Ep 37 - Cardiovascular Expert Dr. Jay Shah on Prioritising Preventative Medicine
How often do you check your blood pressure? Hypertension affects 1.4 billion of us globally, and this number is only increasing. It is the world’s most common chronic condition and the most common modifiable cause of death.Today’s guest explains what high-blood pressure is and how you can prevent its development.
Dr. Jay Shah is a renowned cardiac specialist in the US. Dr. Shah's expertise shines as he shares his journey of building a complete cardiovascular service with Aktiia, a groundbreaking startup transforming hypertension management.
Dr. Shah urges you to prioritise preventive medicine, explaining that 75% of healthcare spending in the US is on reactive events caused by chronic diseases. You'll discover Aktiia, an innovative device with phone software for continuous blood pressure monitoring, essential for understanding hypertension's impact on the 1.4 billion affected worldwide. Dr. Shah empowers you to take control of your health through self-experimentation and lifestyle interventions, encouraging a personalised approach to well-being.
In this episode you’ll hear about:
How did Dr. Jay Shah build a comprehensive cardiovascular service from scratch at the MAYO Clinic
Why does Dr. Shah advocate for prioritising preventive medicine, and how does it impact healthcare spending
How can self-experimentation and lifestyle interventions empower individuals to take control of their health
The significance of calcium scoring in predicting cardiovascular disease
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Find out what most other Doctors don’t tell you, with cutting-edge health-hacktivating advice from Lifestyle Medicine Doctor, GP and Longevity Expert Dr Alka Patel.
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Podcast Transcript
PLEASE NOTE these transcripts are auto-generated and may not be wholly accurate.
Dr Alka Patel (00:01.831)
Dr. Shah, Jay, welcome, welcome to the show.
Jay Shah (00:05.838)
Thank you so much for allowing me to be here. It's great.
Dr Alka Patel (00:08.93)
Oh, I know this conversation is gonna be a super, super important one. So let's just kick off. I would love you to share just to start with a little bit about you, your kind of background and more importantly, I think, why you do what you do.
Jay Shah (00:23.798)
For sure. So I'm a cardiologist by training and practice. I've been in practice for over 10 years in the US. I did my training at Massachusetts General Hospital and Washington University. So very large sort of massive academic hospital institutions. And then I started my career actually by going out and starting a practice from scratch.
quite a different direction from after that kind of training. But I started to practice from nothing and sort of built it up over seven years to very busy clinical practice and ran that for seven years. And
and then had an opportunity to work at the Mayo Clinic. So I did that for the last almost four years and built out their complex aortic aneurysm program. And so that's been my professional background. And after over a decade of seeing patients in one-on-one settings and seeing them when they've had a complication or when they've needed surgery or when they needed a procedure after some event has occurred,
I really started thinking, well, how can I take all that knowledge and sort of expertise and skill set and apply it in a different way to prevent some of these bad outcomes from happening and to help people, you know, prevent them from having to see me or see someone like me after some event has occurred because almost always they would ask me when they come to see me in the office, well, doc, how could I have prevented this?
Dr Alka Patel (01:52.978)
Yeah.
Jay Shah (01:53.098)
And so the, you know, I started looking and sort of went through this sort of extensive exploration journey and ended up finding a role at a company called Actea, which is all focused on how do we how do we optimize and manage better hypertension, which is the world's most common chronic disease, and the primary input largely into most of cardiovascular conditions that I was seeing. So that
has allowed me that role has allowed me to grow in a lot of different ways, but really focus on how can we take that knowledge that I've gained over a decade of clinical practice and apply it to hopefully a much broader population to achieve a significant impact.
Dr Alka Patel (02:36.214)
Yeah, yeah. Well, look, thank you for kicking off with that. I think you've dropped a few things in there. I know you've very casually dropped in Massachusetts and the Mayo clinics, but just to let everyone know, these are incredible institutions and organizations and with, you know, amazing levels of.
of expertise. So really just want to share where you kind of started from in terms of your level of expertise and input in terms of what you've been doing for those initial that initial decade for sure and your background around that because I think that sets the scene for the direction that you're now going in. And I love that you've used two words in what you've just said. One is prevention and another is optimization. So I'm just going to challenge you a little bit on this if that's okay.
For me, certainly when I use the word prevention, sort of part of it's got a bit of a negative connotation to it as though we're living our lives, trying to stop something awful happening. And it's not a really great way to kind of live a fulfilling life, is it? Hoping that nothing terrible happens. It's a bit like, and I'm sure you've kind of come across this as well in your medical practice, it's a bit like practicing medicine.
Jay Shah (03:29.902)
Mm-hmm.
Dr Alka Patel (03:42.49)
trying to avoid negligence or trying to avoid a claim. It's not a great way to practice medicine. You wanna be giving and serving rather than worrying about kind of looking over your shoulders. So what's your view on preventative medicine? And is there a better way of looking at this?
Jay Shah (03:58.974)
I think for sure. I think it oftentimes semantics mean a lot more than just the words that we say they are right. And so, you know, in academic and sort of health care community preventive health has always been a common term that's been used. But just to give you an example, it's not really backed up with action. So as just as an example in the US 75% of all health care spend in dollars is on reactive
uh, events that happened in the hospital usually resulting from chronic diseases. 3% of healthcare spend is truly on preventive healthcare. And, and as you said, like proving a negative is very difficult or, you know, proving that nothing's going to happen is almost impossible. I'm usually something is going to happen. So I think it is a much more positive. Uh, um,
affirming and empowering way to speak about it as optimization and empowerment. And that's, you know, at Actea, that's how I really kind of honed in on optimization and sort of patient driven care.
as really core tenants of what we're trying to do. I mean, we've heard of patient-centered care in academic medicine and healthcare for a long time. And that just really means focusing on the patient at the center, but still using the traditional framework of the traditional healthcare system to build around the patient.
Dr Alka Patel (05:14.67)
Yeah.
Dr Alka Patel (05:27.756)
Mm.
Jay Shah (05:27.874)
But really for chronic disease management, when somebody is living their life 364 days and 23 hours and 45 minutes outside the physician's office or outside the healthcare setting, it's really kind of allowing or enabling patients to really drive and optimize their own healthcare for the longterm. And how can we really help people to first understand that and to build the tools for us, for all of us to be able to do that.
Dr Alka Patel (05:58.05)
Yeah, yeah. And that really is switching direction big time, isn't it? I mean, from your background, and I would imagine that there's some real kind of similarities between us, but I've sort of had to raise my hand at points in my career and say, I've become a drug pusher. And it's a bit of a hard pill to swallow, but the way we've been taught medicine.
very traditionally has been down this route, really laden with pharmaceuticals. And really what you're just talking about is just switching direction and getting to the route, like looking upstream beyond what happens at the end of the stream when everything starts to go wrong. And I think that is something that there's a craving for it in the population, but on the other hand, I don't think people know enough about this yet either because these other routes still exist. So...
Jay Shah (06:35.43)
Right.
Jay Shah (06:38.956)
Mm-hmm.
Dr Alka Patel (06:45.79)
strongly. Here in the UK, we've got the NHS, the National Health Service, they're in the US, you've got your kind of streams. People are so used to going in this direction that when we try to pull them in a better way, it is really hard. I mean, how do you drive that optimization agenda? How do we make that something that is so profound and important and individual for people that they, that's something that they want?
Jay Shah (06:50.638)
Sure.
Jay Shah (06:54.007)
Right.
Jay Shah (07:10.366)
I think, so first of all, to your point, I think that people want it. And there's a real need for it in the end anyway, especially in the US. And I know most countries in the world there's a significant lack of access and the ability to really gain, you know, what people term access to care or a full, complete comprehensive relationship with healthcare systems, because they're so overburdened, understaffed, you know, all these things. And
And the first thing that I think about is just knowledge. It's just giving people knowledge. It's not about medicine, it's not about procedure, it's not about driving towards some lead generation for healthcare, that's not really the purpose. That's not why patients come to see us. People come to see us and I take myself and my family to see a doctor because I have a question. I have multiple questions. Like there's something going on, I just want information.
And so one of the real sort of aspects, at least at Actea, and I think the promises in digital health in general is allowing people access to very scientifically based and vetted information in a way that's digestible, accessible.
and available to them at all times of the day, usually through some of their technological devices or whatever software we have. But it's really bringing that information that we have in our healthcare centers and in our knowledge and after all these years of training and work and opening that to everybody.
Dr Alka Patel (08:49.034)
Yeah, yeah. Knowledge is a really interesting thing, isn't it? Because like you said, knowledge is now so accessible to all of us. And in one way, we've all got the access to exactly the same knowledge through this little device that we all carry around in our back pocket. So knowledge isn't always the problem. As you say, it's the credible knowledge, but it's also then what you do with it. I mean, I know certainly when people have come into my consulting room, I've given them information, given them advice, given them knowledge.
Jay Shah (09:02.902)
Right.
Dr Alka Patel (09:18.702)
but what people don't do is they don't walk out of my consulting room and translate that knowledge into action. And I always talk about kind of, this is one of the biggest failings of the healthcare system is we keep telling people what to do, but we don't give them the tools that give them that empowerment, that belief, that opportunity, that ability to do it. So I do wanna move the conversation onto, you've alluded to it already, data and devices and this other kind of realm of richness of information that we now have access to as well. So.
Jay Shah (09:24.078)
Sure. Yes.
Jay Shah (09:30.432)
Right.
Jay Shah (09:34.036)
Yeah.
Dr Alka Patel (09:48.346)
Talk about, tell us about Actia and more specifically, blood pressure and what this has done and changed in terms of kind of high blood pressure, blood pressure management and awareness.
Jay Shah (09:56.59)
Sure.
So just some brief statistics on high blood pressure for listeners if they aren't aware. I mean, most people are aware that high blood pressure is a very common problem, but hypertension or high blood pressure affects 1.4 billion people in the world. It's growing at a rate of about 10% per year. It causes 18 million deaths per year. It's the world's most common chronic condition and the world's most common modifiable cause of death.
Um, so it's an exceedingly large problem, uh, with these huge statistics. But one of the things that, um, that breeds is a level of complacency. It's a human nature. Everyone has high blood pressure or 50% of, you know, adults of the age of 65 have it. Everyone hears about it. Everyone understands that there's probably medications and they'll be controlled and no problem really. Right. And you can't feel it. There are no symptoms.
And so it doesn't really drive a sense of urgency, but it's at the root of the world's most common problems of immediate causes of death. So as you're alluding to is like not just the giving people information about high blood pressure and hypertension, but also what is their own personal situation and how does their own data really interact with that information in a way that
not only urgency to change something that is really life threatening, but also an understanding of what they can do personally to make interventions. And this is sort of the broad scope. So Actea is building this platform. It's a combination of a device that we can wear, as well as software on your phone. And the data that we collect from this thing.
Jay Shah (11:52.206)
uh, actually gives you a more continuous stream of blood pressure data. So you don't have to sit in one position to get blood pressure measurements. You just put it on and over the course of a day, you get maybe between 25 to 30 readings of blood pressure a day over the course of a week, almost 200 readings a week. And then over time you build a very complex sort of data set that's yours. It's individual to that person, to you.
And then based on that data, we're layering around in the software, behavioral tools, interventions that allow that person to understand not only what is their blood pressure data set look like, but what, what do their lifestyle interventions, how do they impact their personal blood pressure data set? And so that's really the tool that we're building. And, um, you know, that's what we're really focused on at Actio.
Dr Alka Patel (12:40.974)
Thank you.
Dr Alka Patel (12:47.382)
Amazing, amazing. And the reason I say amazing is because I just want to maybe contextualize this a little bit because as you say, we all have a blood pressure and many of us have a high blood pressure, but we don't even know about it. That number you alluded to 1.4 billion. I mean, that's the tip of the iceberg of people who know, but there's also what's happening underneath the iceberg is people who are walking around with high blood pressure and they don't know until bang, an art attack hits or bang.
Jay Shah (12:56.227)
Yes.
Jay Shah (13:12.615)
Mm-hmm.
Dr Alka Patel (13:14.606)
the stroke hits and that's the first time you ever realized you had high blood pressure. Why? Because you're not measuring it. Because it's not convenient to measure it. You've got to go and put your arm in this machine, which you might find in your doctor's surgery or maybe in your pharmacist, or you might need an appointment to go and do that. And so what you've done, what Actea have done, is bought the convenience and the safety and the efficacy and the ability to really take charge.
Jay Shah (13:23.054)
Correct. Mm-hmm.
Dr Alka Patel (13:43.946)
of knowing what's going on with you and then utilizing that information. And I think that's really important to contextualize is that here we have something physiological going on in our bodies all the time, and that we've not had a way of paying attention to it until now.
Jay Shah (13:58.318)
Mm hmm. Yeah. And I think that contextualization to go a bit further is that even if someone does have a cuff, which usually it's like a loved one has a cuff or they're in their doctor's office, you take one reading. And it might be a little high might be normal. And it's very easy to just blow that off. It's very easy to sort of explain it away. Oh, I had more coffee today than usual, or I'm feeling stressed or anxious. I mean, I mean, this happens all the time. That's human nature.
And what people often don't realize is that the concept of one stable blood pressure is false, meaning that one measurement at one time is not reflective of your blood pressure over the weeks, months and years, and that our blood pressure blood pressure is continuously fluctuating, continuously changing. So to really get an accurate understanding over time of what.
your blood pressure pattern is, you require many, many measurements over days, weeks, months, and years. And it gets to the sort of another critical point of blood pressure is that blood pressure does its damage over long periods of time.
It doesn't really matter generally one day, one minute, one week, even one hour. What is someone's blood pressure? That generally isn't that important. What's really critical is what is that blood pressure pattern over years, decades. And that's how blood pressure does its damage to all the different organ systems that it does. So having a tool to sort of, sort of continually monitor track.
Dr Alka Patel (15:23.476)
Hmm.
Jay Shah (15:34.342)
optimize and really show the effect of interventions on blood pressure over time is so critical. And that's sort of the core innovation that sits at Actea as compared to the standard episodic one-time blood pressure sort of measurement that we're all kind of familiar with.
Dr Alka Patel (15:51.138)
Yeah, yeah. And thank you for highlighting that. I think that's a really critical thing to highlight and for people to know and add to their knowledge base, which is that one-off reading in itself doesn't tell you everything that you need to know. And we do have 24-hour blood pressure monitors and things as well, don't you? But they are incredibly cumbersome. And also the readings that you get, I mean, if you've got this thing pumping up your arm every hour, of course your blood pressure is going to go up.
Jay Shah (16:09.827)
Yes.
Jay Shah (16:16.002)
Right. Yeah.
Dr Alka Patel (16:18.102)
because of it as well. And most people don't like to monitor things at night time and have machines on them at all. So let me ask you a little bit more about the device. Some people may be able to see that we're both wearing a little, what I describe as a piece of jewelry, really. It's a bracelet on our wrist for a better word. It looks like a watch strap, right? Tell me a little bit about how this works because there are gonna be people listening who have used the big cuffs or been to their doctor's and have the cuffs.
Jay Shah (16:21.614)
Sure. Yeah.
Jay Shah (16:30.783)
Mm-hmm.
Jay Shah (16:34.363)
Yeah.
Jay Shah (16:38.382)
Correct. Yeah.
Jay Shah (16:45.495)
Sure.
Dr Alka Patel (16:46.894)
How accurate is this thing on your wrist that looks like a bracelet?
Jay Shah (16:48.978)
Mm hmm. Yeah, so it uses the it works a lot differently than the traditional sort of cuffs do there's no physical squeezing or compression of your arm. It sits on the back of your hand and wrist. And so it's what it's doing is using light sensors, LED lights to shine a light into the skin, get a reflection back into optical sensors.
and create these waveforms. And the waveforms are analyzed, that's what our founders really developed over almost two decades of work, analyze these waveforms and deliver back a blood pressure and heart rate measurement both to your device and to your physician via a dashboard at the same time. And so we've done extensive validation on, it's all published, all on our website, and we have extensive validation on our device as compared to the gold standard,
which I can go into and it is in the seated and relaxed position, it meets the standard criteria for accuracy of a cuff. One of the, I would say, intricacies of blood pressure measurement validation is that all cuffs have only been validated in one position.
seated, relaxed, back against a chair, feet against a floor, no talking, no drinking, no eating for 30 minutes, no nothing on your arm, your bowel should be empty, your bladder should be empty, you should not have kids around, this is very sort of controlled environment. That's the only environment and position that cuffs have been validated in. So our bracelet takes measurements when you're standing, when you're lying down, if your arms over your head or down by your side, and we have validation data across every
body position. And so it doesn't take it every second or every minute. If someone's running or walking or very physically active, it's not going to take it because you're going to have degradation of the signal. So it waits until you're relatively still before it takes a measurement and has a complex algorithm to determine those accurate times. And so that's how generally it works. So very passively and automatically, all you have to do is put it on.
Jay Shah (19:01.206)
you'll get these sort of trends of blood pressure readings over, you know, days, weeks, months, and without having to do anything significant.
Dr Alka Patel (19:06.382)
Yeah, yeah, completely, completely effortless. And I think the fact that you're describing evidence and validation, and I've had a look at all of that, it's so important, I think, to give people the reassurance that this is accurate, and it's accurate enough, and it's as accurate as the other forms of blood pressure monitoring that you'll have come across. I think some of the data I read was around sort of about seven millimeters either way, seven millimeters of mercury, which fits within a gold standard, is that right?
Jay Shah (19:19.543)
Yeah.
Jay Shah (19:33.117)
Yeah.
Jay Shah (19:36.642)
Correct. There's a very standard sort of criteria to get validation. And this is a class 2A medical device. So it has to undergo regulatory approval by the regulatory bodies in the UK and the EU. And we have regulatory approval across both. And yes, for them to approve it, we have had to show that we meet the standard criteria for blood pressure devices. Yeah.
Dr Alka Patel (19:59.17)
Yeah. So in terms of the sort of the population of people that you see wearing these sorts of convenient devices, wearables, is Actia, is the device being used more for a population who have high blood pressure or is it more of a screening tool to sort of check in to see if you've got it? Or is it for people like me and perhaps you who don't have a diagnosis of blood pressure or not worrying about their blood pressure, but really.
want to optimize health, live well, live long. Okay, all right.
Jay Shah (20:29.842)
Yeah, all of them across the board. When we look at our real world users, I mean, it's not, sometimes people kind of assume, okay, it's a technology. It works on with a smartphone. This is going to be relatively younger people, more sort of well, uh, healthy sort of proactive people. Actually, it's not the case. We have a spectrum of people from young, uh, twenties and thirties all the way up to, uh, 65, um, are actually most of our average patients are in between 55 and 65, 70.
Now we've just recently expanded our validation to up to 85 years old. So now people up to 85 can use it. So, um, and we often, often get, um, inquiries from caregivers. Usually a lot of times they're the ones who have set up the device for a loved one, an older person, um, that they're, that they're taking care of. So we see the spectrum from well, uh, well intentioned, but healthy relatively, and they just want to optimize their health and be proactive.
through people who've had an event and now really want to take charge of their blood pressure and understand it better and really want to have a much more comprehensive and easy to use solution. So I have to say it spans the spectrum completely.
Dr Alka Patel (21:43.322)
Great, great. And I also have a number of clients who have a family history, have a history of strokes, heart attacks, early heart attacks, early strokes, something that they don't want. So they worry about it in the back of the mind. And now they've got a way of monitoring and changing that risk and having that kind of much more earlier eye really. It's an eye into yourself, isn't it? Wearing devices like this, it's the idea of being able to watch yourself is incredibly fascinating because, and we'll get into this, but.
Jay Shah (21:47.727)
Yes, for sure. Yes.
Jay Shah (21:54.324)
Right.
Exactly.
Jay Shah (22:05.262)
I'm sorry.
Right.
Dr Alka Patel (22:11.55)
It changes your behavior as well, doesn't it? Right.
Jay Shah (22:14.854)
It does. Yeah, it does. And we actually have seen that we've done some real world evidence, sort of studies, just initial ones, just looking at people who bought the device who gave us consent to kind of look at their data for research purposes. And we segregated out hypertensives versus normal, normal blood pressure in the first week of wearing it, and then followed them for six months to see what happened after six months. And the people who had hypertension
did something we don't exactly know yet what they did something and they lowered their blood pressure by a statistically significant amount. Whereas obviously the normal blood pressure stayed normal. And I think it's preliminary evidence of the Hawthorne effect, which it means just if you expose someone to their own data, they will internalize it and then take actions to then try to improve it.
that perhaps they went to their physician, perhaps they started an exercise program, perhaps they really looked at their diet or alcohol or whatever they did. And all it was giving them the data, the information that they could act.
Dr Alka Patel (23:15.45)
Yeah. And I think we should highlight the Hawthorne effect. It's so powerful. We're talking about really the effect of being watched. So the moment you're being watched, your behavior changes. And we're now in this realm where you can watch yourself. Like you don't have to turn your eyeballs inside out. Like you can watch yourself with devices and data. And once you've got your eye on yourself.
Jay Shah (23:26.09)
Right.
Jay Shah (23:33.182)
Yeah.
Dr Alka Patel (23:38.794)
you do change. And I've got this with other devices that I use, sugar sensors, for example, my clients, the minute you put one of those on, you just start that self-awareness changes as well. So it's really interesting you highlighting that cohort of people that put the monitor on and something changed. We don't know what it is, but maybe it was just putting the wristband bracelet on that brought the blood pressure down itself, right?
Jay Shah (23:40.236)
dude
Jay Shah (23:45.81)
Mm-hmm.
Big deal, yeah.
Jay Shah (23:56.313)
Right.
Right? Yeah, yeah, it could be just, you know, who knows, but, yeah, that's a significant impact just in and of itself.
Dr Alka Patel (24:04.474)
Yeah. That's.
Dr Alka Patel (24:08.17)
Yeah, no, I love that. And what about interventions? Because just coming away from sort of the drug interventions for high blood pressure, just give us some more kind of lifestyle orientated interventions for people to take. They may have an actual on their wrist, they're noticing some kind of fluctuations, things are edging up a little bit. What are your immediate suggestions for what to do?
Jay Shah (24:30.338)
So I would say the first thing I would say is that, you know, even if we're going to go talk about the interventions and the, and the things that people can do without medications and, you know,
But the first thing to understand is that the impact of those interventions on the blood pressure isn't immediate. It's not like, it's not like sugar or glucose where you can see an effect after a high sugar meal within like two hours. It's, it's not like the blood pressure takes a little more time, whereas an intervention might take one to four weeks to really start showing some effect. And even, even one like weight loss may take three to six months to really see an effect. So again, that the, the very
of time is so critical is that one thing that I've experienced in my patients have often told me is they get discouraged because they don't see a quick effect. They don't see an effect with some intervention within a week or two. But the truth is it takes much more than that. And so really looking at this over a longer spectrum of time is important. And if we talk about the interventions, the lifestyle interventions.
Almost all people could probably rattle off what physicians generally tell people what to do. It's like a laundry list of look at your, you know, reduce sodium intake, reduce alcohol intake, reduce weight, exercise more, you know, eat better, stop smoking and sleep better. Okay. So this is sort of very generic laundry list that we give to all people, but here's the thing.
behavioral science tells us that if you give people seven things to do, that each one of them is quite complicated and difficult to do, there's literally, they're probably going to do none of that versus if you talk, talk about one or two things that they can really focus on and really get a sense of, is it making a difference? Is it actually improving my overall blood pressure pattern? Can I see the results of this test sort of
Jay Shah (26:24.166)
then it's much more impactful. And then they can actually know and be aware. Okay. That for me, alcohol reduction is much more important than sodium reduction. And that's so I need to focus on that. And a good example of this is sodium reduction. Like we talk about sodium reduction all the time. Almost everybody can know, oh, it's all generally high salt raises your blood pressure.
And the recommended daily intake of sodium is between 2000 and 2300 milligrams of sodium a day. Average intake for a Western diet is 3400 plus milligrams of sodium a day. It's really hard to reduce that because it's sodiums in everything, salts in all kinds of foods. So we talk about it ad nauseum with our patients and I do this all the time.
But we also know that only 50% of people are salt sensitive for their blood pressure, meaning only half of the people with hypertension, even if they did follow a reduced sodium diet, will actually make an impact. The other half not going to have any impact. So for 50% of people we're talking about it, expending energy there, they might be focusing on it. And for them, it doesn't really make a huge difference. So
You know, it really is starting to try to figure out how can we tailor some of these lifestyle interventions to that person? And how can we do this sort of testing, like do dry January and see what happens with your blood pressure. And then we can know, does your level of alcohol intake actually impact your blood pressure? And maybe that's a major thing that you can focus on for the for, you know, the long term. And so really kind of being very intentional about that, I think is, is important.
Dr Alka Patel (27:57.602)
Yeah.
Jay Shah (28:03.994)
And I think for behavioral science purposes, but also just to give people that sort of sense of, um, ability to really make a difference versus giving them seven things to do that are so difficult that they'll never be able to accomplish any of it. And they just say, eh, I'm just going to go back to my own life. And, you know,
Dr Alka Patel (28:21.795)
Yeah, yeah, it's so true. And you see this on social media. I see this on social media all the time, these listicles of seven ways to do this and 12 ways to do this. And you know that you're not gonna do any one of those because behind every sentence is a lot of depth, right? It takes so much to just change things. And I love this idea of self experimentation, fueled by this curiosity, but...
Jay Shah (28:28.95)
Yeah, so that video.
Jay Shah (28:37.086)
Huge depth. Yeah.
Jay Shah (28:44.586)
Yes.
Dr Alka Patel (28:47.926)
without the guesswork that goes with it, because you don't now no longer have to go, well, is it alcohol or not? Or is it salt or not? It's like, do the self experimentation. Enjoy that period of curiosity. Like you say, let's do dry January for a month. Like monitor, see. One intervention. Was it that? Wasn't it that? Okay. I've given enough time. Time is, I'm so glad you mentioned that because we're in this kind of fast fixed world, aren't we? Like, where's my results, right?
Jay Shah (28:50.155)
Yeah.
Jay Shah (28:53.608)
Right. Yes.
Jay Shah (29:02.994)
Yeah, see what happens. Yep. Right.
Jay Shah (29:12.623)
Yes, yeah. Yeah.
Dr Alka Patel (29:15.706)
You've given it enough time. Do you know what, for me, that wasn't my thing. I know for my friend, when she stopped alcohol, her blood pressure dropped, it was amazing, but for me, it's really different. And I think that's the sort of dialogue we now need to start getting into. Okay, so now I've done the alcohol, I'm gonna look up my processed food. I'm gonna look at the hidden salt, right? And the beautiful thing about devices and data and what they give you is, we don't have to all be doing the same thing.
Jay Shah (29:20.16)
Mm-hmm.
Jay Shah (29:23.554)
Right? Right.
Jay Shah (29:32.69)
Exactly. Let's look at that.
Jay Shah (29:42.094)
Sorry.
Dr Alka Patel (29:42.71)
And it's so personalized and we've come back full circle, haven't we, to this idea of having a individual, personal, N equals one approach to health, rather than I think what we've both experienced through our sort of early careers is this very broad brush population based effect. Yeah.
Jay Shah (29:58.958)
correct. One size fits all. And yeah, and I think that is the real promise of this. And, and if you just think about it logically, everyone would say, like, if you're treating everyone the same, then obviously, every single body is different, every response is going to be different. And you're going to have, I would say suboptimal results, which is exactly, you know, generally what we've experienced with hypertension with a global control rate of 20%.
Dr Alka Patel (30:25.846)
Yeah, yeah, no, amazing, amazing. I'd love to know what you do for your own self care, for your own health, for your own optimization. What's a day in the life of Dr. J. Shah like?
Jay Shah (30:33.301)
Yeah.
Jay Shah (30:38.978)
Well, I try to stay active as much as I can, which that means, you know, walking a lot, you know, walking in the US, I think it's a little bit more difficult sometimes in most cities than perhaps the UK. But walking a lot, I exercise, I generally, I use a Peloton, that's my thing. So especially when it's cold and wintry outside, I can just be inside and exercising still. So I use that pretty routinely.
to eat well and balanced and in moderation. I don't follow any real fad diet or fad approach, although they're not necessarily all bad. But again, it's individualized for different people. And I think for me, I have young kids and a family, so we all eat the same thing, but we try to just cook healthy, cook fresh vegetables, fresh foods, very low in processed foods, and don't eat out very much.
Generally, that's what I do. And then I track, I monitor, I try to optimize for myself. And I think those are the main things. I think the other things that people probably don't think about for sort of healthier and healthier lives are just social interactions, being plugged into a good community, having good friends, laughing a lot. I think those are so important and most physicians don't talk about it, but I think as we get older, it's clearly become such an important.
Dr Alka Patel (31:39.753)
Ha ha.
Yeah.
Jay Shah (32:06.915)
part of our mental health, which I think affects our physical health significantly.
Dr Alka Patel (32:12.538)
Oh, for sure. And these are the very forgotten medicines, aren't they gratitude and kindness and connection and belonging. And there's lots more emerging data about the impact on longevity and health and physical and cognitive well-being as well. So equally important to look at as well. Do you track anything else? Do you collect any other data or how do you use that for yourself?
Jay Shah (32:17.869)
Yeah.
Jay Shah (32:22.506)
Yeah.
Jay Shah (32:36.578)
So, I mean, I track my weight. I think that's pretty helpful. And all of us can do that very routinely. So that's pretty easy to do. It's not exciting, usually, to track your weight, unless you're having good success at weight loss. But I do track it because I think it's really important. I mean, obesity and being overweight is a primary driver of so many things.
that it is, and it's something that's so easy to measure and monitor at home. So I do track that pretty routinely. But otherwise I'm not, you know, luckily fingers crossed so far, I'm staying pretty well and healthy. And I do routinely get sort of the traditional measurements taken, blood work once a year. And so I do those things fairly routinely for cholesterol and some other markers that I look at.
Dr Alka Patel (33:16.078)
Yeah.
Dr Alka Patel (33:30.242)
Yeah.
Jay Shah (33:30.462)
And then I just turned 40, so I'm going to get a calcium score if you know what that is. I think those are super powerful and very, very helpful and predictive for cardiovascular disease. So, in my practice, that's always been something that I've recommended for anyone who's over the, at least over the age of 40, who's really, you know, wants to understand the overall cardiovascular risk.
Dr Alka Patel (33:53.504)
Okay, well now you've opened that up, you're going to have to explain to the listeners a little bit more about calcium score and how you can access that.
Jay Shah (33:57.118)
Okay. Yeah. Yeah, sure. So traditionally when you start thinking about cardiovascular risk, it's exactly like we've been talking about. It's very population based age, you know, gender, blood, do you have high blood pressure? Do you have diabetes? Are you a smoker? Do you have a family history?
and what is your cholesterol. And that's it, it goes into a database and it pulls from that database, here somebody like you with these numbers in this database, this is your general risk of a cardiovascular event in the next 10 years. So it's highly impersonal, it's just sort of database matching. But a calcium score is a very personalized test. And a calcium score is a low dose CT scan of your heart, so not much radiation, it's very minimal.
and it's just looking for presence of calcium in the arteries of your heart. And calcium is a surrogate marker for plaque. So the more calcium you have, the more plaque you have in the arteries. And it has been shown many times now to be a very strong predictor of future cardiovascular events. So if you add this calcium score test to the traditional risk-based scoring,
it becomes a much more powerful and personalized sort of risk assessment. And someone who might look great on paper, low cholesterol, not very old, you know, doesn't have much comorbid conditions or diseases or other things, but has a high calcium score is actually a significantly higher risk of future cardiovascular events, but they would not have known about that unless they did the calcium score. And it's a very widely available tool.
Um, and it's, you know, relatively inexpensive in the U S I don't know how much it costs in the UK, but in the U S it costs, um, $99. So most people, not all people, but most people can afford that. Um, and I'm sure in the UK, you know, GPs or, or others can, can put in that order for a calcium score. And I think that's for me, that's been a very, um, it's a very powerful predictive tool.
Dr Alka Patel (35:53.859)
Yeah.
Dr Alka Patel (36:08.214)
Yeah, yeah. And that's great because it's all got sort of additive value, hasn't it, as well, and it's trackable. So most of these things are not just one-off things. You'd never just go and have a one-off kidney blood test. You know, you don't wanna just have these things one-off. Once you kind of get into the rhythm of wanting to just get to know yourself, you wanna be starting to monitor changes over time because things do change over time. And sometimes you don't know until you start to measure as well, which is...
Jay Shah (36:12.749)
Yeah.
Correct.
Jay Shah (36:25.39)
Mm-hmm.
Jay Shah (36:31.746)
Right? For sure. Exactly.
Dr Alka Patel (36:36.034)
which is great. So no, thank you for sharing that. I think that's really useful from this kind of whole cardiovascular heart risk perspective because heart disease still remains the biggest cause of morbidity and mortality, doesn't it, worldwide? Pretty much so, so yeah, amazing. We should wrap up. We could carry on talking about this. For a long time, I think you shared some really important insights in terms of...
Jay Shah (36:47.884)
For sure. Yeah. Mm-hmm. Yes, absolutely.
Dr Alka Patel (37:01.666)
blood pressure, blood pressure monitoring, the time that we're living in now, what we've got able to access, creating some interest and curiosity and fun around health. Like get to know your data. Let's start to enjoy what we know about ourselves as well. So any final messages for people listening, Jo?
Jay Shah (37:13.341)
Yes, yes, absolutely.
Jay Shah (37:21.234)
No, I think that we've covered everything. And all I would say is that, you know, really from, from my perspective, after sort of this career in medicine, what's become eminently clear is that healthcare is, you know, what we have in healthcare is great. They will help. We can help people. We can help people when there's problems and events, but
It always goes much better and we always have a much better sort of outcome generally. If people are really truly engaged in their own health. And generally I've seen this time and again, if patients come to me and they're really empowered, they feel a sense of empowerment. Like I can actually make a difference. I am a partner with my physician in my own healthcare, not just relying on me or a physician or healthcare in general to kind of tell me what to do.
the experience is much better for them and they really feel, I think, yeah, I think that empowerment really gives them some more confidence like, okay, I'm really doing everything I can to optimize my health for the future. And it's not always perfect. And of course, there's no 100% prevention, but at least you're doing everything that in your power. And I think that's really super important. And I think I would wish that for myself and for all of us to feel that way.
Dr Alka Patel (38:39.498)
Yeah, and that's such an important note to end on. It's that ownership, isn't it? Taking ownership of your health, empowerment, feeling empowered to do something about it. And also responsibility. Like just have that sense, this is my responsibility. It's not on anybody else, right? It's on me. I get to choose and we can make that easier. We can make those choices much more.
Jay Shah (38:53.378)
Right.
Jay Shah (38:58.482)
Right? Yes, exactly.
Dr Alka Patel (39:04.706)
focused and targeted and strategic because we've now got access to incredible devices like Actier, which we can use. So thank you for bringing this to us and we will certainly keep in touch. I'll put a link in the show notes in there as well for Actier to make sure that people can access what they need to when they need to as well. So thank you so much, Jay. This has really been an inspiring, enlightening and empowering conversation.
Jay Shah (39:31.362)
Sounds great. It's great to be here. Thank you very much.
