Intro 0:03
Welcome to Maximal Being, a podcast devoted to ditching fad diets and using real science to get you healthy and feeling great. I’m Doc Mok, a GI and functional medicine doctor who harnesses the power of gut health to get you achieving your goals. And I'm Jacky P, a well-informed layman who challenges the experts and ask the questions that you want. Don't forget to hit the subscribe button or leave a comment, and now onto the show.
Doc Mok 0:32
What's going on Maximal Beings, Doc Mok here with maximalbeing.com. Don't forget to hit the subscribe button. Leave us a comment, it does help us to get the word out. If you have any questions, you can email us at [email protected]. Enjoy the episode.
Jacky Homme 0:48
Hello, hello, hello, Maximal Beings. We're back. It is, Doc Mok, and I, Jacky P, here. It's, uh, it's been a while, Doc Mok, I feel like, right? We haven't recorded one in a good little, good little while. How, how you been?
Doc Mok 1:07
I've been really okay. You know, like, firstly, it's good to see you and happy 2025
Jacky Homme 1:16
Yes
Doc Mok 1:17
I'm seeing a silver lining amongst these dark, dark clouds that are happening, you know, there's still diversity equity inclusion in the government, because they include people that both are related to members of our present institution and also people that suck up to it. So that's like two completely separate groups of people.
Jacky Homme 1:40
That counts, yeah, count it. Sure, yeah, yeah.
Doc Mok 1:45
What about you?
Jacky Homme 1:47
I'm doing great, you know, considering, but, you know, we're just talking about this, you know, Ashley and Quinn, they're, they're, they're fighting the flu. So, you know, I'm at home, being being a good a good nurse, take care of them and but yeah, there's a lot going on in the world, domestically, internationally, and we had a conversation about this too, about protecting your peace, right? That's something that I've been very intentional about for 2025 is I've been really bifurcating everything into two piles. There is things that bother me that there's action, and there's things that bother me that I can't take action and trying my best to be aware and be informed, but also understand that there's some things that are out of my hand and do my best to protect my mental health. But you know, outside of that, there are no complaints. You know, we have a day. You know to have a bad day means you have a day, right? People who don't have any days ahead of them can't have a bad day. So I'm trying to remember the good stuff and what the good things that are happening. So, oh, actually, anyone who's listening for the first time, I guess we should back that up. It's been a while. I'm Jacky P and with me is my co hostess with the mostest and the largest calf muscles on this side of the Mississippi, Doc Mok. So Doc Mok, we have a loose agenda today. I don't think we don't have a,
Doc Mok 3:26
Yeah, very loose, very loose, but we have a lot to talk about. I mean, there's a lot going on, yeah, scientifically in, you know, between the two of us, things that we wanted to say that are really cool, and I'm feeling really inspired to have this conversation with you Jacky.
Jacky Homme 3:42
Yeah, no, I appreciate. I'm looking forward to chopping it up. And also, I think hearing your take, because there's a lot of impact from you know, there's the balance on the there's the political changes or the legislative changes. Have it been impact people, but also you as a provider, right? Like you're you're seeing it from a different lens. So I'd love to really talk about that, but I think before we get to that, because I feel like that might be the longer part of the conversation, I also want to talk a little bit about, like, the cool technology, because it's 2025, AI is in everything, you know, if you're anti-AI everyone, I'm sorry, but it's here. You know, there's nothing to do about it,
Doc Mok 4:26
You're probably also AI yourself. If you're anti-AI, like you may have been a robot.
Jacky Homme 4:33
Congrats. You're sentient. You are exactly. But yeah, so you mentioned some wearable devices that's been coming out, which is pretty cool. Um, did you want to kind of unpack that a little bit and talk to some folks about what's on the horizon?
Doc Mok 4:51
Yes, this is a, like a hot off the presses study when we're filming this, which is like beginning of February 2025, this came out in mid January 2025 in Gastroenterology. One of our main journals out there, the lead author is Dr Hirten, and this study looked at specifically the use of wearable devices that are commercially available. Insert the name of company here for individuals with inflammatory bowel disease, different than irritable bowel syndrome, right? So that encompasses like Crohn's disease and ulcerative colitis. And we do a deep dive on this topic with Mo Naem and Susan Kais, two very talented gastroenterologists that I'm friends with at an earlier episode. So listen to that if you don't know about these conditions, but if you're listening and you do have this condition, which I know you're out there, this is really exciting looking at, you know, some very easily available testing. So, you know, Jacky P just to set the stage, like, usually, these people are young people and very sick people. And so these people, if they're lucky enough to survive, like are going to live a long life with these conditions that can be like, really debilitating, can lead to lots of mental health issues. And so the ability to predict something before it happens has a lot of value. The usual way we predict a flare is blood works, stool tests, colonoscopies, right, which I do. But what they did in this patient population, and this was like across 36 different states in the United States, over 309 patients, and they had them wear their device, and they looked at several things like circadian rhythm, heart rate variability, which I know we've talked about in a prior episode, and what they found is that heart rate variability was a lead time predictor of inflammatory bowel disease flares. So so the potential here is huge, like number one, it cuts down on the invasiveness for these people that are going to have this happen periodically for like 50 years, right? And it also gives them an opportunity to do something before it really becomes a problem, and potentially save hospitalizations, surgeries, like new, medications, all these sorts of things. So what are your thoughts about that, Jacky P?
Jacky Homme 7:21
I mean, that's incredible. And I think that is the right use of technology, right? I mean, it's, I mean, I don't know, like it almost, it sounds like something out of, like, a futuristic, like, sci fi, like, oh, you know, I'm like, think of, like, the Minority Report, you know, like, those moves, like, oh, we can just figure out things way before they happen because, well, I mean, so how I guess, tell me this. I mean, if they can use the the wearable device to predict the flare ups. I mean, is there a way to, I mean, I guess it would just kind of be you you treat before it happens. Or is it something like, you know, of course, I'm the layman here, so I don't really understand, you know, what you do with the flare up on if it's something that's preventable, or is it just something that, hey, I know flare up is happening, let me take medication or let me adjust like. So what would, what would the like the day to day of folks that are wearing these devices look like?
Doc Mok 8:29
Yeah. I mean, it can be everything from, you know, changing your diet, making sure that you prioritize rest, recovery versus, you know, exercise, you know, can be temperature controlling your environment. And then on the medical side, like when people flare, we tend to give them big bombs, like steroids. You know, steroids have all kinds of side effects. You know, they give you something called Cushings, where you retain water, you gain weight. It interferes with sleep. It causes cataracts. It makes your blood sugars go wacky. It thins your skin and bones. So the ability to potentially do something lesser than a steroid, or what we call like a tumor necrosis factor alpha blocker, or an immuno modulating this and that that acts on your immune system, the less side effects that person could have, the less bad that flare could potentially be. Because we're talking like a flare can result in a surgery, a flare can result in death, right? So there's a huge potential to save people's time, money, you know, life,
Jacky Homme 9:44
Yeah. This is, yeah. This is, like, incredible. This is almost like it could potentially be, like a life altering for a lot of people. And, you know, I know a few people who had who've, you know, did have Crohn's disease. And I remember a few specific cases where they were sick for a while and it wasn't identified as Crohn's disease as because it just wasn't, you know, they didn't have the factors that would increase your likelihood of having it. So it's like one of those, what's that saying? Right? An ounce of prevention is better than a pound of cure, right?
Doc Mok 10:24
Yeah
Jacky Homme 10:24
So I definitely don't understand, I definitely don't know the science behind it, but I think it'd be interesting to think about. I'm thinking of whatever metrics they use, like, if that's something that can be done with folks who have like disease, like sickle cell, right? Like, what are they looking at and seeing? Hey, you know what, your white blood cell kind of is. I mean, I know, I don't know what the technology limitation is, but I'm just, I'm wishing now, right, pie in the sky. But, yeah, it'd be interesting to know for folks who have sickle cell or any other type of disease where you usually have to deal with the aftermath, after effect.
Doc Mok 11:03
Yeah, and that, and that's like, that's why I wanted to bring it to you too. Specifically, is because of our awesome episode that, like you hosted, ran on sickle cell. They're very similar patient populations, in the sense that, like young people, people that are going to be sick for a long time and and also a population where, if you can do anything to prevent them from getting into the hospital and requiring all these, like, really invasive sorts of things like that, carries a lot of weight. So, like, I'm not in that space, but you know, a lot of people in that space, and like telling them this study may inspire somebody in that space to do a project like this for people with sickle cell.
Jacky Homme 11:51
Yeah, that'd be really, really cool. I think one thing I'm happy with about sickle cell is it's getting a little bit more attention, a little bit more research dollars, you know? So I can imagine that it's, it hope, hopefully there's a someone out there who's much smarter than me is figuring out thinking about it
Doc Mok 12:15
Much much smarter than me too. Like, I, there and there's, like, it's one of those conditions that just doesn't get, like, there's not enough options for treatment in 2025. It just like, and so many people have it, you know,
Jacky Homme 12:30
Yeah
Doc Mok 12:32
And, I mean, I think it's because of the way that we do a lot of Research, right? Like, classically, a lot of the research, like, doesn't necessarily differentiate people of different ethnic backgrounds and racial groups and sexes, and the ability to capture different populations using the same therapy that may have been validated in a primary X, Y or Z population doesn't always transfer over, right?
Jacky Homme 13:08
Yep.
Doc Mok 13:10
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I was gonna say one of the really interesting things happening right now, which is the scientist is just like laughable, is the government and the institutions that they run that are science based have scrubbed research grants and flagged them when they mentioned gender or equity or race in them, which you know if, if there was a scientific advisor as a part of this administration that actually was a scientist, they would realize that, like pretty much every study that we do in the United States, like talks about these differences, because we know that, you know, if I'm, if I'm of Eastern European descent, and the study is not done on me on a certain medication, like, we don't know how that medication responds to that population, right, as an example. So scrubbing that from like grants, you're not going to be giving out any money.
Jacky Homme 16:42
Yeah,
Doc Mok 16:44
Maybe that's, I don't know,
Jacky Homme 16:45
Might be the goal. You know, also, you know, I saw, I saw this, and maybe you could back this up and have more details on it. But a friend of Ashley shared that, yeah, part of like, the resource they scrub. So now I forget the name of the database, and you probably know, like, women can't go and see, like, which types of birth control would would work better or worse for them, because they've also scrubbed that information. So
Doc Mok 17:18
Yes.
Jacky Homme 17:20
Yeah.
Doc Mok 17:22
The funny thing about this, though, Jacky, is that like so so the cronies of this like branch of our government that nobody voted for, who have no scientific background have made these choices, and it's just like lazy, the way that they found the pages to delete were all based upon like, search terms. If you would think, like, a tech person would know that that's going to get some stuff that's like, not related at all to what your goal is. So, like, they've deleted things on Alzheimer's disease and certain infectious diseases that have, like, you know, no no basis for equity or diversity, but also Jacky, like, people think that this like information has gone forever from the planet. But like most of us doctors don't get our information from the CDC, maybe infectious disease doctors do. But like you can find this information a bajillion other ways, through, like, other groups that are leaders in the field, like the American College of Obstetrics and Gynecology, or private things like up to date, which, like is, you know, privately funded, and there's no way the government can control that. So that information is out there still, but they think that's like doing this evil thing where they can control everybody. I don't think I've looked at the CDC website for guidance for a medical decision in decades.
Jacky Homme 18:54
Yeah, yeah. Well, that's that's encouraging, because, you know, one question I was going to ask of like, it's got to be there somewhere out there in the space, still right? Like, can't just, like, for lack of a better word, just hit that delete button. Control alt delete. This is gone forever. And my brain is like, I think they they're actually doing just like, you know, highlight, like, yeah, delete, you know, wipe their hands. And they're like, good job, guys, you did it.
Doc Mok 19:22
I thought this is just like, the us in the scientific community, like we're just sitting back and laughing at the like, the sheer incompetence of, like, not scientists making scientific decisions, because they're just like, I'm gonna get those scientists. And it's like, yeah, no dog. Like, nobody's paying attention to that man,
Jacky Homme 19:42
Yeah, yeah
Doc Mok 19:43
On the flip, yeah. Were you gonna say Jacky?
Jacky Homme 19:47
It just, it's just crazy out there, like just, just to think about what's happening, decisions are being made.
Doc Mok 19:57
Yeah, I, I don't know. I don't know why it's happening like that. It doesn't make any sense to me. One resource I was going to get to the listeners out there is a website called climate.law.columbia.edu, and on this website they've created because of this, like, you know, barrage of orders that come out with the sense of, like confusing people. It's organizing all of the things that are being affected from a scientific standpoint, and this is, like all sciences, into one location with with also the plans for rebuttal. So it's a way to kind of just keep all of these things organized in a space
Jacky Homme 20:38
Interesting, okay.
Doc Mok 20:39
Yeah,
Jacky Homme 20:40
Which is cool.
Doc Mok 20:41
Which I got through a group that I that I work with as well.
Jacky Homme 20:47
That does make me feel better, too, you know, I think you know, like all is all, you know, it's not all lost. You know.
Doc Mok 20:57
It isn't. It isn't.
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You know, the I will say, on the flip side, like so when the financing pause occurred last week, you know, I, I work at a cancer center. We are quaternary cancer care center, meaning we take care of a lot of people that have failed, you know, level 1, 2, 3 chemotherapy, and are looking for answers, right? They're trying to get on clinical trials. And not all clinical trials are funded by the government, but some are and so Democrats, Republicans, independents, like, whatever my patients were that week, probably mostly Republicans, because I'm in Florida right now. Like those people that day couldn't get that intervention that they are working so hard to get on. Everybody just was paused again because of just sheer incompetence and misunderstanding of, like, what this pause would do to actual people. And, yeah, every patient that I talked to about this was just like, I can't believe this. This is ridiculous, like, you know, because God can't, like, there are a few things that are worse in life, other than going through cancer, right? So having somebody stand in your way for getting something that you're already a part of or trying to get on as a glimmer of hope is just not right, you know, yeah, right to do to people
Jacky Homme 24:22
Yeah, yeah. And, and, I know, you know, and, and, for those who may not understand the context, because, you know, I in the financing, being someone who's in the hospitals, are very familiar with how health insurance works everything, but I think we should also take this time to kind of break down, really like, what that nuance is, you know? Because some people might just be thinking, Hey, shouldn't health insurance cover this? Right? Hey, you got sick. There's a trial. There's a treatment that you know, that shouldn't just be covered by like, health insurance. So, you know what, what, I guess, what is the, like, how do, does someone whose patients fall into that category of, you know, having the government help with the clinical trial, versus it being a health insurance, I guess, conversation,
Doc Mok 25:15
Yeah, health insurance takes the guidelines, things that are standard, that are already have gone through approvals and evidence based data to say, this medicine is first like, we know the mechanism of action in animals. We're trying it on a small group of patients, and it's safe. The next level of study is like, does it actually work for the intent that it's coming out with? And then lastly is, like, looking at more long term results. And, you know, once it gets through that process, and there's time, people will integrate these trials into like, guidelines, and then everybody be like, oh, yeah. Like, for high blood pressure, I take something like hydrochlorothiazide and, like, you just know that, right? And the insurance is like, yeah, hydrochlorothiazide. Like, there's tons of data on that. We'll approve that, and we'll save you some money. But for people that have, like, failed relines of chemotherapy that are standard and need drug x that's already gotten through those levels of like safety, of efficacy, and now we need to look at like response over time. This is where clinical trials come into play. It's people that are outside of the box, are don't fall into those like standard of care, trials and treatments and so like companies and scientists will invent compounds and test them and get funding to advance research to ultimately deliver a clinical care and at a cancer center. I mean, we're just, you know, I have grants like people are just, there's grants everywhere. There's opportunities for people to look at things that are outside the box that will probably help them in their cancer. Insurance not has nothing to do with it. Will never pay for that in a million years.
Jacky Homme 27:12
Yeah. I mean, not to get on a soapbox, insurance kind of doesn't pay for things they should be paying for already. But, you know, I'm gonna take this time actually, just aside who decided that your eyes and ears aren't part of your body, and need separate insurance for that? I've never understood that. Like, why do I need eye insurance, it's part of my body. It should be medical anyway. So I don't know how that happened, but, you know, I'm pretty sure there's some sort of history. But I'm the layman. I'm the layman guys, so I don't need to know all the facts.
Doc Mok 27:43
But you're right. I don't get that either, right, any sense at all.
Jacky Homme 27:47
You know? Yeah, like, we have, you know, we have some, some folks that I know that, like, they need an hearing aid or something like that. Nope, that's not insurance. That's a special fringe go over there and have to deal with that. So it's so it's just so goofy anyway. So, so let me relay back to you and make sure that I file, follow for the folks out there. So I'm just going to use very simple there's Tylenol, acetaminophen. You need it in the hospital. Insurance company knows, of course, they're going to charge it 80 bucks a pill, but that's another conversation. They throw that at you all the time, if you are someone who has a specific, specific situation where either your Tylenol doesn't work anymore or it's not strong enough, for instance. And then there is new painkiller X right, which hasn't right. And you then the medical field, have some data and enough research to know that it is effective, but just not enough for the insurance carriers to say, yes, we will start covering this. Is that kind of like,
Doc Mok 28:51
Exactly
Jacky Homme 28:52
Wrong understanding, okay,
Doc Mok 28:53
That's exactly it.
Jacky Homme 28:55
So I mean, is this? Is this a big part of your population of of patients? Is this at half 50/50, or is it just kind of grab back
Doc Mok 29:04
That day, which I think was Tuesday, I had 12 procedures, most of them pancreas cancer. Of the 12, eight were enrolled in a clinical trial or trying to get on a clinical trial, and none of them could do that that day because of this decision that was made without thought.
Jacky Homme 29:30
I can't even imagine how you know. You just do the math and the scale of it, like, how many individuals do what you do across the country so easily thousands of people impacted just
Doc Mok 29:45
Yeah, just because yeah, just because somebody's lazy and didn't think about like, oh, if I do this, it could probably because there's no like, scientists that are advising those people to that the repercussions that their decisions could make. Like the Scientific Advisor for this administration is an AI tech guy who fumbled his way through law school and an undergraduate.
Jacky Homme 30:13
Yeah, so, well, that's scary,
Doc Mok 30:16
I know, but fortunately, like, yeah, you know, people realize how stupid it is, and said something about it, and they paused it, at least in some of the programs, you know, yeah,
Jacky Homme 30:33
That's, that's, you know, yeah. I mean, so many things to say about that. Just, it's just, you know, folks should, should just, you know, if you're, it's just very interesting to me to like, see how quickly and widespread an impact like this can make on someone like as a patient, you know, it's, in a sense, like, you know, they're playing with folks lives, right? And just like, without consequence, yes, and it's just scary to to think about that also, I think, you know, you know, like, what, what can we do? Is there something that we could do, like, as a population, as a medical ministry, to put safeguards, or, you know, contingencies in place, or like, hey, they cut funding. I mean, outside of just going and getting, like, privately funded, right? And like, asking so if a ton of money write some checks, like, I mean, is there anything that folks can be doing, or should be doing, to, like, stop, like, you know, like, because what happens again next Tuesday, right? And say, hey, we're cutting this off again, right? And then we're back to where we were. Like, is there action items, I guess, to sayfor this?
Doc Mok 31:57
Yeah. I mean, the silver lining is exactly what you have already said, Jacky, is that, like so many trials, are not funded by the government. It's actually very difficult to get on NIH funding. There are so many private mechanisms to get grant funding that it circumvents this whole nonsense, right? So it's another, like, we call it workarounds, right? I'm sure you use the same term in the business world, like we're all just working around it, like we're just, like, all right, cool. We're just gonna, you know, we're gonna find some other way for our patient to get what they need, because that's our job, right? As people of light, like and that's not a religious statement, but like doctors, nurses, technicians, we're all people of light. We're trying to help people. We're trying to give good to people. Yeah, and we're going to find a way to do that for our patients, like, one way or another. So I think that's like some of the light there. And I think also, if you're somebody out there that is a healthcare provider that has experienced something like this, you need to share this with your patients like it's our job, like physician means teacher, right? So you need to teach your patients about these things. You need to just stand up and say something to them. And if you're a patient that suffered from something like this, you need to share your story with somebody, tell your aunt, your uncle, your cousins, like the more people you tell, the more it will spread, and the more people understand the gravity of this, because the people that are making the decisions are never going to understand this unless they themselves are in that situation. That's just the way that we work as people, right? We're just like, unless it affects our microcosm, we don't care, like, really, yeah, yeah,
Jacky Homme 33:44
Yeah, yeah, no, that's a good point. And I think, also, I think for me, one thing I learned when we had a conversation about this the other week is just how widespread it is. I think you don't realize, and I think the awareness helps. And I think I don't think people really understand the you know, they say, you know, the you know, the President of the United States is the most powerful person in the world. And in the sense, like, if with the wave of a pen, right? They can, like, stop someone who needs potentially life saving procedures that they've never seen, never met, don't even know exist. That is a kind of a scary thing, because it shouldn't be that way, especially in the medical space, right? I feel like in the medical world, there's some world that should be insulated and protected, right, medical space, civil services, right? Like fire response, all that stuff like, it should just be insulated and protected, because these are the things that every human being needs. Education. I'll put that in there as well. Yeah, education system, right?
Doc Mok 35:00
Yes, our head is a WWE person.
Jacky Homme 35:03
Yeah, yeah, totally nailed that. It's, you know, yeah, we're just crushing it right now, honestly, you know,
Doc Mok 35:12
High five
Jacky Homme 35:13
We did it, but yeah, I just yeah so like awareness and back to your point of people not understanding like or not caring if it doesn't affect them, like it does affect you. You know, that's another thing too. I think that's a lot of the Miss kind of understands like this does affect you, like, explicitly, too and sharply, yeah, you know, yeah.
Doc Mok 35:42
We all, we all have power too, right, in our ability to vote with our feet, you know? And like, I'm, I'm in a very red state, like, physicians are leaving these places like that. That has happened in Texas. It continues to happen in Texas, people are leaving, doctors are leaving, and as a result, the mortality that like is going up in places like that, because there's a suck of like resources and thought and care, like there's not a day Jacky, where I don't get like, 50 texts, emails, calls from recruiters saying, we really want you to work in Arkansas. We'll pay you a bajillion dollars because there's no doctors there, right? There's minimum doctors there, and people are suffering as a result. So like you the patient, have the ability to vote with your feet. Us, as healthcare providers, we have the ability to vote for free. And same thing is true in your industry Jacky, like people are leaving and, you know, there's these places are going into like, economic downturns, their local economies are suffering because there's nobody there to do the work. There's nobody there to like, to make big decisions or advance technologies.
Jacky Homme 37:08
Yeah, no, it's, it's a problem, simply put, that I think at some, will need to be addressed. And, you know, I think as a nation, will need to face the music at like, what are we putting our priorities? But, you know, until then, right? And, but, yeah, I think, I think it's something that should be discussed, something that should be talked about. People should be sharing information and experiences, because that's what really changes the narrative, and hopefully has some folks open their eyes into like what's going on.
Doc Mok 37:49
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