A BARIATRIC SURGEON
WHO IS ALSO A YOGA TEACHER
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Episode 245:
Show Notes
Episode 245:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:18) Good morning, lovely friend. How are you today on a beautiful morning in Melbourne? Dr Lucy here and without Dr Mary because I have a really, really interesting guest for you to listen to today. I think you will love him. Honestly, every now and then you just come across somebody who's like one in a million. And so I would love to introduce to you, my friend and colleague, Dr Arun Dhir, who is a bariatric surgeon, but not a typical bariatric surgeon. So I can't wait to get into this conversation and introduce you all to him today. Arun, welcome to the podcast.
Dr Arun Dhir (00:56) Thank you, Lucy, for that kind introduction.
Dr Lucy Burns (00:58) You are welcome. I think it's so interesting because in general, most people have heard of bariatric surgery and have probably a preconceived idea of how a bariatric surgeon works and what their sort of philosophies are. And I guess that preconceived idea comes from probably what is reasonably typical of a bariatric surgeon. But you're a bit different. So I thought I would love to just hear your evolution and your thoughts on, I guess, you know, all things bariatric surgery, but also all things gut. So let's get into it.
Dr Arun Dhir (01:35) Yeah. So I think you're starting at the deep end, right? Well, yeah. I think my journey I think has been let's call it punctuated with moments of realisation over this course. One of the first realisations when I just started at Monash Medical Center in Melbourne, a fairly large tertiary institution. And I did the first gastric sleeve in that hospital, which is a form of bariatric surgery, which has become very popular. But what happened was that this first patient of mine, and I often say that, you know, your patients are your most significant teachers. They teach you so many things that you should do in life and you should not do in life, right? And I've always been fortunate enough to say that I've had this open mind to kind of view things from different aspects. So this one particular patient who like I got to know very well, I did bariatric surgery for her. And a few years down the track, she failed it, right? And I mean, you remember your failures much more than you remember your successes sometimes. And I think she failed it in the sense that, you know, she lost the weight. Very emotive story. I won't go into the details. But in a sense, it really caused me to think that is bariatric surgery the be-all and end-all, right? When you're a young surgeon, you've got this power in your hand. You've got this hammer in your hand. You know, as they say, everything appears to be a nail. You can fix it with surgery, right? And I knew that surgery, just like any other modality of medicine, is a form of treatment that has its place. But can it fix the problems of obesity that our current society is facing? Well, that was a big shock. I kind of knew it, but I didn't feel it. That caused me to go on a journey to understand the why, the what, the when, and the how, and those sorts of things. So, you know, that requires that level of introspection. And that led me on a journey to not only practice mindfulness meditation but become a yoga and meditation teacher. I started writing books because I felt there was a lack of education. People are being led into an ignorant sort of, you know, filled tunnel. And we are living in a culture of convenience and comfort. And we are not realising where the actual problem lies. We are trying to fix it with surgery, tablets, injections now, and with crash diets. And those are things that will work but only temporarily. They're like Band-Aid fixes. I'm not saying surgery has got no place, not at all. I think every modality has a place, but you've got to put it in a success framework is what I call it.
Dr Lucy Burns (04:42) Yeah, yeah, I love that. I love that. And it's interesting because you're right. I think the measure of a good doctor is when they are able to look at what they're doing and make adjustments rather than sort of stick to their guns. And we, honestly, we're a little bit the same. When I first started real-life medicine with Dr Mary, our thing was always it was about lifestyle. If everyone sorted out their lifestyle, everything would be fine. There would be no problems at all. And I've realised that for lots of people, it's not lifestyle or medicine or lifestyle or surgery. For some people, it's both. And so being flexible and open and not sort of getting into this dogma of it's my way or the highway I think is really helpful for patients because it's actually about them, not us.
Dr Arun Dhir (05:40) Yeah, and I think, Lucy, I would add to that, you know, as I mentioned just a moment ago, I feel it's also important that you know, one thing does not fix all problems. You need to have a framework. So when I talk to my patients, I'm talking to them about creating a success framework for that person. Now, that framework may have three elements only for someone, but if it's a more complex situation, it might have five elements. It might have seven elements that you need to work on. But it's about creating a framework that works for you, you know, because when you have a framework, and I know I love this word framework because I try and put it in my own practice in my own life in many ways because when I know I have a framework, a system that is working for me, I often say, you know, systems create sanity. I've got low-stress levels. I know what happens next. All right, I'm a bit more predictable.
Dr Lucy Burns (06:35) Yeah, yeah, yeah, but that's good, isn't it?
Dr Arun Dhir (06:37) Absolutely it is.
Dr Lucy Burns (06:39) Yeah. So if someone was to come to your practice, you know, and they've got metabolic health issues, they've developed obesity, you know, how do you step them through that?
Dr Arun Dhir (06:53) Yeah, so the process of, you know, how they come to see me. Look, once they've made a decision to come and see me, that itself has been an act of courage for them, you know. Like to come to see a surgeon, you have to have gone through a lot of, you know, I often refer to what you say, the tumble dry in the washing machine. You know, you have to be thrown around a bit here and there, tried this, that and the other before you say, well, surgery, is it really this option, is the last option for me? So they've gone through a lot and they're very receptive. So I want to first listen to their journey because what happens is when you listen to a journey, what they've gone through, you start to pick up the underlying pain points. And what I've figured out is that, and I feel very privileged to be in a situation where I am then in a position to be able to see it from a different perspective. They are also very receptive to my advice, which puts a lot of responsibility on me not to just say that, oh yeah, surgery is the right answer for you. Here you go, sign on this consent form, let's do the surgery quickly. Because I think what is important is that they need to be ready for it. If you're not ready to use a tool, a certain tool, well, you will get temporary results and then you will fail it. And you know what you'll say? You'll say, oh, you know what? I've always been a failure. It's never worked for me. And people who have been on this dieting roller coaster, we know the mindset because of repeated failures, your self-esteem, your confidence is low. Now, you really want somebody who understands you and who is genuinely interested in helping you in the long run to make those mindset and lifestyle shifts. So what I've come to understand is these people need support on three fronts. And it's really critical for us to understand this as responsible medical practitioners. And the three fronts are, number one is education. Patients come to you, Lucy, they come to me because they respect us for the knowledge that we have. And they trust us that we will give them the right advice, which is in their interest and not necessarily in our interest. So that's number one. I see that as an implicit overarching principle. The second thing is to understand that people generally know what to do, but they rarely do what they know. This is human nature. Like we logically know, eat less, and exercise more. Hey, you're going to lose weight. You know, why do you need surgery? And many parents come to me with their kids. When I say kids, I mean, these are not necessarily adolescent kids. They are like kids in their mid-20s, mid-30s. But they come with their parents because the parents are saying, why does he need to have surgery? You know, can't they just exercise more? Well, we know that our emotions come in the way. And it's the emotions that drive us, whether this is past conditioning, past trauma, or whatever you want to call it. And the third and the most important thing that I see is that the bucket of challenges that patients face is their environment. We live in a, medically speaking, what we call an obesogenic environment. That means our society, our culture, our environment of, you know, comfort and convenience causes us to say, hey, you've got this Uber Eat app on your phone. You know, why do you need to cook today? Just order a meal. It'll be delivered right at your doorstep when you reach home, you know. But the challenge is they don't realise it is full of ingredients that are actually hurting you in the long run, whether it's hydrogenated oils, sugars, salts, preservatives, whatever you want to call it, you know. So that environment is not conducive to causing you to stay healthy. That environment is actually working against us, which means they need more education, which is empowering. So surgery is a tool. I often say that this tool is going to create a mindset shift in you and it'll create temporary success. I tell them honestly, the first one year is like a honeymoon phase. You're going to love it. All right. Everything is going to be just beautiful. But the real challenge is not weight loss. The real challenge is weight maintenance. And surgery can't help you with that, sadly. You have to create changes in your mindset and your lifestyle. Actually, our mindset precedes lifestyle, right? I know you'd agree with me on that. Because if you are not thinking right, you are thinking stress and you are trying to sort of douse stress with cookies or chocolate, well, that's a wrong thought process, right? I tell my patients often, to put their headphones on when they're stressed and go for a walk. The same trigger is happening, but it's a different outcome. And I think, Lucy, I'm coming back to the same thing. When patients hear this from a surgeon, somehow it lands differently. And I'll tell you honestly, I think this is answering my first question a little bit as well. I used to hesitate, 10 years ago, I used to hesitate so much in talking to my patients about stress management, and about doing some mindful meditation. Because I used to think they were going to judge me. They're going to say, hang on, he must not know how to operate. That's why he's talking about stress management and mindfulness and doing all those sorts of things. But then I realised, I heard a quote, that your real truth comes out, you are living life on purpose when you are not seeking the favourable opinion of other people.
Dr Lucy Burns (12:48) Say that again.
Dr Arun Dhir (12:50) You live your life on purpose only when you stop seeking the favourable opinions of other people. And that hit me straight in my heart. You know, you hear something, sometimes you read something, and it just pierces, it just lands straight in your heart. Not logic, it's in your heart, right? And that has stayed with me since. And I've always felt, you know what, I need to speak the truth that I feel I would say to anyone. And that's what I tell my patients. I say, you know what, surgery is here. Yes, I understand you're here to talk about surgery. We can definitely talk about it. But this is how I'm seeing things. I actually take their permission, to be honest with them. And you know, not one person has ever said, no, no, no, just tell me the lie, don't be honest with me. Not one person has ever said that. I ask them, I hope you don't mind if I can be honest with you and share with you how I'm seeing things. So these are very profound moments, Lucy. And I think, you know, I come back to this, that every day I come back and I say that, look, I'm so fortunate to be able to do what I'm doing because I can speak my own voice. And that's a privilege.
Dr Lucy Burns (14:08) Yeah, yeah. Actually, as you said, a profound moment, but also the courage to do that because it does feel hard when people judge you for whatever reason.
Dr Arun Dhir (14:24) Oh, of course. Of course. You know, like, I mean, the society puts you on this pedestal and then suddenly, oh, he's talking about this thing, you know, people roll their eyes, you hear from your colleagues, you know, your own medical society is the first one to point fingers at you. So once again, I take solace in the statement or the quotation that I just said, you're only living life, a true life, when you are not seeking favourable opinions of others and not that you're going out and lashing out at people and telling them that, you know, this is so and all. No, no, no. It's not about force. It's about that inner power. And that inner power can only come when you listen to your own self.
Dr Lucy Burns (15:0) Yes. I remember hearing a funny quote that it took me a little while to sort of work out what they were trying to say, but it was something along the lines of, what other people think of you is none of your business. Oh, hang on. And it's sort of saying what you're saying in a less eloquent manner. But, yeah, it was.
Dr Arun Dhir (15:27) Same thing, correct?
Dr Lucy Burns (15:29) Yeah, yeah. And it was like, oh. Oh, so I love that. All right. It's wonderful. And you're right. I mean, you know, I had an auntie who was a heavy, heavy smoker for, you know, decades. And her GP had spent many times, you know, talking to her about smoking cessation. And anyway, at some stage, she had to go and have a medical procedure. I think it was a colonoscopy. The anesthetist at the time, who she had no prior relationship with, asked her about her smoking history and then sort of said something like, you know, don't you want to see your grandchildren grow up? And for whatever reason, right at that moment, that was like the arrow to her heart. And from that day on she stopped smoking. And it was like, ah, it's so interesting that sometimes people need to hear the message, A, lots of times, but also from different people in order for it to finally hit home.
Dr Arun Dhir (16:31) That's so true, Lucy. And I think I'll just add to that, and I often have said this, that every smoker knows that they need to quit smoking. Smoking is not good for them. Every alcoholic knows that alcohol is not good for them. Every individual who's addicted to sugar or food or whatever category of foods you want to talk about knows that overeating is not good for them. But again, it comes back to the same thing that I just said. We are emotional beings. And I think for your auntie, as you just described, that one message about, and the emotion came, you know why? Because that doctor, that anesthetist said about the reason, don't you want to see your grandchildren? I mean, immediately the why, and the reasons came first. So the why became more important, and the grandchildren were the reason why she gave it up. She didn't give it up just for herself. She gave it up for others. So same thing I tell my patients, tell me the why that you want to lose this weight and keep it off. Reasons come first. You know, Simon Sinek wrote that book, you know, start with the why. Start with the why. Why are you doing this? And I've always said why power is more powerful than willpower.
Dr Lucy Burns (17:52) Oh, I love that. Another great saying. Fantastic. Good. So one of the things I'm also super interested in you is that, I mean, you know, a bariatric surgeon essentially operates on the gut, but you are also super interested in gut health in general. In fact, not just interested, but, you know, now a gut health expert. So I'm really interested to know your thoughts on that and how you became interested in that and how that evolves and how that marries in with gut surgery.
Dr Arun Dhir (18:26) Yeah. So look, from a training point of view of being a gastrointestinal surgeon, that's the area of my expertise. But once again, you know, reasons come first. You know, why did I become interested in this? So coming back to the same story of this one patient that I'm referring to earlier, who failed bariatric surgery, it was about 2016. I still remember that time very vividly because I was coming up to my long service leave. So, you know, when you do 10 years of service in the public system, they are kind enough to give you, all right, take three months off and do whatever you want to do. And a lot of my colleagues at that stage, Lucy, were getting into like, all right, we'll take long service leave and we will sort of invest it into doing more private practice. All right? So these were my options. My second option was for people to say, no, no, why should you take long service leave now? Leave it for when you're retiring. You know, that's the time when you're young at the moment. You know, you just keep working hard. And none of those two options were kind of exciting enough for me. You know, who had seen retirement? I didn't know that you know. So I wanted to do something different. So I decided to devote my time and energy to doing a course with the Australian College of Environmental and Nutritional Medicine and doing their gut module. Now, I was super interested in understanding what is this thing called gut microbiome. Like, as a doctor, I knew about it. But, you know, as medical practitioners, when you get busy with your day-to-day rigmarole of routine, seeing patients, operating, who's got the time? So I thought, you know what, this is an opportune time. So at that stage, they were running them, this is pre-COVID, of course. There was no concept of Zoom courses and all that. So I flew to Perth and did this course. There were some modules of assessments and examinations and all that. And the outcome of that was the first edition of my book, Happy Gut, Healthy Weight. Because there were so many aha moments that I got during that course about how our gut health is so critical to maintaining our overall health and metabolism. Our patients, like, I mean, you know, patients that are common to your practice and my practice who are struggling with weight issues, you know, they've been told this story that, oh, you have a weak metabolism. That's how it's going to stay. But can you optimise your metabolism? Is there a method of doing it? Is there a strategy or a framework? Sorry, coming back to the same word. I love the word framework. Sorry, you'll hear the word from me a few times today. So forgive me for that. But the point I'm trying to make is that you know, that really sparked my interest. As a GI surgeon, I was just busy cutting, stitching, healing, and researching the gut and doing things on it and removing cancers and all that. But never once gave it a thought that, wow, this is such a powerful organ in the body. There is this gut-brain connection. Now we talk about those gut feelings, you know, and where do they originate? So all of these things really sparked my interest to the point where I dedicated a significant chunk of my sort of time and career to making the first edition. And actually, recently, earlier last year, we launched the updated revised edition of the book. And we are actually going to be launching the audiobook at the end of this month as well. So the point I'm trying to make is that Hippocrates, the father of medicine, said, all disease begins in the gut. If all disease begins in the gut, then why can't all health begin in the gut? And that was my sort of pressing question. And it's not just about giving supplements to your patients and probiotics and all of that. No, actually, our forefathers, before the refrigerator came, they were using fermented foods. There was no fridge.
Dr Lucy Burns (02:27) Yeah, yeah.
Dr Arun Dhir (02:28) Right. So I said, wow, why can't we introduce some fermented live foods and give ourselves good prebiotics, probiotics, which are going to boost our gut bacteria, reduce inflammation, and also boost our metabolism, which is the real problem we are facing. So I started talking about eating real foods, eating live foods with my patients. Don't eat from the packets. Eat live foods. Eat strawberries. Have blueberries. Don't have a blueberry pie. Don't have an apple pie. Have a real apple. So these were small little things that I started to share with my patients. And those who were interested, who wanted to go deeper into this, we said, sure. We created a program, which we are actually running in a fortnight's time, which is called Peak Health Mastery. That is for patients who want to go deeper, but not necessarily a medically recommended program, but this is for people who want to go in that stream further down. But long story short, in answer to your question, coming back to the interest that I have in gut health, I believe it is very pertinent for us to convey to our patients that we live in an era where we are living in an epidemic of chronic inflammatory diseases. We are trying to fix blood pressure with one set of medications, diabetes with another set of medications, and sleep apnea with the CPAP therapy. We are fixing fatty liver with another thing, high cholesterol with another medication. Now, all of this can be fixed. The bottom line of all of this is obesity. You just lose 10% of your body weight. You don't have to lose like 30% or 40% of your body weight. With just 10%, you start to see significant improvements in all of these parameters.
Dr Lucy Burns (24:28) Yeah. Yeah, absolutely. It's interesting. I was having a little snigger when you kept talking about a framework because we often talk about a framework as well. And I think that frameworks are really helpful. And the first part of our framework is step one, improving your metabolism. And then step two is to develop your mindset. And then step three is having tools to be able to implement those two things. So I love that you're also doing those things because I think it really is critical to kind of just peel back that onion layer and not simply treat the symptom but look further down at the root cause.
Dr Arun Dhir (25:09) Exactly. Exactly.
Dr Lucy Burns (25:12) That's it for this week's fascinating episode with the wonderful Dr Arun. Part two continues next week when he explains how to manage gut health. And I look forward to joining you then.
Dr Lucy Burns (25:27) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
