The Truth About Pain w/ Dr. Asare Christian

What we have as a health care system is as everybody says a sick care system. Okay. And people are recognizing yeah we can actually be healthy and everybody knows nobody want to feel sick and you know people want to produce people want to be productive members of society. Our awareness has evolved. So you got to go to a place where a doctor can spend the time to educate you uh and talk about health pain difficult specialty. Yes. How we experience pain here is very different from how we experience pain in Ghana or in other parts of the world. America only makes up 4% of the world population yet we use 80% of the world opioids. What are the things that you feel most people don't know but should know about health. It's not just one thing that's going to give you health. The body is more complex than that. So really getting people to understand what health is is the fundamentals which never change. The pathways that exist in our physiology have never changed. They're always going to be there. It becomes what do we do to signal that pathway to get to health. In this episode, Assari Christian MDM PH the pain medicine doctor that you want to talk to who's branched into cellular medicine and looking at the body on a whole. his story coming from Ghana to the United States and all of his education, his pathway to peak performance is a story to watch, one that you're truly going to enjoy. Welcome to the show. So, um, let's talk about your background, how you got started, what made you decide to become a doctor. Yeah. So, um, inception for going into medicine goes all the way back when I was growing up in Ghana. I was like maybe three or four. And a friend of mine, a good friend of mine, he he passed away. And when he passed at that time, I wasn't sure why he passed. So I was asking the question, how come he died and I didn't die? And they told me he had sickle cell. So that's when my interest in kind of medicine peaked. And I was like, oh, what is that? Why is he, you know? So that's um how all of that started. And then I was interested in science and eventually, you know, I decided to take the journey into medicine. Here we are. And quite a journey it's been. Absolutely. It's been a in fact I I was not even sure if I wanted to do medicine even though I had that interest in medicine at the early age. I I wasn't sure if I was going to like talking to people. Um so I when I was in college I was studying to be organic chemist. I wanted to be do chemistry. So then I went and got a job at a hospital to see if I would like it to be a patient transporter. So initially it was tough. I didn't like the smell of hospitals at I couldn't I almost quit but then I hang on and then started talking to the patients and uh realized there's a lot of anxiety that they have you know when I'm transporting them they'll tell me all these stories about their life and everything else that's going on. So that's when I became more interested in listening and um subsequently you know decided to go to medical school and here we are. Well in medical school it just and it just developed from there just sort of took off. Yeah. and and so medical school it was like a clear I'm in this path that's what I'm going to do and then you know you also have to determine what kind of residency that you're going to do and that was also shaped by something that happened to my grandmother. So she was in Ghana and she was having all these problems with um uh confusion. She was falling. She was having some incontinence. It wasn't really clear what was going on with her. Um and at that time I was going through a rotation physical medicine or rehab. So I recognized that what she was having was actually something we call hydrophilis like fluent buildup in the brain. So this is when people have fall and they don't get treated this can happen. So I was able to recognize and I said hey this sounds like you know she has brain injury. Let's get her to the hospital. So they took her in and did a CT and that was the case. So she had brain surgery to fix her hydrophilis but then she became disabled because in Ghana we didn't have rehabilitation medicine. So that also kind of changed my trajectory. So when I was a third year in medical school, I was like okay well you know this is something that I can do uh because all along the the the plan has been you know I want to do something that I can take back to South Sahara Africa and uh we did not have rehab medicine in South Saharan Africa except South Africa which was more developed. So that also changed me into getting into physical medicine and rehab um and that's how I end up where I am and then that has also changed. So there's been an evolution with becoming aware of what's going on. How do I make the biggest impact and you know things that I influence in my life? Yeah. Interesting how a series of events Yeah. sort of led you down a path. You ever feel like there was some sort of flow state that drew you into that? Yeah. Yeah. And in fact I I was I was even having and and and you're right because some I was trying to get into a rotation to do internal medicine. I wanted to be a cardiologist or hematologist something like that. and they couldn't give me a rotation. So there was this battle. There was something that was forcing me away from that. Uh so I was kind of really upset with the medicine department. But then this other event came in and you know led me to this path and and from there going through residency um also different events shaping my my experiences and doing what I do and even when I was done with residency and fellowship also taking care of patients I also got to a point where okay I got to do more. I'm just doing pain signal blockade. I'm a pain doctor. I just do injections. I do medications. But deep down I knew that people get better results from pain when they're healthy. So the goal became how do I solve health as a way to solve pain. So I have to kind of learn how to solve health. And that's kind of where I am now where you know going beyond what I learned in residency to understanding microbiome, understanding hormones, understanding longevity, understanding aging, all of this cellular dysfunction that drives state of health. So that's also where we are now and you know we keep moving forward. It's amazing. You know, I think about it. MD, master of public health, uh, CV is deep. Like, you know, you keep going. It's just not, you're not stopping. I mean, it's Yeah, it's this conference, that conference, fellowships. Yeah. No, I I'm just finishing my fellowship in anti-aging medicine because I also came to the place of, okay, now I want to prevent disease. And what is the ultimate risk factor for any disease? It's aging. So if you really want to make an impact in how you solve health, you need to understand how you slow down aging. Because when if you can slow down aging, then you can prevent all the Alzheimer's, dementia, psychopenia, all of this problem that comes on. Um, and there's so much science, so much education, so much technology that's coming up every day. Uh so I think you know to be really be able to make an impact in people's life you have to be forefront really learning every time what's coming up because what we have in medicine that's quite unfortunate is there's all of this science that shows up in how we can help people but it doesn't really translate into clinical practice until 10 20 years right so there's simple ways to solve problem for example beta blockers when we figure out it could help with heart disease it took about 10 20 years before doctors actually start prescribing it so what where I am now is really focusing on the cell and trying to find new ways so we don't have to wait till um you know a medication is approved by FDA or something is approved. The pathways are all the same. So finding different ways to do things is where I become you know passionate about and then you have to keep learning. So that that's passion. Yeah let's talk about passion. Where where do you find it? Ah that's that's a great question. Um so I would say you know it's There is some part of it that's kind of internal. You know, I grew up around an environment where I was inspired by my mom, my dad. You know, they all when I was growing up, my mom was in school the whole time. She has a PhD. They all keep learning. And I have all these aunties that are very um you know, they're all passionate about what they do. They they all going if they're doing something, they just go in there and full commitment. Uh so I think that's some of the influencing part of it. And then also within myself, I want to make an impact. I want to contribute to, you know, I've always I want to contribute solutions to the world in which form maybe through health, maybe through getting people to be uh become more self-aware. So there is something there that also kind of pushes me and I want to make an impact. Um so I think that that's where the passion comes from, but I know it's it's a hard question to answer. Uh but something from outside and something also within me that's pushing forward. Yeah, that passion is the drive to the peak performance, the level of peak performance. I I take it that you're driving your patients every day to to find their version of peak performance wherever they are. Yes. So you see all sides all all types of people. Yeah. Um how do you approach that? So you know one of the things that I'm grateful for and I think it's great to be a doctor and you asked the question I even think back a little bit with the question you just asked. So I see people that have problems that they having all this unnecessary suffering. Nobody's trying to figure it out. They've been to multiple doctors and all of this stuff. If I don't have the solution, I still know there is a solution. So that gives me, you know, I become passion. I like we can figure this out. We can solve this, right? Uh because I've been around some leaders in the field who just say, "Yeah, it's a sale." And you got to figure out how to communicate. You have to figure out how to signal the cell in a healthy way. So passion comes from patience. Um trying to find solutions. Uh there's always different ways to solve problems. So for me um what I've come to is I don't have to be a cardiologist to help improve your cardiovascular health. I can improve the vessels of your health. I can improve your mitochondria health. I can improve something else within your physiology that will help translate to your heart becoming better and giving people the fundamentals which works than anything else. The nutrition, the exercise, the stress management, the sleep. If those things are dialing, you know, tight physiologically and precise, things get better. So that's even if I don't have the solution, let's get those things better. And a lot of times a lot of people have disregulation in those fundamental things that is influencing the state of their health. So um coming across people with problems, you know, inspires me to get out there and learn more and make an impact. Yeah, it's interesting. Um the the notion of fixing the foundation sort of takes care of the bathroom in the second floor. Yeah. All of a sudden, yeah, I just fixed this down here and all of a sudden the toilet's working upstairs again. Yeah. Um, so pain difficult specialty. Yes. Pain is uh poorly understood, poorly treated in the US. Um, and in fact, when I was even finishing residency, I did not want to go into pain fellowship. I was like, I don't want to deal with pain. It's so subjective. It's hard. So when I was at Hopkins, I have five people in my class and all four of them went into pain fellowship and I was like, you know, I don't want to deal with that. I'm going to go to Harvard and do a a fellowship in public health. And then I got there and where I was doing my fellowship, I also became aware of uh pain being one of the biggest public health issue we have in the US. I was like, h I don't want to deal with it. And then I I finished my fellowship working at a rehab hospital. All the patients that were taking care of these were persons with spinal cord injury, brain injury, stroke. So they have all this traumatic event, they all have pain. So I became like the pain doctor. Um and one of the things I recognized was that first of all patients don't understand what pain is and second a lot of providers don't understand what pain is. Okay. So pain is a signal that goes to your brain and your brain have to interpret it in a simplistic form. But while that signal is going up to your brain there's all these modulations all of these things that are happening to that signal to make it big or small just so you become aware of it and it's to a function of your health. So when people are healthy, pain gets better. Cuz people will say, "I've done surgery, I've done medications, I've gone to physical therapy, I do acupunure, I'm still in pain." They're not connecting the dots. What starts the pain is different from what perpetuate the pain. So stress response, trauma, sleep, exercise, nutrition, all of that influence it. So pain can be done well. And that's the basis of what I do now. If you get people healthy, pain gets better. If you fix the gut, pain gets better. So uh it can be done well. It's just unfortunate that how we do pain in in in America is through the lens of you know orthopedics. We look up your X-ray or MRI. Oh look you have a herniation. Let's give you an injection. Oh it didn't work. Go to physical therapy. Oh it didn't work. Go get surgery. And people have pain. Why? Because we didn't talk to them about nutrition. We didn't talk to them about sleep. We didn't talk about their unforgiveness. All of these things that perpetuate pain. So um it's a complex thing but it can be done well uh when you have the knowledge to do it and getting patient to feel empowered educating them to understand what pain is because it's a subjective experience only you experience pain even a doctor doesn't it's very subjective how we experience pain here is very different from how we experience pain in Ghana or in other parts of the world America only makes up 4% of the world population yet we use 80% of the world opioids so it's cultural also so pain has all this complex uh aspect of it and it becomes really educating people to get them to know there's better options and ways to solve it. And in your career, you you saw the entire shift of the opioid Yeah. Uh went from, you know, Yeah. we're we're seeing I remember that vividly. Yeah. I was a resident and that's when we had this JCO, I think it was called JCole, one of my daughter. We made we made pain the fifth uh vital sign. So I remember you have to document the pain and you have to give the medicines and you have to document and you have to give the medicine whether it was causing problems or not. You just have to give it. And that's that's when we have this explosion of you know opioid uh you know epidemic and it's actually caused more than a trillion dollars. It's very expensive you know all the lives that have lost and all this other lost productivity and other things that gone through. So uh a big problem. Yeah. And now we're at this place where we've come full circle looking at how you can address pain. I'm curious there's a cumulative effect uh as a person who's had nine orthopedic surgeries. Um there's a kind of a cumulative effect that takes place with pain. Um, and there's some trauma that can be associated with that. Um, and people have trauma responses. How do you deal with the the trauma as like people go through that process? How are you working with that now to bring that down? Yeah. So, that's a great point that you bring out because pain has an emotional and a sensory component. There's always these two pathways when you have pain. Okay. And the emotional component of pain is there to help us to remember. Pain is a protective mechanism. So when you step on something hot, you always remember you're not going to do it again. And the whole idea of you remembering that that was hot and you shouldn't do that was because there was an emotional response that helps to crystallize that memory. Okay? Same thing happens with trauma. So when you have trauma, there's a lot of emotional response that crystallize. Um, so part of it is when people have chronic pain, even if it's not chronic pain, there's a process called neuroplasticity where the brain has to learn the pain. That's a a simple way for your body cut to kind of make sure that you're safe. So, you know, for example, you cut yourself and this is painful, your brain is always going to make sure that you're paying attention to it so you don't hit it against something. So, the pain signal is always going to be there. So what we have to do or what we do in those context is really teaching people about how to unlearn the pain and it's called you know pain reprocessing therapy, cognitive behavior therapy. There's all these therapies that can be added into how we solve chronic pain but a lot of times it's not part of the treatment. We're just focusing on the sensory component. We're just doing the surgery. We're just giving the medications. We're just doing all of those things. We're not addressing the emotional component. And then emotion feeds into the pain. Emotions will increase pain. When you're sad, your pain goes up. When you're happy, you don't even think about your pain. So, there's all this relationship between the pain, emotion, and cognition. So, doing pain well becomes really integrating all of those things. So, what I do in my practice is uh sometimes I'll give people apps. It's called curable that gives people the neuroscience of education of pain or I can also connect them with a pain psychologist who then give them some strategies and how to kind of look at the pain because pain is basically in a simplistic another simplistic way to look at pain is a signal plus fear. So when you took away the fear from the signal, it's just a sensation. So there's even a exercise that I can have people do called sematic tracking where they can just sit down, just relax, feel the pain and not give it any meaning and just move that sensation around and it just you just when you do that and you're not afraid because the fear is what really creates this pain thing, right? It's it's there. Oh my god, something is wrong, right? Anytime we have pain, something is wrong. So not having that fear, then it just becomes a sensation and it's a nuance and the brain can unlearn it. But all of that becomes easy when we are optimizing your physiology because it's really hard to hack your your brain your psychology. It's just hard to do. So uh bringing those interventions in place plus optimizing cellular health plus medications whatever we need to do is the way to kind of approach comprehensively to address pain. Yeah, I think it's amazing where you've taken your practice and the things that you're doing. I mean it's it's uh like a next level. You're Oh, thank you. Yes. I mean, you're you're just you're on a whole I mean, pretty soon they're going to have uh sorry, Christian running these magazines with everything that you're Absolutely. People need to know because there is better solutions for solving pain and we don't do a good job with pain. It's just it just so it's all about blocking pain signal. We just give you medicine and the medicine just block the pain signal. What is creating that signal? That's what we want to go after. Yeah. What is keeping that signal in place? That's what we want to address. Okay. And that takes work. So it takes work on the side of the provider. It takes work on the side of the individual experiencing pain. And then looking at all of this other systems, hormones plays a part in pain. Microbiome, we can use peptides, we can use all these new therapies that actually are not bad. Because when we look at the medicines we use for pain, none of it is really good. I can give you NSAIDs, ibuprofen that can affect your gut or it can cause, you know, kidney problems, cause all kind of problems, stroke, heart disease. or I can give you gapentin or lica makes you dizzy it makes you confused all of those things and the next step is what opioids traumat so we don't really have good and in fact we just have a new medication that has been approved by the FDA this is 20 years the last medication we had was celebrate so we don't have really anything that's good in for pain we use other medicines such as anti-combosins or anti-depressants and all of those are just blocking the pain signal so what I have done with my practice is let's figure out how we solve health how do we give the cell the the signal it needs the imbalances that exist that is creating the pain. How do we balance those things and how you do that is through health and you can solve health through lifestyle. You can solve health through supplements. You can solve health with peptides, regenerative therapies, protoone, all of these other things. So it's not just a drug. There's a place for pharmaceutical agent. There's a place for signal blockade. But let's block the signal, but then let's figure out what else do we need to do to actually solve the actual problem. And that's what we're doing. Yeah. Yeah. It's interesting. I mean, you're you're really looking at this from a multiffactorial sort of equation and you're taking a look at each individual patient and really getting down to the things that are um happening for them. You talk about peptides, they're hot. Yeah, peptides are big right now. Um in pain, things like uh padcaeptide or BPC57, thymus and beta 4 in combination with that. What are some of the other peptides that you find that might be helpful in a pain situation? Yeah. So um you mentioned this. So thy time was alpha 1 is immune modulator. So that's great. Thyosin beta 4 BPC. There's also penttosin polyulfate PPS which is really good for like atritic type pain. Um there's other peptides that works on the gut. So KPV, BPC, um L37, um what else can I think of? And then there's also peptides that works for like sleep, you know, like because when when you're trying to solve pain, yes, you have things that works on inflammation. And it's not just inflammation. So when people have pain, there is inflammation that which is what most patients understand. There is neurogenic inflammation. There is neuroinflammation. There's epigenetic changes. There's all the cellular mechanism. There's disregulation with your own endogenous opioids, how your body makes opioids. So you can use peptides to signal all of those things. So cycadian rhythm, stress response. If somebody is having a lot of stress and you don't solve that, pain doesn't get better. So we can use peptides that can help people to calm down. We can use cylunk. We can use VIP to help with cycian rhythms. So I use all of these different type of things to address the other factors that goes on beyond just inflammation. So anti-inflammation and anesia is some of these peptides that we have. But we also can do use peptides that helps with sleep, fix the gut, helps with hormones and all of that helps soft pain as well. And then going back even before peptides, it's it's addressing the diet. Absolutely. Those are the I mean those things because as you know peptides don't work in vacuum. None of the things we have work in vacuum. So what I tell people is if we optimize your physiology then everything else that we add even if it's energy medicine whatever you believe those things are better when you're healthy. So let's get the nutrition right and a lot of times that's is the food we eating it creates inflammation and if you have pain your immune system is already hyper so that signal will make the cells more disregulated and creates more pain. Stress will create cortisol. Cortisol is pro-inflammatory creates more inflammation. Gut imbalances will create that. Hormonal imbalances will create that. So if we can get the foundational things right a lot of times you know because even the medicine that we have you know before we even bring a drug to the market is 30% placebo when you do look at studies the difference between the placebo and the active is not that much sometimes some drugs don't even get approved because so the placebo the mind is so powerful so when people are healthy then all those little things that we do takes them far so that's the foundational thing and then it becomes also precision because we all know about you have to eat right you have to exercise you have to sleep you have to do this how do you do that well and that's where I think there's a it's missing in a lot of like you know in medicine so as a doctor how do you use precision tools to get precise on what type of exercise do you need for your condition what type of sleep how do we get you to get good sleep right delta sleep how do we get there we can do CJCmorin maybe it's not solving pain but we're getting deep sleep so you can heal what else do we need to do we can use hormones to get you to get good sleep we can use supplements so there's all of the things that we can do from a ical standpoint that signal to get those lifestyle things to be optimized. Okay, you could be eating and getting all this protein in. If you're not digesting, if you're not absorbing, how is that going to help you? So, people need directions. So, I think you know if we we all know, right? We all know what we're supposed to do. Everybody knows about exercise is good for you and but how do you do it without hurting yourself? How do you do it so it translates to those functional things that we're trying to solve? So I think that's what I I feel like I I have that understanding and really using tools that allows us to make it precise so we can actually dose it. It's all about dosing and timing with all of this signal. Too much exercise may not be good for you. Too much sleep may not be good for you. So too much food, right? We all know that. So um it's all about how do we use the right correct dosing and what timing to to really make that impact, right? To get to the right spot. To get to the right spot. Yep. And had the right person, right? Yeah. and and any everyone is end of one. So, exactly. Yeah. You know, there isn't going to be one the one-sizefits-all that is is right for everyone. I think that's one of the beautiful things that you do is you really get in to figure out what does this particular patient really need and then developing an ongoing plan and that plan is going to change over time. Is that it's always evolving. Yeah. Because sometimes people come with a problem and then they have all these problems. They all connected. Where do you start? Okay. So it becomes the person in front of you. Where do we make the biggest impact? Somebody have a lot of pain. They have a lot of stress. They have all of these things and and you know I have this privilege as a physician where people come to me and they tell me all this stuff and I listen and sometimes people are telling me about their pain but really what's distracting them is the fact that they can't go visit their daughter because of something that's going on. So we come up with the plan. Let's say go take care of that. Let's let's make sure you can go to the wedding and sit down and enjoy. And then once they do that then you can kind of work on other things, right? because when they come in and that's the priority for them and you're talking about nutrition and sleep and all of these things, of course, those are important, but it's really having um the wisdom to be able to connect and see where they are and and how do you help them move forward from there um and you know that that takes some time to to you know, but you just have to listen. Yeah. Now, let's talk about you. Yeah. Because you can't I once heard somebody say never trust a fat doctor.

I like that. Yes. Um, and you know, you are like the picture of of perfect health. Okay. So, um, unless you're not, is there something you're hiding? I don't know. Uh, you got to look inside. Yeah. I mean, sure. Right. Um, but you're really taking care of yourself. Yes. Let's talk about your routine. It's very important. And, um, and it's quite unfortunate that doctors, a lot of doctors knows about health, but they're not healthy. In fact, doctors don't even I think most of us just know about sickness because that's what it is. That's the problem. We know about sickness because in in medical school, you learn a little bit about what goes wrong, but after medical school and you get into residency and you become an attendant, where do you work? Hospitals. What goes on in hospitals solving sickness. You forget all about health. So, when you're in a hospital and you're doctor, you see sick people all the time. When you're fat, you're better than them, right? Or whatever you are. So we don't have that a good reference for health in that environment. So um but we know that to to really make an impact and we have tons of data on this that if we want our patients to be healthier we have to be an example right. So for me even before I got into this space I've always been interested in health but I wasn't really dialing in stuff. I was not sleeping as well, I was drinking a lot, all these stresses and doctors also have a lot of stress and stress is a bigger cause of all these issues uh with disease and we we as physicians actually have a very we don't have a a good um uh lifespan. So uh fundamentally for me I started working on my stress because I used to go to work I'll be so upset so many patients I have to see insurance are not giving me the things I need to do patients are late administrators are putting stuff on me so it was a very stressful environment so I started working on stress um so meditation and then exercise and what I also became interested in is how you change habits because I was interested in how do we because we all know what we're supposed to do how come don't we do it so the difference between the knowledge and doing that's gab what is there this habits. So, learning about the science of creating habits was helpful for me because I I would tell my patients about it. I'll say, "Okay, if you have not been to the gym, let's figure out how we go to the gym. We're just going to set up a time and place and a trigger. Okay? When I get up in the morning, I'll go put on my shoes. I'll go to the gym." So, I do that. I get to the gym five days a week, schedule other things at least three times a week. Um, and then right after that, I meditate. So, when you're trying to build a new habit, you stacking. You stack on it. After I come back from the from the gym, I sit down in a chair. I'm already there. I sit down. I do my meditation. I take my shower. Ready to go. So, uh I do those things and now I'm also incorporating some more um relaxation and some other modalities. Uh red light therapy. I use peptides myself. I'm exploring some hormones. I'm doing all of these things that I'm also doing for my patients. And now I'm also going to really a little deeper because I do all this full assessment like at 360 degrees of people because like you said, people may look healthy. Of course, they they they may have the muscle, they look fit, and they have good, you know, skeletal muscle mass. When we do this body composition, but then when you put them on a bike and you test their B2 mass, it's not great. Or when you check their biological age, it's not great. So, there's all these lenses that I am looking through. It's like some parts I'm doing well, some parts I'm not. But the goal is okay, now you have this foundational thing and how do we get there? Um, and I want to be a good example for my patients. I want to live longer. I want to have energy. I want to be able to perform and to make contribution and it starts with health. So, uh, still pushing for that. Yeah. Yeah. It seems like it's been a journey. Yes, it has. It has been a journey. And I think now I'm, you know, as I'm getting older, I'm getting better because I realize, you know, I don't I don't have the, you know, the resilience that I had before where you can just go out, do all of these things and get up in the morning ready to go and everything is there. So, now I have to kind of dial in certain habits and it's all, you know, it's all good things, right? Your body is telling you you have to listen to your body. Uh, but it's been a journey. Um, and now I'm even interested in building some more muscle. So, we'll see how that turns out in a couple couple months, a couple years. Yeah. The never ending cycle of trying to to do that while living a full life with um maximum demands. Yes. Um you mentioned something that's really really interesting to me and that was testing uh for V2 max. There are some number of things people are talking about, right? So, it's visceral body fat, V2 max and muscle, muscle, muscle, muscle, muscle. Um and if you just take those things, you have a piece of equipment in your practice called a penoi. Yeah. Tell us about that. Yeah. So penoi is um a breath analyzer that gives you uh a lot of information about metabolic health. Basically how your body takes in oxygen. It goes to your lungs. Your lungs blood comes there, takes it to your heart, pumps it, get to your muscle, and then your cells use it. So it's looking at the oxygen chain. And that's basically it's all about how your body make energy and that's super fundamental for health. The system is all about energy. If your cells have energy, they can function well. If there's any disease state, there is like energy disregulation. Something is going on where your cells are not working. So penovi gives us very precise information about one on your V2 max. It tells us about your metabolic rate, how much energy your body is using a baseline. Especially when people are interested in weight loss, you need to know how much calories do you have to put in. It's about caloric deficit. But sometimes people are so low in how much they're eating that they're not even losing the weight. They just plateau. Okay. Some people also have issue with how efficient their body is using glucose versus fatty acid. So ideally fat is actually a good source of energy. So when you're not exercising, your body should be using fat. But we have people that are not flexible that they're using glucose. So they're always tired and they have to put in it. So penoi give us all of this information. And then it also breaks down like your macronutrients need. So, how much carbohydrates, how much um fats, how much protein you need for you versus meat because everybody's different. And this is all based on, you know, measuring your breath. Um, and then it also gives us information about even based on that and and your heart rate because you're monitoring your heart rate and your recovery rate. All of this data, it also gives us information about precision on exercise. So, if your goal is to live longer based on your test, what do you need to focus on? A lot of times I see people that are very fit, they all go to the gym, everybody is doing strength training, but when you check your V2 mass is not great. So we have to do more cardio to kind of push that up. So it really gives us a lot of information to get precise on all of these things that we're talking about. Even nutrition, go see a nutritionist. How much do we know? I mean, so it helps to have that precision with that information. And one of the things I've become very interested in and has always been my thing is how do we know that all the things that we're doing is actually to make a difference. So if you don't measure you don't know where you are you can't manage what you can't measure. So it's pine pen is one tool that we have that really helps us to kind of get some information there and then we go beyond that and look at other systems because it's only one lens. So a lot of times people are just looking through this lens and they go oh yeah this is all you got to do you know V2 max. Okay, V2 mass predicts how long and how well you're going to live, but something that's actually very important and it's not being related to V2 mass is strength. V2 mass doesn't correspond to how strong you are. So there's all of this, you know, isolation. So to really be able to solve health, you know, what I tell people is that we have to have a broader lens of assessment. So Penoi is one way we do it and then we look at other lenses as well because you may look good in Penoi, you may not look good here from a cardio metabolic standpoint. Uh so you have to understand how both days. Wow. It's amazing. You you you've got this again we're going back to this multiffactorial equation. Um tell us what are the other things that I'm now you got me really parati want to know. Yeah. And all of that and I'll tell you what that comes from is like my my specialty as a physical medicine rehab doctor. So we don't you know rehab physicians don't learn about an organ system. Cardiologist focus on the heart. We look at function. How do you get everything to function well irrespective of the organ disease if it's a GI issue whatever it is. Uh so from there we have this broad lens that you have to look at different places. So for example we we looking at longevity right and people say yeah V2 max you know is a predictor of how long you're going to live but we also want to understand what's going to kill you as cardiovascular disease. Okay so we also want to look at your your lipid profile. How does that look? There's all the nuances between like what kind of lipid is it oxidized? Is it small? Is it bigger? There's all of the things that you have to understand. We also have to look at your biological age of your organ system. Some organs may not be working as well. Your liver may be older. Your lungs might be older. So, we do all of those tests. Something called true up true age. We also look at genetics and see what are your predispositions. Are you able to de detoxify? Are you able to methylate? Are you is your cells working well? We look at micronutrient. how efficient is all these things. So you have to look at all of those things and once you have that then you can figure out for this person this is their predisposition this are their limitations this is where they're lacking this is the environment you also have to go beyond and look at the environment because the environment is important you can look at people's physiology this is what they have but then it's the epigenetics where do they live what access to food what access to resources they have to be able to kind of manage health so bringing all of that in helps to be able to kind of create a plan that works for the person in front of you. One of the most interesting things about someone who has a M PH from Harvard is that you understand about health disparities. Absolutely. And the last thing that you just said is truly uh remarkable. That's it. Yeah. If I tell you to go eat organic and you can't afford it or you don't have access to organic, that's not going to happen, right? Yeah. Yeah. Yeah. So sometimes it's just small incremental changes over time. Sort of the Kaizen approach. Yeah. That gets people where they need to go. Um and then as things get better, they can make bigger and bigger changes. When you're in acute situation, uh in the hospital and you got to treat somebody who's, you know, got a serious issue in that moment, that's what you're dealing with. for you. I would imagine you're doing what you can with a patient over time based on their ability to actually work with you. Yeah. What what are the things that you feel most people don't know but should know about health? Okay. So, um thank you for that question. So um even when you ask people how you define health, everybody have a different way of defining what health is. Okay. But I think what I want people to get is that it's not just one thing that's going to give you health. The body is more complex than that. Okay? And the body is a system of systems and one system change, another system have to change, another system have to change, another so there's so many things that we don't even understand in terms of what's going on in our physiology. So um if if somebody just have some protocol and say oh this is the only thing you got to do and it's going to you know like some of this biohacking things that we do. Yes it's great. It kind of helps you know solve a thing but that's not health. So really getting people to understand what health is is the fundamentals which never change. The pathways that exist in our physiology have never changed. They're always going to be there. It becomes what do we do to signal that pathway to get to health and then also becoming aware of the environment that we live in. It's changing. So sometimes there is some type you know there's theories and things that worked when we were at a different place when you have all the stresses in the environment. Now you have the stresses. So maybe you have to take pharmaceutical agents. Maybe you have to do these things to kind of help support what you have to do. So uh I think the point is that people need to recognize it's not just one thing. It's not just going to be a peptide. It's not just going to be a hormone. It's not going to be stem cells. It's not going to be, you know, code therapy or whatever that gives you health. It's really doing all of those things well for you. And a lot of times we don't know. And this is why you need to get to an aspect who understands some of those things and try to put it together, prioritize. Okay, all of those things are good. All the signals are good. But too much of it may not be good for you or it may not be the right time for you. So health is fundamentally doing the basics, the nutrition, the sleep, the exercise, the stress, the connection to community, all of those things get you there. Because we look here and in this western space, we're talking about longevity and we have all this tools. I mean this space and peptides and everything else that we're doing, the people that are living longer in these blue zones don't do any of this stuff that we're talking about. They don't do none of this crap. they focus on consistently integrating their daily life with activities, a lot of walking, climbing up, eating well, hanging out with friends, and all of those things. So, uh, it's more complex, but I think it's I just want people to understand it's not just one thing that's going to give you health. Yeah, but it's more complex than that. Yeah, great point. Um, so for the average person who's out there, um, sees this podcast, um, they say to themselves, "Wow, you know, there's a multitude of information out there. Where do I start? What do I do? How do I go? How do I get how do I get what the end product that I'm looking for when there's all this I'm just confused by it? What what would be the pathway that you would say is the right way to go?" So I think um you know that it is challenging because we have we have this privilege of having all this access to information. How do you distill? How do you make all of those things? So I think for somebody who is really interested in your health, they should do the due diligence to find providers who understands the foundational things that really leads to health and you can tell um you know a doctor should be able to tell you a little bit about exercise. I'm not an aspect on exercise but I can give you some ideas or nutrition and some of those things. So finding providers who are talking about health is important. There's a place for solving sickness. You're in a hospital when you're sick. You want to go to a hospital where they can do heart surgery and do all the things for you. But if you're a person who don't have sickness and you are in a place where you're trying to solve health, you got to find a provider who who understands health. Um and those people are out there. I will also say that educate yourself. There's tons of podcasts and influencers and other people out there who are also talking about how do we get to health. But the things that I want people to recognize is that you know you need to have a clinician who actually have seen patients and who have you know because we have all this evidence there's evidence and then there's what really happens in life. Okay. So you get trained and you have all these things in your head and when you're dealing with people so there's an expertise and extra wisdom that comes with dealing with people in a disease and you know so you can you can't do it by yourself. Sometimes you can there's many things that you can do and then when there's all these protocols that people put out there um maybe it works for them maybe it's not the right thing for you even if it's safe there's natural things natural doesn't means it's safe and what is safe for me may not be safe for you. So really, I think doing the due diligence, educate yourself, um, and then finding a provider who can be open to to provide, uh, those guidance for you. Yeah. And we're moving from this notion of, hey, I get my health insurance really from my employer. Uh, and you mentioned it earlier, the frustration that I think many doctors uh, feel is sort of like, I could sell say this is what the patient needs, but then the health insurance provider could tell me no. Yeah. they have their formulary, their PVM, um all of these things are going to dictate whether or not I'm actually able to treat that patient. That must have been extremely frustrating for you at times, I would imagine. Yep, it is. And um I think what I came to with really moving that away and making the care about the patient. Okay. So, even if we can't do those things, what else can we do? The fundamentals a lot of times are not even that costly. is just having the time to explain to people and talk to people. And when you're an insurance model, that does not exist. You don't have time to counsel people on nutrition. You don't have time to say, "Hey, you know what? Maybe when you finish eating, walk, you know, around your block, even if you can't go to the park, walk around your block after you eat and that's going to decrease your glucose level and that can reverse diabetes." Or eat your proteins first or something. You know, there's all this things that we information that clinician can give to patients to solve health. But in the context of insurance where you have 15 minutes, you don't have time for that. So it's really um hard to to navigate that. But you have to make it about the person in front of you. Um there's a lot of places in the world who don't have access to all of this infrastructure and resources that we have here in America and didn't deliver good health and good care. So it's not just the things that we have here. There's still a lot that we can do for people. It's just having the time to do it which we don't have. That's the limitation. Yeah. In that in that environment. But we're seeing this shift now from people that are they're like, "Hey, I'm not kid. I'm I'm moving out of that. I'm into these, you know, people are recognizing it's going to be cash pay." Yeah. They have catastrophic insurance, but they're now they're taking it to the next level. It seems like we're on the front of front like it feels like the tsunami is like 50 miles offshore of just people waking up and seeing that whoa there's a whole another you know when you see all these chronic diseases taking place and it's like whoa I don't want to wind up there. Yeah. And I think that's a great place to be and because what we have as a health care system is as everybody says a sick care system. Okay. And people are recognizing yeah we can actually be healthy and everybody knows nobody want to feel sick and you know people want to produce people want to be productive members of society. Our awareness has evolved. So people have recognized that the system we have now is not going to give you health. So you got to go to a place where a doctor can spend the time to educate you uh and talk about health and they see the value in it because even the other system is so expensive. You pay all this money nothing happened. They don't we look at your biomes and go everything is fine until you develop diabetes like oh well nobody told me this and I see this all the time. People are coming to me, they have neuropathy, they have all this endstage systems and I do the labs and I say, "Hey, this doesn't look good." And they go, "Oh, well, my primary care doctor told me it's fine." Nothing against primary care doctor or anything, but like the system is not designed. It's designed to treat sickness. So, if that threshold is not triggered, but it becomes very costly. Not just cause in terms of expenses, but cost in terms of people's life, not being able to be there for their family, not being able to contribute to society and all those things. So people are now um I'm glad that we have you know persons uh standing up or patients standing up to say demanding that hey we need to do something better and they recognize you have to make that investment yourself financially as well as you know personally and be committed to making healthy habits because the environment is also not designed to make us healthy. all the food we have, you know, and our culture and everything, you know, we sit a lot. Everything has changed. Everything is convenient. You can just sit there and, you know, order food on you don't have to got it get out. You can you can sit down and so it's designed to really work against health. So, we have to we have to push against it. You can't be passive in your care right now. And that takes also having a provider who understands that principles and help get you there. Yeah. So tell me the ideal patient that you when that you look for where if somebody shows up you go okay I'm so glad you arrived this is the guy or or or gal right uh who is that so ideal patient one they have to be interested in wanting to improve their health okay and really want to do it you don't want to say it and then you don't want to do it okay so one they have to value health because I have people that will you know instead of doing some therapy that actually help them I I have two people and you know I can't disclose it but I have two patients where one of them we're doing this interventions for them one of them is doing it of course it's not covered by insurance but she's doing so well everything is changing her metal profile her weight everything else the other one we did it for a while and you know she wants to go to Vegas and her friend say hey you you you say you don't have money don't you want to spend the money on the medicine so you can actually get she was like no I want to Vegas so we want people who are interested in investing in your health and value their health And um I think that's that's basically it. If you if you value your health and if you think this is important for you, then you are the right patient. Yeah. I mean, let's face it, without health, there aren't going to be too many trips to Vegas. Exactly. Yeah. You're not even going to enjoy. You're going to be tired when you're there. You can't take it too long. I mean, you're going to be like, "Okay, I had a few drinks and I'm done. I'm wiped out." So, we got to get you healthy. We got to get you resilient. So, all of these other things make sense. Life is to be enjoyed. Yes, you can go to Vegas. you can do all these things and I also don't like very restrictive and prescriptive things you know we are human beings we're evolving there's all these things that even in the medicine that we do there's so many things that we still don't know right the quantum go down and everything changes so there's all these other things that it's unknown so it becomes really empowering people and when people feel safe when they feel empowered it's easy for their physiology to follow uh that it's about getting the right person who values health and then they want to make the commitment financially as well as, you know, uh, doing the work it takes. Do you have patients that come in to see you and they're like, "Hey, I'm a vegan." And so, uh, or, "Hey, I'm on keto," or, "Hey, I'm carnivore." Or, "Hey, I'm paleo." And now you have to work within the constraints of their frame. Yeah. How do you deal with that? So, that that is hard to do. And um and I do see quite a bit of those. So I think if it's not for a religious reason and people have significant pathology or issue that relates to the choice they make because they vegan and they don't have any you know they're trying to build muscles and you can't build anything because they don't have brand chain. If it's not a a religious reason or something that is you know like okay this goes against who I am then we figure out some other ways. It doesn't mean you have to go eat meat. can we find some supplements, some other things that maybe there might be some animal product, but it's not directly you eating a meat or whatever it is. Um, so that's hard. And what I also tell people is, you know, like the the body is complex. It's not it's not it wasn't designed to just consume one thing. Okay? So people can come up with all these theories. Oh, when we were garden, this is what we did. We are always evolving. The microbiome is always evolving. So all of those things are just things that people hang on to. But it's if you do your own experiment, how do you feel? People feel well. Of course, if you just doing carnivore and and and I've seen people do this and they feel great. Why? Because they're not eating any of the processed food anymore. Everything has become just clean, okay? But you also need things for the microbiome. You also need things for other things. So, if you're looking for longevity, the people that are living longer in other places, they do a little bit of everything like that. So I think it's just guiding people, respecting people's value. Uh there's reasons why people make those choices and then trying to figure out even if we can't give you whatever it is, can I use something else to improve your mitochondria health? There's always different ways to signal the body. Okay. Absolutely. So that's that's where I think once you have that knowledge and I'm so glad that I I came across Dr. C's because that's where that inception came from. Like you can signal the cell from different ways. It doesn't have to be this. If you don't want to take hormones, I can improve your mitochondria help. How you make hormones starts in the mitochondria. If I improve that, maybe I can optimize your hormones. So, there's all these different ways to kind of signal. But again, I I try to tell people, you know, your body need these things. Um, and if it's not physible, what else can we do? Can we do IV? Can we do something else that try to get you the same results? Yep. Well, my friend, yes, it's been a pleasure. Of course, I appreciate you flying all the way across the country to come see me uh to to spend some time with us and help the world. You're doing such a phenomenal job. Um the people in Philadelphia, man, they're lucky to have you. Oh, thank you so much. I mean, that's um I would imagine that pretty soon it just won't be Philadelphia anymore. We we got to get out somewhere else. Yeah, we got to get the message out. and thank you so much for for having me and your team and and really trying to give me this platform to be able to communicate uh what what we want to do to help people. I think there are solutions and it's just sometimes very simple things and I've seen people where they come in, they've done all of the things. It's just simple things. You give them a little LDN and this pain that they've been dealing with and then they're better, you know. So, there are solutions out there and I want to be able to, you know, try to get to people and ease all this unnecessary suffering. All right. So now this guy wants to get into flow state. How how does he get in touch with you? What does he do? If somebody wants to get into flow state. Yeah. They want to get into flow state. They want flow state peak performance. The pathway to peak performance and they want and they say Dr. Assari Christian MD as we'll take the doctor off. We'll say Assari Christian MD MH uh fellowship train. I mean the list goes on. You can just keep going. Yeah. I want to get in touch with you. I want to work with you. How do I do it? So, um, a couple ways is is one, people can go to our website. So, it's ethermed.com. ether is a e t medicine.com. They can also call us directly 484861101.

So, when people go to our website, they can request an appointment and we'll be happy to connect with them. I also uh do some education on Instagram if you want to learn more about what I do. I like to educate. So, it's also ether_med. Uh, so the you know website or give us a call 484861101. Yeah, we'll put all the information in the links below. But, um, it's not hard, right? It's not hard to get in touch with you. No, it's not. We we are open. We're available. We respond and we get back to people. And, um, we want to be able to uh get to help people. I you know we won't be able to help everybody but there's a lot of people that I see that it's just a little tweak that I do for them and it it just makes a huge difference. So we always learning so there's going to be better ways if we can't fix it today tomorrow we'll be able to figure it out and help you navigate. Yeah. Last thing. Okay. So I should have asked you this earlier but I want to ask you now. There's a thing that came out just uh recently and there's this like big movement with executives saying like okay uh in order to perform at the highest levels I now have to do all of these things uh and they're making big changes. Are you seeing a lot of executives now coming to see you? I have a few um so it hasn't really maybe that has not translate but I have a few people who see me and again they talk about the same thing. They want to be able to perform. um you know I get a little tired and I'm in the room and they like you know I have all these young people and they all you know and I can't play the golf the way I used to. I can't show up. So I have a few of those people and some peptides some hormone balance and then putting some recovery into their workout because a lot of them they work a lot. They have a lot of stress on their body, right? And then they're still trying to exercise as much as they can to kind of keep up with everything else. So we just break that down and say let's let's do some recovery. that's when you know it's not the exercise it's the benefit of the exercise comes when you're recovering so putting some recoveries in there and and helping them uh navigate and in fact that's one of the places that I actually want to try to build a program specifically uh for for those group of people because they're making a higher contribution to society and there is better ways to solve help and a lot of time they don't even know you know they just go to their whatever regular doctors and nobody's checking their hormones I see a lot of doctors a lot of dentists all of this people who are doing really well and traditionally none of their doctors have check the other things that will influence health. So, um Yeah. Yeah. Well, it's been a pleasure having you. Thank you so much. So much so much. Thank you, man. My pleasure. Hey, thanks for joining us today. If you like what you heard or saw, please make sure to like, comment, and subscribe, and share with a friend so that they might be able to get access to this content as well. It really means a lot to us. We truly appreciate your participation and thanks so much.