Ronesh Sinha, M.D.: Insights Into the Manifestation of Metabolic Disease in a Patient Population Predisposed to Metabolic Syndrome – The Peter Attia Drive

Check out The Peter Attia Drive Episode Page & Show Notes

Dr. Ronesh Sinha (@roneshsinha) is a physician based in Silicon Valley who primarily works with patients of South Asian descent. He’s the author of The South Asian Health Solution

Key Takeaways

  • Silicon Valley culture is causing stress, health problems, and unhappiness in kids
  • Insulin resistance is far more complicated than we make it out to be
  • Exercise is essential for long-term functional health
  • You don’t need a Ph.D. to take charge of your own health
  • South Asians are the most insulin resistant population on the planet
  • It’s been stated widely (because it should be), but smartphone and social media use among children/teens NEEDS to be limited 

Medical Talk

  • “The difference between you sitting here now with a glucose of 100 mg/dL, which we would consider perfectly normal, and you sitting here with a blood glucose level of 200 mg/dL first thing in the morning, which is frank type 2 diabetes… that’s a difference of one additional teaspoon of glucose in your bloodstream” – Peter
  • “I thought I kind of understood insulin resistance seven or eight years ago, but I’m pretty sure I don’t anymore” – Peter
  • It’s been found that a low birth weight equates to a higher risk of cardiovascular mortality, and earlier cardiovascular mortality, in every continent except Africa
  • South Asians are the most insulin resistant population on the planet
  • To lower your blood pressure, lower your uric acid levels 
    • “Our little great trick on blood pressure is lowering uric acid. That’s huge. In fact, I take such an extreme view on this that I don’t even think one should use antihypertensive medication until uric acid is below 5.” – Peter
  • “In different parts of the Bay Area and Fremont in particular… probably 25 to 30  percent of Asian Indians have some manifestation of PCOS”

Vitamin D

  • Peter no longer supplements with vitamin D and because of this makes a conscious effort to get more sunlight
    • He aims for his levels to be between 30-40 ng/mL
  • Vitamin D has an anti-inflammatory effect (so raising your levels should result in c-reactive protein dropping)
    • Raising your vitamin D levels should also reduce hypertension

The Importance of Exercise

  • “If you want to take the long view and you actually care about making it to your 80s and 90s, performing really well, and being a super functional member of your family or your community… you absolutely have to be visiting at least four different components of exercise, the first being stability. This is the one that’s most sorely missing and it’s the one that’s the root cause of most injuries.” – Peter
    • In addition to stability, focus on both hip hinge+ push/pull exercises
  • Peter works out every day 
    • He strength trains 3 days a week – each day includes some sort of hip hinging exercise (i.e. deadlifts, squats, leg presses, or Bulgarian split squats)
      • Why the heavy focus on legs? – “‘I wish I had less strong legs,’ said no one ever at the end of their life”
    • The other 4 days consist of a Peleton or treadmill workout 

Stress Management

  • An easy way to practice stress management: using an Apple Watch or Fitbit, frequently take note of your heart rate
    • Very often, it’ll be running higher than you think – take a moment to pause and do some deep breathing (which will ideally drop it)
  • “I view mindfulness like I would view going to the gym. It’s just a training tool that is often uncomfortable and unpleasant, but it teaches me something that I carry with me when I go elsewhere.” – Peter
    • “I think that’s where a lot of people miss the point on meditation. It’s mostly just a tool to be less unhappy.”
  • With his continuous glucose monitor, Peter has noticed that when he’s angry his glucose tends to spike 

Silicon Valley Success Culture and it’s Effect on Kids

  • “The way we raise our kids early on might set a pattern for how much of an accelerated life or how much of a stressed-out nervous system they have later on. As I’ve talked to more and more families here in Silicon Valley, I’m realizing that a lot of the behavioral patterns we instill in our kids are setting the foundation for insulin resistance and inflammation.”
  • Rates of opioid and substance abuse are rising among Asian and Indian populations in the Bay Area – people just can’t deal with the pressure that’s being put on their shoulders
  • “We often treat our kids like startup companies. We back them with resources and funding, we expect them to do great things and go to Stanford, and we expect them to run a company, but we don’t realize that we’re not giving them the opportunity to grow up and just be a normal child”
  • “If you think about how we look at our kids, for many individuals their kids are an extension of their ego”
  • “Here in Silicon Valley, it’s not even enough to be a doctor. Doctors are blue-collar workers here.”

Parenting Advice

  • “One skill that we know we need to teach kids that’s going to lead to their happiness is the ability to look internally and cognitively reframe situations”
    • Kids NEED to learn to express their emotions
      • Be cautious when a child is noticeably quiet – it likely means they’re excessively ruminating (which we all know leads to anything but happiness)
  • “Do you like working at a company where your manager tells you what to do 24/7?… Hell no. Well, that’s how your kid feels because day and night you’re telling them, ‘Don’t do this and do this.’ Give them some ownership.”
  • It’s been stated widely (because it should be), but smartphone and social media use among children/teens NEEDS to be limited 
    • “I look at the phone as literally being a drug or toxin… If your kid is the type to be consuming a lot of media, you shouldn’t be giving them a pack of cigarettes. This is just something you need to delay as much as you can.”
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