Episode 10: Special Guest: Jack Kreindler, MD, Health & Technology Futurist

Owaves Team Body Clock Podcast

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Silicon Valley and London-based physician, futurist and entrepreneur discusses circadian rhythms, technology and innovation with Dr. Haroon and Sohaib. Dr. Jack is an emergency medicine physician practicing human optimization with digital health and artificial intelligence.

Transcript

Dr. Sohaib Imtiaz: Welcome to the Body Clock Podcast. Today I’m excited to announce we’ll be having Dr. Jack Kreindler who is a mentor for me and he is also the founder of the Center of Health and Human Performance as well as being an advisor to several startups and cutting edge technology firms in the health arena. Jack trained as a doctor for 10 years in the emergency department and he has a special interest in altitude physiology.

Jack is very involved in the human optimization, longevity, space. I first came across Jack at UCL while he gave a compelling speech and talk on his involvement Singularity University and how exponential medicine and technology will change our lives. I found it particularly interesting how technology is advancing so quickly and Jack being a very familiar face in Silicon Valley is at the forefront of this change.

I’m excited to be discussing a range of topics on this podcast with Jack and I feel we-it’s going to be an amazing one and we’ll get some amazing insights. We’ll be discussing Owaves and how Jack lives his life and how he tries to optimize his health and the views on different developments which are happening in the digital health space. So I’m looking forward to this podcast very much. So let’s get started.

Dr. Haroon Kazem: How are you at the moment, like practicing, like a lot of these lifestyle medicine approaches yourself? Because I know you have a very strong background in terms of all these different projects that you’ve been a part of. The one that sort of appeals to me most is like your work with the CHHP. Is that something that you’re still involved with every day or?

Dr. Jack Kreindler: Yeah absolutely. CHG is the institute I founded eleven years ago with my team of, now 40, scientists and specialists in human performance science, in elite sports medicine. Essentially what we do is we apply what you might want to call the secret sauce-which is not very secret, it’s all good science of elite sports medicine and sports performance.

And what we do is we work of course with athletes, to get them back on track or winning gold medals or performing better but more importantly to work with two other groups of people. One are very sick cancer patients and may-basically relevant to you-the kind of, you know, global, travelling, super busy person, executive founder or just people living busy working lives who want to run circles half-round people half their age and keep on going, you know, to look after their young families and older parents and so on. And that’s a third of our clients really athletes a third are, you know, the lifestyle-if you want to call it that-kind of category and then a third of the very critically ill cancer patient.

Dr. Haroon Kazem: Very good. And so are you tailoring like the the the approach to each one of those groups like on an individual by individual basis or is there sort of like a like a structured approach that you’re taking with them? Because I find that-

Dr. Jack Kreindler: Yeah. There’s a very structured approach. You know, we do the traditional, non-scientific, extremely brilliant and important deep forensic analysis and history of their medical health and performance. And that’s just basically asking questions in good old traditional taking a thorough medical history way, which we kind of, in some ways forgotten to do really, relying on diagnostics and tests.

And then from there, we understand what it is that we’ll do in our physiology lab, whether it’s cardiopulmonary metabolic testing, whether it’s body composition analysis, what bloods we might want to do that they haven’t already had done and so on and so forth. And then once we get those results, we will then build a program which just adds in a kind of an Olympic sport environment, operates around kind of a three month training cycle where, you know, after 12, 13 weeks, you’ve put a plan together, you’ve had some biomarkers or objectives that you’re trying to achieve, you’ve built a plan around exercise physiology, the fuel to-the nutrition to fuel that, the rest and recovery and sleep to-that is necessary to make that-all of those good things happen in your body that build up your your your your, you know, repair and your muscle structure and so on.

I think the fourth aspect which is very important to watch just like your head-space, your cognition, your state of mind and that is what we would call a program and whether you’re an elite athlete or a very sick cancer patient or an exec or whatever, it’s still the same thing. You know, you still have objectives. It’s a 30 30 month, sorry, plan and involves sleep-mind nutrition and exercise physiology. So that’s it.

Dr. Haroon Kazem: That’s-I love that you say that because a lot of that falls directly in line with what Owaves tries to do in terms of scheduling your day and allowing people to sort of create a visual that they themselves put down so that they can sort of remind themselves of their daily habits. But somebody who’s as busy and involved with so many different projects as yourself, how do you find the time during the day to sort of balance out all those elements in your own personal life?

Dr. Jack Kreindler: Well my own personal life, well sleep, well I’ve been a believer in the restorative sleep hypothesis myself for for a very long time before, really. I mean, I remember at medical school, we probably got one hour on sleep apart from sleep apnea as being a thing. That was really insufficient, considering we spent a third of our lives doing it. There is a probably a good biological rationale for why it is that we sleep. In fact if you think about any single activity it is the one single activity we do more of than anything, right?

Dr. Haroon Kazem: Yeah.

Dr. Jack Kreindler: So it’s incredibly important. So, you know, for me whether I’m travelling across multiple time zones, which is what I do, you know, on a very routine basis, maybe 15 transatlantic flights a year, I’m home with my family making sure that my circadian rhythm, my sleep is as optimized and as synchronized as possible is is incredibly important. And I think that’s sort of like the the basis of everything, to get, you know, “when are you going to be awake, when you’re going to be asleep?”

Okay? Number one. Then, you know, when you’re awake of course it’s what you do when you first wake up, when do you eat, do you fuel yourself for exercise do you-if you’re not going to do anything but sit on your butt for the next five hours, you know, do you stuff yourself full of an incredible amount of, you know, simple carbohydrates? Maybe not. If you’re gonna run to work, maybe yes. And, you know, deciding what it is that you’re going to do, where, what you’re-how you’re going to fuel that, when you’re going to take breaks and, you know, where do you fit in amongst all the work that you got to do, the time for for headspace, the time for moving your body outside of the general activity that you’re doing, and yeah, and the time to eat.

Dr. Sohaib Imtiaz: Yeah. So Jack, it seems you’re-you already kind of work as an algorithm. You’re very flexible and your decision making is very dependent on the activities you’re performing whereas certain individuals, they don’t change what they’re eating or they’re very kind of inflexible when it comes to their lifestyle, not realizing that these principles should change according to your, you know, load or stress load or activity level. So you’re kind of always micromanaging your life. Would you say that’s true?

Dr. Jack Kreindler: My my diet-look. When we were swimming in the sea, maybe when we decided to actually the oceans were not as cool as drinking tequilas on the beach, we evolved out of the sea and then we thought, “Okay, you know, maybe the beach isn’t as cool as the forests and stuff.” Eventually eventually we became us but we’ve only been doing this crazy stuff like crossing trans Atlantic, you know, time zones for a very very short period of time.

Generally, life has been a pretty ordered structured thing until we started travelling an awful lot. You know, we essentially had a-we slept more in winter than we did in summer, we ate food seasonally, you know, apart from war and mishaps and illness and so on, things were pretty simple. And now even when there is no war and mishap, life is complicated. You should have a look at my diary. My diary looks more like a stained glass or the thing I didn’t think any day that I’ve ever done is the same, yeah?

Dr. Sohaib Imtiaz: I mean, your diary seems something that-

Dr. Jack Kreindler: Micromanagement, of course you have to micromanage it because your life is no longer an ordered structured thing. I mean, can you recite what you did this week? Like-.

Dr. Sohaib Imtiaz: I can’t, actually.

Dr. Haroon Kazem: Bits and pieces.

Dr. Jack Kreindler: You can’t. In a world more connected with different types of people, where we don’t have fifty friends, we have five thousand friends. You know, we we do have to-look. You can either say, “Okay, let’s be completely sort of traditional about it and just eat when we get hungry.” But really we don’t live in that world anymore and if you don’t live in a kind of blue zone, where everything is normal, you’ve got to get wise.

And we live in a technology enabled world that’s helped us to live longer. You need technology to help you learn how and when to structure your days. For me, my calendar is probably one of the most important things. My calendar tells me and I build now into my calendar. When, you know, just literally it’s it’s not obsessive but it’s like, “oh there’s a gap. Okay what am I going to do there? I’ve got some time to eat.”.

Dr. Sohaib Imtiaz: Brilliant.

Dr. Jack Kreindler: “This is when I’m going to move.” And then, you know, using using unusual things like-and it sounds crazy but, you know, not just as an alarm but a go to sleep clock, you know, to be able to say, “actually, it’s now time you-because you’re getting up at six thirty every morning, so you’ve got to go to sleep earlier.” Yeah?

Dr. Sohaib Imtiaz: Yeah.  Alexa wakes me up in the morning. I know that until-.

Dr. Jack Kreindler: My daugher wakes up in the morning.

Dr. Sohaib Imtiaz: Okay, so you’re still old fashioned with that.

Dr. Jack Kreindler: Yeah. I get that seven thirty. Wake up. No there’s no question there.

Dr. Haroon Kazem: On the dot.

Dr. Sohaib Imtiaz: So you’re very, um, obviously technologically aligned and you’ve obviously been immersed in the Silicon Valley atmosphere Singularity University. I’ve heard your talk, you’re quite involved there as well. You navigate between this American kind of startup technology VT World and then you’re also based in London. Can you tell us about-more about that, about your kind of projects and interest to do with tech and lifestyle medicine?

Dr. Jack Kreindler: Yeah, I mean, most of my tech stuff is actually less about lifestyle medicine. I would call that health tech rather than kind of Medtech and the kind of tech stuff I’m involved with I think is a bit more sort of the hardcore bioengineering and biotech side of things and computational biology and so on.  I am pretty, I’m pretty impressed with the way that people are now able to access cool tools and apps and and lifestyle management things and even disease prevention, disease optimization stuff through lifestyle with a myriad of options there are for them out there, whether they’re hardware design devices with software or things that they run on their phone and so on.

And I think that’s great. I was involved in a lot in the past but I think that most of my, you know, kind of tech and innovation side of things has gone a bit more hardcore into into deep biology and discovering new drugs, new classes and molecules and so on and maybe new interesting diagnostic things. But I, um-that is not to say that I don’t think the stuff that’s going on in health tech is not important. In fact, I think it’s just as important. It’s just there’s some, you know, fantastic people doing amazing stuff in that space. And it’s about the, you know, designing and marketing those things really really well-for example, Headspace is one of the companies that I advised very very early on, before they are well known.

Dr. Haroon Kazem: Okay, wow!

Dr. Jack Kreindler: And it’s, you know, it’s about incredible product. It’s about incredible marketing. It’s about, you know, you know, achieving something which addresses an unmet need. And, you know, that there are there are examples of companies that have done amazingly well. Sleepio is another-there’s a bunch of them, you know, who are doing some really fantastic stuff. And, you know, just like the sort of work that you guys are doing with your with your startup it’s, you know, it’s brilliant stuff.

There’s tons of tons of-I mean, I think the biggest problem with it, you know, from like looking at it from a market perspective is if I’ve got a real Institute is putting these things into practice and real people with real problems or just really busy lives, which ones do I choose? Which ones have the best evidence? Which ones are the most usable? Which ones are the stickiest? Which ones delivered the most value? And in fact, I think that’s one of the biggest challenges that we face, really is there’s so many people doing this stuff in this unregulated space that, you know, which ones do you go for?

Dr. Sohaib Imtiaz: That’s a great point you touch on, Jack because behavioural economics, we do know when we have too much choice, we make no decision. So-

Dr. Jack Kreindler: Yeah.

Dr. Sohaib Imtiaz: The more apps there are, less likely people are going to be like, “hey, I can’t use all of them.” And there’s no one central App where you can kind of track everything because I think is very difficult to navigate between so many different apps, one for nutrition or for exercise, for your rhythm, biomarkers. So this-it’s difficult it’s not-you don’t have the time for that. So interesting point. So do you think you think technology can augment humans, can you think-can make us healthier? Because a lot of studies that come out that say that we’re addicted to social media and our phones and it’s having an effect on our mental health. So what side of the line do are you on?

Yeah. What does technology do? I mean, these days the, you know, technology-most most of what technology does is enable us to do the same thing as we did before much more quickly, with many more people, in far more remote parts of the world. So that’s what digital technology has done for us. You know, before, you had to, you know, you could you could watch one film a month by going to the cinema and now you can watch 30 a month from for it from your from your sofa.

So I think I think as we do more things, with more people, more remotely, as things digitize and our lives become less analog and less touchable and real, there are some issues there because the speed at which we expect a response produces response anxiety hence people get worried about like you know how many likes they have. The fact that we’re 24/7 available to anyone, the fact that we’re able to do this podcast from very different parts of the world-you’re in Manchester, I’m in London and and the and the company is down in San Diego-which is like fairly super crazy-right-but the-this also produces an issue because, you know, life is sped up and also the world is shrunk so the, you know, if you draw if you if you draw a map across the world of how how and where we’re able to contact each other through the speed of light, I don’t think there’s a there’s not many places now it’s really connected somehow.

So what-well what I’m saying here is that life is sped up beyond what humans were really designed for. And it’s resulted in certain stresses, pressures, anxieties, expectations and loads which we weren’t particularly designed for and therefore, you know, you have to kind of either manage and mitigate that or you can use the same tools to itemize that. And, you know, I I I still think if you look at the people that lived the longest, it’s not people with technology, it’s people who are actually more chill. So there’s my answer, really, is that, you know, we’re using technology to manage the technology effects.

Dr. Haroon Kazem: It’s it’s a great point. It’s a it’s a it’s a strange like dynamic for sure. It’s it’s one of those things where the human element is definitely getting a little bit lost in translation with all these different tools and devices and whatnot. And I think it’s all-I think it’s all for a good cause, absolutely, but I very much do agree that like as a species like we’ve never had this type of access to information before, let alone access to each other before and I feel like we’re sort of in a transition phase where we’re still learning how to deal with all this stuff and maybe the generations that come down the road will have a better grasp of it.

But I certainly feel like it’s one of those things where for just as much as it helps, it probably hurts. And so I think there-I guess you would say stronger minds or however you want to phrase it are probably required to sort of help bring everything back together a little bit to keep those stress levels down because I very much so, I feel like there’s a subtle stressor in my body now, just knowing that I am at the mercy of my calendar and my iPhone, my alarm clock, my text messages and my DMs and all the stuff and it definitely does-it adds up. So, you can’t just turn it off.

Dr. Jack Kreindler: No that’s it. Yeah absolutely right.

Dr. Haroon Kazem: Sohaib, what are your thoughts? Because I know you’re very big on the A.R., VR space when it comes to tech.

Dr. Sohaib Imtiaz: Yeah. So that’s very interesting because I think I mentioned in a previous podcast how there is that Harvard Business School live virtual classroom that I took part in. And although it was-so it was basically, the objective was to create an MBA classroom where people can tune in from around the world but it still feels as though the human interaction element is very much present. And to be fair, through the screens, it did feel like I knew those people even though I wasn’t in front of them.

But one of the questions a part of that discussion that was asked was Facebook. So if a study came out that if Facebook was deemed to be harmful for children’s mental health, you as a company-say if you had a startup-would you would you still interact to kind of get children to follow you? Same with Instagram pages. And my answer was that I think it is different for different people. So technology, I think has helped more people than it has caused harm to.

I’ve got no stats behind that but I think it’s about learning to use it in the right amount and in the right ways. But that’s with most things in life. So I think it’s very hard to-obviously something is a double edged sword. But personally, I’ve always had positive experiences. You can do-so Jack obviously has wherever Singularity University, I think you can go at 10x the speed now than you than you could before. I mean, we wouldn’t be having this podcast right now without technology. We can reach out to so many different people with similar likes so it’s almost creating an environment of of intellect and communication but also making your life a lot more efficient.

So I think it’s positive. But before before I lost a bit of signal, Jack was talking, we were also talking about a number of startups in the space. And that’s interesting because in the UK, so Orca Health is one of the companies and they’ve set up at prescribing so it almost helps health professionals to prescribe an app based on its validity, clinical effectiveness. So I actually, with the BSLM, the British Society of Lifestyle Medicine, we’ve actually set up our own-we are working with ORCA, our version of an app website. So where physicians can almost prescribe apps to their patients via links through text because that’s the problem as a consumer.

You’re hearing so many different apps, there’s like so many for sleep, so many for nutrition and you have limited knowledge and even even as a physician you can’t work out which one is the most efficacious. So I think Jack talked about it brilliantly. It’s about-we need a way of how these apps and wearables can be tailored towards different patients and consumers.

Dr. Jack Kreindler: Yeah. It’s true. I think I think, you know, just as you prescribe prescribe things physically, you need to be able to prescribe things digitally. But also also I think, you know, the aim of an app in a way is to become redundant, like so that you kind of learn how to manage things yourself eventually. So, you know, it’s like the funny thing is a business model, if you’re really if you’re really really relying on something as if there’s something’s gone wrong.

Dr. Sohaib Imtiaz: Yeah, exactly.

Dr. Jack Kreindler: I you’re trying to really push the boundaries, you can’t do that without a coach, you can’t do that without the plan. And, you know, that’s a really good way of thinking about it is that not everyone can have a coach and a plan. So so they can have an app.

Dr. Sohaib Imtiaz: Yeah there’s like a minimum viable version of- Yeah. If you can’t afford a coach or-well obviously a part of my lifestyle medicine, coaching has been shown to have such positive impacts on behavior change and making those changes happen at an increasingly rapid rate and maintaining-cause a lot of it is, we make these changes but we relapse, so it’s preventing that relapse. And I think that’s where-with your CHHP programs, I’m guessing, how are your clients? Have you have you been able to transform a lot of lives quite drastically?

Dr. Jack Kreindler: Well I don’t know if I could “transform lives drastically.” I mean, we do what we do, you know? It’s-we’ve never we’ve never published our our work in the form of a sort of a trial. But we, you know, we do glue together best practice and good science in a way that isn’t easily done just by everyone working together on the nutrition, the physiology, the sleep, and the mind side. And, you know, whether it is anecdote or not, we’ve been doing okay for 11 years and we see a lot of people who we are very pleasantly surprised and so they at their outcome which is great, you know. So if that’s transforming people dramatically then then that’s transforming people dramatically.

Dr. Haroon Kazem: Yeah.

Dr. Jack Kreindler: “Okay. We’re really going back to the basics of how your body works, optimizing that just like you do an elite sport. And yeah, if you win if you if you if you win, you know, three or four heavyweight boxing titles that, you know, no one had heard of you, maybe maybe that’s transforming your life. If you’re surviving an operation your surgeons and doctors have said you wouldn’t survive unless you got fit, maybe that’s transforming your life.

But, you know, for us it’s just this is this is our bread and butter so, you know, it’s almost like for us it’s kind of-if you’re-if if you clearly are metabolically unwell and you can clearly see that you’re travelling too much, eating at the wrong time, sleeping terribly, stressed, not giving your mind space, you know, that-all of those things and you just return that back to normal, if that creates a dramatic change in someone’s life, tere are two things to learn from that. One is that there’s an awful lot in medicine that is low hanging fruit, there’s an easy to achieve without inventing multi-billion dollar, right? The second one is why the heck aren’t health systems-

Dr. Sohaib Imtiaz: Banking on this?

Dr. Jack Kreindler: Exactly. So it’s, you know, those are the two questions that-I don’t call it “dramatic” and “transformative.” I call it, you know, this is basically just good physiology. This is this is, you know, what we should all be doing. Perhaps we just need a little bit of a nudge to get us to all be optimizing our disease outcomes, our health risks or our performance as a result just doing it and-or remembering how to do it or, you know, if we are pushing ourselves and burning the candle at two or three ends, how to get smart and wise to mitigate against that.

Dr. Sohaib Imtiaz: Yeah that’s beautifully put, actually. That’s interesting you mentioned that because it seems like you’re actually hitting the high value points with your CHHP clients and not-because there’s a lot of well, non-evidence based-in the wellness space-a lot of non-evidence based kind of strategies, ect., which which kind of focus on minute parts with with less value added to clients. Having said that actually, with technology I don’t know if you’re aware of lab 100 Mt. Sinai, which has just been inaugurated, actually., it’s in beta version at the moment. So essentially their-it’s kind of like a primary care service for kind of-well like a health assessment.

So you go in, it’s completely technologically enabled where they test your power using virtual reality, your cognitive ability by performing some tasks, they measure all your biometrics, your blood draw is taken there as well, the UX design is very Apple based, and then at the end you have a dashboard-which I don’t know if you’re familiar with, kind of video games kind of like a hexagon, visual graphic which tells you in which which metrics you’re performing well and where you’re lacking in a lot of kind of graphs etc.. So it’s something which seems very data orientated and a lot of the criticism of that has been, “how applicable is that to the mass population? Does it add value?”

Dr. Jack Kreindler: I think, you know, there’s a couple of ways again gaining data and evidence. There’s the traditional way which is really gold standard, randomized controlled trial, et cetera. Then there’s sort of like more heuristic, Big Data analytics, retrospective study, you know, which is kind of the world of-it’s basically how we run stock markets and advertising campaigns and so on. And there’s a sort of a new thing which we can do now which is kind of a high frequency, individualized time series analysis which which enable us to kind of make an assumption based on a lot of screening data and then put in an intervention which doesn’t necessarily havei-f you want to call it “evidence”-or at least the evidence has not been well studied in humans in randomized trials but maybe has some prospective study years and a weaker evidence behind it.

But if you can draw a correlation, a strong statistical correlation in a crossover trial for an individual, you know, you try something, their insulin goes down you take it away, their insulin goes up, you try it again, their insulin goes down, you try, you know, put it back in, and at some point you actually can power that study for that individual. It doesn’t mean that you’re trying any weird science but what you’re doing is you’re really validating your hypothesis is working or not. And frankly, all of medicine should be like that. Um so if you know if if a company like Lab 100 or whoever is taking a methodical approach and even if it’s putting together things that are-don’t have a massively strong evidence base, both the things that have got a strong evidence base and the things that haven’t still be studied vigorously and rigorously.

I I don’t like medicine where you where you don’t have an audit for the individual as to what’s working and what’s not. However, how do you scale that? That’s the big question. How expensive is it, how much value does it add? If it adds-if it costs a million quid and the person, you know, has one quality adjusted life year added to their life and you have to ask the question who’s paying for that? Because you can’t afford that in a population. Only a very rich individual would be able to afford that.

So I think, you know, there are some economics here as to where you’re adding value. And, you know, organizations like Human Longevity Inc. down in San Diego actually, you know, we’re spending an enormous amount of-we’re spending enormous amount of resource and asking people to spend enormous amount of private money of their own in order to study and early catch things and project what is going to happen and put interventions and, you know, there’s been a lot of questions about that in terms of, you know, what’s the-is the business model sustainable, are people getting real value out of that?

People are, you know, like that-they are-they do ask questions of those things. Ultimately for me, if you’re going to do anything in research and medicine and apps and technology and innovation, it doesn’t really matter but what you have to do is you have to think about how it scales, you know, health systems need as much as do things for billionaires. They have to do things for the billions. And, you know, that-those are the things that really hit the sweet spot for me. They can be applicable with a lot of resources around them for individuals that want a kind of tailored service, individualized and, you know, every nuance covered by an expert. But ultimately you also need the thing to be applicable and rolled out so that people have global access in some form to it.

Dr. Sohaib Imtiaz: That’s very eloquently put, actually. And I guess that’s where the usability and seamless design comes in in a way that people can comprehend and understand population level technologies as well. Because we do hear a lot-for example-augmented reality is coming in, so people are saying even like we’ve discussed earlier the smartphone might even get displaced, a lot of those kind of high end changes but to get to a population level there’s always like a five, ten year lag. So what you’re saying is almost you have to obviously have ideas which add a lot of value, then within a certain threshold of cost that the person deems it achievable and affordable and it improves their quality of life. So it’s almost kind of like a cost benefit analysis. Is that correct?

Dr. Jack Kreindler: Yeah, I think you’re right. I mean ultimately that’s it. You know, why do we do all this stuff? It’s to try and improve our health span. Some people want to increase their lifespan irrespective. But for me, it’s increasing your health span. And, you know, it comes at a it comes at a price and it’s the balance between what it costs you in time and money and stress.

Dr. Sohaib Imtiaz: Yeah, exactly.

Dr. Jack Kreindler: What you gain out of it. And I think the responsibility is for every-whether it’s a drug, whether it’s device, whether it’s an app, whether it is a service like ours-is to really kind of be honest to oneself and say, “is it adding value?” rather than just flogging stuff and expecting it to set to work. And actually kind of that is in a sense a disadvantage with relying on maybe as you know a gold standard study that was done on one hundred or couple hundred people 20 years ago, does it actually work today in real life?

How well is it working? You know, we don’t study stuff ongoing. I think the advantage with some of these new apps and so on is that they enable us to put an intervention in like let’s say, you know, our intervention is we’re going to look at you look at a calendar, Doctor Jack, fit in places where you should be doing this, that, and the other and we’ll look at something, some reliable biomarker of aging or the pace of aging or your energy levels or your mood or something, sugar levels, I don’t know.

And not just say that was good practice, go do it forever but actually look every single day. Is it working? Is it not? Aggregate that. Have you changed things? How do you compare to others? So it’s like, it’s not only doing the initial upfront work to validate your claim but then to make sure that you’re continually re validating your claim the whole time.

Dr. Sohaib Imtiaz: So reinforcing your-the kind of positive outcomes you’re getting as well.

Dr. Jack Kreindler: Well, you’re reinforcing your-

Dr. Sohaib Imtiaz: Motivation, yeah.

Dr. Jack Kreindler: Reinforcing reinforcing the-your own knowledge as to whether you’re working.

Dr. Sohaib Imtiaz: It’s working or not. Exactly. And so you actually touched on glucose monitoring so, I mean, that’s a-I’m sure in the tech circles, it’s a very hot hot topic right now. But do you think with technology, Singularity University seems to preach this kind of “don’t think of linear growth, think exponentially.” So in five years time, the amount of information we’ll have and know when the devices and capacity of processing power will become so great so quickly that we almost-being innovators or trying to have an impact in prevention-you almost have to think ahead of the curve.

But whilst lifetime medicine, a lot of it is the core principles of, you know, moving, eating healthily, it’s kind of a lot of broad based rules that people apply to their lives. Do you think with technologies like glucose monitoring coming, again, continuous glucose monitoring, it will have an effect-so, because people can know what foods they eat and how it affects their insulin response. Do you think could have kind of seismic changes in population levels of diabetes?

Dr. Jack Kreindler: Um maybe. It’s a hard one.

Dr. Sohaib Imtiaz: It’s a tough one.

Dr. Jack Kreindler: I think the key thing is that most people are interested in things once they’ve gone wrong, mostly. And then even then it’s a struggle for a lot of people to change their lives and adhere to medicines, And just by knowing more data, are you really going to change? I think some people will and some people won’t. And, you know, finding cheap ways of really understanding what your numbers are that are continually there and it’s gonna create more data which I think will obviously have an impact. But, you know, fundamentally, we have to have motivation to change.

You’ve got to feel things that-you know, the problem is with diabetes is this: is that pre diabetes, you kind of, your sugars are actually below the level at which someone will prescribe an anti diabetic and higher like a like you know metformin or whatever. But your insulins can be much higher for years but there’s no drug for or prescription or reimbursement code for high insulin. So it’s like I’m not diabetic, I’m not diabetic. And yet, you know, and then, you suddenly become diabetic. It’s an interesting one. I I cannot wait for Near Infrared Spectroscopy and other things where we’ll be able to have something on our risk that will tell people in the know that they’re overstressed, they’re producing too much insulin, they’re producing too much cortisol, blah blah blah.

And, you know, chill out, calm down and actually somehow calculate how much years in their life they’ve just, you know, reclaimed as a result of doing that, making that difference. But there’s a vast majority of people who are even diabetic and can visibly see it every time they look in a mirror or stand on a scale and yet they still won’t change. So does continuously telling them “you’re wrong, you’ve got something wrong,” going to change them? No. There’s something else which kind of needs to be the feeling of feeling better about your life. When you see a bad number, you go and do something about it, you see the number change, you feel better, then you go and do it again.

How do you do that with something like blood pressure? How do you do that with something like blood sugar? It’s a tricky one. It’s an interesting one. It’s the behavioral question. It’s a big one. It’s one that, you know, with resistant cases, we see a lot of that here, it comes back down to coaching it comes back down to another pair of ears and eyes another another voice that you can hear that can help you coach your way into taking this more seriously and putting it as a priority in your life. Then you start seeing changes after a long time, then you think, “oh why the heck didn’t I do this before?”

Dr. Haroon Kazem: Sounds like a big part of that is like a social reward system where the patient can get some sort of validation or satisfaction from somebody else complimenting or clapping their hands or showing that hey look you’re doing the right thing. I find-

Dr. Jack Kreindler: Yeah, you’re right. You can get that from the group, you can get that from the crowd, you can get that from buddies, you can get that from, you know, coaches, you know, someone who’s physically you see every, you know, every day or week or whatever. You know, we’re humans, we’re social creatures, we like that, there is a flocking kind of mentality and and we we like to do things as teams. And there there is a huge part of that.

I’d say it’s one of the grand challenges in healthcare is getting individuals to do that more and more, as opposed to relying on massive support structures. But yeah is just simply measuring a new biomarker going to make people change? Not in my experience. Something like a watch, you know, look at my heart rate variability from my little apple Iwatch now. One of my friends found it in Pastika, the guys that do that do the wrist worn monitor that’s got FDA approval for early warning and detection of epilepsy and, you know, from a number of different biomarkers and they’re really incredible. But, you know, there are people like me out there who are quantified selfers, perhaps, more than they are kind of waiting for-.

Dr. Haroon Kazem: Things to happen?

Dr. Jack Kreindler: You know, but I think I think the grand challenge in health care is what can we do for the people that wouldn’t normally engage with it?

Dr. Sohaib Imtiaz: Yeah. So try and find this intrinsic incentivizing people and motivate them but most through the macro environment almost because I think enabling environments make a difference and if you’re walking out and you’re seeing all these processed foods, you inevitably unless you are a very strong driver to be healthy or some kind of advantage of being healthy, work related or financial objective or aesthetic. I think most people just opt for that option or the easy option. So I think yeah, you’re right. The crux of that is in behavior management. And so with with social network, social networks I think people are getting more of an awareness around health, on the positive impacts. But you’re right. You need you need that behavior coach or that social environment. Haroon?

Dr. Haroon Kazem: Sohaib, you want to just send it off? Dr. Jack, thank you for your time. I know you’re-you’ve got to get going. Would you be okay sometime down the road even coming back on so that we can continue the discussion?

Dr. Jack Kreindler: Yeah, absolutely. And maybe maybe see you guys down in November in San Diego. You should come to Exponential Medicine it’s great. You know, we always have such a great gathering of people, they’re really sort of, carving out the future of medicine and, you know, it would be lovely to see you maybe down down in sunny California.

Dr. Haroon Kazem: Yeah I’d love it. I think it’ll be a great opportunity-

Dr. Haroon Kazem: Or rainy Manchester! What about rainy Manchester?

Dr. Jack Kreindler: Very attractive choices, yeah.

Dr. Haroon Kazem: I’d love to introduce you to Royan too, since he’s here in San Diego at that time. That’d be a great opportunity to get here.

Dr. Sohaib Imtiaz: He would love to meet you. I mean, I think he would love to probably even have you on a lot of the academic calls they do as well. I mean you can have a lot of insight. But Jack, brilliant talking to you, always inspiring. I learnt a lot as always and keep doing what you’re doing. I’m glad to have you as a mentor. And we will get you back for further podcasts.