The Iyer Clinic Update

In exactly 5 days I will take the stage at TEDxGARY to broadcast an idea that has been 66 years in the crafting. and my book, "The Road to the RED DOT: Land and Deliver your TEDx Talk in under 12 months", chronicling this journey will launch around Thanksgiving 2024.

Stay connected as I share the vignettes and moments before during and after this milestone, by bookmarking my website www.driyer.com and subscribing to my You Tube channel:

https://www.youtube.com/@driyermd

I found two things this past week:

1) These newsletters go out to the emails of our patients and often the entire family is using only one person's email when they register at our clinic. As a result that one person often forget to share the information they receive with the rest of their family. To avoid this you can all read past issues of the Iyer Clinic Updates at this place: https://driyermd.blogspot.com/2024/09/archival-list-of-iyer-clinic-updates.html

2) Some of the emails we have for our patients are no longer valid. We are asking everyone as they come to our clinic to validate their emails but I want to remind you that please do connect with our clinic on all the platforms we work on as below:

• Website: www.driyer.com
• Facebook: https://www.facebook.com/IyerClinic
• Dr. Ravi Iyer on FaceBook: https://www.facebook.com/IyerClinicMD
• LinkedIn: https://www.linkedin.com/in/driyermd/
• YouTube: https://www.youtube.com/@driyermd

The work I do, for the past 41 years has been committed to bringing out the message of empowerment and health to as many eyes and ears as possible. This is what I do and who I am. Please help me fulfill it by connecting and spreading it and more importantly by letting me know how and where I can do better or more.

With regards and best wishes to all of you for a long and healthy life.

Ravi Iyer MD
Founding Physician

The IYER CLINIC-LMG & NOVA Health Mgmt.

In my work as a physician, I am given the privilege of a ringside seat into the intimate lives of people. I have earned this privilege because I can be a space where the people who come to me can find for themselves a space for their own life to exist as they instinctually intended. Someone reading this sentence may wonder what it is that I mean by this statement.

By this I mean that they experience a space of judgment-free acceptance of who they are in my presence. No expectations just clear reflection. This is a learned skill honed over 41 years of disciplined work but when I exercise it I discover so much about humans in general and the South Asian cultures of Indian, Sri Lankan, Pakistani, and Bangladeshi populations in particular, who come to me for routine care. Of all the issues that I must help people navigate in life, the two greatest issues in these cultures are those concerning the relationship between spouses and between in-laws. Of course, these are social issues but these issues and the emotional struggles they impose produce real biological impacts.

The technical phrase for this is “Social Determinants of Health”. When I look at the wide variety of the way these issues present, they all boil down to a few simple principles.

1) The way people define how love and connection should be expressed.

2) The way parents define their relationship with their adult children and vice versa.

In South Asian culture, it is quite common for husbands to be deeply connected with their biological parents while the wife plays the role of an adjunct to the husband in family life. Second, parents similarly exert primary roles in the power dynamic of family life with the daughter-in-law playing a subordinate adjunct role that serves to adhere to and support the power distribution in the family unit. Now this is the traditional power dynamic, and I am stating it here not as good or bad but that it exists. Of course, there are families where this power dynamic does not exist, and I will talk of those too. It must be remembered that there is nothing malevolent in this structure. All the players deeply believe that they are loving, caring, supportive, and deeply concerned about the lives of everyone under their charge. However, the goals of life activities and purposes must be defined by the people at the apex of the power hierarchy. This form of family power distribution is called a patriarchy, that is a single male member, or a small group of elder members governed by a male defines the conduct and mores and expectations of all other members in the family unit. The members at the apex of this hierarchy naturally expect as a matter of existence that their definitions of life will be what defines the conduct of everyone. The word that describes this outlook is “Entitlement”. In Western society, this is the entitled social structure that existed in the Victorian era. You can see an example of how this kind of structure was lived and played out in the TV serial “Bridgerton”.

All of this is fine as long as all the individuals at every level of the hierarchy happily embrace their status and manage their expectations from life to live within the boundaries of this Victorian-era family unit. The problem arises when this does not happen.

That is when I get to treat women with high blood pressure, stress-related hair loss, obesity due to displaced eating behavior due to loss of communication with a spouse who does not recognize the aspiration of the woman who is a mother of his children at a meaningful level over the aspirations of his mother. Diseases like hypothyroidism, and diabetes run rampant among South Asian women. So also does a resigned hopelessness and loss of joy. In desperation these women hyperfocus on their children and their accomplishments. South Asian tiger moms may sound like formidable creatures but often they are the outcome of redirected passions. Of course, I am making a provocative point precisely to provoke self-reflection. If these definitions are not true for you then so be it. But for those for whom it may ring true or close to home and heart, I invite you to stop for a moment and ask…. Not as a fact, but as a possibility.

What if women were given the freedom and autonomy to craft their path. What if men found it in themselves to take a stand where they see their role as only protector and enablers of the aspirations of the women in their lives and not as rulers. Can a man find the space where he can protect without ruling? Guard without dominating? Lead without dictating?

Can a parent find the courage to take a stand that is only of advice-less support of their children’s goals? Can they find it in themselves to stand in service, ready to clean up the upsets of their children’s lives, without the commentary “I told you so”? Can a father say to his son, “Go ahead do what you desire. I’m here and I’ll always have your back.”

It’s not that parents do not stand in support of their children and suffer along with them. They do. But when they do not articulate it the way I described it, they totally devalue their contribution. It makes a huge difference to a son or daughter to be the recipient of silent, non-judgemental acceptance of their efforts by their parents no matter the outcome. It is earth-shatteringly transformational for a wife to hear her husband say to everyone in their family, “Did you ask my wife her opinion? Let us do what she thinks is the best option.”

Do you think that a wife who is on the receiving end of such support would not work to her last breath to bring the entire family forward? Never mind the radiance that would light up her husband’s the next time they are alone in the bedroom.

Think about it!.... Are you giving space for life to manifest in your life?

The October month of Halloween is not just the month of ghosts, goblins and the South Asian celebration of Nine-Nights (Navratri) and the festival of dolls (Gollu), but also the start of the American fall season.

It is a season of change and like all changes it is a time of renewal and turmoil. This means as we go out to enjoy and celebrate we need to be mindful of something else that is also emerging from the shadows to celebrate its own existence…. Respiratory viruses!!!

Fall is the flu season and we are also seeing a rise in the incidence of COVID and RSV (Respiratory Syncytial Virus).

Get you vaccinations updated. You can get your flu shots at any of our clinics or your local CVS.

I strongly recommend that all seniors above 65 and anyone who is obese (BMI 29 or higher), who has diabetes or any form of kidney or cardiac illness get all their 3 vaccinations (Flu, RSV, COVID) updated.

If you are hesitant about your need to update your COVID shot, you can stop by our office and get your blood drawn to know what is the level of your COVID antibodies in your blood-stream. People with very high antibody levels may opt to postpone getting a shot in this cycle.

Please look through the following educational graphics that will help you with useful information for yourself and your family.

Monday Sept 16, 2024; 7:45 am:

A 45-year-old man came staggering into my clinic, brought by his wife. He was training for a marathon and that morning had been unable to complete more than 400 yards before becoming extremely short of breath. He kept saying I can’t breathe, I can’t breathe. I held his hand to feel a pulse. It was racing, His hand was icy cold and clammy. He was having a heart attack before my eyes. Yelled for my staff to call 911. We got him to the hospital within the golden hour. Still as they were transferring him to the table for an emergency cardiac stent procedure, he arrested. His heart stopped and he was down for 28 minutes. The team shocked him 10 times and got him restarted… completed the cardiac stents , opened up a blocked artery and transferred him to the ICU on a ventilator. After 28 minutes of arrest I did not know if his brain was functional. His wife and family were disconsolate. I prayed with them and told them to have faith and wait the night. After 36 hours he regained consciousness, recognized his wife and made movements with fingers and toes. He was still on a vent and intubated. His kidneys had not yet made a drop of urine in the last 48 hrs so that organ was still shocked into a stunned state… but there is hope. That man will walk out of the hospital this week. He was incredibly lucky, and his story fills me with hope but usually, I do not get to speak of this. Usually, I am placing my signature on a death certificate.

This is not a problem unique to South Asians. It applies equally to my Caribbean and Jamaican islander populations, my Black American populations, my Saipanese and Hawaian ethnic groups and my Hispanic patients. Everyone of these people consume a diet that is nutritionally dense in energy. The food we eat should be thought of not as nutrition but as ENERGY. Our bodies consume energy in the form of food. Everyone of these populations come from cultures where the lifestyle involved hard labor or a life of high physical exertion. The food they grew up with. The foods that they ate to nourish them. The foods that became ingrained in their cultural ethos and psyche. The foods that spoke to them of family, warmth, love and celebrations. That food was wholesome and fulfilling in a life that also consisted of hard work and physical exertion. But when those same people come to America where they succeed and prosper and gravitate from a life of muscular exertion to a life of mental activity, they do not change their food compositions similarly.

They continue to consume and celebrate their success with the nutritionally dense, calorically energetic foods of their history. When the body consumes high energy foods, then that energy has to be used. Otherwise, it will burn you. This constant increased energetic burden carried by these people results in long-term inflammatory damage to their tissue that manifests as these diseases and risks.

Let us do a quick assessment of the most common South Asian breakfast

6 Idlis (rice cakes) with coconut chutney, spicy powder mixed in sesame oil, and a cup of Madras decoction coffee.

CALORIE COUNT IN A SOUTH ASIAN BREAKFAST

• 6 idli = 360
• 1 cup coconut chutney = 480
• 2 tablespoons of sesame oil = 240
• 1 tablespoon of spicy powder= 120
• Madras Coffee (Kaapi): 150 cal

TOTAL = 1350 calories; Even if you reduce your coconut chutney significantly you still are nearly at a 1000 calories.

Compare this breakfast with the calorie-burning capacity of exercise.

Walk Level Ground 2 miles in 45 min. This pace equals 22.5 minute per mile or 2.67 mph or a brisk walk: Estimated calorie-burn = 150 calories.

So to burn that 1350 calorie South Indian breakfast the average South Asian individual will have to walk almost 18 miles every day!

Now a single South Asian breakfast is 800 to 1350 calories and a business meal can easily contain 2000 calories!!

Is it any wonder that Diabetes, Obesity and Heart disease are the number one health problems among South Asians in America?

Why is all this significant you may ask. Here is why…. due to their sedentary exercise-averse culture and their high carbohydrate reliance of their diets.

This is the primary reason for the current recommendation of cardiologists in the US to promote aggressive reduction of carbohydrate consumption and increase treatment of even slightly elevated cholesterol with statins for all these high-risk populations.

In fact, the single greatest finding of the use of GLP-1 drugs like Ozempic is that along with the weight loss they produce, they produce a dramatic resolution of coronary artery disease, primarily due to the patients reducing their total consumption of high-energy foods.

So what is the solution? Does this mean that everything from Dokhla to Dosa and Dumplings must be damned?

No! Life and joyous living cannot be made a slave to health mandates. But, individuals need to discover how to modify their recipes of celebratory meals to make them less nutritionally dense. It is important to recognize that you cannot exercise your way to health when you are digging your grave with your teeth.

I advise my patients to do the 3-spoon exercise. It goes like this.

1. Place ONLY 3-tablespoons of food on your plate.
2. Go sit down at the table and eat your 3 table spoons of food with relish.
3. Drink a mouthful of water and then get up. Go back to the serving table and place the next 3 tablespoons of food on your plate.
4. Repeat from step 2.

By forcing yourself to repeatedly get up and go back for a refill. Three important things happen.

1. Your total portions begin to automatically decrease without making you feel like you are denying yourself.
2. The rate at which you eat slows down.
3. You become full faster before you stretch your stomach by overeating.

Overtime the 3 tablespoon strategy produces a steady weight loss that cannot be denied without depriving you of the joy of eating your cultural foods.

Happy Healthy Eating Everyone!

Next issue: The Health Risks Of Historical Subjugation

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