Episode 12: Molly Maloof, MD, Physician and Innovation Expert

Owaves Team Body Clock Podcast

Listen on: Apple | Google Play | Spotify | TuneIn

Dr. Molly Maloof is a practicing physician and health technologist in the Bay Area. Dr. Molly is on a mission to radically extend healthspan and maximize human potential using scientific wellness, health technology, educational media, & health optimization medicine.

Her fascination with innovation permeates her concierge medical practice that is focused on providing personalized medicine to entrepreneurs, technology executives, and investors.

Transcript

Dr. Haroon Kazem: Hey guys thanks for joining us on another episode of the body clock podcast presented by Owaves. This is Haroon. And on this episode Saheb and I get to speak to Dr. Molly Maloof M.D.. Molly is the Head of Medical Science at Santa intelligence and she is on a mission to radically extend health span and maximize human potential using scientific wellness, health technology educational media and health optimization medicine.

Molly runs a concierge medical practice that focuses on providing personalized medicine to entrepreneurs, technology, executives and investors. She is at the forefront of blood glucose monitoring and her current work with Santo intelligence focuses around that. We’re very pleased and privileged to be able to speak to Molly and we get some insight on her daily routine regarding nutrition exercise and other health habits that she recommends and practices herself.

As always please remember to download the waves app from the Apple App Store. It is the number one wellness app on the App Store and works as a great visual planner so that you can get an idea of how you are effectively spending your day. Please make sure to check us out on Instagram at Owaves.CEO or directly at our Web site at Owaves.com. Hope you enjoyed the show and thanks so much for your time. So hey Molly how are you doing?

Dr. Molly: I’m great. How are you? I’m good as well as coming off nightshift so my circadian rhythm is completely disrupted now which is ironic, being part of a team which focuses on an app which tries to optimize the cadence rhythm. But yeah we’re glad to have you on. So Molly, I first came across you actually during the year I was a business school and you were one of the kind of bright sparks kind of there’s a news article coming out of Silicon Valley.

I’m talking about Dr. Hughes focusing on kind of high performance medicine precision medicine using technology as well to kind of help optimize health. And since then I’ve got quite immersed in this space but I must say that conversation I had with you-I think it was about two years ago-was actually the start of this kind of ride, this wave in medicine and digital health that’s been occurring around the world. And you’re one of the first primary kind of doctors who is in this space. So I mean I have a lot to thank for you for what you’ve been doing because I mean definitely inspired me. So before we go in so Molly is has obviously to obviously graduate from medical school.

You’re doing residency and then you decided to go into this kind of you were kind of a trail blazer and you wanted to go into that kind of precision medicine working in Silicon Valley with tech firms and startups. And since then you’ve obviously you’ve been picked up by large media outlets. You continued experimenting on a lot of, you’ve advised a lot of startups as well. And currently you’re working for-how you pronounce it Sano intelligence or continuous glucose monitoring-which I think is very cool and the future of health. So to start off with could you tell us about your role as Santo intelligence and how was the vision?

Dr. Molly: So I am Head of Medical Science at Tonto and really my job was to make meaning of the signal of continuous glucose monitoring for the masses. So this has traditionally been a device for diabetics and diabetics but I thought a few years ago when I started using these in my practice that there was more to this.

Dr. Molly: There’s more to this story than just waiting to become sick and diseased to use this continuous monitor. Every single person would come to me with some sort of insight they’ve learned from examining their body and their body’s rhythms and a lot of them have to do with circadian rhythms.

Some people would notice that they ended up with low blood sugar in the morning. Some people noticed that when they would drink or eat heavy, heavy meals in the evening you would disrupt your sleep and you know there’s there’s a lot that I’ve learned since about circadian rhythm biology and glucose sensitivity and so a lot of people eat really late in the night and it’s really kind of a problem because you’re the least insulin sensitive in the evening. So you know I know it’s actually hard for me being up in New York or eating these meals super late.

Dr. Molly: Fortunately, I guess I’m technically still on San Francisco schedule but really it’s best for our bodies if we eat during the day and if we really try to time our our food intake with the rhythms of the life cycles and I think it makes a lot of sense that we wouldn’t necessarily be eating in the evening very large meals but because you know technically, it would make sense that you’d want the energy for your day.

I’m also just very very interested in fasting and very very interested in the effects of fasting on blood sugar management and you can really see fasting glucose go down when a person doesn’t extend it intervene fast. So I just been using this tool to optimize health and help people understand what’s going on in their bodies and program this app that we’re gonna be releasing next year and it’s been awesome. I spent the last year just becoming an expert in glucose sensing and it’s been a really really great experience.

Dr. Sohaib Imtiaz: It seems that obviously glucose monitoring has been getting a lot of attention in the media. I think Google is trying to add a lens for the eyes as well. It seems like the race is on but I mean you guys seem to be quite ahead of the curve with what you’re doing. Do you use, is it using artificial intelligence to compute all the data you’re collecting and then giving you insights?

Dr. Molly: I mean you could call it AI but right now as it stands it’s a rules based system. I don’t believe that most quote unquote AI is actually AI most all of it is just really good statistics. Yeah. Yeah. It’s really rare to see true AI anywhere just because the data sets aren’t big enough.

Dr. Molly: But yes we are using you know we are going to be collecting lots and lots and lots of data on many many people and eventually we will be able to apply AI to that data and able to predict you know different events to people’s lives as well.

Dr. Sohaib Imtiaz: So moving towards a very predictive model for people.

Dr. Molly: Yeah yeah. That will be someday, that will be someday. We’d have to get a bigger data-set. We need to develop some strategic partnerships with institutions and still have to do research. We can have everyone sign up through the app to be a part of a bigger study so that we’re gathering data early on and being able to mine that data for answers and then develop clinical trials based off of the learnings that we find.

Dr. Haroon Kazem: Molly, could you touch on what you said a second ago or about a minute ago about the extended fasting and the effect that it has on blood glucose? Because, those are very popular like key,key terms that are being search the really relevant nowadays, yeah. I practice intermittent fasting myself I kind of do like a 16 hour fast and an eight hour eating window. I never correlated the the effects of that with blood glucose. So, could you touch on that?

Dr. Molly: Oh yeah. Well first of all we’re really not designed to be eating 24/7 seven days a week, we’re really our, our genetics are still designed to fast regularly and so the fact that we’re not fasting is probably a big part of the obesity epidemic and a big part of the chronic disease epidemic because fasting legitimately reduces blood pressure, improves heart rate variability, reduces blood lipids, reduces blood sugar. Think about it really really like from a first principles perspective: what’s happening when you fast? You are literally not with food in your body.

Dr. Molly: What happens when you don’t have food in your body? Your body eats its food stores, your body takes out the garbage, your body your body this house cleaning, your body up regulates brain derived neurotrobic factor. When you fast, you do all these things in your body. Essentially, your body is in a lot of ways, slowing down the aging process and part of that is your liver typically has a role to maintain your fasting blood sugar so it generates glucose during fasting.

The problem with most people is that they’re over consuming food and they’re developing fatty liver, developing liver liver insulin resistance and because of that, the liver starts pumping out too much sugar at baseline because the sugar isn’t getting into the cells which because the cells are insulin resistant.

So the liver says “I’m not getting a signal that I’m getting enough sugar so I need to pump out more.” And when you fast, at a baseline what happens is, you essentially start lowering that liver glucose output and when you lower the liver glucose output you lower your fasting glucose. So, it’s really something that I just had an inkling that you know fasting probably lower glucose.

I didn’t learn that it actually did it until I started doing it and I started seeing my fasting glucose drop. And it went from the 90s, to 80s, to the 70s. And you know it’s really profound like just how good I feel when I do like a 24 hour fast now and I see my glucose drop and I see my ketones rise and I just, you’re doing this thing called flipping the metabolic switch, which means going from carbohydrate dominant metabolism to keto metabolism or fat metabolism and this is pretty pivotal science for extending health span if we want to reverse chronic disease and avoid getting sick.

Dr. Sohaib Imtiaz: I think that’s the goal we have on a population level as well. So. So you’re saying you can almost by measuring these values get both better over time. I mean how have you how long a period have you noticed your kind of biomarkers improve?

Dr. Molly: Okay. So, I started monitoring my biomarkers many years ago and it wasn’t until this year that I started fasting regularly. And so it was about April or May when I started doing fasting. And so from April, May, June, July, August, September it was like six months of doing occasional fasts so I was doing intermittent fasting, I was experimenting with prolonged fasts that were three days, but essentially I was, I was flipping the metabolic switch on a regular basis.

And it does change day to day. But generally speaking it’s a pretty dramatic shift and the biggest shifts in my lifestyle, were adding weight lifting and adding fasting. Muscle is a sink for glucose to go into. So you’re getting better peripheral insulin sensitivity but fasting is particularly good for improving liver insulin sensitivity.

Dr. Sohaib Imtiaz: That’s substantial. So what would you say stress effects as well? Do you feel days stressed are you-

Dr. Molly: Oh yeah. I definitely know that fasting and stress are really not great to mix together. I’ve experienced some problems with that. I did an extended fast and then I was really really stressed out. I was very busy very busy and then I ended up eating the wrong food during a re-feed, I was wearing my glucose monitor and I saw my blood sugars spike and I knew it was because I was a little bit glucose intolerant from the stress of the cortisol release.

And then on top of that when you do extended fasts you do develop a little bit of peripheral insulin sensitive insensitivity from physically it’s like physiologic insulin resistance. Your body a little bit of preservation of glucose for the brain. So you have to be really careful what you what kind of food you you add back into your body after a fast, because you really want to make sure that it’s lower in carbs and lower in-maybe higher in fiber a little bit higher in fat and protein, not any refined carbs ever because you’ll spike your blood sugar.

Dr. Sohaib Imtiaz: It’s-you worked out what foods have what effect. So from a behavior point of view has that changed your behaviors? I mean, seeing it in real time seems to really be that kind of part of the puzzle which would help people change their behavior, which often so difficult.

Dr. Molly: Yeah I definitely, definitely feel like the glucose monitoring gives us real time feedback into what’s happening in my life. You know the real time feedback from glucose monitoring can show me, in the course of a few days, of the lifestyle changes that I’m making and whether or not their best for me. And so I’ve just learned that there’s certain foods that will spike my blood sugar that I really have to avoid. And there are certain foods that I know are fine for me.

And so the more that I learned about my blood sugar the more that I learn that it’s really all about blood in my body as possible because I eat as much fiber as possible. Because fiber-this is the coolest thing about fiber-when you eat a lot of fiber your microbiome bacteria species will eat the fiber and convert the fiber which is a carbohydrate into a fatty acid.

They convert them into small chain fatty acids and these small chain fatty acids feed the mucosal lining of your gut and add a-and it literally in a direct way they improve your metabolism of glucose and lipids. So fiber is so like so powerful.

So I just try to get as much fiber as possible in my diet. It’s hard when I’m traveling for sure but when I’m at home in San Francisco I’m eating six to ten cups of vegetables a day. And I know that. And the crazy thing about fasting is that I’ve noticed that fasting has actually improved my microbiome and I have much better digestion and I have much better tolerance of foods that I typically didn’t tolerate as easily.

Dr. Haroon Kazem: Well that’s that’s pretty incredible. That’s-we’re touching on so many different hot topics I don’t know which way to go first because I was interested like how do you structure your your fast like, do you follow a set routine? Because I get a lot of my patients who are asking a lot about that nowadays and it sort of stresses them out because they think that they just can’t like eat at all and they sort of have the wrong idea in mind and so there’s a bit of confusion also with the concept of time restricted eating versus like intermittent fasting.

Are you very strict with like when you’re-are you staying with the same schedule-I guess I should ask-every day or is it sort of like you’re just taking it as is your schedule allows and trying to maintain like a window of eating and a window of just fasting? What do you do?

Dr. Molly: I’m kind of heading into the direction of three. I’m currently doing two 24 to 36 hour fasts a week but I’m probably going to head in the direction of just three 24 hour fasts a week because I find the 36 hour fast are just pretty hard to do because of sleep. The biggest issue with fasting is when you go to sleep and you’re hungry it’s just it’s harder to sleep.

So I really value sleep and I’m noticing that like the 30s-the two 36 hour fasts just aren’t working for my sleep. So I’m going to start doing three 24 hour fast instead probably and big- and frankly like with social engagements it’s a little bit easier to do that because you can eat dinner and then you know you’re just fasting til dinner the next day. It’s a little bit easier to do that than, you know, skipping dinner with friends and skipping social engagements.

Dr. Haroon Kazem: Ok. And during that one meal like is that when your your intake of these veggies occurs or is it?-

Dr. Molly: I mean on a normal day I’ll just be eating vegetables during breakfast lunch and dinner but I’ll eat like a giant salad like I can easily like X cup specials and then it gets easy.

Dr. Haroon Kazem: Oh very cool. That’s so it sounds like you’re also practicing some of the Keto diet which is another really popular thing nowadays like I’ve found it to be very effective for myself and a lot of my family members. Are you are you trying to like it is your intake including lots of like good fats lots of like rich sort of calorie dense foods when you’re also sitting down is that how you’re able to like make it the whole 24 to 36 hours without really feeling too hungry?

Dr. Molly: Yeah I’m definitely not afraid of fat at all. And a lot of my diet is fat. If you look at my chronometer you’ll see a lot of my calories coming from fat. I love nuts and seeds and avocados. And again when you eat fiber it gets converted into fat. So what’s really funny is there’s all these high carb low fat people and I like eating low fat and like actually you’re not.

Because even though you think you’re eating 10 percent of your calories from fat to keep most of your food food calories from vegetables and fruits you’re getting so much fiber that that’s actually converting into fat too. So it’s probably more like 25 percent but nobody thinks about nutrition from this first principles perspective and like I just find it really funny that everyone’s always arguing like, “what’s the a macro nutrition ratio for the for the body?”

And I think that it’s going to be different for different people at different stages in their life. Like in my 20s I can eat high carb and I was fine at the same time I used to get a lot of acne and I wonder if it was related to insulin sensitivity because there’s a lot of research coming out around acne, dairy, and refined carbohydrates and insulin and insulin is a potent stimulus for acne formation. And so people don’t realize that you know eating these diets are not helping us.

Dr. Sohaib Imtiaz: So would you advocate people figuring out what works for them through trial and error.

Dr. Molly: I mean the goal is to use data to drive decisions. This has literally been my question of how do we get personalized nutrition to the masses without breaking the bank? Because right now what I’m doing is gathering a lot of data on people’s bodies and then using that to drive decision making and we need to turn this into like an automated rules based system that can-you enter in someone’s labs and then you give them nutrition recommendations based off of the data that’s coming out.

Right now, I have to do this through a bunch of different companies but hopefully someday in the future we’ll just have better information technology we’ll be able to just very quickly get the labs, they’ll go into the system and they’ll give you your ideal diet. The best company that’s been able to do this through rules based system by the way is Biome. No offense to Biome but they-I don’t think their marketing is honest. Their marketing is about the microbiome tests that they’re doing and I, I know enough about these companies to know that there is not enough data from the microbiome to make those decisions. So I think most of their recommendations are coming from the questionnaires that you fill out with them.

Dr. Sohaib Imtiaz: Oh, cause I did get an e-mail from them and like on Instagram, I’ve seen quite a lot, they’re doing a lot of marketing. Okay.

Dr. Molly: I don’t think I don’t think that the rules come. I think there may maybe like a handful of rules  to the microbiome tests but I’m not convinced that that’s where their special sauce is. I think that they have a really great doctor working for them who’s put a lot of great rules into the system and it’s a rules based expert-rules based expert system based off of a questionnaire. What we really need is to take that kind of system combine it with blood labs and micronutrient tests and Metabolonix and show people specifically what they need to be eating.

And I do think that there are people who thrive on vegetarian, vegan diets and there are people who thrive on higher fat, higher meat diets. I just believe that at a baseline, everyone should be eating tons of vegetables. So the question is is are you going to veer more towards the higher fat lower carb end,or you’re gonna be a more towards the lower carb higher fat end, sorry the higher fat lower carb end-whatever, you get you get what I mean. The point is is that we need to figure out which direction on this spectrum people are supposed to be going and right now the best way to do that without labs is to do month long challenges.

So I, I did a keto challenge for months this year I learned a lot about fat, I learned a lot about not fearing fat, but I also learned that like oh my god my body craves vegetables so hard after that. And then I also have been doing a plant based month, this month, I did it for about two weeks. I kind of fall off but I didn’t feel dramatically better on it. I definitely felt like it inspired me to eat even more fruits and vegetables. But I was hungry all the time because of the protein question. So I just think I need to get a little bit more educated on how to eat for an ath-like how to eat like an athlete on a plant based diet.

I saw a conference, I saw a documentary at a conference called Game Changers and it was all about plant based nutrition for athletes and I was like so convinced that this could be done. But where are the resources for people, you know? Like, how are these athletes maintaining their performance on plant based nutrition? Like, what kind of proteins are they consuming? What are they eating? Like that’s what needs to be given to people if they’re going to do this.

So right now I really I really think that finding experts online and doing these challenges like another good challenge is just doing like a whole 30 which is an elimination diet. Almost everybody would benefit from an elimination diet once in their life. Whole 30 is a really easy way to do that. And then a sugar cleanse a bunch of my friends do these online sugar cleanses where you just drop all sugar for a month and these these are ways that you can tone your diet through just behavior change and just learning firsthand what happens when you when you make these shifts over short-short term periods of time.

Dr. Sohaib Imtiaz: So it seems to me a little bio hacking going on.

Dr. Molly: Yeah. But with data you can start like one of the things that I’m trying to figure out right now is how do I get blood spot testing to people so that they can do these experiments before and after these months. So they do their experiments. I think that’s how I would do things.

Dr. Sohaib Imtiaz: Actionable insights after that. So Molly, in the future, so you’re saying, would you envision something like, so say you’ve moved from you’ve you’ve traveled from San Francisco to New York, you enter a restaurant because you’ve already done kind of all these trials and you’ve tried different diets, you’ve got your biomarkers, your genome, you know what suits you. Kind of a smart based system where you open the menu and almost your decision is made easier by the data telling you which food items are in line with kind of your health. Would you envision a future like that?

Dr. Molly:  Yeah totally. Absolutely.

Dr. Sohaib Imtiaz: Okay. I mean that sounds quite exciting. It seems like you’ve got some big visions and glucose monitoring seems very central. This is glucose monitor, is it, did you wear it on your arm, is it is it quite noticeable is that easy to wear?-

Dr. Molly: A little bit. It’s just a little patch on your arm. Some people do consider the patch to look like a medical device but at the same time like we’re working on making our patch better design so it doesn’t look like that. But yeah I mean it is the way a medical device in some ways but not not-I mean, like I look at it as a lifestyle device like, it’s just giving me information about how my body’s adapting to the world around me.

Dr. Sohaib Imtiaz: So it’s consumer-will be consumer friendly and because we’ve got a lot of these lot of gadgets or a ring which is a good device for sleep. Whilst weight lifting it’s difficult to wear there’s certain, obviously it can be a few problems with wearables but ultimately it’s not that reward you’re getting from kind of living a healthier life vs. the aesthetics of it. So moving on swiftly, could you tell us about your journey into this into the whole space kind of what you’re doing in Silicon Valley and then how you how-I mean you left residency-I’m excited to know more.

Dr. Molly: I sure did. I mean I basically didn’t enjoy working in the hospital and some of my attendings were really unhealthy and one of them had all of these lymph nodes popping out of her arms. I remember thinking to myself, “these people are not thriving and I don’t want their job. And what if I could just have a practice that made people healthier and not just fix sickness and fix symptoms?”

And so I met some doctors who became my mentors and they taught me how to optimize health. And it really came from a data driven approach. So fundamentally I just really believe that this is what the future is going to hold for everyone. And it’s just a matter of better technology and better distribution of this technology to people so that they can, you know, have the tools they need to make better choices. And also like there’s no reason why we shouldn’t be prescribing food as medicine.

We’re doing a study with Thistle Juice in January where we’re measuring a person’s blood sugar over time with a food intervention over the course of a week to see specifically how it affects their blood sugar to go from a standard American diet to a whole foods plant based diet. And I just believe that we’re gonna be able to see some changes in people’s health in the short term and if that’s true then why wouldn’t we show people how to eat differently by giving them a food prescription and showing them how to make the foods and just teaching people a lot more about how food affects their body in their blood sugar?

Dr. Sohaib Imtiaz: And there’s a lot more value that can be derived from that for people. I mean there are a crazy amount of parallels here because Royan, the founder of Owaves, he had a similar awakening to you where doctors were kind of some of the unhealthiest people around and it’s like reaching one thing yet you’re not practicing it. So where’s the authenticity? How can you expect your patient to follow this kind of optimized lifestyle when your limited to what you don’t do.

I mean I think we’re part of the same kind of vision and that same kind of thinking and healthcare does need to change. So that’s quite revealing actually and touching upon Silicon Valley is a very exciting space. So you’re still working on this population level but then you’ve also worked kind of this human performance using nootropics and helping founders you know have more energy, work to that potential because Silicon Valley is a very cutthroat place. So you were kind of right in the cutting edge of things. What did you see, were people using these ideas-were they using validated ideas or people just trial and error?

Dr. Molly: There’s a lot of people are doing self experimentation. And so I think having a doctor who they can work with, who can help run these experiments is really really helpful. So that’s part of the reason why I’ve been, I guess, successful in Silicon Valley is because there’s certainly a market for it.

Dr. Sohaib Imtiaz: Yeah definitely. And you’ve, I mean, you’ve got you’re actually the first female we’ve had as a guest. So um, yeah. So we were we’re waiting for a strong female voice as well. I mean we’ve had an amazing one here. You seem a bit of a rebel as well. Was that correct to say? Going against the greats?

Dr. Molly: Oh yeah. I mean, yeah like there’s there’s been doctors in antiquity who were essentially doctors to, you know, kings like, the king of Persia or Marcus Galen for example. And, you know, most doctors thought that they were crazy and they didn’t really like them. But, you know, Galen basically completely transformed the lives of gladiators and saved a lot of lives by innovating in surgery and figuring out how to keep people’s wounds from becoming infected. And so there was a lot of, sometimes you have to work outside the system to innovate.

Dr. Sohaib Imtiaz: Yeah the system is very against innovation.

Dr. Haroon Kazem: Speaking of innovation, Molly are you able to touch on the technology itself of the patch? Because I know like a big issue with like glucose monitoring is patients having to prick their skin and there’s been other attempts with like infrared and so I mentioned Google had those contact lenses that would measure glucose. Are you able to touch on how your your device sort of does the same thing or?

Dr. Molly: Um, so I mean, like there’s a lot of different CGMs out there right now. I’m very much hoping that Google can do this contact lens because frankly like I just want someone to make minimally and like non-invasive glucose monitoring, like it’s so valuable. I also am really good at just predicting my own blood sugar by just feeling my body now, like I’ve done so many iterative cycles of like checking my blood sugar that like I know what seventy five feels like and I know what 105 feels like and I know 140 feels like.

And you know, it’s fascinating. The more you learn about your body and the more you want more information from it. So I’m I’m like fascinated by all the people that are trying to do this. But again it’s a really really really hard problem and accuracy is incredibly challenging.

Dr. Haroon Kazem: Yeah, I can imagine because it seems like it would have to be invasive to a certain extent. So just to be able to you know get access to somebody’s blood. But if you’re if you’re able to do it I mean I’m sure you know millions if not billions of people would be pretty happy out there but I know that another challenges like getting FDA approval for something like that is is that so that you know just any regular you know medical doctor provider could just prescribe it and have it be covered through insurance or is that a safety thing? Like why exactly does the FDA need to be involved for something like this when it whereas I described that it seems like a lifestyle device? So.

Dr. Molly: I mean that’s what I tried to communicate in this paper I wrote them but basically they want to make sure we’re not hurt-harming people and we actually don’t cause people to be afraid of you know the data coming from their body I.D. that we don’t want to mislead people by giving them the wrong data. So you know accuracy accuracy really matters to people to prove that. And then we have to basically show that we’re not, we’re not diagnosing or treating illness because that’s practicing medicine. So we have to be kind of careful.

Dr. Haroon Kazem: That makes sense. So it sounds like it would be a great way to like implement the device if you’re dealing with patients with you know that already have you know diabetes whether it be like mild, moderate, severe, or whatever it may be and sort of like implementing it as they’re getting regular treatment from their primary care docs and seeing how if that improves make things or makes them worse.

It sounds like objective quantitative data again would be very important for this type of thing just in terms of efficacy which is awesome because, ideal in a world where there’s a lot of subjective and I always preach objective and so it’s it’s something that it’s pleasing to see that that’s that’s hopefully going to be down the road. Yeah I feel like there’s it’s difficult to prove things to people without numbers, right?

Dr. Molly: Yeah I mean I, I wrote this like 30 page non double spaced paper from the FDA we’ve cut it down a bit. But I mean I think I can paint a pretty compelling argument that the world should have this kind of information.

Dr. Haroon Kazem: That’s pretty awesome.  So, could you please describe for us like just a day in your in your normal workflow because a big part of what we do it Owaves is to sort of let our users have like a visual representation of how they’re spending their time and so nowadays with you know so many people trying out these unique ways of dieting and fasting it’s sort of had everybody have to readjust their schedules. There’s no longer like time being put in a lot of times for like three square meals and that type of thing like how how would you describe like a regular day for you when you get out of bed?

Dr. Molly: Um, I get out of bed and generally speaking I like to either meditate a little bit or go downstairs grab the paper and then come upstairs and have some coffee and read the paper and then usually I’ll do a workout where it’s like weight lifting and then I’ll get ready for the day. I usually start calls around 8:00 a.m. and depending on the day I’ll go to work at Sana or I’ll work for myself and with patients either going to see patients or doing calls with patients and then around 4:30 p.m.

I guess around like you know if I’m if I’m fasting then I will eat till the evening but if I’m not fasting then I will eat a little bit of breakfast a little bit of lunch I usually a big salad for lunch and then something smaller for dinner whatever I do for dinner is usually what I eat for lunch. That’s just like a small portion. And then I usually do yoga around 4:30 or 6 p.m.-Ashtanga yoga. And then depending on how busy of a month it is, I’ll either get a little bit more work done in the evening or I’ll go hang out with friends or I’ll go like have another meeting I’ll have a meeting over tea after after yoga. But generally speaking I do like to keep my evenings sort of for self care and definitely try to get some more meditation in and you know just go to bed early. That’s my that’s my favorite kind of day.

Dr. Sohaib Imtiaz: Being such a high performing individual seems like you get the balance very correct has that taken you years to find out or have you always been like this?

Dr. Molly: You know I just learned, I learned in medical school that I could basically improve my performance by working smarter not harder. So by taking really good care of myself, like the more I meditate the better my work is and the less anxiety I have around all the work that I have to do and the less I obsess about email and the more that I’m just like diligent about it, the better things go.

I have to say I do have like a routine notebook that I haven’t told you about but in the morning around breakfast I’ll go through my daily routine and it has a bunch of different check boxes of things that I like to do every day that are usually around mindfulness and mindfulness practices, gratitude practices, re-framing practices, planning my day, checking off today. I check off if I got, you know, 9 cups of vegetables, I check off if I got my seaweed, I check off if I got fermented foods, I check off how many ounces of protein that I ate, my water intake. Did I take my supplements? Did I check in with someone in my family? Did I do something kind for someone? Did I check in with my long term goals like, I do a lot of daily routine habits that really add up over time to just better performance.

Dr. Sohaib Imtiaz: So you’ve kind of been using Owaves the paper form. That’s what we tried to achieve it Owaves. That whole balance of kind of socializing, nutrition, exercise, mindfulness, putting it all together, sleep. Yeah, and you’re checking it often. Owaves is where the objective is is. So it tells you how much hours in a week you’re spending and each kind of zone and helps you kind of improve on all defectors or compensate slightly. So I mean you’ve been doing that already. We’ve got to like just end up with with great you x. So  I think you would enjoy using the Owaves app from when we’ve got the full vision.

Dr. Molly: Totally. I’m gonna test it out.

Dr. Sohaib Imtiaz: Yeah that’d be great to get some feedback. I’m sure Royan will be really happy as well. And so this question I’m going to ask because I was very curious have you tried the ketone esta and have you done it while measuring your glucose and ketones?

Dr. Molly: Yeah totally.

Dr. Sohaib Imtiaz:  What were the effects?

Dr. Molly: The ketone, like, I drank a bottle of ketone ouster when I was fasting and it was like really dramatic how much I could feel the energy going into my cells like I could. I could literally just feel my cells like from my feet going up to my head like literally I could feel them coming along. It was kind of nuts.

Then. I you know I’ve noticed that it does drop your blood sugar pretty quickly. When you when you take it. But it also, you know, like I think it makes fasting slightly more difficult. Is it like a food. It’s like a calorie. So generally speaking fasting is a little bit easier if you just don’t eat anything but it’s really hard to learn how to do that takes a lot of practice and time.

Dr. Sohaib Imtiaz: A lot of a lot of commitment and discipline but I mean these are all good skills we learn as humans. Yeah I guess you become great. Yeah. More self-restraint more you become stronger and I mean the effects. It seems like you said your moods improved your performance improved you have more energy and and just for some of our female listeners are there any kind of tips?

So, a lot of these principles that exist in the media today, they may be more favorable or applicable to males because obviously females have quite a few endocrinology changes throughout the month etc. and you’re you’re quite well read in that so females obviously look into certain things before trying these kind of fasting and diets and exercise routines?

Dr. Molly: Yeah. You have to be really careful with your hormones because I always say this whenever people ask. Your body you will prioritize survival over reproduction and so if you are putting your body under stress and when your body is sent a signal that you are in a famine which is what not eating is then it’s going to prioritize getting you food and finding food which makes you frightened. Frankly it makes me quite not I wouldn’t say aggressive but it makes me more assertive.

It definitely makes me feel a little bit more like alert and if you’re not careful you can stop your period. So really really important for women to monitor their periods as they fast. And you combine Keto dieting with fasting then you gotta be extra careful because you’re you’re sending two signals to your body that you’re in a famine so it’s really really good for women who are insulin resistant like polycystic ovarian disorder but not so great if you have normal insulin sensitivity. So you got to be really careful with your body.

Dr. Sohaib Imtiaz: That’s really important for people and I’m glad you kind of told that message so clearly because on social media it’s easy you know with influencers these days who don’t have a medical background, it’s easy to be misled. So thanks. Thanks for sharing that. And Haroon, any other questions?

Dr. Haroon Kazem: Molly maybe you could touch on this but on that same thread, how how would you say like these types of specialty diets or fasting programs that pertain to like children-since childhood obesity is still a very real thing especially like in the United States-would that be like an interventional sort of method that could be used or would you say that would even be healthy for like a child who’s still growing and developing?

Dr. Molly: Can you give me an example?

Dr. Haroon Kazem: I mean for instance like let’s say like a middle school aged child that’s clearly you know eating too much sugar probably you know displaying lots of signs of like you know weight gain and maybe like less activity would it be wise to put like a person of that age like on a ketogenic diet for instance with like a fasting regimen as well?

Dr. Molly: You know I.

Dr. Haroon Kazem: It’s a very broad question, I know.

Dr. Molly: First thing that I would do in a case like that is not ketogenic dieting is real whole foods, getting a kid off of all the sugar off all the processed foods that so many parents are shoving in their kids mouths to keep them quiet because they don’t know how to discipline and they don’t know how to teach a child how to self soothe. I’m really frustrated with the way that parenting is done in our country because I just see this time and time again where parents are using food as a way to pacify children and it’s causing obesity and snacking is causing obesity. Snacking is causing insulin resistance. Feeding children snacks constantly is unnecessary and we have to change our culture around this.

Dr. Haroon Kazem: Yeah. I totally agree 100 percent, I feel like it’s a very it’s a it’s a mode that we’ve developed as a result of the culture itself. Like you just said and I think a big part of it is like the types of foods that are made available to them and also the types that you kind of see right when you walk into the grocery store because I I’ve I’m very happy that you’ve said all these things about the positive impacts because I’ve noticed a lot of those for myself and it’s for me, one hundred percent, I feel like sugar is the enemy. Do you do you take time to partake in any sweet treats or anything like that at all anymore. You kind of.

Dr. Molly: Yeah I mean I make my own chocolate and I use really high quality ceremonial cacao from Colombia and I’ll use a very very small amount of coconut sugar like a tablespoon and then I’ll also use dates to-like I will make like delicious things like I make these date caramel-basically like you I use dates I’m a little bit of almond butter and you can make like a caramel out of it. And so it’s like you know plant based and then with the chocolate all use like I’ll make it basically like more than 90 percent dark chocolate.

So it’s sweet from the dates and there’s a tiny bit of coconut sugar in it but it’s actually in comparison to what you typically would buy, it’s not nearly as sweet as something to buy like at Walgreens or something. But at least some nourishing some nourishment and value out of it. I’ll make these turtles with broken nuts and sacha enchee, so you get some benefits from there as well. So like I do make really really really really tasty things but I’ll share them with friends. We’re going to bring them to a dinner party.

Dr. Haroon Kazem: Very cool. Is that stuff that you kind of put on your blog which I forgot we should have mentioned.

Dr. Molly: I really honestly should. I haven’t but I need to start posting recipes.

Dr. Haroon Kazem: Yeah. Because you just made me hungry right now so.

Dr. Molly: They’re really tasty.

Dr. Sohaib Imtiaz: And is there any way where before so do it just the effects of on your glucose before having a meal and exercising with 10 or 15 minutes going for a walk or a jog or would it be better to do that post meal?

Dr. Molly: Well I generally recommend post meal, but at the same time like if you’ve just worked out and you have you know like just lifting weights for some for some reason like you want to get some protein in your body within within a reasonable amount of time just start repairing the tears that you’ve created.

Dr. Haroon Kazem: On that note Molly it’s become sort of like a fad especially since I’m also like I’m big on weight training it’s like one of my my passions really is like getting in the gym. I’ve been hearing more and more-and a lot of this is probably bro science really is probably how it’s coming about-that it’s a good thing to sort of have like a a glucose sort of like a binge right after you workout within the 30 minutes after. I know a lot of people who eat candy even, and skittles, and horrible things like that.

Dr. Molly: What they’re trying to do is they’re trying to manipulate the insulin response for growth. You know I’ve seen this but frankly like I don’t think it’s that healthy. I think to be way better off just eating a protein containing meal post exercise with about 20, 20 to 30 grams of total protein. So you’re getting about like 10 grams of essential amino acids and then eat it with a little bit of carbohydrate. Like, you don’t need to spike your insulin crazy. Insulin resistance is not uncommon in the athletes.

And I just I don’t think there’s really any role for candy in an athlete an athlete’s regimen, period. And I’m really frustrated with the cycling Candy that people eat because I’ve seen really unhealthy cyclists who are lean but they have visceral fat and it’s they’re pumping the goose and the gels and the comings and it’s just not necessary. It’s completely unnecessary.

Dr. Haroon Kazem: Well I did not-I wasn’t aware of that. So the visceral fat that sort of like fatty tissue just accumulates over time. Is there any kind of like studies or research on anything like that and long term effects? Cause that’s very interesting. I know a lot of people who do that and it’s a very normal thing.

Dr. Molly: Visceral fat is a big problem for people especially it’s so great there’s a great blog post on this guy’s web site called Clues and Props about this cyclist who was found to have a good amount of visceral fat. And so he went on a keto diet and dramatically-you know, he was a triathelete-dramatically improve his performance because he was able to burn off all that metabolic toxic fat surrounding his organs.

And this is part of the value of flipping the metabolic switch is you’re burning off that toxic fat as you tap into ketosis your body will literally find fat to burn and it actually-what’s really cool about fasting this is kind of going to blow your mind is you brown your white fat your literally turn your white that into brown fat like this has been shown in research of animals and humans. So it’s like you get actually more mitochondria in your fat to burn it so that you can use your own fat as fuel.

Dr. Haroon Kazem: Hmm, that’s very cool.

Dr. Molly: Yeah. It’s like oh this is just first principles metabolism. Nobody pays attention to it because it’s wrong to follow fads and like the keto diet is absolutely ridiculous in most cases because in no way shape or form did people have fat bombs in paleolithic times, okay?

Dr. Haroon Kazem:  The physiology hasn’t changed.

I’m sorry. just hasn’t that’s not that’s not that’s not real. So we need to like turn to ketosis through fasting and through limiting carbs and less so from eating fat bombs all day long.

Dr. Sohaib Imtiaz: We’ve had a very deep discussion on physiology and I’m very taken aback by how much there is to the whole process. And you know, how small changes or incremental changes can lead to such big changes and transform your life. So moving on to technology. Just final thing. Are there companies in Silicon Valley working in the kind of wellness space or any upcoming technologies that you’re aware of or you think in the next two three years will be pivotal-apart from obviously continuous glucose monitoring, or that you’re excited to see?

Dr. Molly: Yeah. I’m excited that heart rate variability is becoming more mainstream. I’ve got about five different products in my home to test.

Dr. Sohaib Imtiaz: Yeah I’ve been using that app.

Really. I’m really a big believer that when we have real time stress and blood sugar monitoring, we’ll be able to have a lot more control over our reaction to the way that we live and you’ll be able to know, “oh I’m stressed out.That’s why I’m craving carbs. I should probably not go do-I probably shouldn’t go binge on a bunch of carbs right now.”

Dr. Sohaib Imtiaz: It’s the worst for you exactly. I mean all my night shifts I’ve been measuring my heart rate variability recently and it’s a lot worse than my day shift and obviously because my circadian rhythm is completely disrupted and obviously the pager goes off that bleep sound I’m sure-this needs to be studies done with the cortisol release-but yeah it helps me figure out more why I need to adjust in stressful situations. So your heart rate variability being the big one but chest straps I think are the biggest limiting factor. Have you got wearables that you can use to measure from your wrist or-?

Dr. Molly: Yeah I mean I’m experimenting with the Oura Ring and I think the Apple Watch will eventually get there.

I mean they’ve done they’ve done EKGs now so Apple is working strongly to get ahead of the puck in this space.

Dr. Molly: Yeah.

Dr. Sohaib Imtiaz: Okay. I mean it was an amazing talking to Molly. We’ve learned so much about a range of topics from the microbiome, metabolics, physiology, you know startups, what it’s like living such in such conditions it’s kind of you know human performance, and having to kind of balance your life whilst working with these exciting startups and companies and it seems like you have a lot of big goals ahead and wish you the best and most importantly so good having a female voice on isn’t it our own we’ve been missing.

Dr. Haroon Kazem: Oh  my gosh, it’s so refreshing.

Dr. Molly: Awesome!

Dr. Sohaib Imtiaz: So let’s see someone so powerful as well you know with such strong kind of big knowledge base, wide, broad depth of knowledge and you know powerful voice great great episode and I think a lot of listeners will be very interested probably to have you back on the show because of the range we’ve covered. I don’t think we’ve covered such breadth before.

Dr. Haroon Kazem: We could, I could have gone on for hours. I’ve been limiting my voice.

Dr. Sohaib Imtiaz: Yeah I mean on every target you’ve got so much information to provide because normally our podcasts end up being on a single topic.

Dr. Molly: Yeah I mean I get this a lot weirdly like this is what people keep telling me and I’m like, “well I don’t know why I seem to know so many random things,” but I think that blood sugar is like this gateway into understanding metabolism and if we can all just get our blood sugar healthier and strong and like more resilient to the world around us by the way that we manage our stress, the way that we eat our food, the way that we manage our circadian rhythms, in the way we exercise and sleep like we’re all gonna be living to 100. But really like focus on your blood sugar as a first place to start and everything downstream improves.

Dr. Sohaib Imtiaz: So guys listen to Dr. Molly.

Dr. Haroon Kazem: Yeah. You heard it there.

Dr. Sohaib Imtiaz: Great advice. Glucose, glucose, glucose and-

Dr. Haroon Kazem: Don’t eat it monitor it.

Dr. Molly: Yeah yeah exactly.

Dr. Sohaib Imtiaz: Yeah. Data tracking, weightlifting, and veggies.

Dr. Molly: Totally.

Dr. Haroon Kazem: Molly thank you so much again. We really appreciate your time.

Dr. Molly: Thank you so much I really appreciate you guys.

Dr. Haroon Kazem: Hopefully have you back on in the future.

Dr. Molly: I can do it. Totally.

Dr. Haroon Kazem: Awesome. Thank you guys. So I you want to-.

Dr. Sohaib Imtiaz: A great great podcast.

Dr. Molly: Bye guys.

Dr. Haroon Kazem: Bye Molly, have a good rest your day.