Join us for an enlightening episode featuring two prominent voices in healthcare, Dr. Sathya Sriram, CEO of Preventive Healthcare at Apollo Hospitals, and Dr. Manish Mattoo, CEO of Apollo Hospitals in Karnataka Region. Together, they delve into the critical topic of preventing non-communicable diseases through proactive measures and health screenings developed using an innovative AI model. Discover actionable advice and expert guidance on safeguarding your health for the long haul. Whether you're seeking to optimize your well-being or gain valuable insights into preventive care, this episode is a must-watch. Tune in now and embark on a journey towards a healthier, happier life!

Sathya:The modern day conveniences that liberalization of the country brought is huge, right? I mean, we are all living it and enjoying it.

But along with that came the bane of some of these lifestyle diseases. Living with diabetes worldwide, people have high blood sugars. There's an increased risk of. Cancel

Manish:one out of three adults have high blood pressure propensity of people to have these issues postcode as you please.

Sathya:What we've realized in a post pandemic world is that loneliness and social isolation is the new sitting and the new smoking.

Ryan:But we're hearing of so many people getting stroke nowadays.

Sathya:In 2020, 65 percent of the deaths in the country were due to NCDs. Our body is very interconnected. When you have such vigorous activity, the lung and the heart have to be in such sync.

Manish:So let's not mistake a fit body for a healthy body.

Ryan:It's the first time we unfold a whole new dimension of healthcare. Ladies and gentlemen, it's a privilege to welcome our distinguished guest today on the Healthshot podcast. Dr. Sathya Sriram, CEO of Preventive Healthcare at Apollo Hospitals and Dr. Manish Mattu, Karnataka Region CEO of Apollo Hospitals.

They join us on a journey where we talk about preventing serious health conditions, recognizing and managing potential health risk early on through advanced AI shaping a better quality of life. So sit back and enjoy as we unravel the secrets of a healthy life with Apollo ProHealth.

Manish:First of all, thank you so much for having me here Dr.

Ryan. I work as regency over the Apollo hospitals and based out of Bangalore, most happening city in the country today. And you know, this year our focus is largely on pro health and how we drive wellness in the city and across the country. Very happy to be here.

Ryan:Awesome. Dr. Sathya, it's a privilege to have you over here.

Tell us a little bit about how you landed into this seat of preventive healthcare.

Sathya:Thank you so much, Ryan. Absolutely delighted to be here. At Apollo Hospitals as heading the preventive health vertical my mandate is to help shift the consumer mindset from curative to preventive. And I bring sort of deep passion for driving consumer behavior change.

And I think that's the crux of changes to lifestyle. The only thing that we can control if we want to be healthier tomorrow than we are today.

Ryan:You know, whenever we have conversations in the corridor, everyone's talking about how India is the seat of ancient wisdom. We discovered the zero over here, mathematics center of the world.

And obviously the Ayurvedic sciences are thousands of years old. And so I'm assuming that this ancient wisdom would have trickled down into our subsequent generations. What we're noticing is that We are getting a lot of these non communicable diseases in the ancient time. We had diseases that killed us because of typhoid or malaria.

But now we're getting rammed by stuff like diabetes and hypertension and heart attacks. So is this on the rise? And what do you think doctor went wrong since ancient wisdom and now modern sickness?

Sathya:Ryan, the non communicable diseases which typically cover diabetes, hypertension. cancers obesity, as well as now increasingly mental health are definitely on the rise.

If we take the Indian population back in 1990, so as recent as 1990, 25 percent of the deaths in the country were due to the NCDs or non communicable diseases. 25%.

Ryan:That means one fourth of our population. Was dying because they were slapping their own selves. Yes, yes, kind of. I couldn't get it from my next door neighbor or my auntie or my uncle.

I brought it upon myself. Upon ourselves.

Sathya:And at that time, the infectious diseases what about 65 percent of the deaths in the country? I think medical technology, access to vaccines, a lot of awareness about some of the communicable diseases has resulted now in the, these diseases going down and the non communicable disease on the other hand have been steadily increasing.

In 2020, 65 percent of the deaths in the country were due to NCDs.

Ryan:So we've gone from 25 percent to 65%?

Sathya:In 1990 to 2020.

Ryan:So the ancient wisdom of Ayurveda is now just a lovely nameplate on our board of India, but internally we are getting sicker and we are not getting sicker because of infectious diseases.

It's, it's these lifestyle

Manish:diseases. That's right. I think just to add on to what you said lifestyle changes that we've had in the last 20 odd years, rapid urbanization, pollution, alcohol, smoking processed food. Right. And sedentary lifestyle while, you know, we may be aware more about our health today, but I don't think it's in our behavior, it's actually something that we are abiding by.

So I think all those things are actually leading to a rapid increase in NCDs. And 7 out of 10 deaths today in, in the world happen because of NCDs. So 7 out of

Ryan:10 deaths in the world happen because of non communicable diseases, which basically is, you don't get it from something, you kind of inflict it upon yourself.

So where do we act? Where do we act? Do we wait till we get that slap? And in your case, you're giving me statistics of death. So does a person need to wait till they die and then act? Or, I know I'm joking about something about death, but people need to wake up and get serious. Where do I get serious? Do I get serious at the first sign of a symptom?

Do I get serious when I faint and fall down? So as doctors you know, practicing this mantra of not curative medicine, but preventive medicine, where do we start? How do we get people to get started?

Sathya:If you see a symptom, it's already, in my mind, a tad bit on the later side.

Ryan:Doctor, if I can interrupt you, for the layman out there, Symptom.

What do we mean by symptom?

Sathya:A symptom is something that you feel is off. And that means it could be a pain somewhere, a discomfort, away from the normal way that something is functioned. Example, you have a pain in the gut area. Or your digestive processes, right, and bowel movements are irregular. You have pain in the chest area.

All of these are examples of symptoms. Something that you can feel, visibly see, sometimes, touch. This is what it is, is a symptom. And when we say you come in after a symptom, at that point, like I said, it's a little bit on the later side. Our body is actually built to be very, very resilient. And therefore can compensate.

For a lot of the abuse.

Ryan:Is that why a lot of us have this God syndrome that we are indestructible? Therefore we ignore the symptom?

Sathya:Exactly. Or symptom or even the path towards that, right? You sort of start getting a little bit of a niggling feeling. You know something is off. The sleep is a little bit disturbed.

But you choose to procrastinate and push it out. Until it becomes something that's really tangible. At that point, it's a symptom. Let's take a example. One of the rising conditions in India is fatty liver. When we think about a liver transplant or liver cirrhosis, automatically most of us think about alcohol related

Ryan:liver cirrhosis.

I drink a lot of alcohol and my liver goes off.

Sathya:Right? Our liver transplant surgeons say these days for every alcohol related liver transplant they do, They do one for non alcoholic fatty liver conditions.

Ryan:So what you're trying to say is that just because somebody's smoking or drinking, in the previous time we doctors said, Oh, this guy is going to get alcoholic fatty liver disease.

Now you're saying even without drinking, they're getting it?

Sathya:That's right. Even without drinking. They're getting fatty liver conditions. That's different from the alcohol related cirrhosis. Let's unpack this a little bit more. How a liver gets becomes a fatty liver is essentially due to excess carbohydrates.

Right? Because the first place of storage for excess carbohydrate, when it's converted into something called glycogen, is the liver. It's only when the liver's capacity To hold that excess carbohydrates is surpassed, does it actually go and settle in other places? Now, when there's excess accumulation of these carbohydrates as glycogen in the liver, there are structural changes to the liver.

And that can be only picked up in an ultrasound. It will not show up in a blood test or the, of the liver function test. That's much, much later. When the liver has stopped compensating for this and says, I give up, I give up. And that's when the liver function test starts to be abnormal. But if you do an ultrasound, you can actually pick up the structural changes much earlier.

Doctor, for the people

Ryan:that don't know, what is this ultrasound?

Sathya:Ultrasound is actually an imaging technology that uses sound waves to help visualize what's going on inside your body.

Ryan:Why would somebody do this?

Sathya:So typically we have heard doing an ultrasound for pregnancy related Yes. Right? Look at the baby.

At Baby the baby and stuff like that in the womb and so forth. But what we found is the ultrasound of the abdominal region actually picks up a number of abnormal. conditions in in this area. So stomach, gallbladder, liver, pancreas, ovary, uterus, right? All of these get picked up in an ultrasound. Also, you could do an ultrasound for kidney stones, gallbladder stones, also carotid arteries.

Sometimes you do an ultrasound to be able to see

Ryan:where is the carotid. It's around

Sathya:here in the neck.

Ryan:That's right. Why would we screen an ultrasound for the neck carotid artery? This is for typically for stroke, you know, but youngsters will be like, I'm not going to get a stroke, but we're hearing of so many people getting stroke nowadays.

So if I'm in the twenties to thirties, thirties to forties or forties to fifties, are we doing this ultrasound or this you know, the checking of my neck artery and all who tells me to do this?

Sathya:Yeah. So also Ryan, you don't do everything for everyone at all ages. Okay. Right. Different people have different risk factors, different age milestones.

You actually the in a risk increases. So we actually can think about a combination of tests that are most appropriate for each individual or group of individuals.

Manish:Got it. And if I can add to that, you know, recently in our pro health packages, we've launched eight specific packages. So, you know, the most popular tests that people opt for our whole body packages.

But essentially that used to be restricted to, you know, 40, 50, 60 days to kind of be more you know, the uptake used to be more in these age, this age category. But now we've realized that, you know, as, as you said, the onset of this disease is also in the younger age group. So we've curated packages for our younger age group as well.

So how young 20 to 40. So yes,

Ryan:20 year old 30 year old can come in and get tested.

Manish:Yes, yes. And we've curated the packages based on the disease conditions that are most prevalent in that age group. So we have, that's,

Ryan:that's very interesting. You know, recently I was working in one of the fortune 500 companies and they contracted us to do the nutrition plans for people.

And we just asked for a basic blood test of the 20 to 30 year olds. And we found that more than 67 percent of the blood tests that we did had very high lipid profiles. Yes. Yes. And the youngsters were shocked. Yeah. Yeah.

Sathya:So that's also part of our genetics as South Asian population, where we are more prone to higher cholesterol.

You know,

Ryan:what could be some of the modern day reasons that the 20s to 30s and 30s to 40s are facing these current lifestyle diseases. What from the air or from the water or from the food or is it my karma booming or something that is causing this? So as doctors screening thousands of people, you are seeing statistics.

So you obviously are like Sherlock Holmes and you will have an inference. What are the modern day conveniences that are putting a target on people?

Manish:One, I think to add to Dr. Satya's point, genetically, we are predisposed to more coronary artery. So I can, I

Ryan:can blame my grandfather, grandma, but only that's part of

Manish:the story.

I would say even in our genetic testing protocols that we have well established in our pro health program genetic screening results have shown us that. That predisposition causes only one fourth of the contribution to the overall illness of the person. The others are, you know, your lifestyle. Like 25%, I can blame my ancestors for that.

And 75 percent is my mind, which is your, you know, dietary intake, your sedentary lifestyle, pollution in there, you know, and the kind of food that I'm eating. And of course, while we may be aware about, you know, health needs. But we are not really you know, doing much about it. Like we see, we are, you know, more leading a lot of sedentary lifestyle choices.

I think those are contributory factors. Also, Indians genetically are insulin resistant more than Caucasians. That leads to, you know, high predisposition for diabetes. And of course, resulting impact on other, other organs as well. So that I think something we really have to watch out for.

Ryan:So Dr. Manish, what I'm hearing and what all our fans are listening in is that, okay, at 25 percent I can blame my family genes.

I still want to blame my family. Maybe for my diabetes, hypertension, cataract, all of those things. Right. As a young adult, should I screen? When should I screen and what should I screen for for this blaming my family part? Let's call it genetics

Sathya:So because I

Ryan:think if I know that I'm gonna have something that has a risk factor, right?

I'm hoping we are smart enough to say that I inherited it, but I won't activate it So what could we be doing as tests?

Sathya:So Ryan, I'm gonna share a personal anecdote here I actually did my own genetic sequencing And some of the results that actually stood out for me and made me change my behaviors, right?

First I realized that I had a higher likelihood of developing hypertension, which is blood pressure. So that's something that I realized as part of my genetic profile. I therefore now regularly take my blood pressure. every week. Now it also helps that I'm in a hypertensive household and everyone goes around, passes the BP meter and we now make it a ritual.

I knock on wood, don't have it yet, but because that genetic sequencing result told me that I'm at a higher risk than the average Indian, I now do this regularly. I'm hoping that I can catch any rising trend. So not at any given one point, but a rising trend that then allows me to. Address it well before it becomes a problem.

Ryan:So you did the testing, know that you have a hypertensive kind of gene and you're now screening with a BP monitor, so you're, you're doing it proactively. Are you changing anything in your life?

Sathya:Yes. So let me give you an example of another gene that was identified where apparently I have a tendency to add more weight.

with high fat foods. The minute I saw that I had a red or higher than the average Indian, it's automatically made it somewhat tangible for my brain to process this as something that's not good for me. And since then, I have been watchful.

Ryan:So when Dr. Satya sees a samosa on a plate, she's like, you're not worthy to enter my body right now.

Sathya:I actually asked. Am I allowed to enjoy that this week?

Ryan:So, let me rewind slightly with you because I want our listeners to understand that you're a CEO of Apollo Preventive Healthcare and you're making changes because you've understood the crystal ball gazing into your future. Which is, if you were younger, did you eat a samosa with abandon?

And now with this knowledge, is it making you realize that your body is the most expensive real estate? It's not changeable. And therefore, you have to make some changes. Is, is there a difference between the younger version of you and now the more wiser, older version of you? Absolutely.

Sathya:I actually develop kidney stones.

Very young and that was a wake up call for a very, very good at some

Ryan:point in their life.

Sathya:And now in my 40s, the number of things I know, I really wish someone had slapped me awake in my 20s and told me the few things that I needed to change so that I could enjoy these unscrupulous behaviors every now and then.

Manish:And, you know, I think that brings us to the point that 20 years back, we didn't have the luxury of genetic testing today's 20 and 30 year olds have that luxury and they must use this because it's very important to get that tested in the early years. Once the disease onset happens, you know, then you can only reverse the disease.

But if you get the testing done in time, you can actually prevent the onset of diseases.

Ryan:You know, I so much agree with both of you. When we studied in our younger years, we didn't have the access to the internet. Today's generations have technology, right? Much smarter generation. Like, you know, if you have a laptop that's running only at 60%, you upgrade it to a new laptop that runs at 120%.

So I think this younger generation is quite smart. And once they begin to realize that I can have a crystal ball gazing into my ram processing speed or what back foot do I have in my body. So I also did my gene testing and I discovered that I'm gluten intolerant. I wrote a whole book about it called Wheatless.

Why? Because when I was a teenager, nobody told me that I should avoid milk and gluten. And so I got acne hammering me late into my thirties. And when I did a gene test, that too, which was sent to America, many, many years ago, the guy called up from there and was speaking Hindi and he said, Bhai, aap toh goan hai yaar, aap toh pav nahi ka sakta hai.

So you can't eat bread. Who's told you to eat bread? But who's going to tell me culturally that my dadima and my grandfather were at two wrong different locations. So, we're done blaming our genetics and our parents and our grandparents. But, If you look at statistics from the medical industry, and I'm sitting on this side of the lens, what are the lifestyle diseases statistically that as an Indian, I should be looking at for

Manish:so which is the top gunda, I would say pre COVID, the top gunda was, you know, the cardiovascular diseases, so cardiovascular for the layman, hypertension, coronary artery diseases, You know, blockages, artery blockages, basically everything to do with the heart and the pumping of the heart.

That was the most common post covid. We've seen a massive shift towards cancer, lung cancer, liver cancer stomach cancer among males and in females, breast cancer, cervical cancer, and then lung cancer in that order. So that's what we see most prevalence of, but also mental health. So what is the age

Ryan:group of people that come in for the preventive health checkups, like broad picture?

Manish:As young as what and as old as young as 25, as old as, I mean, there's no six, five, so if

Ryan:25-year-old is listening in, they can actually make the effort to come in and get screened and tested and

Manish:everything. Absolutely. I think as a habit, we have to incorporate that early on, and as you rightly said, you know, in the early part of the show, we shouldn't really wait for something to happen to us before we take that test.

I mean, just think about it, we get a car service twice a year, four times a year. But I know of many adults with strong family history, not getting themselves tested for, you know, years together, which is, I think, an extremely dangerous state to live in,

Ryan:you know, this is just popping up in my head, which is we get so many people saying that, right?

I do not want to know as a medical doctor. I mean, you guys will see the worst of the worst, right? And now you're sitting on the side of the fence where you're saying, if I throw a ball, I know where it's going to land. Yeah, at this person's age. I don't want to know where it's going to land. What, what do we say to such people who are sitting on the fence saying, I don't want to know.

I want to enjoy my life. But then they're hurting the whole family after that.

Manish:Exactly the same thing. I'm saying, just think about the impact and the consequences that procrastination is going to have on your family. To me, that was the biggest wake up call many, many years back when I started regularly doing these health checks.

Because you just have one life and nothing is going to substitute that. You can't be replaced, you know, for your family and all, there's no replacement. So just think about that, you know, think about your parents. I know so many young, young men and women who've lost their lives. And today I see their parents, really, I mean, not having that closure, not, you know, having nobody for support.

I think that's a very sad state to be in for the family. I

Sathya:think in addition to the loss of life, it's also the additional economic burden on the family. So when we diagnose something. There may still be treatments available and you and your family want to give everything a shot before saying this is it.

We've tried everything. And that costs a lot of money. What costs a lot of money? A lot of stress. So in addition to, you know, God forbid the loss of life, it's also this additional economic and stress burden that you're adding to the people around you.

Ryan:Is it true doctor? Because I was reading about these blue zones around the world where people live into the hundreds.

Yeah. And Japan is one of those areas. And apparently Japan started the system of screening early catching diseases early. So, you know, we, we pride ourself at Ayurveda and the ancient texts and all of that stuff, but we're living so modern today. What is it that we need to do? What does the population need to do in terms of lowering their medical cost?

What are the, some of the small things that they could start doing?

Sathya:I think What's in each of our hands is, I'm going to say first really evaluate your lifestyle habits and these are around what you consume, right? So that's the diet. Food water, how much alcohol, drugs, so everything you consume.

Second is how much you move. So it's not just about fitness, strength, that's important. It's also about how much you keep moving through the day. Climb the stairs. Versus taking the elevator. Walk to get your coffee versus expecting it to show up at your desk. Take a walking meeting with somebody or a standing meeting with a group of people rather than continuously sitting.

The third is sleep. Sleep enough but also watch the quality. of your sleep to make sure that it is restful for you. Because that's when your body actually rejuvenates. And your brain has enough time to process everything that it's collated through the day. The fourth is stress management. The problem with stress is that the levels of cortisol and adrenaline hormones that go up, it's actually a good thing when it is in very short bursts and helps us focus and be attentive and actually perform much better.

When it is sustained over a long period of time, that's called chronic stress. Then the body doesn't even have a chance to get it back to normal levels. And that triggers a whole bunch of downstream pathways in your body, causing everything from indigestion to diabetes, cardiovascular issues and so forth.

And the last piece is actually a community. People that you actually mindfully engage with in different parts of your life. So this, you know, balance. Across different aspect of your lifestyle is I think what we have in our own hands and can do in addition to this. I think there is screening,

Manish:right, Manish?

Absolutely. I think screening and screen time make screening an annual ritual for you for yourself and not just yourself, the whole family. I think because, you know, ill health affects the whole family. That's one. And, you know, screen time, you know, please cut down on that. And last but not least, and it's an important point.

What she alluded to is build meaningful relationships. Today, I feel that taking a backseat a lot of time,

Ryan:you know, the, the diet, the moving and the sleep. I think a lot of people are doing that even in today's generation, but this relationship with community, you sit on a bus, you sit on a train, you sit on a flight, everyone's in their phone.

Yeah, we're no longer fostering even unknown conversations. And when families go out to restaurants, everyone's in their phones. Yes. So I think. My takeaway point right now would be that, but Dr. Manish, to take further on your screening at Apollo Preventive Healthcare, I understand that you're using our AI to do a lot of the screening.

I like to send some of my celebrity clients there. I like to send the young clients over there because they will be able to get these services. So what is the gamut that somebody can expect and what are we screening and how? How early can we capture something like, if you can give me an example, like, Oh, I know my grandfather had diabetes.

So, or something even more life threatening, as you said, the incidences of cancer are going up. Oh, I have XYZ cancer. So, can this AI screening really give us more value for this real estate that I own?

Manish:So, you know, we recently launched our AI enabled precision oncology centers. And we launched them.

I mean, two of them in Bangalore and the biggest USP for those oncology centers is a enabled diagnosis. So one is a faster diagnosis and a more accurate diagnosis because of the huge repository of data that we've built. Apollo cancer centers have built over the last 40 odd years. It has given us the capacity to diagnose Even rare cancers faster and, you know, more accurately.

So that's one. Even in the realm of cardiovascular diseases, our AI enabled engine has the predictive you know, algorithm to diagnose cardiovascular diseases faster and better. So these are the two immediate examples that come to mind. I think, you know, coincidentally, cardiovascular disease and cancer are the two most prevalent entities in India.

And if a polo preventive healthcare program can do something, To mitigate that I think will be a great gift to the nation.

Sathya:Awesome. So, the cardiac risk score. Cardiac? The AI cardiovascular disease risk score that we've built. Actually has taken the longitudinal. journeys of people who've come to a polo over many years.

Can

Ryan:I say, can I say that is like my report card from first standard to 10 standard? That's right.

Sathya:That's

Ryan:right.

Sathya:Of all

Ryan:the, all of a

Sathya:large cohort of people, right? But why would you want to know everybody? Yeah. So a large cohort. But why? What is the purpose? So basically we then know If somebody came in with certain types of indicators early, what does that mean for that kind of person five years out, ten years out?

And we've taken about 21 different contributors to the heart attack and figured out through an AI algorithm, what is the combination that for this person, right? What is the paths that they're on? You said we throw the ball, we know where it will land. This is exactly what the cardiac risk score algorithm does today.

Based on your current state, which includes your family history, unmodifiable risk factor, and all your current lifestyle, as well as your current health state, we then are able to predict your chance of having a heart event within 10 years. Within 10 years. Within 10 years.

Ryan:And if a 25 year old walked in, you could still tell them that you probably are a candidate for a heart attack by 35?

Sathya:That's right. So let me tell you the scarier statistic. When we looked at 30 to 50 year olds who came in and then we applied the cardiac risk score on them after it was developed, one in two of them, right? So 50%, half of them have a moderate or high risk. of having a cardiac event within the next 10 years.

Ryan:So if I'm screening, one is you're putting the fear of God into me. In terms of, I'm one out of two that could have the heart attack. And so now you're telling me that information and then you're asking me to change my sleep, my diet, my lifestyle, and my community. Ryan,

Sathya:we need the wake up call, right? I think we have all realized that without that, we are going to coast in life.

Ryan:Anything. Anything. What do you mean by coast in life?

Sathya:Do the same things that we are used to. without necessarily changing the path.

Ryan:Yeah, preventive health care is saying, let me use the screening and figure out what's your pathway. And if there's a roadblock ahead, you could take a detour,

Sathya:detour, right? So that you're able to ensure that you're and good on a different path.

Manish:And I just like to add one point here. I think it's today the market is crowded with a lot of health check packages being offered by You know, everybody, there are so many, so many packages. So if I walk into

Ryan:a polo healthcare, what, what's, what am I looking for? What am I, what are the first things I need to do?

Manish:So one is of course, as I said, we've simplified earlier, you know, we used to have a plethora of health package. We've simplified. Now we have AIDS specific for men and women. That's it. So if you're a 30 year old male, you have a whole body test, which has already been customized for you. You don't need to kind of look through the whole maze of tests.

So we've kind of simplified it. And then with this AI enablement, you can be assured of a faster and more accurate diagnosis. Third, the point I was trying to make was that today, everybody in the market is offering multiple health packages. It's very important to discern and be very careful in which hospital we go to.

You know, I think it's important to trust a very credible institution because it's your life that you're screening. I mean, that you're entrusting them with. So rather than choosing the most economical. Or the most convenient health screening package, it's important to do that with the most credible health partner that, you know, so do some research, you know, you know, you have these X, Y, Z's selling packages at 1000 rupees and all, I think we are, we, we shouldn't take that very, very lightly, it's better to kind of pay a premium, but get yourself screened at the best center with some research,

Sathya:I think the additional way we've incorporated AI, into pro health, which is a polo's health check program is we are able to today personalize a package if you choose to, based on your risks.

So some people want a thali, right? And we've simplified the thali to be able to easily pick and select. Others say, no, no, I have gluten allergy, lactose intolerance. I actually want to Go a la carte. But how do I pick a la carte? I'm not an expert as a lay person. And what we've therefore done is sat with our doctors with years of their clinical expertise, put together an engine that can predict based on simply 10 questions that you answer what you are at risk for and therefore what you should be tested for.

Ryan:I'm already thinking how to how do I get to the nearest Apollo health checkup and get it done. Okay, so Let's get more people tested in this country, right? That's going to be our mission and vision. Get more people screened, get more people tested. We are a very large country, 1. 3 billion plus people. I'm sure there's a lot of statistical variation.

North India, South India, this is huge. Dietary difference height difference, pollution, body type difference, pollution difference. Are there any data coming up to you guys that says that People from South India should run faster for a testing. People from North India should run faster. Give us some insights.

Manish:So there was a recent report I read which was conducted across several states in India. You know, if I look at diabetes, for example, South and North are actually equally predisposed. Although Central and Northeastern parts of the country have less incidence of diabetes. It's also an urban phenomenon.

So, right, urban population has more diabetes incidence than rural population. But interestingly, pre diabetes is actually the, the number is much higher than the diabetic population, which is a very dangerous thing. Dr. Ford, the un initiated right there. Right.

Ryan:And everyone says diabetes, diabetes, diabetes.

Right. Can you, in a layman term, explain what is diabetes

Manish:and then what is pre diabetes? So diabetes is a condition where the body's ability to produce insulin is compromised. Insulin is produced from Pancreas and when there are cells in pancreas that become nonfunctional, the insulin quantity reduces and our body's ability to process glucose diminishes and hence you have high Blood sugar and when's that blood sugar touches a certain threshold or remains beyond a threshold consistently That's when we call, you know, it a diabetic condition.

So and then the pre diabetic Pre diabetes is a stage which is oh,

Ryan:I'm gonna get I'm gonna get diabetes. So the AI is saying you're gonna go down that path

Sathya:Right, we have a pre diabetes risk score because once you have diabetes, there's no point in any AI predicting anything in the future You have it you have it but the pre diabetes risk score Tells you based again on your family history, your predisposition as well as your lifestyle choices What is your risk of getting pre diabetes, which is your glycosylated hemoglobin or HbA1c between 5.

8 and 6. 4.

Ryan:So everyone if you're out here in South India, let's all get tested pre diabetic Because we're eating too much of carbohydrates or rice and our sugar levels have gone up. But what about North

Manish:India? I think South India overall has a slightly marginally higher risk for NCDs overall. But I think diabetes and hypertension are, I would say, uniformly equally distributed.

Only the central part of India and northeastern part of India had less incidence of these two conditions. Among genders, men have a higher predisposition for, you know, high cholesterol level than women. So that was the other finding. But in all of this, I would say the biggest Alarming finding has been the rising incidence of pre diabetes across urban and rural areas.

So that, you know, I think today, for example, we have 98 million diabetics in the country with a diabetic capital, which is 17 percent of all overall diabetics globally, and I think we love our food and we love our sweets. And also that the fact that we have this propensity.

Sathya:Exactly. Propensity as a population.

Ryan:You made something very keen because my father in law is an orthopedic surgeon. He's 78 years old and he loves, he's from Orissa and he loves his mishti doi and rasgullas and all and he eats more sugar than I do. Right. And he has an HbA1c score of 5. 2. So you mentioned something from that part of India.

People have a diabetic resistant gene or something. I mean, they have less propensity. Less propensity. For diabetes. I'm just

Sathya:thinking.

Ryan:I'm sure

Sathya:he's quite active, isn't he?

Ryan:Yeah, he's very active. I'm just thinking if we could just get that gene, you know, and like eat our Rasculas more often. But jokes apart.

Jokes apart. I think as a nutritionist. People are eating far more than their fathers and mothers and their grandfathers and grandmothers. We just did a food diary with a few of our clients. I had the privilege of working with a family of three generations. So I would ask the grandfather and grandmother how many times you ate out.

So they met out once a quarter at MTR and ate once a quarter because they didn't have that much of money. The father and mother met out once a month. They didn't have that much money. True. The children. are in MTR every third day. Right? So, so the incidence is of external exposure. And therefore, when you go out, no portion control, you eat how much you want.

And with the new thing, which I feel is that people are just eating more because they're stressed out. Like we work very hard. And that's what that grandfather said. We did a nine to five job. There was no SMS, WhatsApp or zoom call at seven o'clock in the evening, which your boss got to you. So you stopped your day, but your generations are working double hard, which means the brain is working so much.

So when you finish your day, Your license. I don't need a reward.

Sathya:Yeah.

Ryan:Yeah.

Sathya:Or you're not as conscious about it also. Because you're so distracted with so many things that are going on. I never

Ryan:thought about that.

Sathya:Right?

Ryan:Being distracted.

Sathya:Yeah, and therefore you end up just consuming whatever, how much ever, without really being mindful about what's going on.

And since a lot of your followers like nutrition, allow me to actually talk about my three rules around consumption. The first is reduce. Reduce. Right? Let's stop eating when we are 80 percent full. That's a nice thought. Yeah. And so reduce. The second is reorder. Proteins and vegetables and fruits first and then carbohydrates.

Oh, I thought you meant

Ryan:reorder as an A waiter. Get me another order please. I was like, this doctor is really cool. Okay, reorder means change the Order in which

Sathya:you are consuming. Yeah, that's right. So say

Ryan:that again, protein first and vegetables. Protein and

Sathya:fruits and vegetables. Vegetables first. First.

Then carbohydrates. So for example, in our home, the proteins come out to the table first, get served first salads, fruits and vegetables, even if in a cooked form, get served first. So while it's first on your table, even if you're mindless about it, that's what you're consuming first and you get a little bit full and then come the carbs onto your plate, right?

And so reorder. And the third is replace where you can eat. Find a way to replace the processed foods that we are used to these days with a little bit more traditional foods, like some of your millets or brown rice, brown sugar, jaggery and so forth in reduced quantities, right? So allows us to then replace some of the ingredients in what we cook for an overall balanced meal, but it's still the kind of food we eat every day at home without putting pressure on the kitchen.

Manish:So I just wanted to add, I mean, you know, and you would probably, I mean, you're the expert. There's that Dean Nash's diet. What have I got the name? Did I get the name right? Dean Ornish diet, right? That actually changing your dietary habits can reverse aging and reverse many of these conditions, isn't it?

Ryan:So as a

Manish:celebrity nutritionist, I make a lot of money doing that.

Ryan:Exactly.

mixed:I meant,

Manish:it's just not this. I mean, screening is big part of it. But I think diet and change and modification, right? I think going forward is going to play a big role. If doctor,

Ryan:I can speak very candidly from a nutritionist to a doctor.

This screening gives you the wake up call. to wake up and smell the roses that you have only one body. Absolutely. And this body cannot be replaced like your mobile phone, laptop, house and even spouse. In fact, one day I had an argument with my wife. I said, my body is my life partner. She says, what do you mean to say?

I'm your life partner now. I'm like, look, dude, I had to get out of bed to get married to you. The body vendor got married to

mixed:you.

Manish:Very true. Our body should be our first love.

Ryan:Yes. And so I told her this. My wife is not hearing this. Like me, like me, I slept in the next bedroom for the next one week. You sleep with your life part.

But at the end of the day you know, when we do these screenings, I have seen an instant disciplinary modification by my client. The reason being is, I'll give you an example. Oh, Dean Ornish told me to eat this diet plan. Ryan Fernando told me to eat this diet plan. But if you're AI heart screening says you are predisposition to diabetes or heart attack in so many days.

Then the person sitting down in the counseling room and saying, what do I need to change? It's the trigger for change, behavioral modification for change.

Manish:And I think over a period of time, if genetic screening were to become cheaper and mandatory in some form or shape, that would actually lead to a revolution, so to speak.

Ryan:And also these exercise variables that we are using gives another data set point. And I think people are shying away from the fact that they can take control of their life. Yeah. But speaking of control we all work, right? And we all work and we have this 9 to 5, we have to report in. You're here today on my podcast.

Sathya:Only 9 to 5, Ryan? What kind of job do you do? Oh, I have a 9 to 5 job.

Ryan:I'm doing my, I'm doing my diet, my sleep and my work class correctly. But The fact of the matter is, here's this, okay? I believe corporates can do a lot more for their employees. How do you think a polo preventive healthcare can be embedded, and do you feel, doctor, that has a productivity impact on an employee?

Sathya:So, let me start with first Apollo's

Ryan:own

Sathya:example, right? What do you mean by Apollo's own example? So, our chairman Pratap Reddy is exceptionally passionate about preventive health. He in fact started the Master Health Screening in 1974 in India. I was not even born then.

Ryan:Wow,

Manish:that, that early on. He's the pioneer of preventive health in the country.

Sathya:And he's constantly pushing us to evolve. About five, six years ago, He said, listen, as corporates, we actually, our biggest asset are our employees and we Apollo are in the healthcare sector. We need to lead the way for all corporates. So all of the employees at Apollo will get their pro health done. At the expense of the company, one year goes by, two year goes by a few people here and there who have triggers in their personal life, went and did it.

But not everybody. Well, many, many people. Avoided it like the general public today. And then one year he said, we will not be doing performance appraisals if you do not complete your health check by March 31.

Manish:And that applied to doc doctors, well, doctors. Doctors as well. You're

Ryan:kidding

Manish:me. Doctors, were not doing the preventive health screen.

Not all of them. And he made it them as well.

Sathya:Yeah. And the park though, that that year was madness. Right. I know, I understand

Ryan:a madness because sometimes you need a parent to take care of you.

Sathya:Yes. But here's the beauty of it. After that, that year, you don't have to repeat that statement ever again. It became a habit every year.

Now we just get people coming because we then give a reminder and then they say, ah. And then the, I guess the trauma of that, you know, they come and they do it. I think more and more and more corporates. need to take this on, right, and do this for their employees. But now that we have, at a large cohort level, multiple years of having done this, right, what we're seeing in terms of the reduction in the unmanaged diabetes, unmanaged cholesterol levels, and most important, the decline in obesity, right?

It's, it's staggering. So we now have the data. to be able to see at an aggregate level of a cause hypertension also part of this because I'm assuming there's a lot of and it's also coming down as a lot of stress. That's also coming down because see, once you're diagnosed with it, you manage it. But if you know you have a propensity and you learn to manage it, and ultimately it comes down to what you consume, how much you move, how you sleep and how you manage your stress, right?

And so we'll talk a little bit about pro health and how we are incorporating some of the follow ups and not just to be able to do that.

Ryan:But staying with your your founder, Dr Ready, And doing this in 1974, I get called in to do a lot of events and speak about it when the leader leads the organization from the value of the employee and the value is not only from a perspective of productivity, but the essence of a person and healthcare becomes crucially and truly important.

Where am I going with the statement? I had a billionaire client who instructed his HR to set up healthcare preventive. In the organization, but many times, and this goes out to the rest of India, many times HR is truly focused on the bottom line, truly focused on only holidays and truly only focused on attendance marking and how we can get more out of people.

And if Apollo as an organization in itself, led by a doctor who's a leader. Insists that everyone gets their health checkup done and puts a diktat to it. And I think the word over there is diktat because I remember once sitting as a nutritionist, I asked myself when I run my own organization today as this, as the head of my organization, as a founder, do I invade my employees privacy or am I actually being the crystal ball astrologer?

And saying, I want to take care of you. So I send a message back to your founder, kudos to what he's done for all the people at Polo. And I think every organization out there needs to have a leader that puts a boot silently up everyone saying that you need to get your health care checkup done. So speaking of offices, can we do these pro health checkups in offices?

Sathya:Absolutely. I think in, in our conversations with corporates and companies, what we realize is even if they have a set of offerings, right, and pro health checks for their employees, very few actually take it up. Anywhere from 10 to 30 percent of employees actually go to a center. And avail a pro health and therefore we realized we had to rethink the model because employees don't want to do this at a, at a, take the time to, to go out.

It's actually quite inconvenient, especially in cities where some of the centers are very far away from their homes. So we've actually innovated on a couple of different models. One is we have what is called an Apollo health check on wheels. This is a mobile bus that is fitted with equipment. such as a digital x ray or a mammogram and has additional equipment that can be wheeled off.

So a cardiac stress bike to make sure that we can test your heart under some endurance eye screening, audiometry, and so forth, along with, of course, your routine blood tests. But we wanted to make sure that what we offer to employees is actually quite comprehensive and not just simply blood tests.

And so we have the fitted AHC on wheels or Apollo health checks on wheels that can then go park itself in an office complex and then be able to conduct the screenings at the convenience of the employees over a period of a few days. Another innovation that we've actually worked out operationally is your health check can be broken up into a couple of different parts.

The first part is we draw your blood. Let's say a phlebotomist or a nurse can come out to the office at your desk or in a common room. You come in and they draw your blood, label your samples, and ship it off to the lab. They are then able to process the reports and keep it ready. You then can book an appointment for the imaging component.

Your ultrasound, your mammogram, your x ray ECG, echo, and so forth, to make sure it's comprehensive. health check in the hospital or the clinic at a time that's convenient to you. And because the blood is already drawn, the reports are ready, the doctor review can happen right away. And this can also be done at any time of the day.

It could be during your lunch break, it could be in the evening, it could be on a Sunday. And you also spend less time because you're not waiting for the lab reports to get, to come in. So this is another way that we've actually innovated to be able to make this more, convenient for employees

Manish:and, you know, in the last year or so, we probably have screened about 8 to 9000 corporate health corporate employees in their campuses through this.

And we besides this, we also give them corporate health report cards. I think that's

Ryan:important. When I get a report card, then I know that I have to do some steps. It's not like washed under the rug that I just got a blood test done. So

Sathya:there's a report card at the individual level that tells you what's going on, what needs immediate attention, and then what are some of the next steps for you to actually do, and then there is a company report card as well.

Right? Because if you think about the company as a community and productivity and the health of the employees is an important asset for you, then at an aggregate level, how are you doing? Right? If your employees have much higher numbers have hypertension than the average in the in the population, then there's something for you to actually think about.

Yeah,

Ryan:it's very interesting because there's a joke over here when we were sitting at one of the fortune 500 companies as a nutrition clinic. So we did a small survey and we asked the employees to tick mark. And one of the questions was about constipation. So about 100 employees went through the survey and about 67 of them or 68 of them ticked mark constipation.

And so when the head HR saw that, she went, no wonder everyone walks through the front door with a, with a grumpy face early morning.

Sathya:That's exactly right.

Ryan:So what you're saying to me is the health of an organization is truly reflected in the health of its people. And that's when I realized this. So getting a report card, not only for the individual.

But the organization. Yes. I think every CFO should be listening and carefully about this

Sathya:and then the head of HR who saw this can then choose to do something more meaningful around constipation related activities, right? Whether it's changing what they serve in the kitchen to have more fiber or talking much more about different aspects of fiber, changing the snacks in the kitchen for more fiber and allows them to focus some of the well being programs around things that actually matter.

rather than there's the generic well being program.

Ryan:So we talked about the adults and the office space, and I'm sure there are a lot of mothers out there who are also working. And the first question that any mother asks is about her children. Yes. So are there any actionable sets of things that people can do.

What can a doctor give an advice for Children out there for this? I don't know if I can call it a pandemic of oncoming diabetes, hypertension and non communicable diseases. So what should parents do with the Children or what? What should we do?

Sathya:So at Apollo, what we found Ryan is that three out of five Children today, especially in urban and privileged schools, are obese.

Three out of five over weight or rupees. Wow. And that essentially is setting the stage for a very young adulthood that could have many of these NCDs much, much earlier. Much earlier.

Ryan:So we are going to be the youngest 1. 3 billion population, but also have the highest amount of lifestyle diseases unless we do something about it now and screening is one of them and changing the behavior of the younger kids.

I'm sorry. So what what is the next part of this three out of five? We

Sathya:actually did with pro health at Apollo is to actually think about from a pediatric perspective, right? What do you need to know about a child at five or six years old? When they're ready to go to school, is their eyesight okay? Do they have any sort of attention related conditions, right, that you need to be watching out for?

Adolescence, hormones kick in, very different kinds of behaviors. What are we doing to actually make sure we're screening for some of those issues? Right. Girl hits puberty. Do we have enough iron in the diet? Right. What are some of the hormones doing to their body? What are some of the high risk behaviors that teenagers are getting into?

So we've actually thought about different stages of childhood, if you will. And then said, what should we be screening for? Based on what the pediatrician is picking up. So the first thing is make sure you do go see the pediatrician. Early ages will be all about vaccinations, but then around five, six, then let's add a little bit around what they need to be ready for school.

Subsequent years after five till 10, you actually lose touch with the pediatrician. True. Yeah. And then you come back for a couple of vaccinations and you're on the cusp of puberty. So the pediatrician has another opportunity. And then what after that. Tell me when you go to a doctor next, only when you have a symptom or you're sick, right?

But I think having some touch and engagement with your pediatrician, at least until you're 16, allows them a window into figuring out if there's anything going on. And it could be something as simple as when suddenly boys grow taller. at a particular age, their body's physiology, right, is not keeping up yet with the shooting up in the height.

And therefore they may have some dizziness. And so it's little things like that, that parents don't have to stress about, but if they know in advance, and the best person to get some of that advice from is actually an expert doctor, a pediatrician in this case. So as parents, if you can't get through to your children directly, find a way to engage with through your pediatrician on a regular basis.

Manish:And you know, to just drive home that point, we have a whole vertical dedicated for kids called Apollo Children's. I mean, it's a whole vertical and not just looking after acute care or chronic care, but also wellness as part of this vertical, just to kind of focus more on this, this age group which needs attention in multiple forms.

Ryan:I think most of us as parents, we kind of like. Here are hospitals name and think Oh, if I take my kid over there, the kid is sick, it's a place of pain, but actually we need to rethink preventive health care, even for our children, because I am at the nutrition clinic doing a lot of sports kits and in these sports kits, we Ask for a blood test because I am going to give them a protein powder, a sports drink, a multivitamin.

And I'm like, look, I don't want to give you a product. I know you're playing four hours of tennis a day, six hours of tennis a day, or six hours of golf a day. But I know that I can't give you this stuff unless I know there is a nutritional deficit. Let's do a blood test. And lo and behold, when we do a blood test, on a nine, 10, 16 year old.

We have high cholesterol. We have uric acid. Right. And

Manish:that's scary. Yeah. I think some somewhere parents also have to share some part of that blame because you made that point early on. Also, we are consuming more than we need. And that's true for kids. I mean, obesity is on the rise and I'm not surprised with these cholesterol levels and sugar levels on the rise as well.

You know, screen time, look at screen at the kind of processed food they're consuming. I think it's. Extremely unusual, and I'll not be surprised, and that kind of ties into a point about pre diabetics on the rise. So it's all a chain, and somewhere I think parents also have to share that responsibility and be strict with their kids.

Sathya:See, right in the modern day conveniences liberalization of the country brought is huge, right? I mean, we are all living it and enjoying it, but along with that came the bane of some of these Lifestyle diseases we have the advantage of seeing what it's done to the West Let's learn from it and not make the same mistakes and wait as long

Ryan:Those are wise words.

You know, we touched about children in the office space and somewhere in our conversation, Dr. Manish, you said that one of the biggest post pandemic targets on people's back was cancer, the big C. Right. Now, are there any specific types of cancer that you are seeing at Apollo Healthcare on the rise? And what age group are you seeing it?

And somebody watching in. If they are in that age profile, what are you telling a person in their thirties to forties, forties to fifties, fifties to sixties, sixties to seventies, are they watching out for anything from a cancer screening point of view? So cancer screening, I think as the incidence has picked up, so has screening.

So for the layman and me also, what do you mean by cancer screening? I'm going to go in and you're going to stick a needle in me or what are the basic things that you do when you do cancer screening? So,

Manish:you know, for females, for example. Get a breast screening done, whether it's an ultrasound or a mammogram, and there are guidelines for it, you know, and then get a pap smear done, you know, annually, and then a colonoscopy every 10 years, say after 50

Ryan:years.

Yes. Yes. Yes.

Manish:Because

Ryan:I thought only men get colon cancer

Manish:and the incidence is higher, but you know, colon cancer is on the rise in the country across genders. So these are, and for men, of course, oral examination, prostate. And colonoscopy, as I said because among men, lung cancer, prostate cancer, cancer of the stomach, oesophagus, head and neck cancers are on the rise highest incidence and in females cervical breast and lung cancers in that order.

And

Ryan:these cancer screenings that you're doing, you're also having the genetic screening done because I'm asking this question from a perspective. Can I blame my grandfather and grandparents? Or is this environment that is causing my cancer now?

Sathya:So, Ryan, there's an expiry date. for blaming your parents.

Right? There's an expiry date for blaming your parents.

Ryan:I'm assuming, I'm assuming the day you say bye bye mama or papa and you leave the

Sathya:house. I think it's somewhere in your early 20s. Where you start to truly take charge. And own your life. I think the challenge I have is that blood tests almost never Catch the cancers until much, much, much too late.

In some cases, not at all, unless it is blood cancer. Imaging, radiology scans, chest x ray, load OCT, whole body MRIs mammograms, ultrasounds, colonoscopies. This is what catches the cancers early and therefore making sure that based on your age, you And family history, that is anyone close to you who you may know has had a cancer, please then regularly screen yourselves and regularly means at least once a year, once a year.

Yes, for some, right? Like he said, colonoscopy, you need once in 10 years, 10 years, perhaps me or you need once in three years, as long as you're clear. So there are guidelines. And this is what also feeds into our personalization engine as well. So if I have a family history of breast cancer on the maternal side, My chance of breast cancer is very high and therefore I better start scanning at 35 Every year, but if I don't have that I still am a woman greater than 40 have a chance of getting breast cancer Please screen at least every other year for sure after 40 in our data at Apollo We found that 25 percent of women who were diagnosed with breast cancer were less than 40

Ryan:Wow.

That's a, that's a heartbreaking statistic. Yes. Why? So the, so it's all the more reason if you're younger than 40 as a female to get tested. Yes. Just to rule out that you're not one of those 25%. And early detection I think is one of the best things a person can do in cancer, right? Yeah.

Manish:And you know, that's one.

And I'll tell you the reason also, because it's been found you know, a study was done in UK. By National Cancer Registration and Analysis Service that the more severe form of cancer you know, it, it is, the less that presentation, the typical symptoms are lesser and difficult to diagnose. For example, you know, brain tumor, for example, will present with head, head, headache and nausea and all, which we can mistake for any other, you know, minor ailment indigestion can, can be a symptom of stomach cancer, but we don't take it seriously.

Pancreatic cancer, the symptoms are very. atypical, nontypical and perhaps can be ignored. But that's the warning sign. Unless you get yourself screened every year, there's no way of knowing. And by the time they present in far more severe form, it's already too late.

Ryan:Wow. Speaking of too late, moving from the big C to yes, we're screening people.

People are getting more healthier. There's the other end of spectrum where people are getting too healthy. The gym goers, the gym buffs, body transformation, six packs, I can run 32 kilometers after starting yesterday morning, right? So we have a lot of these flag bearers because in school they played for the Ranji team or they were on the volleyball team or they were on the swim team and like, yeah, I'm so fit.

And I've watched all these podcasts and Fit India programs and all of these influencers and all. And then suddenly you see a lot of people dropping dead. from heart attacks in gyms, you know, in marathon runners. So are we confusing ourselves with fit body and healthy body? Doctor, what's your take on this?

Because when you're doing screening, you're like the referee over there, you're referring and you can see everyone on the playing field and you see this fit buff person who hasn't done screening. And then you see this average Charlie who's done the screening. So fit body. Healthy body. What's your take on this?

Yeah,

Sathya:so especially gym goers, marathon runners, the organ for us to focus on here is the heart. Yeah. And the most common condition of the heart that we've all heard about is the heart attack that is caused by a clock. And that is a result of many years of plaque deposit inside our arteries that hardens breaks off and a clot will go and block.

A blood vessel and then that area will not be able to get oxygen from the blood and hence it ends up being a problem when that blood vessel is actually in the heart, right? It causes a heart attack. That's the most common thing that we've all heard of and that comes from years of unfit lifestyle and diet and lack of activity and so forth.

However, the heart is actually a amazing organ. It requires electrical impulses. at a regular frequency for it to beat. It also requires muscles to be able to pump the blood enough so that it reaches the tippy toe and the corner of your brain. When you put the heart under stress, while your arteries may be clean because you're eating very well and you're extremely active, it may actually come in the way of the electrical activity and the pumping activity.

And that's what sudden cardiac death, or people suddenly dropping dead, actually comes from.

Ryan:So, doctor, I'm just thinking about everybody who watches my podcast. At some point, they want to work out. Oh, you're talking about head screening. Oh, you're talking about exercise. Oh, you're talking about diet. I'm going to start exercising.

And everyone goes into fourth gear suddenly.

Is there any test that they can do at Apollo health care, preventive health care that will give them some sort of indication by go slow or go all out? Is there anything that we can discover?

Manish:There is Apollo pro health heart screening package. If you ask me for somebody who is interested in doing this, that's actually a sure shot test to know whether you are fit enough to do it.

take take up these vigorous physical exercise. You will get patients that you will have to tell them go easy, glossy. Absolutely. Absolutely. Yeah. I mean, they look young. Oh yeah. Many of them. I mean, we've had patients in the early 20s coming in with, with an ischemia, with, you know, with a, with a heart attack.

Arrhythmia means what? Irregular heartbeat.

Ryan:Is this inherited or this is a lifestyle? Because I'm asking this question. If I, if I had arrhythmia. Oh, where did I get it? Do I look at my parents

Manish:or do I look at my diet? I think it could be both. Arrhythmia could be a result of a lesion that you have in your heart because of a previous heart attack.

So it could be linked to your history or your lifestyle. And these

Ryan:conditions are maintainable, reversible? Or every condition?

Manish:Manageable, I would say.

Ryan:Manageable is the word.

Sathya:I think reversible is used too loosely today. Yeah, everyone wants Damage is done. It depends on how much damage, no?

mixed:Yes,

Sathya:right. So, if if a home is damaged, slight damage, we can fix and correct and it will look as good as new and even feel and maybe it's or if you

Ryan:maintain your house very very well, then it goes doesn't get damaged that often.

Sathya:But if the foundation is off, and the damage has been there for 20 years, and you didn't even know because you didn't get screened. And it showed up as a symptom, then I don't think a reversible is possible. What you can do is manage,

Manish:manage. And I also want to come in that point of marathoners, you know, having these sudden cardiac arrests and all.

I think it's important to get the underlying heart condition checked, which has been aggravated by, you know, a symptom called a syndrome called long COVID. The long term effects of COVID, which we are seeing across genders across age groups and all. So I think the propensity of people to have these issues post Covid has increased.

High cholesterol level, diabetes incidence, hypertension, and so on and so forth. So we have to be very, very mindful. Coupled with the fact that many of these you know, victims have had vigorous physical exercise and an undetected underlying condition. That's led to these incidents that we have seen in the past.

Sathya:And I think the other realization is also that our body is very interconnected. It's not like one organ is individual and another, right? And so when when you have such vigorous activity, the lung and the heart have to be in such sync with one another. So a VO2 max test along with a treadmill allows us to see under the conditions of such endurance and stress, how does your heart and lung perform together?

And therefore, are you ready? Otherwise, an ECG echo and TMT treadmill test, this combination can actually tell you what your current heart condition is. An ECG will detect the heartbeat and the electrical activity. The echo is about the pumping and the treadmill test is about placing the heart under a little bit of stress increasingly and seeing how you respond and how the ECG, the pumping as well as the electrical activity response in that context.

Manish:So let's not mistake a fit body for a healthy body. That's the mistake people are making very commonly these days.

Ryan:Yeah. And I think because of lack of time, everyone's trying to get this instant body, instant result, instant health. And so even when they're doing their fitness, they're doing this instant fitness and that instant fitness is actually a very high level of expert fitness.

Yeah. And I think also we have to caution the workout industry, right? Yeah, absolutely. The trainer is given a certain pressure to deliver a certain result very quickly. And I think the, the sports trainer, the athletic trainers, the physio trainers have to work with the industry and their client and say, like, slow and steady wins the race, you know, and do you do anything like a body fat percentage test?

Sathya:Yes. So we actually do the body fat composition analyzer. Right, which actually gives you a sense for not just BMI, right? That's okay, an easy metric that many people know, the body mass index. But I think how much visceral fat do you have? And that means how much of your fat around the abdominal organs, right?

Around your organs do you have? That's actually far worse than what I'm going to call The total fat or in your periphery, right? So it's okay to carry a little bit of fat in your thighs and your hips and your buttocks, right? But not so much in your abdominal region. It also gives you a sense for your basal metabolic rate, which means when you're at a resting state, typically sleeping, what is the metabolic rate of your body at that time?

The challenge with sitting without moving for 30 to 45 minutes. is that our body thinks we are in a little bit of a resting state and the basal metabolic rate drops to as if you were sleeping. That means when you reach out and have that sugar cookie and drink that chai with Oh, it's

Ryan:going to the liver.

Sathya:It's going to the liver. Exactly. And it's not metabolizing it even. As well as it should. And so the body composition analyzer allows us much more insight into what to do next.

Ryan:You know why I asked this question? Because everyone joins the gym or goes marathon running to lose the fat that they gained over 20 years from college.

into their first job, second job, shadi, having two kids, and then they need to lose it fast, but they don't know that to burn one kg of fat requires slow walking of two hours every day for one month.

Sathya:Because you have to be in that fat burn zone, right? Not running, that puts you in a cardiac zone, which is great for your cardio.

But not doesn't burn your fat as easily

Ryan:you've heard it there first from the doctor Fat burning and I have been always been saying this I told even Amir Khan in his dungal movie role He has to walk 38, 000 steps to lose fat. You have to walk to lose fat You don't need a fit body running like Hussain Bolt or Kenneth Bednarek.

You need to walk and have patience to get to that goal and always do a health screening when you're speaking of screening, we've got the fit body. 80 percent of gymming audience in India is male. What about the female? I know we talked a little bit about breast cancer screening and all, but quickly, what are the bang, bang, bang, bang scans that a woman has to do?

Because most women I meet, they're always in a hurry managing the home, managing the family, managing everything, right? So they're like, they don't have time to do lots of stuff. So quickly, What should a woman do for all her screenings?

Sathya:Definitely a DEXA scan. DEXA scan, what's that? Bone density as well as muscle.

Bone density and muscle? Heart after menopause. Heart after menopause? Because your hormones actually protect you, estrogen and so forth, before menopause. The mammograms we talked about, pap smears, cervical cancer. As early as possible. And if you're really young, then please get the vaccination HPV vaccine far more protective and my generation didn't have it.

I think the only other one I will actually highlight here. is cognitive screening.

Ryan:Cognitive screening.

Sathya:And that means figuring out your brain function. And the reason I say this is we're seeing also that, perhaps because of the many, many priorities we juggle and hold on to the stress. There is a slowdown of the brain function.

much later in life, manifesting as memory losses, dementias and so forth. And so please find a way to do some cognitive screening.

Ryan:Husbands, if you heard this in, this is what you need to do. Don't get angry at your wife. Take her to Apollo Healthcare and get her screening done because Dr. Satya said so, not you.

So, there's one part that I want to ask because I get a lot of young athletes and I don't know if this is relevant to preventive healthcare screening. All the female athletes I work with from the age of 12, their first menstruation cycle till maybe even their marriage, they have never met a gynecologist.

Doctor, how important is it for a young female girl, a young lady to go and meet a gynecologist, even if nothing is wrong?

Sathya:So it's a great question, Ryan. I think firstly, definitely meet the pediatrician. Pediatrician. Yes, because the pediatrician is trained up around multiple facets, including the puberty, right, and sort of what I'm going to call early fertility period.

Ryan:So that means when the girl first gets her menstruation cycle, the pediatrician is a great person to have a touch base with.

Sathya:Absolutely. Because it, the pediatrician all then can decide if there is anything that we should be watching for allows the pediatrician to educate the parent and the girl child to be aware.

Ryan:We have a lot of teenage weight gain nowadays in the female athlete. Yes. So is that towards the PCOD condition?

Sathya:So the polycystic ovary syndrome is actually on the rise and impacting fertility.

Ryan:Are we testing this in a preventive health care setup?

Sathya:So the way we would test for this is, Through hormones and the hormone panel and we absolutely do it thyroid typically comes up as the number one So we have thyroid stimulating hormone test included in our women panels We also make sure that if someone is overweight or obese then we throw in a hormonal panel And then there is questions around your menstrual cycle.

I think it's very important for women to find a way to make note and understand any patterns or trends that they're seeing. There are apps on the phone. We are married to our phones. And enough of this is available and if not go old fashioned calendar. In you know, either the digital format or noted down.

So

Ryan:if a woman's cycle is 28 to 30 days, she's good But if it's skipping or missing, yes, then maybe pick up the phone and talk to a guy and an in between

Sathya:spotting That's another one.

Ryan:Okay, so in between spotting ladies, please watch for that and we're talking about the youngsters Yes, many of them will go and meet a gynecologist after marriage for birth control or for fertility I am seeing girls in much younger ages not doing this.

So So you could get yourself screened with a good gynecologist. Now we move into the part where not only girls and boys, but everyone at all age has this stress problem. Now, I don't know whether preventive healthcare screening throws light on this, but obviously you have all of this data and screening all of these people.

We know we need to get screened. Yes. That's, that's a given right now. Some tips from Dr. Satya in terms of stress and sleep. How important are these two? Are they married to each other? And are there any insights you would like to share with our audience?

Sathya:So, stress and sleep are collaborate with one another and also then cause a number of physical changes that lead to the downstream non communicable diseases we've been talking about.

I am going to go straight to the hacks and the tips Ryan. I think when it comes to stress, I think it's a very, very important to find a way to declutter your brain every day. We get about 23 to 25 GB worth of information that our brain has to process, right? So think about your computers and when it crashes and the hardest essentially stress levels are related to how much processing you're doing and not allowing your brain to figure out what's important to keep What to discard and what to not worry about.

So decluttering is important and that comes in a number of different ways. It could be taking a very, very short mini break to a place that is away from a city so that you just have less visual stimulation. It could be locking yourself up and just reading a book with nobody around you because then you're focused only on one thing, the words on the page.

It could be doing yoga and staying through the shavasana. Because it's a really important part of decluttering your brain. And it could be ensuring that you actually get enough and good quality sleep. I think sleep, in at least our research findings for people who come to Apollo, we find is correlated with diabetes and hypertension.

And the risk of that goes up. So we've incorporated sleep screening and stress screening as part of ProHealth as well. And there are so many different ways. We all hear it from so many influencers. Don't look at the blue light. Turn off your TV one hour before sleeping. But guess what? That's also the time we want to binge watch.

And use our Netflix and Amazon Prime accounts, right? So we may need to figure out, okay, after that binge watching, can I do a 15 minute meditation app that allows me to go calm down and sleep? Is it a Epsom salt soak while I'm binge watching Netflix so that I'm able to actually sleep. I'm smiling

Ryan:because I do a lot of that Epsom salt soak and it really works magic.

It worked

Sathya:for me by the way. It worked for me. I had such a big sleep problem because of all the stress and I had to figure out solutions that would work for me. Only then can I share it with other people and Epsom salt soak was one of those. And so these are the quick hacks and tips that I would share with people to please proactively manage.

sleep and stress. It has crept into our lives. And it's less talked about than diet and life and physical activity. So please be mindful of it and see how we can actually proactively manage it.

Manish:And lack of good sleep has been found to be a big contributing factor to these sudden cardiac deaths that we just spoke about.

Yeah,

Ryan:you know, Dr Manish, I remember reading this line from the Netflix CEO. He said, We are on a war with sleep. So if you think about it, you can binge watch into your Saturday night and Sunday night and run up like a zombie at work and then have to download that 25 GB and work for the next five days.

That brain processor is overheating and that's

Manish:your stress at the

Ryan:end

Manish:of the day. It's not changing anytime soon. Our lifestyle is not going to change anytime soon. I think the wisdom has to

Ryan:come from the ancient behaviors that we had or the texts that we had. But the modern day screening that kind of gives you a little bit of cold water thrown on your face saying, wake up, buddy.

Yes, you know, you have these issues. The speaking of cold water being thrown on all of our face as a sports nutritionist, I constantly have to motivate my athletes. And I've been practicing for two decades now. And I'm noticing a lot more of the younger generation, maybe in the last 10 years, I don't know whether it's the environment, the food or the pressure of the fast pace of life.

But. Mental health problems have cropped up. How do we first find that I have a mental problem? How do I know? Is there any secret out there that says, Oh, I'm facing this and I'm beginning to break down because I think a lot of my athletes are waiting too late before they come in. So from a health care perspective, how can we manage it?

Or how can, I think before we manage it, one is to detect it and then is to manage it. So any words of wisdom or insights that you guys have?

Manish:In our hospital experience we've seen that the stigma that used to be associated with mental health issues has come down significantly after COVID. COVID actually was the inflection point where people started talking about it a lot.

So in fact you know, pretty consults for psychologists and psychiatrists have almost, you know, multiplied three, three times since COVID. So that's the kind of influx we are seeing because people are accepting mental health issues as so there's a normalization of mental health issues. So I think they were also always there.

I mean, these issues where I think people are recognizing them early on and we're talking about asking for help. So I think the first step is to recognize and seek help, which I think is. You know, it changed a lot in the last three years. So that's, I think, one step. And then, of course, there are several therapies available now.

You know, psychotherapies, there are, there is medication management, which is available. So, and mental health from that standpoint is fairly controllable now. Many of these conditions, because I think there are a lot of You know, I've seen friends and family seek help and get treated, you know, very fast, which wasn't the case, perhaps 10 years, 10, 20 years back.

So I think that's a big advancement that has happened. So I guess seek early help. Facilities are available now called code has changed that and many drugs that are available today. I mean, not to speak of other therapies like yoga and meditation. But I think there's room for many such therapies out there in the market today.

Sathya:I think in addition the point we discussed earlier about a community around you. It may be hard for you to recognize it and come to terms with it, but if you have a community around you that you have been mindful with, then they will recognize it for you. And I think it therefore is every one of our responsibilities to watch for the people around us whether it is at work, whether it is on our social communities or in our families and to pick up these little signs.

It could be someone who is not paying attention the way they used to, someone who's very distracted, someone who slips away into social isolation, doesn't join a number of the activities that we do, and then be able to have a conversation or get somebody who is trained to have a conversation and help that individual recognize it.

We, I think, have heard that sitting is the new smoking. What we've realized in a post pandemic world is that loneliness and social isolation is the new sitting and the new smoking. I've heard that it's As bad as smoking 15 20 cigarettes a day in terms of the kind of damage that it does without you even realizing it.

Ryan:Wow, that's profound. Loneliness and? Social isolation. Social isolation. Yeah, and we come to think of it, you know, we're always in our phones and tend to find that as an easier companion than the community around us.

Manish:And, you know, what's more worrying is the impact mental health issues. are having on our kids today and adolescents.

That I think is a ticking time bomb because as adults, we still have some you know, agency to deal with these issues because of her experience. But kids have nowhere to go. Adolescents have nowhere to go. They take a long time figuring out what's wrong with them.

Ryan:So, taking time bomb, I mean, there's a lot that we have to do to help society at large.

Now, as a country, the whole country, there are a lot of these casualties happening from non communicable diseases. What can we do to reduce that?

Sathya:I think definitely screening. And we've designed ProHealth. To be able to take care of it at a personalized level and to be able to help you figure out what the next steps are once you've done that.

I also am going to appeal to companies and organizations that do and have the luxury of funding CSR. So our screenings need to go beyond those who can afford it. So one second,

Ryan:you mean to say if a company has more profit, they have to give that to a corporate social responsibility, they could actually take that money and test people and screen people?

Sathya:Yes, those who can't necessarily afford it, they could take care of the urban poor rural areas, semi urban areas. They could look at areas around their factories, around their ports and adopt those communities and screen them so that we're able to actually reach much, much more of India and ensure that you know, we have this silent epidemic that is going unnoticed under control in the country.

Ryan:Doctors, your vision and the mission that you're on at Apollo Preventive Health Care, if you had to sum it up and tell us. What is it that India needs from Apollo Preventive Healthcare?

Sathya:I think we need to be NCD free by 2040 as a country. That's a tough ask. And we've always risen to a challenge as a country.

And we have gotten independence for the country. And I think this is an alternate form of independence for ourselves, right? To ensure that we are living healthy for ourselves, our families, and for the country.

Ryan:Awesome. It's been a pleasure talking to both of you today. If there's one thing that you did for your own personal health as a secret, both of you, could you share that with our viewers?

Manish:I started you know, I had a 10, 000 step challenge, which I started four months back. You know, I, I mean, I used to play sports, but now I've, you know, like you said two hours every day for a month to lose one kg. I think I started on that drive four months back, and it's really helping me a lot. So 10, 000 steps is your secret, secret goal of, I need to do this.

Ryan:I mean, a lot of other things. Do you find it difficult to do that?

Manish:No, actually, it's very invigorating. And I mean, I actually thought that, you know, playing sports was the be all and end all, but I realized walking is a big contributor to good health and also changed dietary habits. Less of red meat, more of salads and all, which I thought I would never need.

But I think that's come as a wake up call some months back because of some tests I ran. And so it was the testings that were part of the trigger. Yes. Screening was part of the trigger and which, you know, kind of, you know, nudged me towards adopting these healthy lifestyle changes. Whatever to you, Dr.

Sathya:I shared so many podcasts. Let me share one more. I think sugar. Sugar in our diet as a family is something that we did. My children grew up with no sugar in their milk. No additives whatsoever. But we as adults were pampered and had a lot of sugar in our lives. And the reason I say we went and did this as a family is because it helps the kitchen when you do things together.

And it helps each other. Go through that withdrawal that I had when we stopped sugar. It took us about 10 to 14 days.

Ryan:Was that rebellion

Sathya:from your kids? No, the kids were okay because they never had sugar. I ensured they weren't

Manish:given a choice. They weren't given a choice.

Sathya:And so now they even you add too much sugar, they can't even handle it.

Right. But I think sugar in beverages, that alone, if you take care of, then I'm not saying we don't enjoy the occasional Mysore Pak. sugar, right? Or we should that's part of life. And that's part of actually having a good time. It doesn't

Ryan:become mainstay as a regular dosing.

Sathya:That's right. Because we as Indians actually are consuming on average five times more sugar than the WHO guidelines.

Ryan:Once again, we're consuming. So we're getting to become a developed nation. And in that trajectory, we're consuming five times more sugar. That's right.

Sathya:And the sugar comes in the form of, you know, in your beverages. Much, much more than you need. In biscuits and cookies that we snack on. Ketchup, bread. I mean, I could go

Ryan:on, right?

Yeah. So you're absolutely right. Because I remember creating a video on the National Survey of Consumption, talking about India in the 1990s and India now, and 2023, the recent consumption survey. And so 100 rupees spent earlier, it was 54 rupees towards food. Obviously, we didn't have much money. But now it's come down to 40 rupees.

But out of 40 rupees, 10 rupees 50 paisa towards processed foods and beverages and only 3 towards fruit and paisa towards vegetables. My goodness. Goodness.

Sathya:That tells you right there what we are doing to ourselves.

Ryan:So I think for everyone who is watching in. You are educated. You have the knowledge. You have the ability to choose what you put into your body.

You have the ability to purchase what you put into your body. You have the ability to purchase a screening program. You have the ability to understand the screening test. And finally, you have the ability to take the decision. Either to have Epsom salts in your bath. Or walk 10, 000 steps, or in my case, having too much of non veg where my uric acid went through the roof, and my, I was wondering why are my fingers hurting?

Let's go and get a screening done. There was a yogi guru who said this, no? I was going on a flight, and the airline baggage handler says, Sir, you are overweight. And he said, Who? Me or my bags? So I think everyone has to go in that direction, you know? Only your bags are overweight, but not yourself. Not yourself, absolutely.

Less is more. Less is more, absolutely. This has been a wonderful time with both you doctors. Thank you so much. I wish you all the success on your mission. I hope you change millions and millions of lives. And let's show India what is in store for a healthy nation. If you've liked this episode, then please gift me a like, a share, or a subscribe.

Or better still, if you comment, I'll come back to you. And don't forget, let's stay tuned for a new learning coming in. But till then, your body is the most expensive real estate. Take care of it.

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