# Transcript - Augmented Wellness 004: Dr. Rabin Rahmani

_Timestamps are aligned to the final published master. Lightly cleaned to remove production resets, excluded claims, and failed demo sections._

[00:58] **Demian:** Welcome.

[00:58] **Dr. Rabin Rahmani:** Thank you. Thank you. As am I, Thank you for having me. Great to have a good reason to visit Miami. Yeah.

[01:05] **Demian:** And obviously, Full disclosure, you recently became an investor in Betterness, which we're very proud of and we're very excited about what we could do up north, a new market for us. So let's let's go all the way to the beginning, right? You know, Iran, obviously it's in the news. Sure, it's a lot going on there. You know, you grew up there. You grew up there in a, you know, difficult time. Tell us a little bit about that. And, you know, obviously we'll get into how that shaped you. But what was it like growing up there, and at what age did you leave?

[01:43] **Dr. Rabin Rahmani:** So I was there till I was 9 and then it took about a year or so to get to the US You know, obviously you, you aren't able as a Iranian Jew to leave so freely. I remember at the time there was definitely a lot of trials and tribulations just to be able to get out. At one point, you know, I had to actually go for an interview where, you know, the pretext, which was a known pretext by the government, but this is basically how you were able to get out, is that I had to go for some, you know, treatments in Austria. And, you know, almost had to be trained as an 8 year old, you know, to do a official government interview. And then, you know, you got that stamp of approval and, and, you know, you get out and, you know, you see on the news, as you mentioned, that people can't fully fathom what it's like and what it does to you to shape your personality and, and your future, You know, having no electricity or having scud missiles going overhead, you know, almost on a daily basis at that time, it was direct, you know, Iran war.

[02:51] **Dr. Rabin Rahmani:** And, you know, especially for, for, for Jewish people, it was a very precarious time to be there. And, you know, those formative years definitely shape what kind of person you become. It's something that my kids make fun of because to this day, when I hear a loud noise, sometimes I jump, you know, involuntarily because you, you know, you're almost wired to think that something bad is happening When, when, when you hear that. But at the same time, it really builds character because when you see what your family goes through in order to provide a future for their children, success is not an option. Success, you know, at least trying for success has to be almost ingrained in you. And you know, it was also something that really shaped me into wanting to make something better of myself, but also doing something to make the world a better place, right? We keep coming back to this word better every time I speak to you. And I think that's something that really gets ingrained to you from from a, from a young age when, when you see your family go through that.

[03:56] **Demian:** Yeah, yeah. And myself, I came, I came to this country around that age too. And and obviously, you know, different hardships, but yeah, it definitely focuses you and as a father as well, you know how to ingrain that in our kids. It's very important. So, so you came here at that age 910 went to well, you came to New York.

[04:21] **Dr. Rabin Rahmani:** Yeah, Yeah. So we moved to to Long Island. We already had some family here. That was another part of the the, you know, experience, which was interesting. You know, it's the immigrant experience, I guess for all of us is that, you know, family members came a little bit at a time. You know, my, my father was one of 12 and all the brothers and sisters left Iran at different times. I remember at one point, you know, this was a couple years after we got here, the last uncle came and he hadn't seen his brother for almost 30 years. And the first time they met each other was actually, you know, in the public setting and, and just the emotion, you know, you can't imagine that it's things that we don't really think about. You know, it's something that that you try to pass on to your children, but it can't be explained. It has to be experienced. Yeah. And, you know, basically we moved to Long Island. You know, I, I, I started in a, in a, in a Jewish school. That was another part of the experience, which was very interesting, is just the freedom to be able to learn about your Judaism, you know, something that that we didn't have before the same extent. And then, you know, little by little, you know, obviously you assimilate into the society. You know, learning the language by itself is is something that people can't fully imagine. You know, it takes time. And, you know, fortunately, you know, I came young enough where I was able to learn it, you know, pretty quickly. But, you know, probably to this day, there's still certain words that I say, you know, that that aren't exactly the way that a New York would, a New Yorker would say it. And, you know, I grew up from high school, you know, spent some time in some time abroad in Israel and college, pre Med medical school. And then that basically, you know, let me on my path to becoming a, becoming a physician, a gastroenterologist.

[06:05] **Demian:** And and so, So what? When when did you decide that you you wanted to take that path?

[06:12] **Dr. Rabin Rahmani:** There's probably sometime during college, you know, I was exploring different options. You know, obviously, again, part of the, the mentality is that being in Healthcare is considered kind of a very, you know, noble profession and something that that my parents definitely encouraged. But I think, I think basically when I got to college, you know, just kind of thinking about the different options, it seemed to be one of those, those those options that would provide, you know, a very fulfilling career and also allowed me to to help people, you know, allow me to hopefully support my family, which which is very important to me.

[06:51] **Dr. Rabin Rahmani:** And, you know, it, it kind of just went one step after, after the next. And before I knew it, I was taking my Mcats and starting at Einstein Medical School. And then, you know, you look back and you know, 25 years has gotten by and you know, here we are.

[07:07] **Demian:** Yeah, yeah. And the and the specialty gastro is is reason.

[07:12] **Dr. Rabin Rahmani:** So I, I wanted to do something where it would be procedural based. I wanted to do something where, you know, you could kind of see the fruit of your labor, you know, a little bit more quickly. You know, a lot of things in medicine kind of have the ability to help people, but it takes time. And that's, that's fine. You know, the long term, long term, you know, Healthcare is obviously a very important part of healthcare. But gastro was kind of, to me in that interface where it's almost like a surgical procedure, you know, procedurally oriented field where you're doing a lot of things with your hands, you're working with technology. You know, over the years I had, I had a lot of opportunity to kind of test out new technology that was coming on the market because of my, because of my, my research background. By the same time, it's, it's medicine, You know, you're, you're seeing people, you know, through different chronic conditions and, and it's not one and done. So you almost have like the best of of both worlds.

[08:15] **Demian:** Yeah, I remember well as I was doing research with my agents that were research, doing research on you that they had a quote about from you I think from a decade ago that you said that you, you chose it because you like to work with your brain in your hands. It found that. So yeah, I, I saw it somewhere. So, so, yeah. So today you're you're in Gastroenterology Associates in Brooklyn and, and the Brooklyn Endoscopy Center. What is it to build a practice? You know, you know, obviously, you know, we talked a lot about this because in in betterness, our goal, as you said, is to help people live a better life. And obviously the doctors are a big part of that equation. We also work with many others. But you know what? Take me to like building a business as a doctor, I mean.

[09:08] **Dr. Rabin Rahmani:** It's, it's a tough Rd. you know, you don't really learn how to be an entrepreneur as, as a medical student or even afterwards. And these are kind of things that you have to figure out on your own. And there's a lot of pitfalls. And there's a lot of times where you know, you're, you're almost, you know, humiliated by, by what you're facing. You know, when we started, I was fortunate enough to, you know, be together with some of my Co fellows. And, you know, we had kind of tried joining another practice, you know, with the with the vision of of someday kind of growing together. And as time went on, you know, we realized that that it would probably be best if we went on our own, which was at that time already a very, you know, difficult decision because I had kids already. You know, it's kind of already a little bit established in the in the first practice. But we, you know, we believe in ourselves and we thought that we could build something bigger together. And you know, at the time, all my friends actually, except for my friend Brian that, you know, everyone thought it was crazy and, and they thought that I was just basically, you know, I should take the safe, safe route, which was staying where, where I was. I had a relationship with them.

[10:21] **Demian:** Let's double click on that a little bit because you know, obviously as an entrepreneur, everybody thinks you're crazy. Obviously I come from the, the tech world, which, you know, you try to build something that nobody sees. What, what is it that is crazy about? You know, so you know, as a doctor that you, you, you were in a safe, I guess, environment practice, You know, what are the risks? You know, how do you how do you measure risk or, or?

[10:43] **Dr. Rabin Rahmani:** How do you, well, I mean, the, the first part of it is obviously building a practice, you know, so when you're starting a new, you're starting a new, new practice, you have to get the word out. And even if you're known a little bit in the community, you know, I had a little bit of a presence because of my, my, my academic background, but you still are starting fresh and you never know how, how that's going to pan out and how long it's going to take. The second part of it is just, you know, financially, you need a place to, you know, to do your procedures. And, you know, obviously a big part of the financial burden is, is the procedures, but also as a, as, as an entrepreneur, that's, that's how you could capitalize, you know, and, and try to, to kind of capture all the different things that that are being, that are being brought to the table because of your work.

[11:34] **Dr. Rabin Rahmani:** And that's very challenging. I mean, you know, at the, at the time, you know, the, we were all pretty young and, you know, I'll, I'll never remember, I'll never forget our first kind of interview when we went to a surgery center to try to obtain something to call shares, right. When we go to a surgery center, basically they, they give you or they sell shares. And the four of us went and met with, you know, kind of one of the, one of the principals and they, you know, they had kind of reviewed our, our work and they knew us. And he, basically the person, you know, the doctor at the time offered us 8 shares. And, you know, initially we thought that he was offering 8 shares to each of us. So we're like, oh, that's not bad. Lo and behold, he meant 8 shares for all of us, all four of us. And we're like, you know, we know we're young. We know they were coming in as a, as a, as a secondary kind of of partner, but that seems very low. And I'll never forget, you know, the guy was holding a newspaper and he stands up and he slams the newspaper on the on the table and says, I'm not giving a bunch of kids more than 8 shares. This is ridiculous. And he storms out. And you'll keep in mind, this is after we had all gone through college, medical school, residency, fellowship stuff, fellowship, couple years already working as a, as an attending. And to see that scene, you know, obviously, you know, is, is, is kind of very challenging at the time. And we could have folded at that point, but we didn't. And what we decided to do was basically go to A, to a center at the time, which wasn't doing so great, you know, and, and we basically emptied our bank account to, to, to get some shares. And thank God we built it up. And that center ended up doing a lot better than the one that, that wanted, wanted to give us to 8 shares. And overtime we're able to parlay that into what's now, you know, thank God, the biggest practice in Brooklyn and one of the biggest in New York. We have 4 different centers now, you know, with different surgery centers and, and office space, endoscopy and things like that. So it was really just believing in yourself, believing in, in wanting to be better, believing in, in your partners, believing in, in, you know, the, the world and believing in God. And I'm putting that together and, and going for it. And of course, having a very supportive family and supportive friends that say, you know, you could do this.

[13:50] **Demian:** So, So what? What is, you know, large practice? You know dimensions? How do you measure number of patients? You have 4 locations.

[14:00] **Dr. Rabin Rahmani:** Yeah, I mean locations, the number of doctors, the number of patients, you know, those are all different things, you know, number of staff, you know, at this point, I think, I think, you know, we have overall between the different locations, you know, almost almost 250 staff members. So, you know, there's a lot of moving parts. And you have to keep in mind that your, your, your main goal still is to be a doctor. You know, and I think one of the things that really got me excited about AI and, you know, obviously, having spoken to you guys over the over the past few months, is if we could do something to facilitate taking care of all the non clinical parts that we have to deal with on a daily basis as doctors would make us better doctors would give us more time, you know, to spend with patients, which is obviously why you become a doctor.

[14:46] **Dr. Rabin Rahmani:** And it would be better for the patients, which is ultimately the most important thing, right? Because now instead of, you know, us having to do all those kind of, you know, what you call menial tasks as as a non doctor, right, as as other part of your job, which, which is very time consuming. We're really focused on on being caught up with all the all the evidence based medicine. You know, AI obviously could help you with that as well-being able to focus on your patients, being able to spend more time with your patients. So it's it's really very exciting.

[15:14] **Demian:** How do you see that as, you know, I mean, part of, of your serve role that you have to have today, you know, and you know, and it has to be a doctor, the one that speaks. It can't really be, you know, the, the, the, the staff. So how do you manage that? How has it changed? Do you see it changing in your day today?

[15:34] **Dr. Rabin Rahmani:** Yeah, absolutely. I mean, look, a doctor ultimately is an educator, right? You know, that's, that's what your job is when it comes to consultation. You're trying to educate your patients, you're trying to educate hopefully the next generation. And the the easier that you could do that, the better you're making the world. And and I always strong strongly believed in getting the word out. You know, some there are situations that have witnessed where people were very protective of their knowledge, which is which is strange to me because again, we all learnt it from the people that came before us, from our mentors. And you want to pass that on. So, you know, traditionally the way we did that was conferences, you know, educational forms like dinners where we get together and try to discuss things. You know, obviously, you know, you've heard of rounds, you know, on, on, on TV when you watch doctor shows, you know, making rounds or grand rounds, but it's very limited in terms of what are you able to actually do to get the word out. So social media is such a powerful tool to be able to educate, you know, the masses. You know, obviously it comes with some dangers. You have to make sure that you're doing it the right way, that you're not getting false information out there and that that's being monitored. But maximizing that has always been a very important goal of our practice. We actually have a doctor whose who's sole job, who sole focuses on that. Obviously we've worked with different, you know, social media companies and to be honest with you, it's always left a lot to be desired because, you know, there seems to always be a lot of things lost in translation. So I think the most effective way of doing it is if you could facilitate the doctor himself or the provider doesn't even have to be the doctor. You know, we have, we have a physician's assistants and we have, you know, nurse practitioners being able to communicate directly to the patients. I mean, that's a very powerful thing that, you know, we've been working on. But it's very, very exciting to see how that's going to exponentially grow over the next next short time.

[17:37] **Demian:** Yeah. And obviously, you know, we play a little bit with agents that could even, you know, not only be, you know, guardrail and harness around the knowledge of a doctor, but even have a doctor's voice, which obviously within the context of that, of that, of that relationship. Now, obviously they always need to talk to the doctor when they need to, but sometimes, you know, just having the doctor be accessible to answer some, some, some things through an, an agent could be an interesting way to, to connect to, to the, to the patients. So let's talk a little bit more now about sort of, you know, your specialty, right, where I showed you my colonoscopy before, you know, colon and stomach, you know what, you know what, how, how have things change in that space, right?

[18:29] **Demian:** I mean, obviously, you know, in some of the earlier conversations we had, you know, blood work today is very available. A lot of people are doing blood work. But you know, I saw from 10-15 years ago you were talking about colonoscopy, the importance of catching things early. What, what, what, what is the status of of of that you know that testing modality today?

[18:55] **Dr. Rabin Rahmani:** Yeah, man, I think one of the very exciting things about about our field is there's constantly new technology that's that's evolving and that's being developed. You know, I'll never forget, you know, one of my favorite stories is, is I used to do a lot of what's called advanced endoscopy and we used to do the procedure which was called a pancreatic systo gastrostomy. So basically what what that meant was if somebody would come in with a big collection in the pancreas, which is a very difficult-to-reach organ and we wanted to non surgically drain or get rid of that, that that collection. It would take us hours, you know, And, you know, I remember the first time I was told that there was a new technology that came on the market where you could basically do the same thing and it would take about 8 minutes. So I remember what year was this? This was probably about 10 years ago. Yeah. So it's about 10 years ago. I remember they, they actually, I was at a conference at the time. They, they took me through like a maze with like bodyguards staying there to show me the technology to try it out on an animal model. And I was, I was, you know, blown away by, by how easily could do the same thing that, you know, till now. It's taking such a long time. And then I'll never forget the first patient that I had was mailman actually that came on a Friday afternoon. And at the time this was still in the child phase. We had to get approval from the, from the, from the hospital Ethics Committee to be able to use the, the technology. They approved it, they expedited it Monday morning. I remember this, this, this gentleman walks in from Utah. That's where the company was based at the time with basically a suitcase that looked like he was carrying the nuclear device. And at the time, I remember that, you know, obviously the hospital was aware of it and they send the media people and, you know, the, there's residents and fellows. And we ended up doing it successfully. And the entire procedure from the beginning till the end took about 7 minutes instead of about 7 hours. And, you know, people found out about it, you know, but, but very few people, you know, at that time, I think this was the first, you know, first time that this procedure was being done in, in, in, in Brooklyn. And I was very excited, obviously, but it was very hard to get the word out of what we're able to actually do with this technology. And I think one of the biggest changes that that, you know, the AI brings now with the social media and again, with the power that we have is something like that would have become viral and people would have found out about it, you know, probably in a matter of minutes. And, and it would be like a really cool thing to show people what we actually haven't had the ability to do recently. We actually start using AI technology to detect polyps, right? Probably the most important thing that we do as gastroenterologist is prevent colon cancer. And, you know, everybody needs a colonoscopy at some point. And, you know, traditionally we always used our eyes to be able to look for, to, you know, to be able to detect polyps. And now there's an AI technology where, where it helps you be able to detect polyps, which increases what's called adenoma detection rate. So that's, that's really exciting. And then there's other things which you can't really see. My research experience in the, in the, in the beginning was actually very focused on the gut microbiome, which again, going back, this is probably now in 2008 to 2010, wasn't as known as it is now. But one of the first things that we described was that the microbiome could affect different disease conditions like irritable bowel syndrome or inflammatory bowel disease and fatty liver disease, pancreatic insufficiency. And over time we've seen that become more and more of a, of a, of a reality where we could see how each individual patient's microbiome could determine what their phenotype, which means what their actual condition is going to be and how it's going to be different than somebody else that has the exact same thing. You know, probably the most most common thing that that we see now in liver disease is something called fatty liver. That's the, you know, there's a lot of different names for it. But with fatty liver, we are able to actually use technology called fibro scan to monitor how much fatty liver exists and what it leads to in terms of what's called fibrosis, which is scar tissue. And what's very interesting is that you could have two patients, exact same BMI, body mass index, same weight, same height, same comorbidities in terms of whether they have diabetes, you know, diabetes, cholesterol, blood pressure, but they act very differently with the liver disease. And, you know, you know, historically we really didn't know why that was. And it turns out a lot of it has to probably do with their individual microbiomes, you know, something that you don't necessarily think about.

[24:04] **Demian:** Well, that takes me. So I don't know if we, we discussed this about my, my background is actually something called graph computing, semantic computing. And I and I, I was like Accenture for a while. We did a lot of models, you know, modeling the complexity of medicine, right, in the complexity of human body and all these interrelationships that we have. I mean, I mean, remember doing models that went all the way to sort of the, the protein level, right? And I'm being able to connect. But this is actually something that is readily available, right? Being able to connect someone's microbiome, you know, results with the conditions like fatty liver, you know, could be low hanging fruit. How do you connect it today? Because as I understand it, a lot of these data is disconnected, right? I mean, you, you might have some data that is in an EMR, you might have some data that's somewhere else.

[24:54] **Dr. Rabin Rahmani:** How?

[24:54] **Demian:** How do you how do you connect the dots or you know you need companies to come in and and sort of do it?

[25:01] **Dr. Rabin Rahmani:** Yeah. I mean, this is probably the biggest challenge that we have right now where we, where we know what's going on, but we just don't know how to use that knowledge to our advantage. And, and a lot of it has to do with just basically that gap in technology, right? We need, we need companies that could tell us, OK, this is how patient A is different than patient B and how to use that information to translate into management. You know, how do you, how do you go ahead and, and be able to individualize treatment planning? You know, whereas even though 2 patients could have the exact same condition, their condition could act completely different. I mean, this is something that we know in medicine, you know, for a long time. If we could fill that gap and and we could you know, custom make what the treatment strategy would be based on that, that's a game changer.

[25:56] **Demian:** Yeah, because I mean, we've been listening or hearing about personalized medicine for for a long time now. But you know, it's interesting that, you know, you're at the forefront, right? You run a big practice still not there, right, already available. And obviously, you know, if it's not there for, for such a practice like yours, even for a smaller practice, you know, it's very interesting to, to, to see that there's still plenty of opportunities right now for, for innovation. So, you know, entrepreneurs, you know, listen, so you know, gut microbiome has become like big word now, right in, in, in medicine or, or in, in sort of the, the new wave of health medicine. 3 point O everybody talks about it. How do you measure the gut microbiome? I mean, my daughter the other day, she's like, oh, I have this stomach issues. I think I'm lactose intolerant and, you know, and I'm like, OK, what tests do I get her to do, you know, because my experience at least has been if I go to pediatrician, she's going to go, she's fine, you know, but I still want to do some tests. So. So what, what is your advice? I mean, what it what would you do for yourself or for your kids? If if you know you need to take a first step in in understanding what's going on with your Yeah.

[27:08] **Dr. Rabin Rahmani:** It's, it's, it's very challenging. You know, there are there are some tests on the market now that that claim to to be able to decipher, you know, individual patterns. You know, without getting too technical, I could tell you that they they are still far away from what they need to be. These are.

[27:29] **Demian:** Stool samples.

[27:31] **Dr. Rabin Rahmani:** Or the stool samples are are are one option. You know, there's a very common condition which we've known a lot about for a long time called SIBO, small intestinal bacterial overgrowth. You know, traditionally we used to kind of diagnose it just based on symptoms. There's, there's breath testing now that you could do where it measures basically different gases that are fermented based on, based on your gut microbiome and based on the bacteria that you have in the small intestine. But again, there's a lot of false positives, false negatives. So a lot of times you almost get a little bit more confused. You know, there's situations where definitely helps, you know, where you think somebody has it and this confirms it. There's other considerations. For example, some insurance companies won't approve treatment even if you're sure that somebody has it, unless you have a positive SIBO test. So sometimes even if, if you know as a doctor that somebody has it, you have to prove it. So there are situations where it definitely helps. But you know, it's, it's something that that, that is still evolving. And I think that over the, over the over the next months to years, you know, that's probably going to be the forefront of, of medicine. You know, I remember again doing a study many years ago looking at how aspirin effects your gut microbiome. And, and one of the, you know, things that we're we're studying was something called C diff colitis, which is a very common infection that people get after taking antibiotics. And our thought was that obviously has to do with your gut microbiome that's affected by antibiotics, which is why you're more likely to get an infection. And aspirin is probably the most common medication that that the world is on. So my thought at the time was maybe if aspirin affects your gut microbiome, it could also mitigate how likely you are to have C diff. And we did, you know, a relatively straightforward study, which was which was definitely very, you know, revealing. And I remember presenting it and in San Antonio at the time. Oh, San Antonio big next go next. So, you know, at the time it, it, it garned a lot of attention, even though we didn't really know what we're describing. You know, we're just basically describing almost like the, the hiding phenomenon that different things could, could affect this, this kind of unknown phase of your body, the, the, the, the microbiome. And, and that could, you know, eventually lead to having this C diff infection or not having the C diff infection. And, you know, 20 years later, we're definitely closer to figure out what it was that we're describing. We're not there yet. And I think that's something that that that, you know, I could definitely see coming to coming, coming to the forefront over the next couple of years.

[30:21] **Demian:** So in terms of test, so again, there's some tests that maybe could work or not in terms of biomarkers or any biomarkers that you specifically focus on that you think are are, you know, things that you should watch? How do you, how does blood biomarkers fit into? Yeah.

[30:39] **Dr. Rabin Rahmani:** So I personally actually have different panels that I use when people, you know, come to to me with the with different symptoms. You know, obviously the regular electrolytes, you know, that I, I find a lot of things in electrolytes that you really have to focus on to be able to find. In other words, you know, whatever you get a print out from the lab, you know, it would tell you something is within normal, but there's a big range of normal, right? So for example, if somebody who's 25 comes to me and, you know, their electrolytes make them seem like somebody who is 50, right? So I would look at that and say, yeah, it's technically within the normal range, but for 20 year olds, right, their sodium or their potassium or their chloride should be very different. So I think you get a lot of knowledge from, you know, even the basic labs that now, because again, the lab would just send you a print out of what's normal you could miss. And I think that's something that that could be definitely explored at the frontier is individualizing those markers based on age, based on a person's health, right? A 50 year old with diabetes is not the same as a 25 year old without diabetes. But if you look at their creatinine, right, which is basically, you know, a number of of their, of their kidney function, the lab would tell you they're both normal, right? But if you have, for example, an AI based tool, which could individualize based on different factors, that could that, that could definitely be very helpful. The other marker, which I used a lot is something called C reactive protein. It's a marker of underlying inflammation. I think that's something that's that's, you know, underutilized. Traditionally we use sedimentation rates which are not as sensitive. So I think I think that's that's a very, very useful marker that that we have to focus on. And then there's also things that you could check based on stool studies. There's something called the elastase level, which tells us about the pancreatic enzymes which are very important absorption. So, so you know, and again, it's not an absolute number, right, Depending on, on what the symptoms are, you could you could kind of figure out how much malabsorption is going on in each individual patient. So there's a lot of them, but I think the main point is being able to individualize even the basic things that we would otherwise ignore by by seeing patterns. Yeah. And I think patterns are are are something that AI is, is definitely very, very promising for.

[33:21] **Demian:** Yeah, I'm, I'm actually excited as you know, towards the end of of every episode, I get our agents to come in. I would like to, to see what, what they say about, you know, some of my my recent tests. But actually, one of the exciting parts that we're working on as you, as you know, is you know exactly what you're saying. Imagine that you have a doctor that has, you know, their own way of looking at data, right? Your own ranges, your own, you know, and, and your agent basically is Privy to those, you know, those ranges. So when I go in and I have your, I interact with your agent, I'm able to, you know, you know, personalize my analysis based on sort of how you see things. And it could be pretty detailed, right? It could be up to the, you know, the, the, you know, the age and the gender and, and the different conditions that person has. And you could do it at scale. So I think there's a really interesting areas to, to explore that. As you said, it's, it's enabled through, through AI. So let's let's go a little bit into, you know, a topic that I think a lot of people are super interested about protein. You know, there's a lot of opinions about protein. How much protein we should we take? How you take the you know, how you actually consume the protein. You know, it's a bar the right way. You know, what are how do you see protein and, and you know, and how do you know? How do you how would you take it? You know yourself as as you know your own personal.

[34:50] **Dr. Rabin Rahmani:** Yeah, so this is definitely a controversial topic, you know, within, within medicine and, you know, within gastroenterology also. I, I, I'm still a very firm believer and this could change, but I'm still a very firm believer that the best source of protein is, is dietary protein. And you know, obviously I think, I think part of the problem is not necessarily the protein itself. It's, you know, obviously the substances that unfortunately a lot of times are infused into that, into those proteins. But I always tell my patients that, that, you know, the, the best way to, to ensure that you're getting enough protein is to, to, to have it in your diet. You know, I think there are situations where supplements are very, very helpful. But again, to me, a lot of times what I've, what I've noticed, you know, at least in the supplement market is, you know, you are kind of enhancing 1, but you're reducing another, right? So you have protein supplements that have way too much sugar. You know, you have, you know, nutritional supplements that don't have enough protein. And I think getting that balance is obviously very challenging. But if you have a plate in front of you and you know, you have basically 50% of good protein, 25% of, of, you know, good vegetables and 25% of, of good carbohydrates, I think that's still the most tried and true. A lot of times it's difficult because of, you know, people's lifestyles. So I think there is room for the, for the, for, you know, for the protein supplements and, and that and that market. But I, I still think in, in, in a way, the old fashioned way, you know, is, is, is superior. But again, it's something that that could definitely change over the over the next, next, you know, months to years.

[36:41] **Demian:** And fiber is another important one, obviously.

[36:46] **Dr. Rabin Rahmani:** Right. So fiber is interesting. I think fiber is actually the opposite of what I just said with protein. I tell people that unfortunately on an American diet, it's very difficult to be able to consume enough fiber. And you know, I routinely tell patients to take a fiber supplement, you know, not, I don't want to, you know, get free advertising, but probably out of the out of the products out there, Benefiber I find is, is the best tolerated. So, you know, I tell people, you know, they may they, they, they have different formulations, you know, you could do it with, with a powder. You know they have chewables and you know I, I tell patients.

[37:27] **Demian:** Generally all patients or patients that you know have a fiber. Yeah, so talk about diet GLP-1s. They have a big connection right to the gut and and the pancreas I believe and the satiation receptors. How you know how, what are you seeing there? What are you seeing you know now and, and also what what excites you and also what worries you?

[37:52] **Dr. Rabin Rahmani:** Yeah. I think that as we have seen more and more of it in use and you know, now basically, you know, the numbers are, are astronomical of, of how many people are actually taking some, some form or other. But I think that it's, it's become more and more promising. I mean, I think initially, you know, anytime you're dealing with something that affects the pancreas, obviously you're concerned, you know, with the pancreas being one of the main hormonal sources of the body that, that it's going to lead to significant side effects. And it seems so far at least to be working a lot better than we had anticipated with less side effects. Obviously, again, it has to be used the right way. I think there's definitely a lot of misuse and abuse going on out there. And that's something that has to be addressed. And of course, we still don't know what the long term ramifications are going to be, right? I mean, these, these, these medications are still relatively new when you look at medicine globally. So they do seem to have a lot of positive effects that we didn't anticipate, whether it's in terms of lowering blood pressure and lower, you know, lowering vascular issues. I think, I think that's definitely a big positive. The big question is are we going to find things 10 years down the line that we're that we don't know about yet, but that's with any new medication that comes in the market you always have that, you know, you always have those concerns.

[39:16] **Demian:** I mean, maybe because I had a couple of encounters through my life in pancreatic cancer. I mean, it's probably one of the most scary things that that I've seen. I never seen anything work as fast, you know, so, yeah, you know, anything. So you mentioned before hs-CRP and and, you know, inflammation and pancreatic cancer. For me, it's one of the areas that I'm looking at when I think of GLP-1s and GIPs And you know, it's, you know, the reduction of this sort of chronic inflammation that that we seem to have. I'm, I'm taking Z bound and I definitely feel very, very different very well compared to, to before. But sometimes I feel that because of that, I'm not doing enough of what I should be doing because it's almost like you're cheating in a way. So it's, it's very interesting. So let's, let's talk about some of, I mean, you told me you wanted to cover a couple of things and you, you send me a number of acronyms, IBSIBDEPI, you know, what do they mean? You know.

[40:22] **Dr. Rabin Rahmani:** Yeah. So we actually touched on on a few of them already. So IBS is irritable bowel syndrome, probably the most common GI condition that we see, you know, abdominal pain, bloating, Constipation, diarrhea, or both. And it's one of those things that even though it's so common, we really don't have a good explanation. There's different theories of why people have have IBS. Some people think that it may be a secondary food allergy or at least food intolerance because some of the the research does show that it's histamine mediated. I think that's why that's been one of the exciting things. Also that's that's come come out in our field is we have a lot more potential now to actually do specific food sensitivity testing. You know, whereas traditional, we used to tell people to just stay away from all sugars or stay away from, you know, all, all legumes. Now we could say, OK, this is the, the thing that you're actually more, you know, more sensitive to. A lot of it again goes back to the gut, gut microbiome. You know, irritable bowel syndrome definitely has a lot to do with gut microbiome. And there's theories that irritable bowel syndrome is actually just a continuation of the spectrum of IBD, which is inflammatory bowel disease. You know, traditionally we always thought that that inflammatory bowel disease, which is Crohn's colitis is an autoimmune mediated condition. That's your body attacking itself. It turns out that irritable bowel syndrome and, and, and inflammatory bowel disease may just be different parts of the same spectrum, right? And it's mediated by a lot of different things, by your environment, by your gut microbiome, by stress, but by what you're eating, by your genetics, obviously. So, you know, it's, it's very interesting that you have kind of, you know, these very common conditions that we know a lot about, but we don't know enough. And, and the more we learn, the more we realize how, how little we know. EPI is exocrine pancreatic insufficiency. You probably hear a lot about it more on the radio now because you know, the treatment has has changed recently. But again, one of those things where there's malabsorption, you know, patients go undiagnosed for, for for a long time. Again, going back to what I was mentioning before with the elastase levels now we could, we could usually between that and sometimes imaging make a definitive diagnosis and there's treatment for it. And so that's that's, that's been kind of a very exciting new development for the past past few years.

[42:45] **Demian:** Interesting. Great. So I think it's, you know, it's time to to bring maybe some of our our friends here from the, you know, the Betty universe. So I was thinking, you know, bring the nutritionist here. Let's see, let's see, let's let's call her up.

[43:04] **Bett-i nutrition agent:** I'm your nutritionist here to help with nutrition, meal planning, supplements and culinary guidance. Demian, what are you working on right now?

[43:12] **Demian:** So I'm here with Dr. Rahmani talking about, you know, all things gut microbiome and and, you know, things that have to do with the gastrointestinal aspects. Tell me what what's going on? Anything on the news that is sort of, you know, you're picking up on?

[43:33] **Bett-i nutrition agent:** I'm your nutritionist here to help with nutrition, supplements, meal planning and culinary insights. Let me fill you in on the latest gut health trends. What angle are you curious about what what are you? Any social media signals that you've been monitoring that of things that could be interesting? I'm seeing fresh chatter about gut microbiome targeted diets modulating immune status and also some buzz around slowly fermentable fiber, improving insulin sensitivity on high protein diets. There's also talk about personalized glycemic response predictions. Which of these directions interests you most?

[44:09] **Demian:** We talked about fiber. Let's let's dig a little deeper in that one. What are people saying about it?

[44:16] **Bett-i nutrition agent:** Got it. Let's explore the fiber angle more. What's your main goal, improving insulin sensitivity or something else?

[44:23] **Demian:** Tell me what people are saying in the, you know, you got a post or something that people mentioned something about it.

[44:31] **Bett-i nutrition agent:** I'm seeing a post about a high protein diet paired with slowly fermentable fiber showing benefits for insulin sensitivity. Does that match what you're looking for or do you want more details on how that works?

[44:42] **Demian:** Can you do a search on that and tell me a little bit more about what you find?

[44:49] **Bett-i nutrition agent:** Here's the key finding. A study found that supplementing a high protein diet with slowly fermentable fibers like potato fiber and sugar beet pectin improved peripheral insulin sensitivity in individuals with overweight compared to a placebo. This means adding these fibers might help balance blood sugar for those on high protein diets, per PubMed. How does that align with what you're aiming for?

[45:11] **Demian:** That's a little bit what we talked about, right? The need to have a fiber and also a balance it with protein. So it's a parting thought advice for people. You know, I'm, I'm amazed, you know, it always comes down to how simple things could be. I mean, good sleep, right? As you said, a balanced diet, but it's so hard, I guess in today's society. What are the practical things you've learned after obviously treating so many patients and, and you know what? We know how. How should we? At least we have to make two or three decisions. Lifetime changes, What would they be?

[45:50] **Dr. Rabin Rahmani:** I think sleep, my general rule is everyone needs at least six hours of sleep every night for good, for good gut health. I think obviously your diet, a balanced diet, you know, with some variations depending on on, you know, what the underlying medical issues an individual may have. But I think a balanced diet is something that's definitely lacking, at least in the US.

[46:16] **Demian:** And the the balanced diet, you know, there's all this controversy about the pyramid, inverted pyramid, this pyramid what how would you describe in your words the.

[46:24] **Dr. Rabin Rahmani:** Balanced diet. Yeah. My, again, my general rule is basically if you have a plate in front of you, 50% good protein, healthy protein, 25% of, you know, fiber, carbohydrates and 25% of fruits or vegetables. So I think, you know, obviously it's hard to always keep to that, but those proportions in my experience have have always been very helpful in maintaining a diet. And the other thing which is, which is very important is exercise. I think that, you know, it's getting better, but there's a, there's a tremendous lack of exercise. You know, the bare minimum, as I tell my patients, whether they have, you know, fatty liver or, or irritable bowel syndrome is you have to have good cardiovascular exercise at least 30 minutes a day for at least three times a week. I mean, that's the bare minimum. Obviously the more the better. And then I think the, the, the other thing is availing yourself of the technology that exists, you know, obviously as that evolves, more and more options are going to be on the table. But even now there's a lot at our disposal that's not being utilized, right? There's so many different things that nowadays could be found early treated easier. So sleep well, eat well, exercise and make sure that you're doing the screening, the age appropriate screening that that's available to you.

[47:47] **Demian:** That'd be great. Perfect. Well, thank you again. Thank you everybody for for another episode of Augmented Wellness and we'll see you in the next one. Thank you so much.

[47:56] **Dr. Rabin Rahmani:** Thanks so much.