- 57 minutes ago
At the Health Wealth conference following the release of his book '21 Days to Good Health', cardiovascular and thoracic surgeon Dr Shriram Nene addressed preventive healthcare, longevity, health span, and lifestyle habit formation. Dr Nene outlined five pillars of health: nutrition, movement, sleep, stress management, and community connection. The session examined the management of diabetes and heart disease through balanced traditional Indian diets, protein intake, complex carbohydrates, and the elimination of added sugar. Medical discussions evaluated fitness metrics, identifying muscle mass and waist-to-hip ratio as more reliable indicators than body mass index or weighing scales. The panel addressed the limitations of standard blood tests masking conditions like visceral fat, while positioning commercial wearables as supplementary dashboards rather than definitive diagnostic tools. Additionally, the dialogue explored the role of artificial intelligence in supporting clinical workflows, addressing rural healthcare delivery gaps, and managing health data systems without replacing medical practitioners, while advocating a transition from hospital interventions to early home prevention.
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00:00As we begin the next session with Dr. Shriram Nene, whose book has just been unveiled here.
00:08This is the book, 21 Days to Good Health.
00:11Of course, Dr. Nene, apart from his illustrious life as Madhuri Dixit's partner, has had a career in medicine.
00:22Dr. Nene is also an MD, cardiovascular and thoracic surgeon and founder of Pathfinder Health Sciences.
00:29Dr. Nene, I'm going to begin with the title of the book and ask the question which is on everyone's
00:35minds.
00:36Can 21 Days really change your health or is that a wellness myth?
00:42It's a great question and we almost poked fun at it to some degree because 21 Days was the classic
00:51habit formation arc
00:52which Maxwell Maltz observed in his patients when he operated on them in the 60s.
00:59with plastic surgery and what would happen is it would take 21 days for them to notice that their face
01:05had changed.
01:07But in truth, there was a very good study in 2024 which suggested it takes about 59 to 66 days.
01:14What you notice though is that every journey starts with one step.
01:1721 days is attainable. It's not a generation for anyone to start a journey.
01:24The second thing is that in 21 days you'll start to see changes as you make changes in your life.
01:29So what we did was put the book together in a fashion where you could actually use everything and digest
01:36it.
01:37Not written in a very high format medicalese document but rather in a way which would push simple things through
01:45five pillars over a 21-day period.
01:48And then beyond that, the rest of it, the experiment is your life and the idea was to embrace each
01:55other and to democratize health care and to improve how people perceive their health and to prioritize it.
02:03Since for all those who may not have the copy of this book, I'll just give you a brief idea.
02:10It also has 21 days of diet plan for vegetarians and non-vegetarians.
02:16So you get a clear idea of how 21 days of wellness actually works.
02:21I'm going to move ahead, Dr. Nene.
02:22You write in your book, forget living longer, what if you are simply living longer in poor health?
02:32Your book actually puts health span ahead of life span.
02:38When do we know that distinction?
02:41How difficult it is to find that distinction?
02:43So let's talk about that.
02:45Everyone's talking about living to 150 if you see the longevity scientists.
02:49And longevity is the hot button ticket globally with lotions and potions and miracle cures.
02:56My view of that is that if the last 20 years of your life in that 100 is bedridden with
03:03a diaper and a feeding tube, that's not life.
03:06Instead, what I adhere to is that health span, the number of years that you are healthy and can do
03:13everything for yourself and live well are what matter.
03:16And so in my idea, I want people to put more life in their years than years of life there.
03:25But I think the combination should be the same.
03:27So the idea is the notions which we put together will actually build a better life for you where you're
03:34on your own two feet, doing everything for yourself, very independent.
03:38And also mind, body and soul.
03:41So your brain works, your body works, and you're doing things with purpose.
03:45Is there a difference that if I say, because we have a very young audience here, Dr. Nene, so let
03:51me engage them in this conversation.
03:55For a 20-something, for him or her, what's life span and what is health span?
04:02So if you look at India, for instance, our life span actually went up to 71 years.
04:09We are almost forced to retire by 60, right?
04:13That's right.
04:14And the interesting part of that is now we're pushing the envelope.
04:18A lot of people work beyond that for various reasons, financial as well as otherwise, right?
04:23The idea is that through decades, if you invest in yourself, people talk about investing in stocks, this, that.
04:32The name of this conference is Health Wealth, and I'm proud of you guys for doing it because it's such
04:36an important thing.
04:37You can't have vixit Bharat without swast Bharat.
04:40And so the idea is the two have to be hand in hand.
04:43And the idea is that for a 20-year-old, the things which you do in your life will change
04:51everything later on, the investments you make.
04:54And this was the whole notion of the book, that I had operated on numerous patients over my career, and
05:0110,000 patients, 20 years of operating.
05:04But there were three commonalities.
05:07One is I could save lives with millimeters and milliseconds at the natural history of the disease's end.
05:15But what I was finding is I couldn't turn back the clock.
05:1820, 30, 40 years of bad living cannot be undone in a heartbeat.
05:23And the second part was that as a heart surgeon, it wasn't scalable.
05:28At most, I could do 500 open-heart cases in a year, another 2,000 consults.
05:32When I looked at the planet in 2011 when I moved back to India, I was seeing a planet with
05:397 billion people.
05:41And of that, 1.25 billion in India.
05:44That's grown since then.
05:45And there's a huge gap with lack of awareness, lack of access, lack of alignment, which needs to be addressed.
05:52So in writing this book, I poured in my heart and soul to see what I would have given my
05:58patients 40 years before
06:00to avoid them coming to the operating room altogether with moving the pendulum from acute care to prevention, early recognition,
06:09and early treatment.
06:10And when I dealt with my patients, I treated them like family.
06:13Everyone in this room is my family.
06:15Think of it that way.
06:16And when that happens, what are you going to do for each other?
06:19And what are you going to do to change the world we live in and the impact we create?
06:24When I bring you with me for 100 years and 100 good years, the things we can do together, the
06:29experiences, will be so different.
06:31And we'll change history from India, built in India for India, and then take it to the world.
06:37Dr. Denison, you speak about the family.
06:40So I'm going to ask you this very, very specific question.
06:42And what have you and Mrs. Madhuri Dixit, what are the changes that you both have brought in in your
06:51lives, Dr. Nene and Mrs. Madhuri Dixit Nene, personally, in these 21 days?
06:58What have you done to tell to the world?
07:01So there's a few things.
07:03First, it's the fifth pillar in our system.
07:06We've talked about some of them, and I'm sure you'll get to it, but nutrition is paramount, 70 to 80%.
07:12Second is movement, and that can be just simple walking after you eat, 15 minutes.
07:18Three times a day is 45 minutes.
07:20Plus, in addition, gym and strength training and this are critical.
07:23Third is sleep.
07:24Fourth is stress and mindset.
07:26And then we come to community and purpose.
07:29Your kids watch what you do and how you treat people and how you play things forward.
07:37Even in a small amount of time, if you unplug from your devices, it cuts down the stress and issues
07:46that you have.
07:47Some of the sort of hacks which we've developed are at the dinner table, creating a tray and just putting
07:54our phones away.
07:56Do you know that?
07:56We do.
07:57I see so many people going to restaurants as couples, as families, and everyone's on their phone.
08:03Even here in the auditorium, obviously, people are making reels or doing things.
08:06But the idea is if I can engage on you one-on-one, I didn't get the time to meet
08:10every one of you before, but I would love to do it after.
08:12But the idea is that we need to have conversations between humans, not just on a chatbot and not in
08:18the social dilemma context.
08:20The second thing is finding things which you have in common and playing to those strengths.
08:26We love animals.
08:27We love playing music together.
08:30We jam.
08:31We cook together.
08:32If you see on my YouTube channel, I do a lot of things with the boys.
08:36In addition to that, we race cars.
08:37We do things which are crazy cool, but at the same time are separate from our work lives and our
08:45study lives and our education lives.
08:47And what that community part does, and this is one of the most important parts, that loneliness is a disease.
08:54We'll talk about it.
08:55I'm going to come to this.
08:55And I'll save it for later.
08:57But the point is when you have a family structure like this, it saves lives.
09:01And the fortunate part in the last generation was India had a very rich family structure.
09:07A very nuclear family.
09:09That's changing.
09:10People are working longer hours.
09:12They're in traffic longer.
09:13They're on their devices.
09:14They come home.
09:15They watch OTT.
09:16That is separating things.
09:18And that community structure is breaking up.
09:20And community, by the way, in the blue zones, which Dan Buettner talked about, was one of the pivotal things
09:26which was seen in people who lived over 100.
09:30But Dr. Neni, you spoke about, you know, workout and walking.
09:36Is that something that you do as a family as well?
09:39You bet.
09:40We love sports.
09:41And it's something we join on.
09:42And even simple things, just taking walks, you can, it's rigid habit formation at its core.
09:48But even if you put your shoes at the doorstep when you're at the dinner table and you see them,
09:55you know the next step is I'm going to go take a walk.
09:57And after a while, it becomes automatic.
09:59But more than that, we play tennis together.
10:02We do a lot of things together.
10:04But you don't need fancy things.
10:06You can go as a family and just take a walk.
10:08You can go and throw a ball around.
10:11You can play with things.
10:12We have dogs, and so we take them for walks.
10:15And so those things not only bring you together as a family, but they also give you exercise.
10:20And if it becomes a habit that you're doing automatically, the one thing I tell people is that find an
10:27activity which you love to do.
10:29And this is something I told people in practice.
10:32Do something for yourself before someone forces you to do it.
10:35If they have to put an incision on your chest, that's not the way to learn that you needed to
10:39eat better and exercise and do all that.
10:41Instead of that, find something you love to do.
10:43My wife loves to dance.
10:45I love to play tennis and run and do a lot of gym activities.
10:51Those are things I do naturally.
10:53But if you can do it socially, like my spin class has eight different people in it.
10:58They play loud Bollywood music, and we make fun of each other, and we have a lot of fun together.
11:03When you do that, there's a reason for you to go, not just because someone tells you you have to
11:07go to the gym.
11:08And so that changes everything with the kids and my wife and everyone else.
11:13Help us understand what is that U.S. is doing right and India is not.
11:18Because, you know, Indians tend to go viral when they speak about something which has been so intrinsic now.
11:27Moringa is discussed.
11:28India has been using it for years.
11:30Turmeric now is the big discovery which has happened.
11:32So what are the things that we can do better, and what are the things that we can learn from
11:38each other?
11:38So I would not say the U.S. is doing it better.
11:42They spend 18% of their GDP on health care.
11:45We spend 4%, and about two-thirds of that is private, right?
11:50In that, we're serving up to 1.4, 1.5 billion patients.
11:56It's not one India.
11:57It's 28 states, 8 union territories comprised of 30% metro, 70% rural, and there's only a million allopathic
12:04doctors.
12:05Yet, we still have the means to do things.
12:08The second thing is that we're a young country in an old culture, 4,000-year-old culture, but two
12:15-thirds of our people are below 35, and the median age is 28.
12:23J.P. Nadaji commented on the maternal-fetal successes, and that's pushed the life expectancy to 71, which is dramatic
12:31because we were down at 124 out of 128.
12:34We're way up now in the top quartile.
12:36And so I think that is something India should be applauded on.
12:40Let's turn the page.
12:41There's some things we've done for years which are only being discovered in the West, yoga, some of the other
12:49preparations and things like that.
12:51I think the one thing all of us are doing globally, which is a problem right now, is we're not
12:57focusing on ourselves.
12:58That's more true in women because they're often the caregivers, the mothers, the daughters, and the wives, and they put
13:07themselves last.
13:08I think as a country, we need to champion each other, and we need to prioritize health, and we need
13:15to build habits and move the hospital to the home.
13:18What I mean by that is we need to learn health early and often and move it back to prevention,
13:24early recognition, and early treatment.
13:26One of the pillars that you have spoken about in your book is nutrition.
13:30And in that context, you raise something which is so intrinsic to our lives, which is about eating rice, roti,
13:39and dal.
13:39You write, can Indians eat rice, roti, and dal and still beat the diabetes trap?
13:47Your book has approached nutrition through science rather than what many say, dietary ideology.
13:55What needs to change among the South Asians and Indians in particular?
13:59It's a great question.
14:01So first, let's put it in context.
14:03South Asians are at risk for some diseases like heart disease and diabetes.
14:09And I don't want to be a capital for that.
14:11We don't want to be number one in those two areas.
14:13Many other things we should strive to do.
14:15Part of that equation is because we went from an agrarian society where we were doing a lot of manual
14:20labor
14:20and we needed the carbohydrates to plant crops to till fields.
14:25Now we're in an industrial age, and more people are working in IT centers, BPOs, and other places where intellectual
14:33capital is more important.
14:34Add to that energy-dense food and the ability to order it very, very fast, it compounds the net effect.
14:42So the question is, really, how do you change how people live?
14:48And the answer is, all of the staples of well-cooked Indian food in the proper proportion and personalized to
14:57your own genetic code,
14:58your family history, your social history, your socioeconomic background, and then also what you're doing with it.
15:05If you're an athlete and you're working out continuously, you're going to need the carbs.
15:09You're also going to need the protein, though.
15:10And we talk about the plate motif in our book, where half the plate is fibrous vegetables and things like
15:18that,
15:18a quarter is protein, and a quarter is non-refined complex carbohydrates.
15:24What I mean by that is, and J.P. Nadaji talked about it, that sugar is now the enemy to
15:32some degree.
15:32It is the enemy?
15:33In the sense that regular sugar added to everything and not used can cause serious complications with heart disease, diabetes,
15:44all kinds of secondary effects.
15:46But the idea is that you can actually get away with no sugar and just no added sugar, right?
15:52No added sugar.
15:53Yes, and form habits where if you stop it and try this one on for size, don't add any sugar
15:59to your coffee or your tea for a week.
16:01Then push it out to 14 days.
16:03Then push it out to 21 days.
16:04What you'll find is that quote-unquote addiction goes away.
16:09The habit goes away.
16:10And there's science behind that.
16:12It stimulates the dopamine centers in your brain, and it makes you happy.
16:17When you eat something sugary, it's quick calories, quick sugar, glucose spike, insulin spike.
16:23But the interesting part is if you go away from that.
16:27What about sugar-free, Dr. Nene?
16:28So this is an interesting question.
16:30Is there something called sugar-free?
16:33So there's two points to that that you're going to make.
16:36The first is that naturally occurring sugars and fruit and things like that are fine.
16:42Going completely sugar-free and then eating a huge meal like they do in the West with the super-sized
16:48me McDonald's-style thing makes no sense to me whatsoever.
16:52And in that context, what difference does it make if you have that extra Coke with sugar versus a diet
16:58Coke, right?
16:59You have 2,000 calories or 1,000 calories coming from your meal.
17:02It doesn't make sense to me.
17:03There have even been studies for two things.
17:06One is that doing sugar-free can actually not be beneficial to you.
17:11And in some cases, depending on the type of sugar-free you use, it can spike your insulin.
17:16And so the answer to that is why do sugar at all?
17:21Why not kill the habit, take it away, and just go to naturally occurring things like fruit and things like
17:29that?
17:30Because you'll find over time that habit fails.
17:32I'm sure we have just about everyone in the audience who must be having some kind of ice cream or
17:36sugar.
17:38I have sweet tooth.
17:39How many of you do have it?
17:41Everyone, right?
17:42Everyone would be having ice cream.
17:43What will you be telling them?
17:44Stop having ice cream.
17:46No, no.
17:46No, no.
17:47Hang on.
17:48I do episodes on my channel called This Versus That.
17:52And we bring things.
17:54And my belief is you don't need to change your life dramatically, right?
17:59There are going to be days where you fail.
18:01There's going to be a day where you take one step backwards and you go then two steps forwards.
18:04But the idea is you need to build a habit and understand why we're doing what we do, right?
18:13And so to your question, I do the This Versus That where I take a traditional food.
18:21Like in one case, I took warrapa.
18:23It's very famous in Mumbai.
18:24It's a carb on carb on carb, right?
18:26And it was originally formed for people who were doing manual labor because it gave them a lot of carbohydrates.
18:32It was very inexpensive and it filled your stomach.
18:35We took that and we first changed the potato to ratala because it's a lower glycemic index, has more fiber,
18:44and equally tasty if not more.
18:46Then we kept the pow.
18:48We kept the pow, but we then changed the pow to millet or to other types of substrates which had
18:55a little more fiber in them and a little less carb.
18:57The second thing we did is we altered how you make it, fried versus air fried versus baked, because that
19:03removes the oil component to it.
19:05And who do you, which one do you think people liked the better?
19:09I think people would have preferred baked.
19:12Well, no, the baked is fine, but they actually liked the ratala sweet potato.
19:18Sweet potato.
19:20And it was healthier for you.
19:22So my point is that it doesn't mean you have to get rid of everything.
19:26Once in a while is fine.
19:27But the issue is that know what the context is and know where you're at.
19:32If you're a diabetic and you're eating a lot of these sugary sweets and other things, you know what's going
19:37to happen.
19:38So what is the right age to begin all this caution in food?
19:43For a 20-something in the audience, what will you be telling them?
19:47So I would say teach your habits early and often.
19:50My wife and I have this argument that can we reward the kids with Oreos or, like, cookies when they
20:01come home from school and all that.
20:02I said you can, but it's a slippery slope because those types of sugars are A, delicious, right?
20:12Everyone likes something that's sweet, right?
20:14The second thing is it spikes your sugar, spikes your insulin, does all that.
20:18But it should not become your go-to food when you're hungry because it instantly gives you sugar.
20:24Instead of that, if you train with fruit, with other things, and they don't have to be uninteresting.
20:30They can be interesting.
20:31Another example we gave is we took standard shira, right?
20:35The puja shira, which had jaggery and ghee and everything in it.
20:39And I changed it into a vegan version because I went vegan a couple of years ago and I enjoyed
20:44it.
20:44And we used cashew butter and we used monk fruit and all of that.
20:48Again, people preferred that over the heavier shira and the number of calories it was less and there were no
20:56added sugars in it.
20:57So similarly with the kids, I think you learn early and often two things.
21:02One is, what is your body makeup?
21:05You need to personalize this.
21:06If you're running, you're doing everything, you can afford to have some calories.
21:11But remember something.
21:12At some point, it's very easy when you're a teen to eat whatever you want.
21:16When you're a child, eat whatever you want and not gain weight.
21:19Once you go to college, you get married, you have a job, everything changes.
21:25Your metabolism and all that will change.
21:27For women, it's even worse with hormonal changes later.
21:30And so you have to keep this in mind that if you can understand the equation, which is what we've
21:35built into the book and understand what you're facing and then build these habits early and often, this book is
21:42for the youngsters as well as the middle age, as well as the seniors.
21:47Yeah, because it has something for everyone.
21:50You've read the book by now.
21:51Yes.
21:51And I think you can attest to that.
21:53Yes.
21:53It's done it in a way which is easy.
21:55And I'm saying that one of the programs we're trying to run is through CSR, donate books to all the
22:03high school and college students.
22:04Second thing we're doing is for corporate wellness where we have all of the big corporations give their employees the
22:11gift of health as Diwali rather than just giving them a tie.
22:15Because the difference in their lives will be so dramatic.
22:18So to your question about kids, I taught my own kids this early.
22:22I taught them how to cook.
22:23And it gave them huge abilities to have discretion on what they took in and also to know that if
22:33they have a heavy workout coming out, they're going to need protein, they're going to need this substrate, they're going
22:37to need that.
22:37If they are doing a cardiovascular workout, then having a little more carbohydrate would be helpful for them.
22:44So these are the things that they don't teach you.
22:46There's no manual that they give you when you're born.
22:48I'm going to move towards the weighing scale and also blood test because you have addressed both these questions in
22:55your book.
22:55And I'll tell the audience that I'll be taking questions.
22:58So be prepared to ask questions to Dr. Nene in just five minutes.
23:02So Dr. Nene, you write, is the weighing scale distracting us from what really matters how long we live?
23:10So where is your weighing scale in terms of muscle building?
23:15Because we don't tend to lose weight.
23:18But what about losing weight versus losing inches?
23:22Excellent question.
23:24So your weighing scale just tells you your weight, but it doesn't tell you how healthy you are.
23:30An athlete can have a very high weight because muscle takes more weight than fat.
23:37But you would not say that they're unhealthy from the internal standpoint, the visceral fat health standpoint, the heart standpoint.
23:46They could be, but they won't be if they're active and they're eating right and they're doing everything right.
23:52So when you compare, remember what you're comparing.
23:56I think there's better measures.
23:57In a recent discussion at another place in Gurgaon, I had the discussion that weight and BMI are not meaningful
24:07endpoints.
24:09Why is that?
24:09Because when someone's a weightlifter, BMI is mass in kilos over height in meters squared.
24:17The point is, if your mass in kilos is muscle weight, your BMI will be high, but you're not necessarily
24:23unhealthy.
24:23Instead of that, what we should be looking at is your waist to hip circumference.
24:29That's a very good predictor of health and of other problems.
24:34And it correlates better with that also with body fat, because body fat is a very interesting variable, which we're
24:44just starting to examine.
24:45Now, there are certain scales which measure all that, but they do it by impedance and sort of not completely
24:51accurate.
24:51Should BMI be done away with then?
24:53So it's a great question.
24:55I have said that nothing should be looked at in a vacuum.
24:59It should be one more data point, because if you only look at the weight and the BMI and you
25:05judge someone for it as a threshold screening tool, you're doing them a disservice.
25:11Instead, what you need to be looking at is all their variables, their family history, their medical history, their work
25:18-life balance, what they're eating, all of these things.
25:21And then look at this, because as weight goes up and down, what if they're working out a lot?
25:26What if they're building muscle and dropping body fat?
25:29And you're then prescribing a medication on the weight?
25:32Come on.
25:32But then how do you rely on the blood tests?
25:35Because you have also tried to dismantle that theory, that even though your blood tests may look normal, you ask,
25:41could you still be heading towards a health crisis?
25:43It's a great question.
25:44So two things.
25:46When I trained in the 90s, 80% of your diagnosis was made by history and physical.
25:53So you were actually talking to your patients, examining them.
25:5720% was corroborative with blood testing or other exams, right?
26:03Nowadays, there's such a volume of patients, sometimes the tests are ordered before the patient's even seen.
26:08And it becomes a fishing expedition.
26:10It's basically a hammer looking for a nail.
26:13I don't believe in that.
26:14I think that's the wrong approach.
26:16Instead, I think we should be tapering what tests should be done.
26:20Now, to your second question, that could the tests be normal and you not be normal?
26:25Yes.
26:25In some cases, that's absolutely possible.
26:27There's this skinny fat syndrome and it's a corollary to what you're saying, that in Indians in particular, at lower
26:34body mass indices, you can have significant visceral fat and not look fat on the external.
26:43So exterior cues are not always telling.
26:46With regard to your labs, one data point shouldn't matter.
26:51It should be the trends that come over time that matter.
26:54The second thing is it should be used as a screening tool in the properly selected candidates, meaning that if
27:00your risks for disease are high, then only should you be doing that.
27:04Lastly, but not least, why are you ordering a test if it doesn't change what you're going to do?
27:12If it's not going to change your outcomes, why are we getting yearly tests?
27:16Instead of that, why don't we design systems where we order tests when they're appropriate?
27:21For instance, if your parents have a history of first degree relative has heart disease, your risk of heart disease
27:28is four to tenfold higher, right?
27:30If you understand that, you also understand what the risk factors are for heart disease, then you will be more
27:37receptive to having some corroborative workup done, right?
27:42But just ordering these tests and then seeing them, it becomes another data point for the wearables where you get
27:48anxiety from that, not knowing what to do with it.
27:52But Dr. Dennett, do you actually believe in wearables?
27:54Because you tend to say in your book that these supplements, the health supplements, the wearables and health hacks, is
28:02this some kind of a booming industry and are we being fooled by it?
28:06It's a great question.
28:08So here's my thought.
28:09Now, there are things you can learn from wearables.
28:14They can act as a dashboard.
28:16In your car, you have a dashboard which shows you the speed, the gas tank, whether it's full or empty,
28:22the batteries and all that, until we get them to the point where they're perfect.
28:28And they can measure you in a continuum over time.
28:32And it's not in a vacuum, meaning that's the only thing you look at.
28:36And I'll give you an example, right?
28:38I don't know how many of you have these devices, but sometimes they'll say you didn't get enough sleep the
28:43night before.
28:44You feel perfectly rested.
28:45You're like, is there an error here?
28:47The second thing is how many calories did you burn?
28:50How many steps did you take?
28:51Maybe that's not what the focus should be.
28:54It should be the overall picture of what you're trying to achieve, and then you use these as a means
29:01to tell you which direction you're going in and how you need to alter that.
29:06So the systems we're designing for Pathfinder Health Sciences, where we look at awareness, access, and alignment, build a cloud
29:14-based EMR with AI, which looks at genetics, medical history, family history, social history, socioeconomic background, microbiome, and then gives
29:22you wearables.
29:23And it builds an end-to-end feedback loop.
29:25But remember, it's not just one thing.
29:28To your question on supplements, why are we supplementing in patients who don't have a visible abnormality?
29:35In other words, you should not be repleting something which isn't wrong, number one.
29:42And number two, the hype around supplements and the social media around supplements is wrong.
29:47Unless you know the source that it came from is credible, there is a preponderance of data,
29:54data, and not just one paper, but many papers and a consensus on something being correct.
30:02Why are we advocating supplements?
30:04In the end, I have an MD.
30:06I practiced.
30:07I took care of patients like family.
30:10And I took a Hippocratic Oath, which says, above all else, do no harm.
30:14And I cannot, in good conscience, tell you to do something if there's not evidence to back it.
30:22And in the book, we've talked about this on how to decipher that code.
30:26Because nowadays, with AI and with the supplement equation on the reels and with all of these influencers talking about
30:36it,
30:37I created the YouTube channel for that purpose.
30:39Because it seemed like in the pandemic, everyone was raising their hands after staying in a Holiday Inn Express the
30:44night before
30:45and claiming they were a health care expert.
30:47And I said, look, someone needs to be the voice of reason.
30:49So if you see my pieces, I've got the documentation, meaning the bibliographies, in the description.
31:00Similarly, in the book, everything we've talked about is science-backed,
31:04but it's done in a fashion which everyone can consume, not just a college PhD or something like that.
31:11Okay.
31:11So I'm going to open the floor to questions, if the mic can be moved.
31:15Yes, right here first, please.
31:18Go ahead.
31:23Hi.
31:24Sir, given the economic divide between the U.S. and the India,
31:28how do you make health a priority and also accessible?
31:33Because it's not prima facie that we have health as a priority or even it's accessible to the masses.
31:39So how do we do that?
31:41That's a great question.
31:42So the whole purpose of this endeavor was for that very reason.
31:47And for my whole career, 40 years I spent taking care of people at the end of their natural history.
31:55What I wanted to do was write something for them that would take them back
32:00and move the pendulum from acute care to prevention, early recognition, early treatment.
32:06Let's talk numbers for a second, right?
32:091.54 billion approximately spread across 28 states, 8 union territories,
32:15which are 30% metro, 70% rural.
32:18Only a million allopathic docs tending to those people.
32:21And then another set of Ayush docs, right?
32:25Only 2% of the allopathic docs make it to the rural areas.
32:29We've got a huge gap in three areas as I see it.
32:32One is awareness.
32:33When you're born, you get slapped on the bottom, you take a deep breath,
32:37but you're not given a manual for life.
32:39And that manual is different for each one of us.
32:42And so that type of awareness has to be raised.
32:44The second is access to world-class, evidence-based international standards.
32:48And the idea is simple that whether you're rich or poor, health is not discretionary.
32:53When you're sick, you're sick.
32:55And if we can move the pendulum back in the course of the natural history of disease
33:01by preventing early recognizing and early treating, we'll make much more headway.
33:06What we've done is divided it into five pillars that we've talked about.
33:10The second part of that is there aren't enough doctors,
33:13there aren't enough health care facilities, there aren't enough ways to do it.
33:17So we're adding an AI layer and trying to use that as a triage engine and do other things
33:21where it doesn't replace doctors.
33:23It's used as an adjunct.
33:25But in India in particular versus the U.S., the U.S. is not better off.
33:30They spend 18% of their GDP and their life expectancy actually went down
33:35due to the pandemic and opioid crisis and other things.
33:38And if you've ever practiced or had friends or family there,
33:43they have to wait months to get an appointment.
33:45And they have to pay humongous co-pays.
33:48And so the last part of this, awareness and access, the last part is lack of alignment.
33:53The business of medicine is not aligned to the patient.
33:56And the bottom line is that if we can change that dialogue
34:00and say that everyone is important, how we do it matters.
34:06And if we can teach early and often,
34:08the lucky part is two-thirds of our population is below 35.
34:12And the median age is 28.
34:15So we have a huge audience where we can come in early
34:20and teach them proper habit formation
34:22and make it scientifically based so it's personalized to them.
34:26I think that's the start.
34:28The second part is creating different constructs
34:30where we can change the way medicine is practiced.
34:34And the one nice thing is with so many patients
34:36and the Ayushman Bharat digital thing,
34:39and I worked with iSpirit during the pandemic,
34:41and I've done a lot of work with the digital part.
34:43I'm a tech entrepreneur as well.
34:46We have so many data points to train LLMs and neural networks with
34:51that we could potentially eclipse the West very, very quickly
34:56because we would have the data to train our neural networks
34:59and answer fundamental questions.
35:01We could tell you where the sort of clusters of disease are.
35:06And in doing that, we could triage those people
35:09and get them to help earlier.
35:10And I've been working with different concerns,
35:12iNetra, this, that, the other,
35:14to early recognize using a combination of technology
35:17and AI and other things.
35:21But I think it has to be a full court press.
35:23The one nice thing is we have the smartest people on the planet.
35:27We don't just succeed elsewhere.
35:28We dominate.
35:29And if we can take that same thing
35:32and use it in India for the betterment of our own population,
35:35the rest is history.
35:37We will be number one in the next 20 years.
35:39Let's take more questions.
35:40Please go ahead.
35:41Welcome to Delhi, Mr. Nene.
35:43And say hi to Madhuri Dixit.
35:46So I just wanted one question from you.
35:49Can you give me some tips or suggestions
35:51on how I can lose my weight?
35:53Lovely.
35:54So I'll tell you, 70%, 80% of that.
35:59First of all, thank you.
36:00Delhi is like home to me.
36:02I have so many friends and family here,
36:04and I come here often.
36:05And it's more a vibe than anything else.
36:07It's culturally rich.
36:09The history is amazing.
36:10The food is amazing.
36:11The people are.
36:11And I was telling her that the Hindi is so shudan.
36:16I'm on a journey to learn better.
36:18So I'm sorry I'm speaking in English.
36:20The next time, perhaps, I'll speak in Hindi.
36:22I can speak Marathi or Española todos.
36:26Do you love Vada Pao?
36:29So let me get to that.
36:30So nutrition is one of the pillars
36:33that we talk about in the book.
36:35And it's about learning your own body.
36:38Not everyone can afford everything.
36:39I get that.
36:40But if we can basically organize how we eat
36:44and, you know, prioritize the vegetables and that.
36:49And, you know, we estimated in the book
36:50there's 30 different vegetables
36:52that you eat in a given week in India
36:54because our food is so rich with vegetables
36:57and things like that.
36:58That should be half of your plate.
37:00A quarter should be protein.
37:01A quarter should be starches and complex carbohydrates.
37:05The second thing is move.
37:07Move all the time.
37:09If you're eating, go afterwards and walk for 15 minutes, right?
37:13After a while, it'll become a habit.
37:15In addition to that,
37:17think about strength training and cardio.
37:19And you don't need a complex gym for that.
37:21You live somewhere.
37:23You have a floor.
37:24You have a table.
37:24You have a wall.
37:25You can do push-ups.
37:26You can do sit-ups.
37:27You can do body weight exercises.
37:29The third thing is sleep.
37:31We don't get enough sleep.
37:33And the idea is that if I can get you to prioritize that,
37:37turn off your devices an hour before you go to sleep,
37:39and also cool down the room, make it dark,
37:43it will change everything.
37:44And then the fourth and fifth pillars you'll discover,
37:47but I think we'll move on to another question.
37:49Yes, yes.
37:50Let's quickly move on to two questions from this side.
37:53There are two girls waiting to ask questions.
37:55Please go ahead.
37:56Quickly, let's combine those questions.
37:59Greetings, sir.
38:00Sir, my question is you left a top position in Denver
38:03saying that you want to put a doctor in everyone's pocket.
38:06So also in an interview a week ago,
38:08you said that you really want to make a difference.
38:11Sir, you have built Pathfinder Health Services
38:13where we are focusing on AI, smart services, variables, etc.
38:17So how do you think AI can help us solve
38:19the rural health statistics?
38:21So where we can see there is 60% of a shortfall
38:24in the surgeons and physicians and specialists.
38:28So my question is that how can AI help us solve that?
38:30Professor Rani, we'll combine the second question.
38:31Please go ahead.
38:32Pass on the mic to the girl behind you who wants it.
38:37Or the one in front?
38:39The one in front.
38:45Yes.
38:46So good afternoon, everyone.
38:49Sir, my question to you is that in your conversation right now,
38:53you were talking about calories and everything.
38:55So here almost half of the audience is the college students
39:01and half of them are hostlers too.
39:04So I want to ask that how can we students manage our diets
39:09and take care about the food we are eating
39:12and as you know that hostlers have to eat the food of hostel only.
39:16And so please suggest that.
39:19Love your question.
39:20So first on AI.
39:22Look, AI is a tool.
39:23It has to be driven by a human.
39:25Maybe sometime in the future,
39:27that might not be the case where it's teaching itself,
39:29but I don't want to be out of the equation.
39:31With regard to how you use AI for discovery,
39:37there's been numerous advances across the board.
39:40Drug discovery, you know, training it with different disease processes.
39:46Give you multiple examples, right?
39:49That you can take the number of people we have in India,
39:52put them into a database,
39:54and figure out what diseases they have bases their genetics.
39:57Then see how they play out dependent on their diet and their lifestyles.
40:02At the same time, we can see what medicines we've given them,
40:04and we can say what is the best outcome from that.
40:07That instantly gives you the ability to dictate what best practices are there
40:12and do it in a cost-efficient way,
40:14because there may be some medicines which are cheaper than other medicines
40:17or other practices which are much more efficient and can be enacted on.
40:23I have invested in over 130 startups,
40:27many of those in the healthcare realm,
40:29and they have looked at each one of these things,
40:33and these portfolio companies are part of the platforms which we're building.
40:37To be honest with you,
40:38we are at a very interesting time in Indian history
40:41where we can scale things massively.
40:44My biggest problem as a heart surgeon is I could not scale.
40:47I created R&M, and I created Dance with Madhuri,
40:51which scaled massively for education in cultural arts
40:54and got an exit offer.
40:56But I say the combination has to be there,
40:58and don't think for a second that AI alone is there.
41:01I gave a talk about a year ago
41:07at the Times Now Conclave on Doctor's Day
41:11on how AI will replace physicians.
41:14And it was a play because I wasn't intending to do that.
41:18You can imagine 250 doctors were looking at me
41:20and saying, you're going to replace us with this?
41:22By the end of it, they were all lining up
41:24because I was telling them how to improve their workflow.
41:26Because what you can do with AI
41:28is bring in all the records earlier
41:31and document them and organize them.
41:34You can try it yourselves by doing voice memos,
41:37dumping them in the chat,
41:38and seeing how it plays out
41:40and getting your work done more swiftly.
41:42And that will cut some of the workload.
41:44And we're building apps and other things
41:47which doctors can use and are free
41:49and basically will join
41:51with a Yushman Bharat digital mission.
41:54Now, back to your question on the hostellers.
41:57Excellent question.
41:59As I've talked about in the book,
42:01Indian food is rich in culture, history, tradition.
42:05But you need to now personalize it
42:08to your own life situation.
42:10A lot of foods are very, very healthy
42:12that you can use with each other.
42:14But the perfect combination
42:16is what you have to figure out.
42:17And there are times
42:19when you're going to be faced with choices
42:21which you don't want to make.
42:22Once in a while, that's fine.
42:24But the point is that
42:25if you can center on the plate idea,
42:29center on how things are done,
42:31and also read labels.
42:33Figure out, nowadays you can take pictures of food
42:35and you can figure out exactly what's in it
42:38and how many calories you burn.
42:39You can also document
42:40how many calories over the day you burn
42:42and how many you need to stay active.
42:44That combined with the exercise
42:47and all the other things
42:48that we've talked about comes in.
42:50No one thing is alone.
42:53They don't exist in a vacuum.
42:54You have to bring them together.
42:56But your point is well taken,
42:57and I think it's a discussion
42:59which we have to have with the students
43:00because if we can build those lifestyles early,
43:04it will change everything for you later.
43:08All right.
43:09Thank you for this fascinating conversation, Dr. Nene.
43:12I'm sure the audience had a lot of fun as well,
43:13and the questions will continue off stage now.
43:16Thank you so much.
43:17Absolute pleasure, Miriam.