House Calls Podcast

How Stressed Are We? (And What Can We Do About It?) (Part 1)

With guest Dr. Rangan Chatterjee,

Physician & Podcast Host

Hello and welcome to House Calls. I’m Vivek Murthy and I have the honor of serving as U.S. Surgeon General. I’d like to introduce you to Dr. Rangan Chatterjee, physician and host of the most-listened-to health podcast in Europe. Today we’ll be talking about how we can keep our bodies and minds healthy in a stressful world. This is Part One of a two-part conversation. How do you experience stress? Notice I didn't ask whether you experience it, but how? That's because the world is a stressful place and we're all feeling it whether we're late for an appointment, worried about money or health, or live in a difficult environment. My guest today, Dr. Rangan Chatterjee, knows a lot about stress. How it impacts us, how we handle it and how we process it. He's a doctor who practices lifestyle medicine, which means he helps patients make changes in the way they live to address chronic health issues At home in the UK, Rangan has become a household name. His podcast series Feel Better, Live More is a number one health podcast in the UK and Europe. He also has published a number of bestselling books and hosted a BBC documentary series where he made house calls to families across the UK. Rangan believes medical wisdom should be shared with all. And he does so thoughtfully with practical advice for healthy living. I found this conversation to be truly healing. Rangan helped me reflect on recent stresses in my life. And we connected as doctors who are the sons of doctors about the power and some of the pitfalls of modern medicine. Rangan shared the deeply moving story of when his young son became unexpectedly and critically ill. Modern medicine saved his son's life, but Rangan came to view this terrible health scare as something that could have been prevented. It set him on a new path to understand doctoring in a whole new way, one that looks more deeply at root causes of chronic illness, including stress work, poverty and food. He now treats patients by focusing on addressing these underlying drivers of illness through lifestyle change. As always, we're eager to hear your thoughts and reflections. Reach out to us at HouseCalls@HHS.gov Rangan, thank you so much for joining me on "House Calls."

Vivek it's an absolute honor. I really enjoyed the first time we spoke on my podcast a couple years ago, so it's a real honor for me to have the tables turned. Really looking forward to our conversation.

Well, I must say that that conversation you and I had three years ago was really one of the best and most fulfilling podcast conversations I've had, and so it's really stuck with me and made me look forward to today. There so much I want to talk to you about Rangan, about your personal story, about what's happening in the world. But let me start with what's happening all around us right now, which is that when I travel around the United States and meet with people in big cities and small towns, I hear one thing in common, which is that people feel stressed, and they're stressed about all kinds of things, about what's happening with their kids, about what they see happening in their neighborhoods, about the news they're reading in the papers. But I'm curious to know what you are seeing as a doctor, as someone living in the UK right now. What are you hearing from people around you when it comes to stress?

I think there's no question that stress is something that's top of mind for many people, if not most people, in a way that I've never seen before. I qualified from Edinburgh Medical School in 2001. So over two decades ago, and I would say during that time, the amount of stress related conditions I would see, I feel has always been going up very, very gradually. I think the last decade it's been a huge thing to the point where I think in 2017, 2018, the World Health Organization had on their website that stress is the health epidemic of the 21st century. This was, you know, only a few years ago, and I thought things were pretty bad back then with respect to stress. And my second book was called "The Stress Solution." I actually wrote all about stress, because I felt this was something that people were talking about a lot, but they didn't really understand the impact it was actually having on their bodies, on their minds, on the way that they saw themselves. But I honestly feel in the last two or three years it has ramped up again. Like stress, it's almost part of the common vernacular now, Vivek, you talk to people, how you doing? Yeah, I'm okay. I'm a little bit stressed, but not too bad. It's just become normal. We use that word every single day. I find patients are using it, my friends are using it within my family, people are using it. And I think you touched on one of the things in your intro, which is that the world feels out of control to many people. And when we don't have that sense of control over our lives, there are all kinds of problems in terms of how we see ourselves, in terms of how we interact with people. And there's sorts of science by psychologists, which has shown that people who have a strong sense of control, they have higher academic success, they have higher self-motivation, higher social maturity, they have lower incidences of stress and depression, you know, when you have that sense of control. So I don't mean to give you a long-winded answer, but essentially I agree with what you are saying. It's the same in the UK. Rates of stress and stress-related conditions are going up all the time. I think it's a big problem. I think it's arguably the biggest problem in the type of medicine I practice, the type of patients that I see. So a lot of the behaviors that people want to make to improve their lives in the short term and in the long term, I think one of the reasons people can't make them is because those lifestyle choices are a response to the stress in their lives. So let's take alcohol for example. Many people are trying to reduce how much alcohol they're consuming. And typically we see this in the UK and I'm sure in the US, January, dry January is a big movement where people decide after maybe the Christmas and New Year festivities that they're going to, you know, get back on track and they're gonna get their lifestyle back on track. They're gonna cut out sugar, they're gonna cut out alcohol. And I've been observing this as a doctor for many years, and what's really incredible is that you see a pattern where many people manage to do this for a week, for two weeks, sometimes for three weeks, but then their existing behavior starts to creep back in, the alcohol intake starts to come back in, the sugar intake starts to come back in. And you know, one of the things I have, one of the issues I have with public health and the way we deliver information sometimes, is that we can say that you should not consume more than this amount of sugar or this amount of alcohol. But the problem is, is that many people know that. The behavior is actually there to help them cope with the stress in their life. So they can white knuckle it for two weeks, and they can, you know, cut it out. But they needed that behavior to help them cope with stress. So I found that I can only help my patients reduce alcohol, for example, when I also help them address the underlying stress levels.

That's such a good point. Which is some of these behaviors, like you're saying, are a reaction to stress. And I think, I'll tell you there are a couple things that have struck me about this whole conversation on stress. One is that we don't always even know, like how stress is manifesting in our life. I'll tell you in my own life, at the beginning of the pandemic, I noticed that I was waking up at, I don't know, one in the morning or something like that, and just was wide awake and couldn't go back to sleep for another hour or so. And that's very unusual for me. I was always a very good sleeper. And it took me a long time to realize that I was actually feeling stressed with all the changes that were happening in my life. And that was actually one way that it was manifesting is sleep disturbances. But I do wonder at times if we even fully appreciate how some of the shifts and changes in our bodies, and in how we're feeling, are actually manifestations of stress. And so in your experience, like how have you seen stress manifest in people's lives?

I mentioned some of these behaviors, that I see people engage in alcohol consumption, sugar consumption, how much time they're spending on social media. How long they need to unwind in the evening, to stay up late, watching boxset after boxset. And again, then, which is then impacting their sleep, so the chronic sleep deprivation then impacts their stress the next day. Really, look, I see it impacting every component of my patients' lives, because the stress response system in the body literally impacts the entire body. And what I often do with my patients is, I always make a real effort to explain to them physiologically what is happening when they are feeling stressed. And the reason I think it's important that I do that, is for two reasons. Number one, I think it's always good to inform your patients, treat them like adults, treat them as partners in their care. Help them really understand, because I feel when people understand what's going on, they're much more likely to engage. That's certainly been my experience. But it's not just that Vivek, I think one of the things that I've noticed in medicine, having been practicing now for over two decades, is that sometimes when medical doctors use the word stress, oh, it's just stress. Oh, don't worry about it, it's just stress. I think a lot of patients feel as though they've not been taken seriously. And you know, I'm sure sometimes as a profession we get it wrong, and we don't communicate it as well as we could do. And I think sometimes doctors have in the past dismissed symptoms that are stress related, but the stress response is real. It affects every organ system in the body. And so I always explain it to patients like this. I say, "Listen, stress is not necessarily bad. You need a bit of stress for you to perform at your best, but when the stress becomes too much and it's there for too long a period of time, that's when we start to get problems." And I think there was a editorial in JAMA, the Journal of the American Medical Association, I think in 2013 that suggested that maybe up to 90%, 9-0% of what a primary care doctor sees in any given day may be in some way related to stress. 90%.

That's extraordinary.

That is, that is extraordinary, and even more conservative estimates that I've seen would put it at 65 to 70%. So I think it's fair to say that consensus is that certainly above 50% and maybe a lot more north of 50% of the symptoms we see are in some way related to stress. And I think when you understand the stress response, when patients get it, when they really understand it, they're like, of course I understand it. So what I typically will say to a patient, Vivek, is, look, just imagine 300,000 years ago you were hanging in your hunter-gatherer tribe. You were just getting on with your business. You guys were doing whatever you were doing. And let's say you spotted a wild predator of some sort approaching. In an instant, your stress response would kick into gear. And it would have one thing in mind, which is to keep you safe. So I say, you know, let me just show you some of the things that would happen in your body as that stress response kicks in. Number one, your blood pressure is gonna go up to deliver more oxygen around your body and to your brain. That's a good thing. Your blood sugar is going to go up, because that's gonna help you deliver more glucose to your brain. It's gonna help you. Your blood is gonna become more prone to clotting. Fantastic, because if that predator was to attack you and cut you, instead of bleeding to death, the blood's gonna clot, it's gonna save your life. And then I always use the example of the amygdala. I say, there's a part of your brain, the emotional brain, that goes on to really high alert, because in that moment when there's a wild predator in your eye line, you want to be hypervigilant, you want to hear every sound, every pin drop, you want to hear it, so you are hypervigilant. These things are very helpful in the short term. And then I go on to tell them, them that, look, the problem in the 21st century is, is that for many of us, our stress responses are no longer being activated by wild predators. They're being activated by the states of our daily lives, our email inboxes, our workload, the three social media channels we're trying to keep up to date with, the elderly parents we may be caring for, as well as trying to look after our own families. The fact that maybe as we discussed when you came on my podcast, the fact that a lot of immigrant families now live away from their communities and their families and their friends. And so are having to do lots of things by themselves. The point is for the body, the stress response is the same thing. If it perceives danger, it gets activated. And so I then explain to my patients, so look, let's just take those four responses that I mentioned, and there's many more, but let's just take those four, blood sugar going up in the short term. Great, helps you for half an hour. If that's happening day-in day-out, to the state of your life, that chronic raised blood sugar will make you gain weight around your stomach, it's gonna make you tired, and ultimately will lead to type two diabetes in some people. Your blood pressure going up, fantastic for half an hour to run away from a tiger. Fantastic if you're in a spinning class at the gym for 30 minutes. But if that's happening to your work, and the state of your life every day, that chronically raised high blood pressure is gonna put you at a risk of heart attacks, strokes, and all kinds of other chronic health problems. You know, clotting, clotting in the short term is great, in the long term, that's what predisposes us to heart attacks and strokes. And then the one I always make sure I say to them is the amygdala. If you are approached with a predator, let's say a lion, you want to be hypervigilant. If you are walking in downtown New York on a Friday night by yourself and you think someone's following you, you want your amygdala on high alert, so you can be vigilant to everything that's going on around you, that's great. But if that's happening day-in day-out to your email inbox, well that's kind of what we call anxiety. Right? So a very helpful response in the short term, problematic in the long term. So in answer to your question, what can it be? What can show up as stress? Or certainly related to stress or worsened by stress, anxiety, depression, gut problems, low libido, brain fog, fatigue, weight gain, blood sugar going up, irritability, difficulty sleeping. I mean, the list literally goes on. And then Vivek, two things I always say also to my patients is look, as well as what the body prioritizes when your stress response gets activated, like I've just mentioned, there's two things I think it's worth you knowing about that it switches off, and they say, well what? I said, okay, well two things. Number one, your gut, right? So in an emergency situation, if your body feels chronically stressed, digestion is not something that is essential at that point, so your body pretty much switches off, or at least downgrades what it needs for digestion. And in the UK at least 70 to 80% of UK adults each year are thought to suffer with at least one gastrointestinal complaint. So gut problems are very, very common, and a lot of people go to food and you know, what foods am I consuming that might be causing this? And of course that can play a role, but honestly, in my experience, stress is the number one factor, because when we are stressed, our gut switches off. So I say that's one thing. The second thing I want you to be aware of is what happens to libido. And this often gets people's attention because I, again, as a doctor for over two decades now, I think I'm seeing more complaints of low libido than I've ever seen before. I'm seeing it in younger and younger adults. It's not just sort of people in their 50s and 60s, many men and women in their twenties and thirties, I've seen with low libido over the past few years. And again, I feel that stress is one of the key factors if not the number one factor. And what I say to my patients is, look, if your body feels that it's under attack and it needs to run away from a lion, the last thing it needs to be able to do is help you chill out and procreate with your partner. And it's a really simple way, I think, of explaining to people what the stress response is. And when I go through that process, they generally, they suddenly get it. They suddenly go, oh, now I get it. Now I understand what you mean. Now I understand why this symptom might be related to the fact that I work 10 hours a day, I don't take a break, I don't have time for the gym, et cetera, et cetera, et cetera. So I think chronic stress is a huge issue. I think it's getting worse. I think there's many things that contribute to that. I think the state of the world at the moment, and the fact that people feel out of control is certainly not helping. But I honestly feel that I, I probably bring up the stress response with the vast majority of my patients, because even though it may not be the sole cause, chronic stress never makes their symptoms better. In fact, many times it exacerbates them, it makes them worse.

Well, that's really well put, and I couldn't agree with you more that stress has such a pervasive effect on our health and wellbeing, and it does seem to be getting worse, and not better. You alluded a few times to these conversations you've had with patients over the years and how you bring this up so often. I wanna actually talk a little bit about how you, how you doctor, if you will, like how it is that you minister to patients. Because one of the things that has struck me in my own journey through medicine, is that while I learned a tremendous amount in medical school and in my post medical school training, there was a lot that I didn't learn about. And stress was one of those, in terms of the broader impacts of stress. But I'm curious as you think about your own journey, when did you know that you wanted to be a healer in the tradition of medicine?

It's really tricky that when I reflect back. Because, I've been a father now for 12 years, nearly 13 years, wow. So one of the things I've learnt as a parent, and from actually some of the TV work that I've done over the last few years where I would spend four to six weeks with different families who've got chronic health problems and can't get better and help them over four to six weeks dramatically improve their health by making some small changes to their lifestyle. I remember one family in London, and I remember going to the school with the boy who was maybe seven or eight at the time, and I know this is quite obvious, but I followed him to school, there were TV cameras with us, and we were following the family's story and their journey and me trying to help them. And I saw the facilities, I saw what they had access to, and I really, I remember phoning my wife that night saying, wow, it was incredible. These kids are gonna have a very different experience of life than our kids. They're gonna be exposed to very different things. I think that we are going to be able to expose our children to a huge variety of different experiences and different people. And I really feel that what kids see influences what they think is possible, right? So this is related to your question in this sense. As a kid growing up, my parents were immigrants from India to the UK. My dad came in 1962 in search of a better life, so he could work hard, own his own house, give me and my brother a good education, send money back home to look after his family and his parents. Dad came in the early 1960s, and I remember growing up that all of mom and dad's friends, they were all doctors, and at least one of their kids went to medical school. So I've reflected on this Vivek, in terms of when did I know I wanted to be a doctor? Honestly, I only think I really knew a few years into my career as a doctor, like with my heart and soul knew. I knew as a kid, I knew as a teenager, but I think now with hindsight, that that knowledge was purely because of what I was exposed to. I think I've always been a caring person. You know, as a family, we looked after my father who had lupus for 15 years. Dad was on dialysis for 15 years. And yesterday was 10 years since dad died, which was quite an emotional day yesterday. I didn't expect it to be, but it was actually quite emotional. And I think I saw how to care from my mom. I think I've got it innately in me as well. So I think going into a caring modality is the natural thing for me to have done, but I can't honestly say that as a teenager, I really knew. If you'd asked me 10 years ago, Vivek, right? Or 15 years ago, I probably would've said, Yeah, I knew when I was a teenager. I knew, you know, I knew like, 'cause you have to, when you go to medical school, you have to, you get asked that question at school, why did you want to become a doctor? Now that I've seen the science and the neuroscience on memory, and I know how changeable memory is as well, I think, did I really want to be, or did I end up memorizing an answer that I knew I needed to say to the people at medical school? This is me being completely honest with you now. Like, I genuinely love being a doctor. I've always loved patient contact more than anything else. I've never been that interested in being part of committees and boards. I've never naturally been drawn towards, I always love meeting people, getting to know their story, hearing them, understanding them. But I honestly think that 22 years in now to my career as a practicing doctor, I'd probably say, I'd probably say it was in the last 10 or 15 years when I've really, really understood that medicine is for me. So I'm sorry that was a slightly long-winded answer, but I'm trying to be as honest as I can now as I reflect.

Well that's what I wanted. I mean, and the truth is, I think for a lot of us, our paths are evolving, our feelings about our work is evolving, and I think that's just the truth. Very few people know with clarity as a child exactly what they wanna do. And so I think that path of evolution completely makes sense. And one of the things that I have loved in just reading about your approach to medicine is how you really try to get at the root of what may be causing trouble in someone's life, which often involves, I think, going beyond what we were taught in medical school. And I love the fact that on the TV show that you did, that you actually went to people's homes. I remember the very first time I went to a patient's home to do a home visit, which is, which is something that used to happen very commonly when your dad and my dad were both doctors in the UK. My father practiced in the UK for many years before coming to the United States. But it's very unusual now. But the first time I did that, I just remember feeling like a whole world had opened up in front of me. I had seen this patient a number of times in clinic, but when I went to her home, it was like I understood her so much more. I came to see that her home was actually stacked with boxes and trinkets and rugs that were bunched up, that made it actually very hard to avoid falling as it turns out. And she was an elderly woman who was actually at significant fall risk. I came to see that she didn't have as much room to move around and there were other people living at her home with her. So it was a very cramped sort of environment. I came to see that her pills were actually scattered around the house and not in one place, which then made sense to me why she was having difficulty remembering where her pills were and how to take them. And so there's so much you get when you actually meet people where they are literally, as well as figuratively. But I'm curious sort of what led you to take this approach of going deeper than we're normally trained to go, and actually going to where people are to understand how they live.

I've reflected a lot on my career, especially given where I'm at today with my career. So, if my dad was alive, I often wonder what he would think of what his youngest son does now. Yes, his son is a doctor, but the way I practice is quite different from dad's in many ways, not only the way I approach patients, I think, but also the various different mediums in which I work. I've been releasing podcasts for over five years now and, very fortunate that the health podcast I have is the most listened to health podcast in the whole of Europe, which is incredible. So I get to communicate with millions of people now every single week. And I used to think is that being a doctor? Of course it's being a doctor. A doctor is an educator, and through this medium I'm able to educate people. And, you know, on a side note, but related to this question, I probably get several hundred messages a week on social media, private messages from people saying things like, oh, my depression is under control now, because of this thing that I learned from you. Or my anxiety is 80% reduced, or I put my type two diabetes into remission. Or I'm now pain free, basically from my books or the podcasts when I record with guests. And I've, for many years had to really question myself and go, wow, well this is also being a doctor. Being a doctor is not just one-on-one with a patient in a consultation room. Yes, that's very important. But if you can communicate well, that helps you in the consultation room, but it also helps you using media now, podcasts or books. You can communicate a lot of these messages in a very powerful way. And that speaks to, when did I start to practice like this? I've always had a slight frustration, even when I was working in hospitals, that the way we were taught at medical school, I learned a lot of valuable tools for sure, no question. I think it was really good conventional medical training. But the problem is, when I went out into the real world, and I had real world problems, a lot of the time I felt slightly handcuffed. I thought, I don't really know how to help this person. I don't feel I'd been given the tools, particularly for chronic issues. I think when I went into general practice, Vivek, I really noticed it. I remember in my very first week as a GP, there was a young lady came in, I think she was in her early twenties, and essentially she had symptoms of depression. And I remember just looking at these protocols I had, and essentially I was being guided into prescribing an antidepressant for her, an SSRI, a type of antidepressant. And that's what I would've been perfectly medically okay to do that. I would've felt competent to do that. Medico-legally that would've been completely fine. That was the guidelines, no problem. But I couldn't do it. I just felt, hold on a minute, I need to understand what is going on here. I can't just start a pill. And I remember saying to her, I said, "Listen, I've got three patients waiting today already. I've spent a bit of time talking to you. Are you able to come back tomorrow at the end of my morning clinic? I'd love to spend a bit more time with you. I'd love to really try and understand what's happening." And so she said, "okay, sure." So she came back the next day. I spent maybe 25 minutes, half an hour with her. I started to build up a real rapport with her. And I actually thought, I don't think she needs a medication at the moment. I feel that she's got some pretty, some pretty, I wouldn't say serious, but some significant problems in her personal life, including she recently broke up with her boyfriend. Which it would be completely understandable that you would feel this way after that life event. And again, I was, this is my first week as a GP. And I remember for the next few weeks she kept coming in once a week. I made sure we had a double appointment where I spent time talking to her. And maybe four or five weeks later, she was like a different person, completely. She felt, yeah, I feel, I feel okay now, I feel I understand what I need to do. I mean, I'm giving you the short version of this story, but essentially what I learned was that, well, I learned two very powerful things. One was, I don't need to rush to give a pharmaceutical intervention. Maybe it's useful for some patients, but sometimes you don't need to go there. You can actually do other things first. That's one thing I learnt. The second thing I learnt, and this is one of the most powerful lessons I've learned in my entire career as a doctor, is that there's something incredibly powerful about a patient feeling seen and being heard. Because I realized after those four or five weeks, I hadn't actually done any medicine with her, certainly not the medicine that I was taught at medical school. But I've realized now with hindsight, I gave her something very powerful indeed, which she didn't have in her life, which was, I guess in some ways, you know, attention, compassion, listening, like listening can be medicine, listening can be real medicine. And by actively listening to her, by taking her seriously, she found through her conversations with me, four or five weeks later, she's like, yeah, I think I'm good now. She didn't feel low in mood anymore. She felt, like I sometimes feel as primary care doctors, and I know the system doesn't always allow it, but sometimes a patient doesn't have that in their life or people in their lives. They've got, you know, pre-judgment, they've got pre-existing relationships with. There's something quite unique about coming to see, let's say your doctor, that they don't know you personally, so maybe you feel you can open up about things that you couldn't do with your friends maybe, or your partner or whoever. And so, I imagine sometimes this is what people get from therapists, that they get to go somewhere where they're not gonna be judged, somewhere neutral, where they can just open up. So it was very powerful for me. So that was, I mean, that was one case which made me start to question how I practiced, many other cases like that for sure. But I always felt a frustration, and I wonder how you feel about this now, especially given your role, but I sort of feel in medicine, we get involved quite late, like let's say type two diabetes, right? Most people have heard of type two diabetes, a condition where we have chronically elevated blood sugar, and diagnosed by a blood test where if you are above a certain point, let's say, say your average blood sugar, the HbA1c, if it's 6.5 or above, we say you've got type two diabetes. Okay, and then we get involved and we might give you treatment and might give you some recommendations. But I always felt, yeah but what happens at 6.4 or at 5.9 or at 5.7, like health is a continuum and we are being trained to get involved right at the end stage here. But we know that maybe many people with type two diabetes, that problem has been brewing for maybe 10 years. So wouldn't it be wonderful if we could get involved five years before that, or four, you know, whatever, sometime before it, where we can maybe make a more significant difference. So I've always felt this on some level. I think I've been quite frustrated in the early part of my career. And then the truth is when my, in 2010, my son was pretty unwell, which really caused a big shift for me. Would you like me to explain what happened?

Yeah, please do.

So, in December, 2010, my son was six months old. And so first time I'd had a child. My wife had been breastfeeding for six months. And in the Christmas holidays we went over to France to see some friends. And let me try and give you the shortish version of this story. But essentially it felt as though he had a cold, he had lots of phlegm and mucus. And we had got there before our friends, so we were in this apartment, this house there basically in Chamonix in France, by ourselves, and for some reason my wife didn't want to put him down to bed in his cot. She just, now with hindsight you know, maternal intuition, she just knew something. I don't remember, I was doing the washing up in the evening, I think I was cleaning up the dinner plates. And she came up to me, said, "Rangan, Rangan, he's not moving." And basically my son had gone stiff, like a board, his arms had gone back, he was completely motionless and I thought, maybe he's choking, maybe a big block of phlegm has got stuck. So I got him, I turned him over, I tried to clear his airway, nothing was happening. And I think now as I reflect, I think I froze. I was just like, you know what is going on? And my wife said to me, Rangan, come on, we gotta go, we've gotta get to hospital. So we quickly got into our hired car. I nearly killed us all, it had just snowed. And I remember trying to get onto the main road and the car skidded because I was just trying to get us to the hospital really quickly. We got there to this local mountain hospital, and you could see that the doctors were worried, because essentially he was having a convulsion. And, but he had a normal temperature. And as you well know, at that age, if you have a temperature, it's like, okay, at least we have a reason for why you're having a convulsion. This is a febrile convulsion. We'll get the temperature down and things will be better. But no, he had no temperature. So you could see the worry on the doctor's face, on their faces and they had to give him treatments, stick a line in his neck. And then he had to get put in an ambulance to go down the mountain to a bigger hospital. And I followed in the car thinking, what on earth is going on? Like yesterday everything was fine. Now suddenly our baby boy is in an ambulance in a foreign country. And we got to the hospital and he had two lumbar punctures, you know, they were investigating everything, what was going on. And then a few hours later, they came to see us, the doctors would say, look, we know why he's had a convulsion. His levels of calcium are very low. Yeah, so in that hospital, the serum calcium level, the normal levels were 2.2 to about 2.6 on their range. My son's calcium level was 0.97 so.

Oh my god,

Extremely low. And then we were saying, "Well, well why, what's the reason here?" They said, "Well, we don't know, we're doing more tests." A few hours later they came out, said, "We now know why, his vitamin D levels are extremely low." So basically my son had severe vitamin D deficiency. That caused hypocalcemia basically, which caused the convulsion. And there's a huge backstory here, including that two weeks prior to that, I went to see, I was at work and I remember phoning my wife at lunchtime, and this is back in 2010, so I don't think our knowledge around vitamin D was quite what it is now, certainly awareness wasn't there in the same way that it is now. But I was seeing a lot of patients with low vitamin D levels, and I was talking to the endocrinologists a lot in the hospitals about different protocols. And I thought, hmm, I wonder if my son should be on vitamin D drops? So I remember phoning my wife and I sent her this protocol that we had, and I said, "Why don't you go and see the GP and just say, look, my husband's a bit concerned, he thinks he should be on vitamin D drops." And I don't know if it's the same in the US, but here in the UK it is really frowned upon for you to do anything for your own family. So, you know, under GMC, the General Medical Council here in the UK, we are not really meant to make decisions for our wife, for our children, for our family. So I said to my wife to go and the doctor was pretty condescending really towards my wife and said, this is rubbish. You know, you could have printed this out on Word, he doesn't need anything. And that's fine, look, whatever, maybe it wouldn't have mattered. Maybe it wouldn't have changed anything, who knows? Modern medicine in many ways saved my son's life, because he got a calcium infusion. He then got a huge dose of vitamin D. But I remember being four days later, them discharging him, and said, yeah, that's it. And I was thinking, okay, great that we fixed the acute problem, but I was thinking, could this be why he's had eczema? Could this be why there's an allergy to cow's milk? There's all kinds of things started going to my head. But there was no answers for me from the doctors. It was very much a case of this is the acute problem. The acute problem's fixed, off you go. And I made myself a vow that day Vivek. The word vow is quite a strong word, and I've probably loosened my grip on that word over the last 12 and a half years. But initially it was a vow. It was a huge guilt that I felt as a father. I felt as though I'd let my son down. I thought my son has nearly died from a preventable vitamin deficiency, and I should have prevented it. So the vow I made to myself as we walked out of the hospital was, I'm gonna get my son back to full health as if this had never ever happened. And I became obsessed. I started to read about vitamin D, the immune system. I started to come across the gut microbiome. I basically would probably study three, four hours a day trying to research things. What's gonna help my son? What can I do? How can I repair this? I went round the world in my annual leave, in my vacation time, I went to conferences, I went to learn. And everything I learned, I started to apply with my son, first of all. And just to be clear, he's nearly 13. He's a fit, healthy, thriving, lovely individual.

I'm so happy to hear that.

He's absolutely fantastic. But the tools I learnt to help him were the same kind of tools that I then started to apply to myself and my wife and my daughter. We're starting to feel better and better. And then I start to apply the same things that I've learned with my patients, and I'm suddenly getting patients better than I have ever managed to before. And I'm using less pharmaceutical medication at the same time. Now again, when you say that, I think it's a very nuanced conversation, because everything in the world these days tends to be black or white, right? And people want it black or white on Twitter and on social media, but things are not black or white, there's many, many shades of gray. So I'm not against the use of pharmaceutical medication, what I'm against is the overuse of pharmaceutical medication without exploring other potential options, when people are amenable to them. And I'll give you an example what I mean by that. I always want to respect the patient's choices, and what people want. So if a patient, let's say, let's take a simple example. If a patient comes in and they've got a really bad migraine headache, and it's affecting their work and they've tried some over-the-counter medications and it's not getting better and they want help, then I feel my role as a doctor is to say, okay, and if I feel it's a migraine, I do my history, do my examination, make the diagnosis, I feel, or certainly the way I like to practice is, I say, listen, I think this is a migraine. I think there are certain things in your lifestyle that I'm aware of that may be contributing. I'd love to help you with those if you're interested. But there's also these two or three medications that may well be able to help you in the short term here. And then I always wait to see what they say. Now, sometimes they'll say, actually Doc, I don't really wanna take any medications, if you can help me figure out what's causing this. Okay, great. Some people are not interested. Say, listen Doc, I don't care about anything. I just want a tablet. I want it to go away 'cause I need to get to work. Okay, and I will respect that as well. And then a lot of people are very much like, listen, I'd love you to help me try and get to the root cause of this if possible, but in the short term, can I take the pill just so I can get back to work? Certainly that's how I like to practice medicine, where I feel I'm being really honest with the patient and I'm meeting them where they're at. So, this is kind of, you asked me a very simple question, when was it that I first started to realize that I wanted to practice in this way? I don't think there was one moment, if I'm honest. It was just a general awareness that our training is very good for acute problems. In hospitals, it's very, very good for that, but it's not so good for these chronic conditions that we're seeing, many of which have their roots in the way that we are living our lives. And again, I'm not putting blame on people. I think it's really important I say that. I understand that life is stressful, life is tough. People are finding it hard to make the decisions that they want to make, I totally get that. So this is not about blame, saying you are doing this to yourself. No, it's about empowerment to say, listen, there are things in your lifestyle that you may not realize are contributing to the way that you are feeling. So if you're open to it, I'd love to help you. And something else I'd love to say here, Vivek, if you don't mind, is that when it comes to talking about our lifestyles, often people will say, this is a red herring, these are structural social issues. I know it's the same in America, but here in the UK, depending on where you live, you could have a 10 year difference in life expectancy, potentially, depending on your socioeconomic status and where you live. Okay, I'm aware of that. That is real. But it's not either/or, it's not either we go for big social revolution in social change, or we empower individuals. It's like we can sort of do both. Like, I don't think the environment around us, the food environment, the work environment, I don't think these are these things are helping people make the choices that are gonna help them thrive, I really don't. But at the same time, I have worked, like for seven years, I worked in a practice in a place called Oldham in North Manchester in the UK. The practice serves a very, what you would call, I hate these terms, but it's what you would call a deprived population, low socioeconomic status, high, a lot of immigrants, a lot of single parents, a lot of people working two or three jobs. And it was one of the favorite times of my career, I loved working in that practice. And here's the thing that I learned there. Those patients were some of the most compliant patients I've ever had in my entire career. If I could really connect with them and say, I honestly think this is gonna help you if you can do this, even though they didn't have much money, even though they had real challenges in their life, I found that they would make some of these changes, and let's say something really simple, right? Like a breathing practice to help us lower stress, right? Because there's a lot of research on how the right breathing practices can help us lower the stress hormone cortisol in our body. Now it will be easy to go and people do say this. Oh yeah, how is that gonna help someone who's poor and who's struggling with their job? Well, I'll explain how it's gonna help them. It's not gonna remove their poverty, it's not gonna remove the stress in their job, but if they have a simple free tool where in the moment they can actually lower their stress levels, it's gonna help them be better able to manage the stress in their life, they're gonna be less inclined to be reactive or fall out with their boss or then have a row with their wife when they get home. So, I do believe that these sort of lifestyle changes that I try and inspire people to make and try and empower them with, I believe that for everyone, even though the common narrative is it's only for the middle classes or the well off, I really don't believe that, it's not what my experience has shown me. I believe every single person has the right to good quality health information. And I think that's a problem. When we look down on people of lowest socioeconomic status, like many healthcare professionals certainly in public do. Well, let me rephrase that. I don't think they're actively trying to look down, but they say, oh no, these are social problems, it's not about lifestyle change. It's far too simplistic because you could make the case that it's a little bit derogatory as well. Oh, you know, you guys, you don't need this information, because actually there's some structural social issues there. And I'm like, well, hold on a minute. It's a bit condescending there, how do you know that they don't want that information? How do you know that they won't take action? You know, I have lots of free, the word hack is overused a lot, but I have a lot of free hacks. One of the things a lot of my patients know and do, and a lot of the public who follow me know, is something that I call a five minute kitchen workout. It's completely free. You don't need equipment, you don't need to go to a gym, you don't even need to change your clothes. And I use that with patients poor and rich alike. And so, I don't mean to go off topic, but I'm feel very passionately about this, that everyone can have access to this information. Yes, for some people it's gonna be more challenging than for others, but I still don't think we should withhold that information from them.

No, I think you're absolutely right. Every human being, I also believe, deserves to have the tools to live a healthy life. And I think that everybody wants to be healthy, they want their families to be taken care of. There's so many powerful things in which you said, but one thing that I'm struck by also, is that as doctors, I think all of us want to be able to get to the root of what's causing problems for our patients. We want to be able to spend the time we need with them to have those kind of meaningful conversations. And we want to be partners with them in progress. This is extremely difficult, I think, to do in an era where you're being told that you have 10 minutes with a patient. And many restrictions on what you can do for them, based on, in the United States at least, what kind of insurance coverage they have. And I know there may be other barriers in the UK. One of my worries is that part of what is driving burnout among doctors and healthcare providers across the board is this lack of self-efficacy, is knowing what your patients need, not being able to get it for them, and that causes a moral injury that I think is really quite profound. I think, what I love about what you're saying also though, is that you've found a way to really, I think, use the power of listening to heal. And you said that I think even directly that listening can be medicine. And I think there's a powerful lesson there, not just for doctors, but for everyone, because I think, given the amount of suffering that exists in the world right now, the amount of anxiety and stress that people are contending with, we need more than just doctors and nurses and therapists to be sources of healing. We need everyday individuals to recognize that when you check on a friend, when you simply listen to them to understand what they're going through, when you give them a space to be heard, to be seen, to be valued, that that is healing. You know, that is powerful. You may not be able to solve all their problems, and that's okay. But being able to open that door to healing is something that all of us have the power to do. Thanks for joining part one of this conversation with Dr. Rangan Chatterjee. For part two, tune into the next episode of House calls with Dr. Vivek Murthy. Wishing you all health and happiness.