291: Life Changing Improvements Using Lifestyle Medicine with Dr. Rakesh Jotwani

Dr. Rakesh Jotwani is a physician and lifestyle medicine advocate, having worked as a hospitalist for 11 years. He is passionate about connecting with people and helping them to understand the power of simple lifestyle choices to improve their quality of life and longevity. Struggling with depression and feeling overwhelmed, he embarks on a journey to discover a better life balance and lifestyle medicine, only to find himself battling the ironic conflict of having to choose between his dream of connecting with people and his demanding hospital job.

In this episode, you will learn the following:

• How did Dr. Jotwani become a physician and develop an interest in lifestyle medicine?
• How did volunteering and taking courses on cultural anthropology and death and dying to help him make this decision?
• How did his experience of depression and the challenges of being a hospitalist propel him to seek lifestyle medicine?

Resources: 

Peace Corps

Mora Medical 

Visit Dr. Rakesh Jotwani’s Socials: 

Website: https://www.thehealthfeast.com/

Instagram: https://www.instagram.com/rakyourlife/?hl=en

Transcript

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00:00:00 Dr. Rak: Over time, I started remembering why did I go into this? I like connecting with people. Somewhere along the way, I lost sight of the fact as stressful and as hard as being in a hospital it is, the thing I miss about it is you have literally unlimited time. If you needed to spend an hour and a half with a patient to talk about something, you could.

00:00:22 Maya: You have more power over your health and what you've been told. This is the Healthy Lifestyle Solutions Podcast. I'm Maya Acosta, and I'm passionate about finding healthy lifestyle solutions to support optimal human health. If you're willing to go with me, together we can discover how simple lifestyle choices can help improve our quality of life and increase longevity in a big way. Let's get started.

00:00:51 Maya: And I have with me today Dr. Rak. And it's spelled R-A-K. Welcome, Dr. Rak

00:01:00 Dr. Rak:  Thank you. Thank you, Maya, so much for having me on. It's awesome.

00:01:04 Maya: Yeah. So I'm interested in having a conversation with you about your story. I know that you're a physician that promotes lifestyle medicine. I met you in person in Orlando at the Lifestyle Medicine Conference, and you are now working with Dr. Laurie Marvis, who has a new group named MORA. So let's introduce you to my listeners. Tell us a little bit about... by the way, feel free to start wherever you'd like, but I would love to know how you became a physician interested in lifestyle medicine.

00:01:38 Dr. Rak: Okay, I guess there's two parts to that question. How did I become a physician? And then how did I become interested in lifestyle medicine? And the physician part is, well, I like to say I'm every immigrant parents dream I went in. Immigrants come to this country. It's hard to come to this country. It's hard to get into this country. Why so many people want to come here, even to this day, because there's these opportunities, particularly education. My parents had that front and center in their head. They're like we want him to get a good education. And my mom especially had a front and center like, "Oh, it would be wonderful if he became a doctor." So remember when I was a kid, there's a really small, I guess, I played doctor and said, but at a certain age like 11, 12, 13, hearing that, I was just like that's the last thing I want to do right. Leave me alone. 

00:02:40 Dr. Rak: And so, seriously, for a few years, as I got older, it got to the point in college, applying for college, and there are these combined medicine programs where you can go to undergrad and medical schools combined seven or eight years. I was, I guess, interested enough in going into medicine that I applied to some of those programs. And I got into our state program, and my parents were so excited. They were so  thrilled. They were like, "This is it. You're going to do it." And I was very honest with them. I said I haven't made that decision. I don't know if that's what I want to do. It's something... I'm now open to it. When I was in high school, I really, really gravitated towards sciences, but I also gravitated towards... I would say connection and debate in some ways. I didn't do debate, but I did [inaudible]. 

00:03:30 Dr. Rak: So I got to college, and I'll be pre-med, and half the school, I think wants to be pre-med, and then every year it drops by half. So by the time you graduate, it's still a lot. It's like 10%, but it goes down a lot every year. So you take chemistry, organic chemistry, these kinds of classes. And then I had an advisor in college who said, "How do I make this decision? I wasn't sure what I wanted to do. And she said, "Well, one the biggest thing is you have to ask yourself, do you enjoy?" I don't know if she said enjoy. Do you find enjoyment in taking care of people who are sick? Does that feel good to you? Because it doesn't feel good to everyone. Some people don't want to be immersed in an environment where lots of people are sick. And so I said, "Well, I need to find that out." And so I did a few things. I said what can I do in terms of courses to learn sort of more of the human side of medicine? So there were offerings in cultural anthropology, for example, on death and dying. 

00:04:38 Dr. Rak: So I took that class in 2011, during September 11. I actually went to class that morning. It was a couple of hours later. I went to class that morning. Only a few of us showed up. I don't know why. I knew there was no class, but I just felt like we processed that that morning. It was very interesting. But in that class, I also volunteered with the hospital chaplain, and I used to go that semester once a week, I used to go with the chaplain around the hospital, praying with people. And Duke is there. I don't even know the denomination , but it's in the south. There are a lot of religious people. It wasn't just of Christian faith like we would pray with people of Islamic faith. We would pray with people from Buddhist faith. So many people come there because it's a big academic medical center. So that was really cool. It was really powerful. And I was like, there's really strong energy in this room. I know there's a lot of anxiety, but there's really strong energy. I could feel it back then.

00:05:43 Dr. Rak: I also volunteered at the cancer center, and it was like a navigator position. So I was helping people sort of figure out how to get to their appointment. And when they were waiting, I would sit with them. I would sit with them and I would talk to them and I would hear about their lives and how they got their diagnosis. And those can be very emotional stories, and yet I would look forward to those. So that, to me, it said, this is a sign. This tells me maybe this is what you should do. So then at that point in college, I made the decision I'm going to go to medical school.

00:06:17 Maya: Were there any physicians in your family at the time? Were you the only one expected?

00:06:25 Dr. Rak: Yeah. Right. My father's an engineer, and I don't come from... My mother majored in psychology. He doesn't practice as a psychologist, but I don't come from a background of physicians. My brother is in technology and programming. So that was my own sort of realization that this marries, I desire to connect with people on a deeper level, people who may actually be having and experiencing some pain and struggling. There's something there that resonates with me and that I also enjoy science.

00:07:08 Maya: Right. So it's interesting. I just kind of want to add this, that my husband and I are both also from... I'm actually an immigrant. We migrated when I was younger, but highly expected to be successful. That's why we came to this country. And my husband's parents migrated after they both completed medical school. And so I would ask him in the past, kind of playfully, "Did you choose medicine or were you expected to go into medicine?" And so he's like it's just what his father did. So then I asked him what would you have done had you not gone into medicine? And he said technical stuff, he would have been an IT person and kind of another stereotypical kind of role.

00:07:52 Dr. Rak: There's kind of the list. This was like the joke. It was like doctor, engineer, I guess lawyer has been added to that list and business or something. It depends.

00:08:07 Maya: There's so many different fields. But he definitely is my tech person. When I need help with my computer, my iPhone, anything, my husband takes care of it. So he's definitely smart. So now just one question. How hard was it for you to get into medical school? It's so competitive now. I just wondered at the time.

00:08:26 Dr. Rak: Okay, yeah, this was in 2000. I graduated college in 2002. I will say I'm doing alumni interviews for undergraduates right now for my college. And these guys have won like... one guy started a business and is selling dog toys, and he won a national pitch competition. I don't know how I would have gotten into any of these schools if I was applying now. How did I get into medical? Well, it's like test scores and grades and I don't know, I guess I was a somewhat on traditional applicant because I took a gap year and I actually applied during my gap year because I didn't decide until later in college that I wanted. It wasn't until towards the end of college when I had that experience and that death and dying seminar. And what that meant was I had to take the MCAT test, the medical college admission test, and then I had a year in between that's when I did the Americorps program. And you're familiar with the Americorps?

00:09:31 Maya: I don't know. Please tell us.

00:09:32 Dr. Rak: Okay. Are you familiar with Peace Corps? 

00:09:36 Maya: Yes.

00:09:37 Dr. Rak: I think the name kind of comes from that. But it was like the program that was started to basically do a year of community work that's sponsored or paid for by the government, all sorts of places, not for profits. I did a particular type of program. It's called VISTA So the VISTA program predates the Americorps program, but now it's the Americorps VISTA program. VISTA was started, I think, by President Johnson. It stands for Volunteers and Service to America. And it was a national program where you would basically get paid a stipend, small stipend. It's not a lot, but they actually set it at the federal poverty level. That's how much you get paid, because the goal of the program was to end poverty. And as such, these are not for profits that are working on issues related to poverty and home housing and other I worked for a healthcare organization. 

00:10:37 Dr. Rak: I worked for an organization that was trying to expand universal health care in Illinois, the state I was in, but also nationally. So they're a big proponent of a single payer system similar to what they have in Canada, where there are lots of private entities that provide healthcare. There's different doctors and hospitals, but the only insurance company is the government. The government is the only insurance company. And in doing that, it'd be like if everyone in this country had Medicare. And so they're proponents of that because there's a lot of overhead, and it actually adds so much cost to... I don't know if you're involved in billing or your husband's involved in billing. It's so complicated.

00:11:17 Maya: Yeah, I understand.

00:11:19 Dr. Rak: Yeah. So if you imagine if there was just one payer, how much easier it would be for everyone. It'd still probably be complicated, but less complicated. And so there were big proponents of that, and then that's something I guess I talked about. I don't know. I don't know. That process was so bewildering to me. I was like am I going to get... There were some places that didn't even offer me an interview. And then I got into this place I wanted to go to. I was from Chicago, as I want to stay in Chicago. I liked the idea that University of Chicago is on the South Side of Chicago, which is the most underserved part of the city, and that's where I got in. That's where I went. I was happy about that.

00:12:05 Maya: Chicago is where Dr. Kim Williams is, right? 

00:12:08 Dr. Rak: That's right. I think he recently transferred. If I'm not mistaken, he was at Rush for many years.

00:12:15 Maya: Yeah, I recently interviewed a cardiologist who trained under him. It's just incredible, just the idea that  he was introduced thus well. So let's talk about your exposure to lifestyle medicine. So as you know, as we're getting more and more involved in lifestyle medicine, we go to the conferences. I'm always amazed when I meet young physicians, like early in their career where they now have learned about lifestyle medicine. And I feel like they're going to be the best physicians ever. My husband's daughter is now trying to get into medical school, and I've been planting that feed for many, many years now about how much more effective she could be if she can teach her patients not only about nutrition, but stress management and all of that. So it sounds like maybe you had an exposure early in your career as well. How did that happen?

00:13:12 Dr. Rak: Well, that's the second part of the question. How, why lifestyle medicine? So when I went through medical school, I really didn't know internal medicine. I gravitated the most towards because that's where I found you spent the most time talking to patients. At the end of the day, that's what I enjoyed doing the most was talking to patients and some clinical diagnosis and work up, but that never really excited me as much as talking to patients. And there was a lot of thoughtful discussion about the patients, too, in internal medicine. So I was like, "Okay, these are my people." And then I went in internal medicine and I didn't really know what I wanted to do. And I became a hospitalist after I finished. And are you familiar with hospitalist?

00:13:54 Maya: Yes.

00:13:56 Dr. Rak: Someone who takes care of adults in the hospital. I was adult hospitalist.

00:14:00 Maya: Yeah. And I understand the term itself because when I do have guests on the show that our hospital list. They always have to get that permission to appear on a podcast. Typically just to make sure that they're not violating anything.

00:14:13 Dr. Rak: Yeah. Yes. So I did that for eleven years, twelve years. So it's nice of you to say when I have young doctors on the… I mean, I'm young-ish. Thank you. I attribute healthy lifestyle, but I've been practicing. I finished residency in 2010, so I've been practicing since then. And most of that time I was a hospitalist. As a hospitalist, you're taking care of adults who come in with complications of chronic disease, right? People coming in with heart attacks, strokes, complications of diabetes, infections that run the gamut. And I, at this time I met my beautiful, amazing, wonderful, supportive, so many great things, wife in medical school, we went to different schools. We went in Chicago. We both matched out in San Francisco. She's from the Bay Area and she's a kidney specialist. She did a chief resident a year after we finished. And during her chief year, we had our first child, our daughter, who's now eleven. And then a couple of years later, we had a son, first son, and then a couple of years after that, we had our second son. 

00:15:33 Dr. Rak: As we were having children, I was working as a hospitalist. My philosophy on how I ate and how I took care of myself, I didn't really have one. I mean, mostly food. I used food, and I had used food for many years as a way to, as I say, treat yourself in parks and rec. I would basically use it to treat myself. I would eat whatever I wanted and deal with stress, to be honest. And I had a lot of stress that working in a hospital is very stressful. And as much as I enjoy, really, I get a lot out of making those connections. That environment is very intense. People come in sick, the family members, there's anxiety is high, and then there's just a lot of beeping. There's a lot of things happening at any given moment like your patient's heart could stop, and you have to run to their room, or somebody could have a stroke, you have to run to their room. And it's very unpredictable. Whole day, you're often running on some kind of adrenaline.

00:16:37 Dr. Rak: I think when I was younger, that keeps you going and also eating then, I was just eating the food that they get us for conferences. Back then, they would get Chinese food with orange chicken and all the really unhealthy stuff like pizza and pasta and sandwiches, and I would eat that stuff every day. I'd be like, "Why wouldn't I eat that stuff? They're providing it. I don't have to pay for it." And that all anyway to say, it took a toll on me. It took a toll on me physically, but it took a toll on me mentally. I share this with on my podcast and share with your listeners. I have a history of depression, depression that probably I had as long ago as maybe even high school, but didn't recognize the signs and symptoms of it. And then in medical school, I did my psychiatry rotation, and I was like, "Wait a second." And I you know, so I was like, I go long periods, two weeks where I don't want to do anything, and I stop eating or whatever, all these things. I was like I check, check, check. And I was kind of struggling with it at times in medical school, too. It was a very stressful environment.

00:17:53 Dr. Rak: So finally I self diagnosed myself. But then I went to go see a psychiatrist and got formally diagnosed and then started a medication, antidepressant. And for the first time in a long time, I just sort of felt I remember it, it just felt like things felt normal. I don't know how to describe it more than that. They just felt normal. And really, for a long time, I was on an antidepressant, and I would have these ups and downs, and sometimes I tried a different one dose was changed a little bit. But now, I think there's a role for medication, obviously, in mental health. And I'm not a mental health professional, but obviously your listeners talk about your mental health with a professional, but go ahead.

00:18:38 Maya: Well, if I can share, I get it. First of all, I kind of want to revisit what you were saying about your work environment, because now I know, even though I am not a physician, that you're around disease and sickness. You're not at a wellness center. You're not in a place where people are meditating, taking deep breaths and pre-sensing themselves. You're in a highly intensive environment. And my husband still works at two hospitals, so I get. The calls, I get it when he gets the calls and an emergency and all that stress that comes about. So you have that going on along with nutrition, which now we know affects our gut, which can affect there's actually between the gut and the brain. 

00:19:23 Maya: I once heard a celebrity, and I don't remember his name, but he had a significant weight loss experience, and he said that he realized one day that he was eating like a fifth grader at a birthday party. That was his diet. And when he had that awareness, he made the change, and now he's living very healthy. I appreciate that you're bringing up your battle with depression. That's an important topic that we cover here on the podcast as well about mental health. I, too, many years ago, suffered with depression and did the antidepressants as well until I started doing more internal or inner work. But same way, if you need to get on the medication to get you started, that's a wonderful way. And so then the medication started to help you normalize you said like I feel a little bit better?

00:20:12 Dr. Rak: Yes, it helped me normalize, but not I mean, normalize. Like, I could yeah, normalize my mood and in a way, just kind of I'm not blame. Medication helped me a lot, but I didn't change my other lifestyle habits. It wasn't like an impetus to it was like, "Oh, now my mood is okay. I can kind of go back to doing the stuff I was doing and do it better." I bring all that up to say that my middle son was nine months old, and then my wife told me she was pregnant, and that was really intense for me. I felt like work was so stressful and crazy. And then when I come home, we had two small kids, and now my wife was saying we're going to have a third small kid, which was really awesome. It was a blessing. I mean, it took me a minute to get to that, but it was also felt very overwhelming. And my wife will tell you when I would come home at those times, I wasn't in the best of moods. I don't know what the best way. I was like Oscar the Grouch. I basically just complain about things that happened during the day, how busy it was at work, what this patient's family said to me. I think I was just looking for empathy or for support, I don't know. 

00:21:34 Maya: But regardless, I was living in my head and I was dumping my head onto everyone else. And one day my wife said to me, she said you come home. Before you come home, we're usually in a good mood. And then you come home and you're always so upset and you're always so tired. And she didn't know how to tell me, actually, because she knew that I might react to that. She was actually probably a little worried about telling me, and my reaction to that would be worsening depression like I would sort of go to our room and seclude myself. So she told me that, and I said to her that time, I said, I don't have a choice. All day, all these things are happening . It's so stressful. When I come home, this is when I'm allowed to do these things, complain or whatever. I'm allowed to be this way. And then that's when she asked me. She said, how is it fair that the people you supposedly love the most get the worst version of you? 

00:22:43 Maya: Oh, my God. 

00:22:44 Dr. Rak: And I didn't know how to answer that. I didn't know how to answer that. I had to sit with that. But I found... when you sit with it and I asked, I legitimately asked the universe God for help. And that's when this physician wellness talk got in my purview. It was scheduled and I went to it. It was after work one night, and it was called Evidence Based Workplace Happiness. And it was all the things you can do to be happier. Which initially, when I heard that, I was like, that's not even a thing. You don't choose to be happy. And Maya guess what, were some of the things I bet, you know, what were some of the things that came up with this workshop?

00:23:24 Maya: In terms of finding happiness? I'm assuming that maybe the workshop incorporated learning how to laugh a little bit. I don't know, spending time in nature.

00:23:33 Dr. Rak: Spending time in nature. I don't know if they talked about that, but that's a really good one.

00:23:37 Maya: Yeah, I assume that maybe journaling or I don't know...

00:23:42 Dr. Rak: Some sort of mindfulness practice. Yeah, I mean, journaling is one way to do that. And they talked about mindfulness meditation. They talked about gratitude and having a gratitude practice and just saying thanks to people like genuinely telling people why you appreciate them. And all these things were like they had us pull out our phone and text somebody we work with a reason we appreciate them. And I texted my office mate who is senior to me, and I just told him, "I really love getting advice from you, and it's really great having an office mate who's also a good friend," or something like that. And then they said, "How do you feel?" And I was like, "I feel better." What is this magic trick? And what else can I do? And so then I started pulling over on the side of the road and doing Headspace. Ten minutes a day, I just download the Headspace app because they recommended that. And I was like, 'Okay, I'll do that." 

00:24:46 Dr. Rak: And then my wife, within a few weeks, she said something to me, unexpected. She said, there's something different about you. And the difference was I was recognizing all the thoughts I was having from the day and all the things that bothered me. And as Andy on Headspace was helping me sort of let go of those things and notice them and not judge them and then take some deep breaths, and I was down regulating my body. And then I was coming in the door for ten minutes. I was doing that, and I was excited to see my children. I was excited to pick them up and give them a hug. I was excited to find out what they did that day or what my wife did that day. My mindset went from being stuck in my head to being out in the world that I was living in. That's the change I made. And I didn't have any, like, presupposed expectation of what was going to happen. Actually, when I would sit and meditate, I'd be like, "Why am I doing this? This feels weird. I don't like this." 

00:25:45 Dr. Rak: And luckily, Andy says that. He says, this is going to be a little weird. You're not going to like it. Because if they didn't say that, a lot more people would give up. But that's such a small change. Small change. I'd say ten minutes, small change. But I started noticing difference in them, my relationships at home. I started noticing a difference in my relationships at work because I started looking at work differently. I thought about my colleague who I texted, and then I started thinking about who else is here? If I get to work with a lot  of my friends, that would be a better experience. I started to get to know people more. And yeah, that's it.

00:26:20 Maya: Wow, it's such a beautiful story. So many key points here. One of them that I want to bring up is Headspace, the app that you use, because I recently did a series on my Thursday Maya Tip, health recommendations that I make. I went through the pillars of lifestyle medicine and made recommendations for heart health, and one of them was using apps such as Headspace to get the support that you need to quiet your mind or whether it's calm or whatever app to do, the deep breathing and all of that. And it sounds, Dr. Rak, like you needed support like maybe you were experiencing burnout as well. Do you think ?

00:26:59 Dr. Rak: Yes, I think so. I think so this depersonalization and the feelings of emotional and physical exhaustion, these are things I was definitely feeling. And it's interesting because the meditation sort of reminded me over time, I started remembering like why did I go into this? I like connecting with people. Somewhere along the way, I lost sight of the fact. As stressful and as hard as being a hospital as-is, the thing I miss about it is you have literally like unlimited time. If you needed to spend an hour and a half with a patient to talk about something, you could. You would just see that patient in the afternoon and then kind of check in on everyone else. You could sort of triage in that way and give people more time if they needed it and that's no other... like in a clinic, you can't do that, right ? Everything is scheduled. So that was cool. 

00:27:59 Dr. Rak: But anyway, I took meditation and I created a space. I would say this I created a space before I got home where I allowed myself to sort of sit with these thoughts like how did today feel? What was hard about today? And then as I noticed my life, my relationships changing, my experience at work changing, I think I also recognized, what else am I choosing to do right now that may not be in my best interest? And it was clear my health was just from a physical standpoint. My weight had just been going up and increasing to the point where I didn't even know how much I weighed. I was that was something I didn't want to know. I was kind of afraid of that. I hadn't gone to see a doctor in years. And so then when my wife told me having a third kid, I started meditating, started thinking about it. She's getting closer to the due date. 

00:28:51 Dr. Rak: It wasn't until after he was born that I went to go see my doctor. And my doctor reinforced what I was... my blood pressure was high. My weight was such that I had obesity. And then he wanted me to get labs checked. And I was afraid to get the labs checked, but I said, I got to do something. And the universe hearing me again. There was a doctor from the hospital system I work in who came for medical grand rounds, and this was telling he comes and he tells the story of how when he was 40, he had a heart attack. He didn't have a heart attack, but he had chest pain. He's dropping his two young kids off at school. He goes to the ER and then they tell him, you need stents. And he gets stents, and he goes on the American Heart Association diet. And then six months later, he's at the gym and he gets chest pain again. And he goes back and they say your stents have closed off and there's new disease. And now you have to have bypass surgery. He has bypass surgery and he says, "How is this happening?"

00:29:52 Dr. Rak: He was eating lean meat and olive oil and veggies and fruits and exercising. But then he did his own deep dive in the research in the literature, and he discovered a whole food plant-based diet. Discovered how it has the power to reverse vascular disease and heart disease. He said how has no one told me about this? And so he started eating that way. He started educating his patients about that and then he took it on himself. This was in 2015 to travel to every medical center in Northern California Kaiser System, every medical center, and give this grand round, share his story, encourage other people to eat this way. 

00:30:30 Dr. Rak: And I'm going to be honest, I was not eating that way. But I saw him speak and it planted a seed. He encouraged everyone to eat this way. A whole food, plant-based diet medical center was sponsoring a three week challenge. I signed up for it, but I couldn't bring myself to do it because it just seems so different than what I was used to eating. And yet I knew that something needed to change. And so I started doing eating that way, doing Meatless Mondays. So I used to call it back then for once a week for I did that almost, for a year. Actually it was about a year because the challenge came back a year later and then I felt ready to do it. So in that year, I learned how to make plant-based meatloaf and plant-based... I learned about soy curls. I needed that stuff because I was coming from, first of all, really liking meat and eating it my whole life and worried that I wasn't going to enjoy food. And then when I started realizing, no, actually, this is so tasty, this is so tasty. But I was only doing it once a week, so it didn't really have a big impact on me. I was eating all the other same food. 

00:31:44 Dr. Rak: But when I did it for three weeks, I finally went and got my labs checked. I had prediabetes and my cholesterol was high, and I just ate this way for three weeks. I had a whole plan because I knew which recipes I could make and all this. And then I got my labs checked again and I felt great. First of all, I mean, the first week was like a little, I'd say, like withdrawal. And then by the end of it, I felt really good. I was sleeping better. I felt like I had more energy. I wasn't exercising at that time. But some things that happened, my prediabetes reversed in three weeks, which is faster than my LDL cholesterol dropped 40 points, and my resting heart rate went from the 80s to 60s. This was not from increased activity. This was from my heart getting better blood flow, which that blew my mind. So I was wearing a Fitbit at the time. 

00:32:44 Dr. Rak: So I started eating that way, like 80% of the time, and I won't get in. It took me several years to finally learn okay, this is the food that makes you feel good, and there are ways in which you can eat it that are really enjoyable. So just keep doing that and let go of the stuff that you thought you loved. You know, there's a process by which I work with patients, you get disillusioned by it. And that's, I think, what's finally started to happen after two, three, four years, where I was sort of like, "Oh, I really want that In and Out cheeseburger." A year or two eating this way, I'd be, “I'm going to allow myself.” And then I would eat it, and I would be like, "I feel terrible. Why did I eat that?" Because you thought you wanted it.

00:33:27 Maya: It's amazing that before you made the change, you didn't feel that awfulness initially like you do now when you clean up your diet. These changes in your numbers and your biometrics that you just told us were mainly as a result of just nutrition. Changing your nutrition, not even exercising yet. That's so awesome.

00:33:52 Dr. Rak: So I just kept going, and then I got used to get stopped. I didn't make these changes to lose weight. I had kind of decided, I was a bigger kid. I had kind of slowly gained weight. I was like okay, this is probably just a bigger guy. And I made these changes because I started to focus on my health. I said, I really need to be healthy for these children. And that's I think the space that meditation allowed me to recognize is the choices I'm making, they're not in alignment with the type of person I want to be. Well, who do you want to be? And so once I started exploring that, I was like well, then something needs to change. And then universe heard me and said, well, this is what you need to do. And it took me a year, but I started eating that way and noticed all these changes. Weight just started coming off then. And not everyone has this experience, but a fair number of people do, because you just start eating a lot of foods that are really high in fiber and really high in water, you end up eating less calories. I wasn't counting calories. I was just focusing on eating broccoli and potatoes and beans and rice and things like that. 

00:34:59 Dr. Rak: And then within a year or two, I started asking the question, why are we doing this for patients? This was like 2017. I was like, literally, I would meditate on that. Why aren't we doing it? I didn't know about the American College of Lifestyle Medicine, believe it or not. I decided in 2017, one day, a couple of years in, to send an email to that doctor, Dr. Rajiv Mesquita in Sacramento, South Sacramento. 

00:35:25 Maya: I know who he is. I met him at Plantrician in 2018, and I knew about the lifestyle medicine practice that yes. Oh, my God. That's awesome.

00:35:33 Dr. Rak: Oh, my God. He had such a big impact on me. And so I wrote him an email. I just said, gratitude . I just want to tell you, your talk changed my life. I am not going to have our attack when I turn 40 because of you. Because I was 36, I think, or 36, yeah, when I saw him speak. And so that was just sort of... I used to think, now I think back, I would have become one of my patients in the hospital. And he advised me. He said there's a certification in lifestyle medicine. 2017 was the first year I had missed that. But he said next year you get certified in lifestyle medicine. I got certified in lifestyle medicine. He said, well, he had created all these programs in South Sacramento and so we brought one of them to our medical center in 2018, and that program still continues to run. At a certain point, 2019, I said, I want to do this 100% of the time. And then the pandemic came, and I was a hospitalist. And I said, you know what? Society, the universe is telling me I need to do this right now. 

00:36:43 Dr. Rak: And so for the first year and a half of the pandemic, I did my hospitalist job. But it was glaring at me, like the people getting admitted to the hospital were people with chronic diseases, chronic diseases that were caused by lifestyle factors. And so I couldn't ignore it any longer. In 2021, the summer I decided I'm going to do this, what I ended up doing was going into primary care for a year. So I stayed with my organization. I went into primary care for a year. I became the director of lifestyle medicine. That was an inaugural position that was created. And what I realized was I realized a lot of things, but I realized that our current system is not really conducive, unfortunately, in many respects, to providing this type of care to providing because lifestyle counseling really relies on having deep conversations and connection and getting into things like why it's difficult for people to make change. You know, what their history with food is, their relationship with food. Perhaps some history of trauma that might be affecting their ability of change. We don't even have time to ask about these things, much less talk about them in clinic visits. I don't want to get into all that right now, but most of our current medical system is really focused around managing illness. It's focused around identifying and then managing illness, not preventing and reversing it. 

00:38:07 Dr. Rak: And so if your goal is to manage illness and there's wildfire of poor lifestyle habits that are causing all this disease and you're just managing disease and at a certain point, the system won't be able to handle the amount of disease that it has to manage. That's not a sustainable system. And that's what we're seeing right now. We're seeing so many parts of the system buckle under this epidemic of chronic disease. So in an effort to change the system, I decided to go work for a lifestyle medicine startup. And so last November, I joined the team at Mora Medical. You can find us @mora.com Mora was started by Dr. Laurie Marvis. Laurie Marvis, she has history of starting based telehealth in the past. This new company provides lifestyle medicine care, virtually. Both physician visits but the care is really centered around multi week disease reversal groups. We call them circles. And so these are physician led or sometimes physician assistant led disease reversal groups that meet for several weeks. They actually meet for ten weeks, and they're centered around reversing chronic disease. So developing it's basically the pillars of lifestyle medicine that we go through. But there's an emphasis on whole food, plant-based eating. 

00:39:33 Dr. Rak: And we accept insurance, we accept Medicare in California where I practice, although I'm now licensed in other states as well, because we're now in five states. We're currently in New York. We just started in New York, but we're currently in Texas, Florida, California, Ohio, Soon then, Colorado. So you go to our website, you'll see, and even if we're not in your state yet, we're maintaining a waitlist because our goal is to continue to expand across the country. And what I like to say is we're democratizing lifestyle medicine care because right now you just by chance may have a doctor who knows something about this. It's still a very small percentage within medical community. Or by chance, you may be in an area where you can see someone. And some of the services online are quite expensive. $150, $300 a consultation. Some private doctors are doing that. 

00:40:26 Dr. Rak: Our company is set up around these  medical visits, they're group medical visits. So we work with your insurance. You get billed your copay. And if you don't have a copay, then there shouldn't be a cost to you. We're working to accept most insurances, but that's a process as well. But we have quite a few that we've already been able to secure contracts. So, yeah, who are we reaching out to? People with chronic disease who want to reverse their chronic disease with lifestyle changes, which is many, many, many people.

00:40:54 Maya: And it helps, well, a couple of points there as well. It helps to know that you've gone through the process as a patient in understanding how your mood has been affected by say, poor lifestyle choices, for example, or even the nutrition. You've gone through all of this with stress, dealing with stress and burning and using the results of implementing these pillars into your life. So it feels so good to know that we can work with a physician who has that understanding, who probably is more likely to be compassionate with us as we're making.

00:41:29 Dr. Rak: Absolutely. I get everything. I get food addictions. I've had some of the worst food addictions. There's nothing that anyone does where I'm like there's no judgment here because I feel like I've either done those things. I agree. Actually, I often will connect with people on that, which isn't typical, I don't think most doctors are typically sharing their experience with depression or eating disorders or with food addiction or things like that.

00:42:06 Maya: Yeah, it's actually kind of discouraging. Dr. Rak when I've tested out doctors and I see that they're in bad shape, the last thing I want is for them to try to give me recommendations. I don't want to be judgmental about it. I'm just saying that sometimes doctors are the worst patients. They don't take care of themselves. So we really appreciate what you're doing and the fact that okay, the fact that you're licensed as well, especially here in Texas, we get a lot of people always asking they want a doctor that's on board with this way of living. So that's great. And we also have spoken in the past about telemedicine and the benefits of having telemedicine, because it's still that's one of the gifts that the pandemic gave us, in the sense that some of those things moved to the comforts of our own home. So we can now see our doctor here at home with a little bit more of an extended visit rather than that 15 minutes that you're lucky to have when you do an annual visit with your primary. That's awesome. Is there anything else you'd like to share with us?

00:43:13 Dr. Rak: I do want to share my podcast.

00:43:15 Maya: Tell us how you got started with your podcast, because that's a component of your work.

00:43:20 Dr. Rak: Yeah, so that's a component of my work. It's an unfair component of my work, but an extension of my work. And yeah, no, it's something I'm really passionate about and I feel really good about. I enjoy it. And what do we do? So it's called the Health Feast.

00:43:37 Maya: I love it.

00:43:38 Dr. Rak: Health Feast. The Health Feast. You can find us at the healthfeast.com, you can find us wherever you get podcasts. Most places where you get podcasts, I'm sure, And it's myself, Dr. Rak and I co-hosted with a friend of mine. His name is Po. To Po two. Po is someone I was connected with. He actually did an immersion program, one of the Plantrician immersion programs in Abu Dhabi. He applied and was accepted to be on a reality TV show that I think is going to be released later this year. And after he came back, he lives in the Bay Area north of San Francisco. His doctor there, his doctor who I did residency with, who I haven't talked to in years, she messaged me online on LinkedIn and she said he needs the support of a lifestyle doctor. And this is how I also know I'm doing my calling, or following my calling is when I hear that I was like I called him that day or the next day. I was like, "How do I connect with this guy?" Because that's what I want to do in life. I want to support people to make lifestyle changes because I've experienced the power in my life, and I've experienced the punishment of dieting. I lost 30 pounds for my wedding by forcing myself to just eat less and run and I hated running. And then guess what? Right after my wedding, within a month or two, I gained more weight, all of it back and more, because that was a punishment. 

00:45:08 Dr. Rak: And so what I've learned is there's a way to honor your body and your needs and to treat yourself with kindness and compassion where you can enjoy the food. It's delicious and it supports your best health. So it doesn't have to be either or. It's a health feast. Because when we think of a feast, we think of the best things and things that are super delicious. When people think of health, they think of boring or punishment or that's not the way it has to be. Health can be a feast, and so we want everyone to experience that. And so Po and I talk about our journey. He's still figuring it out. I'm still figuring it out, and it's been going on for a couple of months. We're starting to have some more guests on now, so check it out. Yes.

00:45:55 Maya: Well, awesome. We're going to add a link in the show notes for you for anyone who's interested in listening to your podcast. I really like what you bring to the table today, Dr. Rak. The fact that you overcame it can be very debilitating to suffer with depression and physician work burnout as well. So I appreciate that you found a way out of that. And your wife played a significant role, so congratulations to her as well.

00:46:25 Dr. Rak: Absolutely.

00:46:27 Maya: Many of my listeners are women, and I like to support women in health, but I always say that the reason I want to encourage women is because we are the ones that bring this information to our homes, to our families. And so she clearly knew something and supported you in that. So it's wonderful.

00:46:47 Dr. Rak: Yeah, I can't say enough good things about... My wife is a nephrologist. She works full time as well. And for many years I was a hospitalist and I worked two weekends a month, and I was gone certain nights. And I think that happens to women a lot. They have a career and there's an expectation that they are primary manager in the family, too. And that has changed a lot in my household, and that's been through deliberate conversations and kind of a better understanding on my part. I was living in my head. I'll say it again, but it's not an excuse, but it's to say now I drop and I love it. I drop off my kids at school every day and we talk about we do a gratitude practice in the car. What are we grateful for and what are we excited about for today? And that's like, one of the highlights of my day is doing that with them. So... yeah.

00:47:39 Maya: Awesome. And then I'm going to bring this up because I had a meeting today with the women's group that I'm part of for ACLM. And have you ever heard of the stress free MD, Dr. Robyn Tiger?

00:47:52 Dr. Rak: Yes.

00:47:55 Maya: She's coming back. She's been on the podcast. She's coming back again. And this time she's going to talk about how she partnered with another physician to develop the first ever physician coaching program in lifestyle medicine, specifically to address physician burnout. So I'm going to tell her about you as well. You might want to be on her podcast as well. 

00:48:18 Dr. Rak: Oh, sure.

00:48:20 Maya: Yeah. During the pandemic, she lost colleagues to I don't want to say the word but self harm, because sometimes you get.... So she made it her mission to really support physicians. That's what she's all about. I was like, "Yeah, you have to come back on the show and talk about this. It's so important for us to see our physicians as human beings and to be compassionate as well and to support our physicians and to maybe from time to time when we visit our physicians just to ask them how are you doing today?"

00:48:53 Dr. Rak: Yeah, 100%. I'll look forward to listening to that. And that sounds like someone I would love to connect with. Thank you.

00:49:00 Maya: Absolutely. So as we're wrapping up, is there anything else that you'd like to share with our listeners and what's the best way to get in contact with you? You gave us your podcast as well.

00:49:11 Dr. Rak: Yeah, you can. On our website. The health feast.com. You can submit questions for the show. You can sign up for an email list. I'm on Instagram at Rakyourlife. I go by Dr. Rak, but my first name is Rakesh, so R-A-K is Rak is my nickname and also my doctor name. And so it's Rak Your life, Rakyourlife, that you can find me on Instagram and anything else. I'd like your listeners to know just that good health is an opportunity. I say it all the time. It's an opportunity to feel good. It's an opportunity to live the life that you actually want to live. And when you start looking at it that way and you start realizing that you can do it yourself.

00:49:55 Maya: Yeah. Well, I can't thank you enough, Dr. Rak, for two things for taking your time for my busy schedule to speak with our listeners, and also just for sharing your story and being so vulnerable in that as well. So thank you again.

00:50:09 Dr. Rak: I appreciate you having me on your show. This was awesome. And I wonder when you come on the Health Feast.

00:50:18 Maya: Yes, that'll be fun.

00:50:20 Dr. Rak: All right. Then we're going to make that happen. Yes, I love that. Okay. 

00:50:25 Maya: All right. Thank you.

00:50:26 Dr. Rak: Wonderful. Takecare. Goodbye.

00:50:30 Maya: Goodbye. You've been listening to the Healthy Lifestyle Solutions Podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave us an honest review on Apple podcast that helps us to spread our message. Thanks for listening.