a social media follower at Rahner Sinha, MD at Instagram, that’s where I post some scientific research and daily habits and tactics that I use in myself and in my patients as well to

george grombacher 22:12
love it. If you enjoyed this as much as I did show Dr. Ron your appreciation and share today’s show with a friend who also appreciates good ideas go to Roger Sena md.com You got it. Yeah, r o n e s hsinhamd.com. Check out the meta program.com You got as well. And I mean, I wrote down small changes, big results. So it’s all we’re all busy. We’ll have a lot going on. So the more you can integrate those small little bites into your day. That’s how we find success and then find him on Instagram as well. I’ll link all those in the notes of the show.

Unknown Speaker 22:49
sounds correct around thanks for the opportunity. Take care.

george grombacher 22:53
And until next time, remember, do your part but doing your best