Hello, everyone, and welcome! I'm Dr. Michael Greger, coming to you live from my treadmill, from my new place in Seattle, where I'm sheltering in place until the world opens back up. Working on my next book, How Not to Age, on the latest in longevity research. There's tons of research, but I should be able to get out the book by December 2022, and hopefully by then I'll be able to resume my speaking schedule and come to your hometown in 2023. To help keep you satiated until then, my new How Not to Die cookbook, How Not to Diet cookbook, sorry, just came out last month, following how to survive a pandemic, which came out in August and unfortunately continues to be relevant. Check them out at your local public library, and of course all proceeds I receive from all the sales in my books are all donated to charity of course. All right, before hunkering down to write How Not to Age though, I had to script out more than entire years worth of videos for NutritionFacts.org, so I could truly immerse myself into the entirety of the longevity research for the book, and it is from that large batch of cued videos that I pulled out the videos for this webinar, the role of diet in racial health disparities. All these sneak preview videos I'm going to show you are going to be going up on NutritionFacts.org in the next few months, but you're going to be able to see them right here right now, but first some housekeeping logistics. If you can't hear me right now, there are instructions in an email that was sent out last week to tweak your audio settings if at any time you run into technical difficulties. There are live chat room staff standing by, and in fact, let me paste that link in the chat box. You will see I will paste stuff throughout the webinar. If they are unable to help, then we do have NutritionFacts.org staff standing by as well, but presumably if Zoom people can't help you, I don't know what we're going to be able to do, but let me paste that into the box as well. We want to give you as many resources as possible. Please reserve the Q&A button that you will see in the Zoom webinar there to ask content questions as opposed to technical difficulty kind of questions. The webinar will go for an hour, super quick, way too fast hour. This is I think the shortest webinar we've ever done, typically like three hours, but I have reserved some time for Q&A at the end, so feel free to add your questions in the Q&A by clicking the Q&A button throughout the webinar and our NutritionFacts.org staff will be compiling your questions to be answered at the end, and now you may want to wait to see if I cover a topic before asking your question, just in case it comes up later, but feel free to ask anytime. You don't have to worry about taking notes or anything because after this webinar is over, we are not only going to send you a full recording of it, but also a free link to download all the videos that I'm showing you in high definition, so you can see them in all their full resolution glory and you can pause. The videos go so quickly. You can pause, you can see what the papers, you can look up the papers, you can rewind, you can watch them again. All right, but let's get started here. I'm going to start with a video entitled, Spoiler Alert, How a Plant-Based Diet Can Help Reduce Black, White Health Disparities. Let's check it out. During the COVID-19 pandemic, the death rate for African Americans was as much as six times higher than White America. The higher Black pandemic deaths placed a harsh spotlight on their long-standing higher mortality and diminished longevity in general. Unfortunately, diminished African American life expectancy predates the COVID-19 pandemic by decades. The black-white death gap for women is about three years and for men closer to five years. The COVID-19 death disparities may have to do with limited access to healthy food and predominantly Black communities, the housing density that need to work or else, the inability to practice social distancing, but also the underlying burden of ill health. Increased COVID-19 mortality and complications occur more often in individuals with pre-existing conditions like hypertension, obesity, diabetes, and cardiovascular disease, comorbidities that are more prevalent in African Americans. More high blood pressure, more diabetes, more strokes, and more likely to die at early ages from all causes put together. The question is why?  Well, one big factor is socioeconomic status. In the United States, race is closely tied to class, with African Americans about twice as likely to be living in poverty. On average, education levels are lower as well. However, even among African Americans whose socioeconomic status is comparable to that of whites, despite the higher education and more socioeconomic resources, health outcomes are still poorer. Part of that has to do with lifestyle behaviors. For example, fewer than 5% of African American adults met physical activity guidelines. Smoking rates are actually comparable, though African Americans tend to be exposed to more secondhand smoke and have lower quit rates. This may be because they're more likely to use menthol cigarettes which enhance the addictive potential of nicotine. Why menthols? Because tobacco companies target the marketing of mentholated products to African Americans. Black lives? Black lungs. Similarly, if you look at food messages on African American television shows, not only does Black prime time contain a greater number of food commercials, African American audiences may be receiving nearly three times as many advertisements for low nutrient junk such as candy and soda. That may be one reason why African Americans tend to consume fewer fresh fruits and vegetables and are more likely to eat junkier foods. Of course, where are you going to get those fresh fruits and vegetables? There are fewer supermarkets located in Black neighborhoods compared with white neighborhoods, as in four times fewer supermarkets. What Black neighborhoods do excel in, though, is fast food. Predominantly Black neighborhoods have 60% more fast food restaurants per square mile compared to predominantly white neighborhoods. Now, of course, dietary behaviors alone do not fully explain these significant differences in diet-related disease patterns between racial groups. There are differences in employment and poverty and home ownership and health care access, all of which can affect outcomes. But while there are certainly many social and economic factors such as racism and income inequality that contribute to health disparities, there is good evidence that simply eating a more plant-based diet could help eliminate disparities in cardiovascular disease and diabetes. Here's the diabetes data. Even after controlling for education, income, physical activity, and even BMI, non-Blacks eating strictly plant-based diets had 57% lower odds of diabetes, and among Black vegans it was even more striking 70% lower odds. And that was after taking BMI into account. So even at the same weight, Black vegans had 70% lower odds of diabetes than Black omnivores. And the racial disparity is only about half that, 36%. So the increased risk of diabetes among Black participants was on the order of one-third, while the protection afforded by vegan diets in this subgroup was about 70%. Even just a vegetarian diet that includes still eating dairy and eggs may more than counteract the racial disparity in diabetes risk. And they're not the same weight. African Americans have higher obesity rates cutting their lifespans by six years, but Black vegetarians and vegans have less than half the risk of obesity compared to those who eat meat. And this is after adjusting for differences in physical activity, so even at the same exercise levels, those eating more plant-based had about a fraction of the obesity risk. High blood pressure. In African Americans, hypertension is the most significant contributor to their increased cardiovascular disease burden and mortality, but Black vegetarians and vegans combined had 44% lower odds of hypertension, an important finding for Black individuals where hypertension is so prevalent, with no benefit found for those who cut out all other meat but continued to eat fish. And the same thing found for total cholesterol and LDL cholesterol cutting odds in half among Black vegetarians and vegans. As with non-Blacks, the researchers conclude these results suggest that there are sizable advantages to a vegetarian diet in Black individuals. What about vegetarians versus vegans? The title gives it all away. Cardiovascular disease risk factors are even lower in African American vegans. This is something we've known about when Caucasian vegans have been compared to vegetarians. However, it was not known whether African American vegans exhibit a more favorable cholesterol profile until now. Significantly lower LDL cholesterol in vegans. Now, of course, the vegans were also significantly slimmer on average in normal weight as opposed to the overweight vegetarians, but even after taking that into account, those eating more plant-based had significantly lower cholesterol. So there's a tremendous potential for plant-based diets to promote health among Blacks living in the United States. In fact, they may have an even greater benefit. For example, African Americans have an excess burden of chronic kidney disease, not only because they have more high blood pressure and diabetes, but there are genetic factors. 8% to 12% of African Americans are carriers of the sickle cell trait, which places them at significantly higher risk of kidney disease. So while Blacks represent relatively small fraction of the U.S. population, they account for more than a third of all patients on dialysis due to chronic kidney disease. And that's where plant-based diets can come in, shown to protect against both chronic kidney disease development as well as progression. Three-quarters of Blacks are lactose intolerant, too, so would again stand to benefit even more from eating plant-based. It is unacceptable that for decades the American healthcare system has failed African Americans and other minority communities in terms of helping to prevent some of our leading killers. But that just makes it all the more important for them to take the reins of their own health destiny. So just like diet can trump genetic factors, regardless of what lifestyle diseases run in our families, but diet can also trump societal factors as well. Next up, I'm going to review some of the issues that have plagued African American food culture in a video entitled The Harms Associated with a more Southern-style diet. And as you'll see, you don't have to live in the South to eat a Southern-style diet. African Americans have a higher burden of cardiovascular disease and diabetes in other American ethnic groups, but recent evidence indicates that eating a plant-based diet may help eliminate such health disparities, as I explored previously. African Americans as a group tend to have the highest reported meat consumption and the lowest vegetable consumption and part of this is access. But this article detailing the experience of a more house lifestyle medical clinic noted that there also appears to be an issue with aspects of the African American food culture. Enter the regards study, the reasons for geographic and racial differences in stroke study. The study found that regardless of where African Americans live in the United States, they are much more likely to consume what the researchers called a Southern diet, which is a dietary pattern characterized by added fats, fried foods, eggs, organ meats, processed meats, and sugar-sweetened beverages. They found that this type of dietary pattern mediates the majority of the racial disparity. Adherence to the Southern dietary pattern increased stroke risk by 39% in Black Americans. In contrast, the greatest benefit was seen among participants who followed a more plant-based dietary pattern which conferred a 29% lower stroke risk. Same thing with heart failure. Eating more plant-based was associated with a 41% lower risk of heart failure, while the Southern dietary pattern was associated with a 72% higher risk. And this is after controlling for things like education and income, death from kidney disease. Same thing, more plant-based linked to lower risk of mortality, whereas eating closer to the Southern diet associated with a greater risk of kidney disease, mortality. Those eating more Southern-style diets likewise had a 56% higher hazard of acute heart disease. This finding was particularly interesting. Dietary patterns and the risk of sepsis. Sepsis is the syndrome of body-wide inflammation triggered by infection, and is a major public health problem.  Now, we know diet plays a vital role in immune health, but its association with sepsis was unclear. But a Southern dietary pattern of eating was associated with a higher risk of sepsis as well, particularly among Black participants. What about cognitive function? Once again, greater consumption of the Southern dietary pattern was associated with worse outcomes, lower scores on the assessments of each of the cognitive domains, like learning and memory, whereas greater consumption of the plant-based pattern was associated with higher scores. Here's the data on learning. The more plant-based people ate, the better they were at a learning task. Meanwhile, the more Southern-style people ate, the worse they were at learning. Same thing with memory. Better, the more plant-based, worse, the more Southern-style. Is therefore possible that the increased prevalence of Alzheimer's in African Americans could be partially reduced via dietary modification? Easy for a privileged me to tell people to eat healthier, but isn't it expensive to eat plant-based? Have you seen the price of beans? There's this common misconception that plant-based diets are more costly than animal-based ones, so proper education will be needed. A vegetarian diet could result in approximately $750 per year in savings. So healthier and cheaper, what would you do with an extra $750 in your pocket? Not to mention all the health care cost savings. I mean, a plant-based dinner consisting of red beans, brown rice, collard greens, sweet potato, and cornbread could feed a family of four for under $12 or three bucks per person. Check it out. Some of the healthiest foods on the planet are some of the cheapest foods. Such a meal would not only be cost-effective, but nutritious, providing a mountain of nutrition, plus a host of antioxidants to protect against various diseases like heart disease and cancer. Here's the save $750 a year eating more plant-based study. Why? Because you're cutting out meat-poultry seafood. And when one considers total grocery costs, animal products can be the most expensive food. Animal products can be the most expensive components costing more than double the cost of a serving of vegetables or legumes like beans, but peas, chickpeas, and lentils. That meal is making me hungry. Next time, I got to eat lunch before I do one of these webinars. Note that it may sound like I'm using the terms African-American and black interchangeable. Interchangeably, I know they are not synonymous. I'm just using whichever term was used in the particular study I was referencing. Before taking questions, I'm going to wrap up with a video. I'm calling Soul Food. That's good for the soul. The burden of cardiovascular disease in the African-American community remains high and is a primary cause of disparities in life expectancy between African-Americans and whites. Why is there such an excess burden? Because of an excess burden of risk factors, for example, high blood pressure, diabetes, obesity, and high cholesterol. And what's underlying those risk factors? Much can be traced back to diet. Among the ethnic groups, the proportions of people meeting healthy diet recommendations were generally lowest among blacks. In this national survey, most black Americans were found to be eating a particularly poor diet as defined by the American Heart Association. African-Americans may face unique challenges to adherence to dietary recommendations, and one such challenge is an alignment with a cultural tradition of soul food. Now, some soul food components are fantastic. Can't get much healthier than collard greens and sweet potatoes, tomatoes, legumes, dried peas and beans, the black-eyed peas, watermelon, blackberries, corn, okra. It's all making me hungry. But conversely, soul food can also behind added fats, sugars, and salt with prominent use of high-fat meats, not to mention the use of deep fry.  Where did the pig intestines custom come from? You have to trace the roots. Soul food is what the enslaved Africans were forced to come up with in the deep south to survive during slavery. That's in stark contrast to traditional West African diets where they come from, which were predominantly plant-based, centered on a foundation of greens and fruits and legumes and nuts and vegetables and whole grains and even more vegetables. However, these traditions have been westernized, bastardized into a diet high in fried foods, sweetened beverages, and bread and processed meats. But the good news is more and more African Americans are adopting plant-based diets to combat their health problems, helped by a growing movement of vegan soul food restaurants that serve healthier plant-based meals. Soul food scholar Adrian Miller even wrote that after eating his way across the country, it was clear to him that soul foods creative energy burns brightest in restaurants that are targeting upscale vegetarian or vegan clientele. Are they reaching the people who need it most though? Well, they do tend to be located in higher African American higher poverty areas. A significant number of restaurants were classified in food desert zones where there's a dearth of supermarkets implying their potential to provide healthier meals to residents in the surrounding neighborhoods. Therefore, having more vegan soul food restaurants and growing movement centered on Black veganism may provide opportunities to influence the nutrition habits in the African American community, especially since some are even able to offer cooking classes. So establishing public health partnerships with vegan soul food restaurants to get more African American adults to eat plant-based foods could be a promising first step in reducing some of the Black white health disparities. We're not meat shamers, said owners of vegan soul food restaurants promoting healthy eating in the African American community. We're plant pushers trying to tie the best of soul foods origins to a 14th century plant-centric West African diet in hopes of making people feel that being vegan is in fact a legitimate part of Black culture and Black identity, even potentially tying it into the concept of social justice in an attempt to reverse the effects of targeted marketing efforts by fast food companies to children in communities of color. This movement has been helped by a plant-positive who's-who of Black culture, not just luminaries like Coretta Scott King and Cory Booker, but the likes of NBA star Samuel L. Jackson and Beyoncé and, influentially, the late activist Dick Gregory, known in popular culture as a comedian, but was also an outspoken vegan health advocate influenced by Alvinia Fulton, who imagined soul food that was actually good for the soul. Instead of celebrating the fact that slaveholders denied enslaved people access to quality foods, she persuaded Black communities to view food as an agent of health and healing, advocating fresh whole foods as the path to alleviating or reversing the crippling burden of chronic disease. Black vegetarians and vegans are showing a plant-based diet isn't just for white people and never was. In fact, you can go back centuries to The Liberator. Back in the 1800s, the abolitionist publication where William Lloyd Garrison wrote his famous essay, I Will Be as Harsh as Truth than as uncompromising as Justice. Well, in an 1853 issue, it was written that a man whose stomach is crammed with animal abominations can no more appreciate lofty moral and intellectual teachings than a swine can appreciate pearl necklaces. Logic, humor, and eloquence are wasted on such persons. If only the American people took more thought what they should eat and drink, obeying the rules impressed upon them by experience and science, by which they meant a vegetarian diet, America would be half-converted to anti-slavery, peace, temperance, land reform, women's rights, etc. in a single year. Isn't that wild? 1853. Anyways, if you are fascinated by the soul food slave food connection, check out slavefood.org. And for a book that covers the subject, check out Healthy at Last, written by none other than Eric Adams, who may very well be the next mayor of New York City. Imagine that. And Healthy at Last features recipes from all sorts of plant-based luminaries, including my purple sweet potato smoothie, which actually is what I had for breakfast this very morning. And I didn't even plan that. It's just that's what was happening. There are also organizations like doing great work, like the Los Angeles Food Policy Council, that has been working to improve access to produce and healthier options in LA's food deserts. And you can check them out at goodfoodla.org. All right, time for your questions. Let me pull up. The Nutrition Facts staff has been compiling questions. And so let's go read through them. Okay, question number one. Is the reason why this webinar is so much shorter than typical ones is because there's just limited studies slash information regarding the health of African Americans. And that is indeed exactly the case. So in fact, one of the things I normally say, in fact, I should have said it again today, is like by the end of this webinar, you will be an expert on topic X. Because basically I searched every possible study that has ever been done on any particular topic, and that's when I pulled the webinar together. And so basically if you have questions about anything that I didn't cover, the answer is probably I have no idea because it's never been covered. There just aren't studies on this. And so I have covered the swath of the best studies that have ever been done on this. And as you can see, there's not much out there. I wish it was a three-hour webinar. But as more studies are published, I will do more videos. So the number of videos on nutritionfacts.org reflects just what's in the scientific literature. People ask me all the time about some weird mushroom or some weird herbal medicine or something. And I'm like, the reason there's no videos about it, odds are. It's possible I haven't got to it yet, but odds are at this point, we've been around almost... Wait a second, is this our 10th year? I think this is our 10th year, 2021. Nutritionfacts.org I think went live in 2011. By now, if I haven't covered this, probably just because there hasn't been any, there hasn't been any science on it or any good science, any science that is practical, groundbreaking, interesting, et cetera. All right, let's move on to our next question. And guess who it's from? None other than Tracing Me Quarter, which I, who I am going to be doing a live Q&A with. Oh, when is it? Hold on. Oh, I have my calendar app shut down. Let me hold on, let me pull it up. I believe it is, yes, next Thursday. And this is going to be January 28th at... Two o'clock, oh, Pacific time. Sorry, I'm Pacific time now. Five o'clock Eastern time. We're going to be talking all about the wonderful stuff she's doing. Anyway, let's get to our question. She says, can I talk about the role of systemic white supremacies, root cause of the highest rates of chronic disease that African Americans experience, related since a lot of challenges African Americans face in regards to healthy eating like targeted marking, food deserts are systemic. How do we begin to reverse the, how do we begin to reverse those challenges as opposed to expecting them to just eat healthier? Okay. And so you'll note, I did not talk about a lot about racism or white supremacy because they're just, those aren't covered in the medical literature. But as I noted, even if white supremacy, even if racism accounted for 100% of the healthcare disparities, the racial healthcare disparities, meaning socioeconomic class, education, all that didn't account for even a percentage. If it was 100% racism, still eating healthier could not more than eliminate the healthcare disparities. So that is hopefully the kind of good news, the kind of optimistic positive view, but not to detract from the horror of white supremacy. Obviously, I'm so looking forward to having a conversation with you, Tracy, next Thursday. So we can cover some of these topics and you can offer some of your ideas of how we can get ourselves out of this morass. Okay. Next question, are African Americans more at risk of any mineral or vitamin deficiencies that can be corrected with a plant-based diet? Well, in general, national surveys show lower food and vegetable consumption and that's where most of our essential vitamins and minerals come from. They come from the ground. And in fact, even vitamins, minerals, people tend to associate with animal foods like a calcium and dairy products or something. Where does that come from? It all comes from the ground, right? It all comes from plants, all comes from the soil and we can kind of cut out the middle move by going straight to the plants themselves. And so I would assume things like folate deficiency, which can cause birth defects. Folate comes from the same root as foliage. It's found in leaves, first discovered in spinach. And so, but also found in beans. So beans and greens, please get folate. But actually, African American women have the highest dark green leafy vegetable consumption in the country. Which is very exciting. Of course, not saying much. People eat so few greens in this country. But anyway, yeah, any diet, so whether Southern style diet or ketogenic diet, low carb diet, any diet that's cutting down on fruits and vegetables will cut down on the most nutrient rich foods on the planet. And so, yes, one would indeed expect relative vitamin and mineral deficiencies in those eating diets with fewer whole plant foods. All right, next question. Are there similar studies done for South Asians? What about Hispanics and Latinos? I did talk, I do have videos about the Hispanic paradox, so-called Hispanic paradox, which is the term used in the medical literature to describe why Latinos have the longest life expectancy in the country. And so that's actually, so there's a healthcare disparity in which whites live significantly shorter. And so wait a second, why is that? Spoiler alert, who eats beans in this country? Probably beans. So legume consumption, beans, split peas, chickpeas, lentils, single and most important dietary predictor of survival around the world. You want to know how long a society lives, ask how many beans they eat. Indeed, all the blue zones, every single one of them. The areas around the world, which have the greatest longevity, so I'll obviously be doing a lot of research on them for the next book, how not to age. The greatest number of centenarians, people who live over a hundred, they all center their diets around, I'm not just plants in general, but specifically use some form of legume as a primary protein source. And so, but of course, doesn't matter where your family came from, we can all eat healthier. Okay, and in terms of some of the studies done for South Asians, South Asians in the United States, there's not much out there that I certainly ran across. Are there racial differences, next question, in blood types? Oh, interesting. Is blood type O associated with less severe illness while A is associated with more severe COVID infections? When I was writing the book, How to Survive a Pandemic, I actually looked at the blood type data. There was this suggestion that people with different blood types had a different COVID-19 course. I mean, anyway. And at the time I was looking at it, the data was really wishy-washy, so I actually didn't include it in the book. And I haven't looked it up since the book came out to see, oh, well, has the data firmed up at all? Because it doesn't really matter. Like your blood type, you're born with it and there's nothing you do about it. So who cares? I mean, I was interested just kind of theoretically, but when I looked at the last look of the data, there was no difference. And are there racial differences in blood types? Certainly with sickle cell trait there is, but I don't know. That's a good question. It's not something I've ever looked into. And doesn't really matter much other than blood donation and blood recipient, blood receiving. Hopefully we can avoid that by not having to go in for operations and avoiding accidents, etc. All things I've got videos about on nutritionfacts.org. Although you'll note I don't have a lot of videos about accidents. That's actually a leading cause of death. It was not. There was no chapter in how not to die. I'm preventing accidents. I actually do have a video coming up on accidental death. on nutritionfacts.org. That's in the queue. So stay tuned. All right. Do this is a good, this is an interesting question. Do I have research on racism and the release of cortisol that additionally impacts healthcare disparities? And it shows up infant mortality rates and other health conditions. So the question would be are those, so for example, those who experience weight stigma. So obese persons who report that they are discriminated against, whether for a variety of ways that's tested. I don't know if my, no, they're not up yet. So I have a whole series of videos coming out on weight stigma. Those that report higher levels of prejudice against them actually do have higher levels of cortisol, the stress hormone, which actually ironically keeps weight on your body. So the cortisol is an adrenal hormone, which is kind of a long-term sense of your kind of long-term stress and it actually helps accumulate abdominal fat. The most dangerous type of fat. And so based on that data, I would assume that those who are discriminated against for any reason would also likely have higher levels of cortisol. And since that's associated with increased abdominal obesity, then that may indeed play a role in some of the healthcare disparities that we've looked at. Okay. Next up, curious how healthcare providers can take into consideration personalize their recommendations to include cultural and traditional food for different people, so it's not all the Western vegan fad items. Well, first of all, those vegan fad items, no one should be eating, right? It's like no doctor should be plugging vegan donuts and vegan ice cream and all the vegan, you know, fake stuff out there. They should be pushing for some vegetables, but indeed we should be sensitive to the cultural aspects. And there are certain vegetables that some cultures don't eat, certain fruits and vegetables that they love. And so, yeah. And so, you know, giving people recipes that, you know, are similar to the recipes they grew up with is definitely a way to do it. And so we, for example, nutritionfacts.org, you know, we have a Spanish version of our healthy eating guide. Which we've kind of adapted to make it more kind of user friendly for those with that kind of cultural background. So, but certainly I think it's a great idea, particularly if your patient population is a certain, you know, has a certain, you know, cultural, racial, ethnic backgrounds. So for example, I helped start a free clinic at Tufts Medical School when I was in med school. And we served a kind of Southeast Asian community largely and just in that area where Tufts Med School is. And so a lot of our patient materials really had to target, you know, recommendations that, you know, would be more likely to be, to kind of fit into their, you know, to require the fewest changes. So, you know, it's something that is easier to do. Because, I mean, we know the whys, we know all the data on what, you know, tremendous benefits in terms of health and longevity changing that I can have. But it's really how practical ways to make it doable in your day to day grocery store kind of life. And certainly this is the time of year as our New Year's resolutions are crumbling. Right. We know what to do. It's just how do we do it? In fact, I'm going to be part of a webinar series coming up later this month with Dr. Jen Hock and Dr. Douglas, which will cover some of these kind of practical tips as well. And that's in the latest New Year's Infects newsletter. If you didn't get it, make sure you subscribe. Next up, why are people of color more likely to be lactose intolerant than white people? Ah, that's a great question. Well, we all, meaning the human race started out in Africa.  But that's where the human species started. And so there were benefits from having darker skin to get less sunburn, etc. But then when you go up to the northern climates like Scandinavia, then that could actually, having darker skin can be a disadvantage in terms of vitamin D production. And so as humanity went to different niches around the world, there were different traits that were more or less useful in terms, and the ones that were useful in terms of better survival, better reproduction, obviously became more common. And so those who developed this weird mutation to allow them to digest lactose after weaning, the normal state, think of animals, milk is for babies. No species on the planet drinks milk other than us after weaning milk is for babies. And then, of course, drinking milk in another species, that's a whole other issue. And so the normal state of humanity, in fact, most humans on the planet have lactose intolerance. But that's actually, so that's the normal state. The mutation is this lactase persistence. Having this lactose digesting enzyme persist after infancy was that wacky mutation that allowed some in Scandinavia to outlive the competitors. And why? Because winter. When you're in equatorial Africa, there's food all year round. But winter, what are you going to do on winter, right? You've got some root vegetables that are going to stick with you. But if you are able to milk some cows, churn some butter, and maintain calorie intake during the winter, then you have a survival badge. Of course, if you puke it all up because your lactose intolerant, you're not going to survive as well. And so this mutation was beneficial in those northern climates. And so the whitest among us, the Scandinavian country people, those are the folks that have the highest levels of this weird mutation called lactase persistence, lactose tolerance. That's the weird thing. But most people in the world are lactose intolerant because, of course, most people in the world are people of color. Next up, Owen, I have some videos. I have some more lactose intolerance videos coming up as well. Of course, that's just one of many reasons why there are better things to eat than cow's milk and cow's milk products. Is the rate of, next question, is the rate of higher kidney disease related to the intake of alcohol also? When we think of an organ system being damaged by alcohol, number one on the list is liver. Kidney is more damaged by high blood pressure. It was more a sodium thing. And so I mean, alcohol is a carcinogen. Maybe it may increase the risk of kidney cancer. There's a whole long list of cancers that are increased by alcohol consumption. But that would be one potential connection. I actually don't know if kidney cancer renal cell carcinoma is increased by alcohol. I would not be surprised. But no, the high rates of kidney disease are threefold. One, high rates of hypertension, high rates of diabetes, which can damage the kidneys. And then third is this sickle cell trait. So about one in 10 black Americans have the sickle cell trait. It doesn't mean they have sickle cell anemia. It's just they carry this kind of genetic predisposition that increased the risk of chronic kidney disease, regardless of what they eat. Okay. And the next question is, oh, that's interesting. Speaking of which, has there been a correlation between sickle cell disease and COVID? That is something that I've never heard of. It doesn't mean, so it's not something I've looked at specifically. But I assume since there was a time I was reading every single article on COVID in the medical literature and it never came up. I'm assuming the answer is no, but the book came out months ago. And since then, I've not been staying on top of the science. So it's possible new stuff has come up since then. How would you tell you could go to PubMed? So it's the database of the largest medical library in the world, which your tax payer to always pay for at the NIH in Bethesda, Maryland. And you can look it up. You can type in sickle cell and COVID and you can see if any articles pop up. Okay. And if you're like, wait a second, but there's a paywall. How do I get at those articles? I've got videos about that too. Okay. What can health practitioners do to address health disparities like this? Can you also speak to lack of representation of Black RDS and RDNs? And how the healthcare industry itself can provide more opportunities for clinical and community-based plant-based vegan nutrition support, especially since most GPs, general practitioners, get about seven hours of nutrition training. It's actually a little more than that, but still it's miserable. It's difficult to talk to them about this or get insurance for nutrition advice. Yeah, no. So absolutely, there's people of color in general are underrepresented in many aspects of the healthcare field. I talked about one of the ways, in that last video, how the public health community can work on these issues by forming these partnerships with these kind of vegan soul food restaurants in urban areas for cooking classes, et cetera. And of course, everybody needs more nutrition training. That's unfortunately not limited to any specific group within medicine. So yeah, in general, just informing people about the role, diet may play in preventing, arresting, or reversing. The majority of our leading killer lifestyle diseases would be good for everyone, particularly because, right, so diet is the solution and diet, the solution is the problem. And black Americans have greater rates of the problem, and so we need more dietary intervention across the board, and that will preferentially help communities of color, which are stricken particularly hard by these horrible lifestyle diseases. Next up, oh, I think I addressed this a little bit, do African-Americans have lower vitamin D levels? The answer, absolutely yes. If so, do you recommend higher supplementation? I just heard about an expert opinion that the, that's their quote, it's not mine, that the evidence for vitamin D supplementation are really strong and might pass by like vitamin C supplementation hype years ago. Okay, good questions. Yes, African-Americans have higher rates of vitamin D deficiency, because they have lower rates of vitamin D production in their skin, because the melanin in their skin actually protects against the UV rays in sunlight, but it's the UV rays, the same UV rays in sunlight that give us vitamin D are the same ones that damage our skin, cause skin cancer, particularly melanoma. And so they're protected from certain types of skin cancer, but they need greater exposure to sunlight. So for example, at lower latitudes, just if your skin is light enough, and you're young enough and thin enough, then just five minutes on forearms and face, so it's not like you have to be in a bathing suit, you get all the vitamin D you need for the day of midday sun, so between 10 and two. But for someone with really dark skin, that a few minutes could be 45 minutes if you just have forearms and face exposed. And so you can see how you would have much higher rates of vitamin D deficiency. And then the question is like, well, does it really matter? Because vitamin D has all this hype about it, but it turns out vitamin D may not be as beneficial as we've seen. I've got a bunch of videos on that.  And indeed vitamin D absolutely flops when it comes to a number of conditions. The reason we thought vitamin D was so amazing is because these cohort studies, these epidemiological population studies, tie high vitamin D levels with lower rates of almost every disease on the planet. But guess who has high vitamin D? Those are running around outside. And so maybe it's the exercise, right? Maybe the, you know, so there's reverse causation, there's confounding factors, right? I mean, so reverse causation meaning maybe instead of low vitamin D levels leading to high rates of disease, maybe high rates of disease lead to low vitamin D levels, right? Because you're sick, you're inside, you're not getting enough sunlight. So anyway, that's why we need randomized double one placebo controlled trials where we give people vitamin D or an inert placebo like a sugar pill. And we actually see if these, there are lower rates of diseases. And in some cases it absolutely flops. In other cases, it significantly improves things. And in fact, I have a fun series of videos coming up where there's like a scorecard. It's like, okay, vitamin D totally bombs on that. But who would have thought it helped with this? Anyway, bottom line, spoiler alert. You need to make sure you get enough vitamin D. And for those at high latitudes, particularly this kind of the year, this time of the year, the sun's raised at such an angle, no matter how long you hear in Seattle, you somebody naked by the Puget Sound on the beach here and in January, February, you're not going to make enough vitamin D. And so that's why you need to take a vitamin D supplements. And so I recommend 2000 international units of vitamin D a day. And that is the same for white and black Americans. And look, you should be taking vitamin D year round if you're getting insufficient sun. It doesn't matter if you live in Phoenix, if you're sitting inside all day, you're not getting your midday sun, you need to get vitamin D either from sufficient sunlight or from supplements. Okay, there is a misconception that meat-based meals are quicker and easier to cook. If you're working long hours, exhausted center, how can you rationalize eating plant-based meals? Do you find that plant-based meals are easier, faster to cook? I think it's a similar kind of preconceived notion to the cost. People just think eating vegetarian is more costing when in fact, the science shows it's absolutely the opposite and sensing with convenience. People are like, oh, I don't have time. That's why I go to fast food, right? Because it's so much more convenient. I don't have time, right? You want fast food? An apple, that about is convenient. It even comes in its own edible wrapper, right? Anyone, in fact, yeah, anyone who doesn't know how to eat convenient lamb, I've never met an apple. I mean, come on, right? Some of the healthiest foods are the easiest foods. In fact, they're already done, right? Many first investors can be raw.  There's now all sorts of, sort of like whole grains, for example, and beans, pre-cooked, like canned beans, right? No salt added canned beans, VPA-free canned beans. They're already cooked. You open up the can, boom, done, right? It's 30 seconds, they open up the can. Now they can be a little mushy, and so I actually cook beans from scratch, from dry beans, super cheap. Save lots of money with electric pressure cooker, like Instant Pot. Takes a half an hour, but it's basically a press of button, and it just shuts off automatically. And so you make a whole bunch of beans, and they're a little firmer bite, and I think taste better, but it's totally up to you. So instead of, you know, 30 cents a can, it's, I forget what the calculation was, but it's even cheaper buying dry beans yourself. And there is pre-cooked, even whole grains. You say, well, I don't have time to like make rice or something. Again, you can make it in a rice cooker, electronic pressure cooker, or some of these other grains, like sorghum, which is my favorite rice substitute. But you can also buy pre-cooked grains, like you can get these pre-cooked quinoa packets from like Trader Joe's and things, where literally you just slice it open, it's done. And you can make a little quinoa salad, whatever. Oh, there's all sorts of easy, easy. So if you just Google quick, healthy, plant-based meals, tons of stuff will come up, right?  It's easy, convenient, healthy to eat, plant-based. All right, next up, how we doing on time? Oh, right, we're getting towards the end. All right, okay. Regarding the cost of eating healthier, it doesn't matter if you're eating organic. That's a good question. Eating organic versus non-organic, as long as you're eating a healthy diet. Are we compromising our health by eating cheaper non-organic foods? You know, how not to die? I have a, I talk about a video, kind of a computer modeling study. No, don't talk about a video, I talk about a study in which they estimated that if half of Americans in a single more serving of fruits and vegetables, we would prevent, I believe it was 20,000 cases of cancer every single year. That's how powerful fruits and vegetables are. Just half of Americans, one more serving of fruits and vegetables. Now, but they were taught, because they were talking about conventional fruits and vegetables, pesticide laden fruits and vegetables, the additional pesticide burden on the American public by that extra produce consumption would cause 10 cases of cancer. So overall, we would just prevent 19,990 cases of cancer a year, right? That gives you a sense of the tremendous benefits of fruit and vegetable consumption versus the tiny bump in risk. You say, wait a second, why accept any risk at all? I'm choosing to eat organic, great. But we should never prevent, we should never use concern about pesticides preventing us, prevent us from stuffing our face with as many fruits and vegetables as possible. And so if buying conventional broccoli allows you to get two heads of broccoli for the price of one, then go for the two heads. In fact, broccoli, bugs don't like broccoli very much. Conventional broccoli has about the same pesticide residues as organic broccoli. Now there are other benefits to organic, such as better soil and it's better for the workers in the fields, et cetera, to not use pesticides. But from a strictly personal selfish health point of view, the most important thing is the quantity of fruits and vegetables. And so one could argue with the cheaper, the better. Of course, if you actually buy more fruits and vegetables and actually eat them. Okay, we are, oh, and next question, it kind of ties in a little bit with all the government subsidies that various standard American diet food industries get, how can veggies be cheaper? Yeah, so our taxpayer dollars go not to make kale cheaper or apples cheaper or sweet potatoes cheaper. It goes to make sugar cheaper. It goes to make feed crops cheaper for to make dollar menu meat. And why? Because the most powerful lobbies within the Beltway are, is big ag. And so that's why we subsidize animal agriculture and process food industry to make cheap sugar, cheap corn syrup. And so why? Because they make more money. You make more money selling a snack cake that sits on the shelf for a few weeks than it does making produce. Because produce goes bad, right? It's not a lot of markup. You can't brand it anyway. Lots of reasons why unhealthy foods are more profitable. That's why we need to, we cannot rely on the corporate world or our government. Which in many ways has been ensnared by the corporate world to best feed ourselves and our family. We need to regain, reclaim our health by sticking to the science. But there are ways to get cheaper veggies. If you look at my, oh, I have a fun cooking video coming up. We're actually show what's in my fridge and freezer. And if you look at my freezer, half frozen berries, half frozen greens, and other vegetables. So frozen vegetables, because you can get them year round. Shop of farmers markets, community, community support and agriculture. These are all things that I personally do in my own life to cut down on the cost of veggies. And yeah, eating in season, all sorts of good stuff. Anyway, all right. We are, time is almost up. I hope everyone learned a ton. I know I certainly did. I learned about as much as anybody else doing these videos during my monthly live Q&As. You'll note that just basically I have two questions, two answers to, two kinds of answers to the questions I'm asked, which is check out my video on the subject, or I have no idea, but I'll look into it. Well, that's because I don't know any of this stuff either. I wasn't taught much real nutrition in medical school. So I've got to dive into the primary literature, like anybody else. Dig up the original studies and figure it out myself. I'm just so honored to be able to share this information with you. You will note that this webinar was free, as in not even asking for a suggested donation free, but if you would like to see more webinars like this, please consider making a text-deductible donation to nutritionfacts.org, which is a 501c3 nonprofit charity that supports all this work. Thank you so much, everyone.


speaker is Cee Lee. Cee Lee is at the University of Illinois and is gonna give her presentation on PyRiverbed, a Python framework to generate synthetic riverbed topography for constant with meandering rivers. Hello everyone, I assume anybody can show tell me you can hear me okay? Yes. Okay. My name is Julie or just come easy. I am a graduate student working with Professor Marcelo Garcia at UIC and today I'm going to give you a brief introduction on the Python code PyRiverbed, which is a synthetic riverbed topography generator for constant with meandering rivers. And I will start from the motivations. So meandering is one of the most unique processes in earth's surface dynamics. If you open Google Earth or any kind of similar tools, it will be very quite easy to find meandering rivers like this by their iconic shape. And most likely you also see the beautiful southern bar pattern just as the left figure shows you. The figure on the right exactly reveals what's very interesting. So the research question is, can a model use river centerline coordinates and give back the riverbed topography in equilibrium? Why do we need such a model? As you may know, many channels of centerline based meandering migration models were proposed in the past 50 years and most often derived the near bank shear stress or the near bank velocity from the steady state shallow water equations in the intrinsic coordinate system. And they always adopted the linear transverse slope assumption. But no one is specially designed for generating good quality bed topography. And the second motivation is for myself, why, what triggered the development of this model in the beginning? The answer is to create bottom boundaries for telemarketing models because my main research direction is using CFD models to study meandering rivers. And we always don't have the full basimetry data for river reaches we need to study. And in some cases, we have very limited data and a good estimate of the bottom boundary can be crucial in this situation because the bottom boundary is one of the six phases of a control volume if we consider meandering as a dynamic system. And then let's look at some details about the model. Firstly, it has a graphical interface. There are two modes to select. The first one is generating kino shita curve and the second one is loading your own centerline coordinates. So if the first mode is selected, user needs to enter kino shita parameters here, which include the number of bands, of course, and the arc wavelength, the maximum angular amplitude, the skewness coefficient, and the flatness coefficient. And if the second mode is selected, a level of smoothing can be specified according to this on the quality of the user provided centerline coordinates. And the channel with the water depth, the channel slope and the discretization resolution in both stream wires and the transverse directions should be specified. So in the next, there are two things need to be given. The transverse slope corrector and the curvature face lack strength. These two things are the new things proposed by this study and I will discuss them later in this talk. And finally, the meander migration submodel is embedded. And if it is turned on, users need to enter meander migration parameters just like other meander migration models. And the workflow of this pyrobat is very clear. And please note how the time advancing is coupled in the model. If the meander migration submodel is turned off, the whole workflow is going to be executed only once. And the figure on the right shows you the console output. Now let's take a look at the inputs and outputs of this model. So in both mode one and mode two, users need to enter channel parameters in the interface. And in mode one, there is no extra input file required. And in mode two and ASCII file containing the centerline coordinates must be provided. And the outputs of the model include a result figure showing the synthetic riverbed in the Cartesian XY coordinate and in the S and N, which is the intrinsic coordinate. And the next is the XYZ format point called of the synthetic bed. And the next is three output files, the river bankline file, the finite element mesh file and the boundary condition file are prepared for CFD modeling. And if the meander migration sub model is turned on, all kinds of files I just mentioned are going to be created for each snapshot during channel migration. And the final GIF animation file will be created to visualize the migration trajectory. Here is an example of all the output files. The first one is the point called and second one is the finite element mesh. And the third one is the boundary condition file. If you are a tally map user, you may have noticed the blue boundary and the green boundary already sat there. And the blue boundary always is always a flow discharge boundary in the upstream side. And the green boundary is always water surface animation boundary in the downstream side of a channel. And the last one is a bankline file. And here is an example of the meander migration sub model. This is a Taylor band in Sabine River, where is also the boundary of Louisiana and Texas. In about 2005, a neck cutoff occurred. You can compare in the to the Google Earth images before and after the neck cutoff shows us the model predicts reasonable back topography. This is a model outputs. And here's one thing I need to mention. The false colors are used to imitate the colors in Google Earth images. Because the output point cloud of the synthetic bed is always a wavy surface. And we can always set threshold depth and set the color below the certain depth to dark green and set the color above the certain depth to the color of sand to visualize the sandbar. And what if we run the meander migration sub model using a straight channel in the beginning, but giving a random perturbation to the near bank shear stress, sorry, near bank shear excess velocity at the first node, which means the perturbation is from the upstream side. And lower figure is river centerline migration trajectory. And this has been studied by quite a few studies. And the upper figure is the bed topography evolution trajectory by applying the same idea of false colors, we can visualize the sandbars during the migration. And here, if we run the same setup for multiple times, again, the third and the first and third rows are the centerline migration trajectories. And the second and the fourth rows are the sediment bar evolution trajectory. So after seeing a lot of results of PyRailBad, let's go back to take a look at the theoretical basis. And in 1988, Stuart proposed an analytical solution of bed topography in equilibrium form. And its foundation is linear the linear band theory and the experiment data feeding. And the method device here in the first equation, the method device any perception profile along the channel to a half linear half and an exponential half. So this group of equations tells us the bed admission could be a function of three parameters, whether depth, the channel base and channel curvature. And if this group of equations is applied directly for a symmetric meander band, like this one, the band will be symmetric to the geometry because the symmetry comes from the usage of local curvature. And the figure on this figure shows you an example when this group of equations are applied directly. So the question comes, can we simply replace the local curvature with some kind of cumulative curvature? And after a series of derivations of a linear stability analysis, using the shallow water equations as a starting point, and we can get the equation 2.40, this equation in the end and a number of studies already did some research on this equation. And we can evaluate the red hand side term by term. And the first term depends on the UB0 and C0, UB is the perturbation velocity at the first node, and the C is curvature at the first node. C the curvature and 0 is the first node. So these are the initial conditions. The example on the previous page just showed you the UB0, when UB0 is a temporal bearing node 0, what will happen? And the second term, this term, the A3 term, implies the near bank access velocity is negative proportional to the local curvature, because chi here is the sinuosity to the power of minus one-third. The sinuosity is a number between one to two or three. But then chi is larger than zero, at least to A3 is minus below zero. The third term, the convolution integral, is equivalent to imposing a phase lag to the local curvature. And A4, the last parameter wraps score factor A, friction coefficient Cf0, half ways to depth ratio beta, and the zero's order from number f0 and the sinuosity to the power of minus one-third into it. And here in Baxi equation, the score factor A has a relationship with beta, which is aspect ratio divided by two. And then we can reduce the number of depending parameters of A4 from five to four. Then but this relationship of A is found too high when the beta is high. So which brings the motivation to put a corrector in front of the formula to reduce or adjust the determine the magnitude of the transverse slope. The final formula is in the next page. So here now we work on replacing convolution integral of the local curvature C. We can write the convolution integral as a fancy f here. And we can write another corresponding upstream word, weighted moving average of the local curvature C as the fancy G. And the macro effect of G is same as the f. It's just imposing a phase lag to the local curvature. Note that the moving average also a type of convolution in math. Now you may ask a question from f to G, what if the amplitude and the phase shift changed? Here is a solution provided in this model. And in the interface, there are two more model inputs to control the amplitude and the phase amount, phase shift amount. And they should work like a calibration parameters. Then the final formula of transverse slope is showing this equation, the 2.45. So I can summarize what I have done in this graph. The black line is local curvature. And the red dash line is lagged curvature. It can be the convolution integral or the moving average. So in this study we chose moving average because it's easy to control the phase. And here the implementation. We all know Python is a lot slower than C or fortune in sense of computing, but we have none but to make the Python code fast. And for the interface, I chose the standard Python interface, which requires no extra installations for the users. And the code is hosted on GitHub. And why the final thing is why it makes a finite element mesh and boundary condition file. So the major motivation of making the finite element mesh and boundary condition file right after the production of the synthetic bed is to offer a convenient follow up step to perform safety models. So here I'm showing you a workflow for me and the river modeling could be. So the riff map and Paris, which are two softwares or packages already published, and they can we can extract the river centerline coordinates from satellite images that the land set imagers and the period with the centerline coordinates and give you the topography and you can use the topography in the following safety model. Here, I'm sorry for my interruption, but could you wrap up in the interest of time? Yeah, I'm not going to read everything here in the interest. Yeah, I'll stop here. Thanks. Thank you for your presentation. She before we move on to going to have maybe one short question. And if there's no question, I can I have one question. And she because I I found the meandering river is really fascinating. And maybe you touched upon this and I missed it. But I can imagine that the different grain sizes in the riverbed can have a big impact on the riverbed topography. Can you maybe touch upon how your model is dealing with that? Or if your model can deal with that? Because this is an analytical solution. So it's assuming. So based on the channel base depth and the slope, that's just only three parameters. So it's assuming the channel foaming. Because there's no discharge there. And there's no information of sediment there. And it's so it's assuming it's the same bad river. And the channel at the discharge is the channel foaming flow. So it's not recommended to use this model for your experiment, the flu studies, because the discharge can you can vary discharge and you can change the transfer slope by your own. So it's not controlled by the channel foaming discharge. So that's my answer. So it is it cannot capture the effect of different grain sizes, but you can play with the calibration parameters and you can play with a little bit to capture the real transfer slope. Wonderful. Thank you.


So now that we've talked about all this what we got to talk about is your internal state to be able to perform an Udalloop because what goes on around you compares little to what goes on inside of you and having control of what's going on Inside of you is what's going to make you a good practitioner of the Udalloop So you got to check yourself before you wreck yourself because Udalloop's work when you're calmly stimulated, okay? They jam up when you become too amped up and too excited And they depend upon metacognition and working memory and freaking out kills both of those like that so In the lecture that I spoke about at the beginning Scott Weingart MD and Michael Lauria came up with this mnemonic For how to keep your internal state so that you are in the appropriate zone for performing optimally under stress And they called it beat the stress foolish padawan and Those each stand for something and it stands for breathe talk see focus and posture, okay? So breathe we're talking about tactical breathing or box breathing, okay, and it's as simple as this You breathe in over a four-second count You hold breath for four seconds You let it out for four seconds and you hold expiration for four seconds and you repeat that four times When you do that that calms you that slows your heart rate that blunts your sympathetic drive And it brings you down to where you're more optimal in your functioning under stress This simple measure by itself has decreased in doctor nation washout in military special forces training by a third Just that alone has decreased the number of seals that go up ring the bell and say I quit What we're doing when we're doing this is this is out of a book by lieutenant colonel david grossman called on combat and He shows this physiologic response, and I know this is hard to read But basically as your heart rate goes up you get more and more undesirable Physiologic reactions so when your heart rate is going from 90 to 120 your fine motor skills start to diminish Which are complex and gross motor skills are starting to ramp up some but between 120 and 150 complex motor skills Start to break down you got to keep control of that and then between 150 and 175 Your cognitive processing deteriorates you get tunnel vision like I described when I passed out on the floor Loss of depth perception everything that you need to perform in a high stress situation starts to degrade and when you get up here This is unintentional fight-or-flight response. This is Soiling yourself Submissive behavior all of those things kick in an extreme stress. Is anyone in the room here ever been scared enough where they actually Pissed or craft themselves Good you have lived okay? The thing to keep in mind with this heart rate is this is hormonal and fear induced heart rate increases It's not necessarily the same thing when your heart rate is increased by exercise So you can get up into those higher heart rates with exercise and not have the same degrading response The other thing is ramping up happens really quickly ramping down into a more acceptable range can take as long as three minutes and If you rest longer than three minutes, you can have what's called parasympathetic Parasympathetic backlash and if you've ever wondered how soldiers can sleep in a foxhole with mortars going off all around them That's parasympathetic backlash Okay Talk and what so beat the stress bullshit. This is talk T That's self-talk you talk yourself up. You got to talk to yourself. Why you're doing this You got to think about your thinking so you got to say you can do this You've got to consciously enact metacognition say what's going on here? What's going on around me and then ask disconcerting questions check yourself for common thinking fallacies Now Eric Daniel is going to talk to you guys about thinking fallacies tomorrow So pay very close attention Because whenever you're in a stressful situation, it's very important that you ask these disconcerting questions of yourself See that means to visualize That means you picture your desired outcomes you picture potential problems and what your response to them will be and Vivid visualization before the fact is just as good as doing the real thing Every time I'm driving in for an ER shift. I do three things in as much vivid detail as I can I Visualize performing an emergency department for economy and all the steps of it like you saw at the beginning with a Seabooth at UCLA I picture performing a cricothyrodomy which is getting into the wind pipe when you can't get an airway by another mechanism And I picture doing a postmortem C-section Those are two or three of the biggest gnarliest procedures that I might have to be faced with and I run through those from beginning To end on my drive into work every time I go so that when the hammer drops I don't hesitate because hesitation kills in those situations. You got to act fast Focus focus is a key word that you're going to have for yourself to put yourself in that state but you got to use that keyword in combination with Meditation exercises that you perform at home You got to become Confident at zen like meditation. I use a specific hand gesture, which is two fingers on my thumb When I'm meditating and getting to that state of clarity So that when all of a sudden The back doors crash open and a parent's carrying a dead child in their hand I stand up take a deep breath put my fingers together And if you're practicing up at it, you will go there almost immediately and The last one posture Okay, when you are in a stressful situation assume a dominant posture It increases your testosterone by a third and suppresses your cortisol by one-third Very important in the stressful situation. You want to be open and expansive You don't want to be curled up and taking up less space. You don't want to be timid.  I think it's a bunch of people that think they're really smart that Probably couldn't fix a toaster sitting in the office You know just toppling theories left and right, but this one is exceptional by Amy Cuddy on the power of posture I recommend that everyone just hit YouTube and or Google and go check it out It is a very powerful talk about posture one thing I notice amongst my colleagues Whenever we have to call a consultant in and bring them in on a case Sometimes it's like selling refrigerators to Eskimos and the people that are all curled up and acting timid while they're talking on the phone Always get shit People that sit up tall Expansive have their feet up on the desk while they're talking those people always get results posture is important Another and that brings us to dr. Doug McGuff Let's bring it home First time I remember having it We were At the end of shift and I was coming on and we were talking about the patients the ambulance rolled between us with this well-dressed middle-class looking guy curled up on the stretcher moaning and groaning and Acting dramatic and I thought now brother That guy rolled between us and my attending said keep a close eye on that guy.  Well two and a half hours later after multiple testing and an angiogram of the gut. He was right Okay, and I realized because this guy was well-dressed and he was acting dramatic I made an assumption about him and I latched on to that for normal C bias. I See it with nurses. They'll bring back a patient That and if you ever show up in an ER kind of look a little scrungy my friends Don't wear your clean underwear because the more normal you look the more Normalcy bias will kick in for the people taking care of you We can believe that some derelict that we pulled out of the gutter is going down the drain But you come in, you know with your you know khakis on and a nice press shirt and you're doubled over.  I see them bring someone that's actively dying and put them in a non Acute room and if you're seeing a really sick patient in a room that's designated for not sick people Your brain will run to normalcy bias and you have to protect against that and then finally We want to be able to bend the curve and what we're looking at here on this curve is You have performance on the y-axis and heart rate on the x-axis and what you'll see is as heart rate goes up You reach this optimal performance zone here at the top Okay, if you get too stressed out You start to go into that realm where everything starts to go to pot Well, there is a way of performing stress inoculation to bend that curve So you go from condition red instead of going into condition black You just extend condition red out further Loops and think in terms of breathing self-talk actually do all those things


Good morning Marvel Squad. I hope you guys are having a wonderful day so far. So last night has been a really hard night for Bill and I just wanna say that I give him a lot of credit for going through with the surgery and being as tough as he is because he literally slept on a gaming chair. His gaming chair that he sits on and edits and does all of that, I'll throw up a clip right here. You can already see how uncomfortable, how he's not like, it's just, who has to sleep on a chair? Like that is like, I would not wanna be able to do that. That's like so uncomfortable. But today I'm basically gonna be taking care of him and just making sure he's okay and you know, giving you guys a little bit of an update. So, Bill is actually sitting right here. I'm talking like he's not even by me. How are you doing this morning? It's a weird seeing my head like this. It's kind of- Does it look like an alien Marvel Squad? It's kinda gross, I'm gonna cover it a little bit so people don't really cringe out. It looks like an alien. Sorry, if a lot of you guys find this gross, it's really not gross because all it is is a shaved head with little hair follicles. Yeah, it just buzzed, like it's like a buzz. I don't even wanna come close guys because it's kind of like crazy. But Bill, tell us about your night, how was your sleep? It was absolutely terrible. I woke up every single hour on the dot and I woke up like mad every single time because I was so tired but I couldn't get a good sleep and my head was throbbing. Not because of this, this doesn't hurt at all. It's my stitches. Which we're gonna show you guys later tonight because I actually have to clean that tonight for him. We're gonna film him dumping, are you doing the water dumping tonight? I can, yeah. I think tonight he's gonna kinda clean his head. Just stay tuned because this is gonna be the first reveal of the stitches at the end of the video or somewhere in between this video and you're not gonna wanna miss it because- It's actually crazy. Bill showed me the video. Well actually, you guys probably saw it already on camera. Right? Yeah, but now you'll see it like actually up close. But now you'll actually see it up close and I have to be the one that puts a needle's sporn on it and I just wanna say, I would do anything for Bill. I love him so much and I don't care if he has the biggest wart on his face and I had to pop it for him. I'm just saying. Well, do I ask her to pop up people for me before and she's never. Okay, well I'm just saying, if I had to I would. The thing is, I used to not really care as much but recently over the past couple of years I've been kinda like, if I see blood or I see stuff like that, I cringe and like I feel like I'm like gonna faint. I don't know why. It's not even like that. It's not even red. It's just a little red. It's not even like that.  Oh and I still can't bend over all the way so I have to like, anything that I do, if I drop something on the ground, I have to like, do this. Yeah, and last night he said, where'd you say you accidentally did?  I woke up to me like touching my head. I was like, but it didn't mess anything up. I don't think. No. So today, can you bend over at all? Like, or is it? It's probably more solid in there now. You might wanna call, I think you should call the doctor today and make sure that you can like. They actually called me. I didn't call them back. Oh my gosh, wait. We have to call them back on video then. We should call them back on video. Let's show them really quick though what you had to go through last night. I already cleaned it up. Well, I wanted to be sweet, baby. Okay, so picture this. Yesterday, we popped a clip. We already kinda showed it. This is right here, but no. I had all of this. I've been trying to kinda clean the room up as much as I can. I had all of this on the ground and basically what I was doing is I went like this. Like, cause I was like this half the night but then I wanted to come over here for a foot rest and then I would take the blanket and I would wrap my arms in it and put my arms right here. Oh, it's had kinda help you from not. But when I would sleep, that ring is around here. So my head's kinda like only being supported by that ring and I was kinda like. Last night, he was literally procrastinating going to bed because he did not want to itch himself in the night.  I just wanted to, you know, but now it's probably more solid in there.  Yeah. That's what my hair has to do. That's why they said it could fall out but like, I think it's dry. Let's go call your doctor back. Let's talk to her. Let's see what, you know, ask her all the questions that you need to ask so you don't have to keep calling her. This looks so weird to the model's client. It probably does and I'm so sorry guys this is a little bit too much for you. But I got a hairline now. But we want to show you guys like the whole process.  Or girl. Or girl. Yeah, actually the girl's girl at the gym, this older lady asked with asking Bill about it and I was like, good for you. I know I can show her actually. Yeah. I was like, you could be a baddie just like him. All right guys, he's calling, hopefully they answer. I just had a hair transplant surgery yesterday and I just had a couple questions about the aftercare and what I can do on the second day. I know we went over it in the office but I just have some questions about like showering and washing and stuff. All right. So here's the way for the phone call back. I'm kind of not showing the top of your head right now just so if people are a little bit cringed out.  Well they called you, you didn't answer. So honestly, what about you? I know. So Bill, how much do you have to do? So after we were done getting surgery, they were spraying my head like the whole time. They were like implanting everything. As you saw, if you watched our recent YouTube video you can kind of see a little bit of what they were doing. This is like nutrition hairspray with sea salt and all these like, you know, minerals and stuff. It's supposed to like make, you know, your. Head moist, right? And kind of clean it. It's supposed to keep your head moist and also kind of like. I think the sea salt cleans it. Yeah. Like there's water in it and everything. I use that for my cartilage piercing here. Oh yeah, you could probably use it for your ears but this is for like scalp. So like all you do is you just kind of go over and spray it a little bit and then just let it dry. Oh and there might be a little redness around here. Oh yeah. That's because first of all, that's where they put all the shots, you know. But at the same time, there might be stuff that's dripping and that's just like kind of all the stuff on my hair. That's why we're hoping. The D-L-O-O-D, that also is kind of getting washed off but none of this is like bleeding out. That's why we're hoping we're able to kind of clean it tonight. So it doesn't look as red and gory. But it feels good. Like I'm not gonna lie, it doesn't hurt. Oh. The stitching hurt but I took three, I've been proven today. I feel good. And it feels way better, yeah. That's probably why I went back to life. I don't know if we told you guys but Bill's head, like I feel like in the next video it's gonna be swollen.  Oh yeah, after the fourth day. They say my head is gonna swell up because they have medicine in my head right now that only lasts like three to four days that keeps the swelling down. So my head's gonna get huge and like. How big did they say like? Just gonna start bubbling up and swelling. Guys, stay tuned for that because we're gonna document it all. It's gonna be crazy. Hopefully it's not as bad as it sounds. Hopefully it's just minor. But sleeping is the worst thing that works.  We are gonna have to try to figure out how to block this off.  It's worse than getting stung by the anesthesia or whatever they were using on my head to numb it. Oh, that sleeping is worse? Sleeping is worse because first of all, I can't get any sleep.  So you can't even really focus on sleep. So we figured out a better comfortable situation for him. We didn't really think about this last night. They gave me this too, so. Yeah, they gave him that. So he's just gonna. Do this. But we just have to keep the cats from coming up. Like this is comfy. Okay guys, I'm kinda blocking his head. So if you guys, since it's more close up, you guys aren't getting a little bit down. But yeah, this is gonna be a sleeping. We're gonna have to figure out how to block it off because the cats are gonna like to play, huh, snap. Snap! You like to play?  You go back to sleep, but you got, when he's out here, you gotta be a good boy. Also, I wanna give you guys a little perspective of my night. So if you are somebody that is, or their boyfriend or your girlfriend does go through this, just know I, last night, was tossing and turning because all night I was worried about him. I wanted to make sure he was sleeping good. I wanted to make sure he was taking his medicine on time. Even though he was giving me a hard time, I tried to wake him up at like five in the morning and I was like, babe, I'm like, can you take your medicine?   You wanna stay on it so that the pain.  You didn't? No, I was just about to sleep. No wonder why you were in pain this morning, baby. You have to stay consistent. That's why I woke you up at five in the morning and then I woke him up and he starts to go like this. He starts to go like this and I'm like, babe, no. And he looks at me, he looks at me like this. Did you even look at me like this? He's like, what? I think I've been a pretty good girlfriend during this. I've been really trying to help him. I've been cleaning. I brought the blanket out for you. I've been trying to make you comfortable. I kept asking all night if he was okay. Like, I love him so much and I just wanna help him because he's, I feel like I've never seen you in pain like this.  Y'all proud of I am, are you? Yeah. And how much I love you? Love you too.  Me too. All right, baby. So I don't know if you can see right there but I surprised you with breakfast because I really want to take care of you. The reason, guys, I did get the surprise one that I wanted to was Bill touched his head and- My stitches are bleeding and I don't know if they're supposed to, I feel like stitches bleed, right? I don't know. I feel like stitches, my stitches, I went like that and they were bleeding, so.  Maybe it's from me moving this around a little bit. I haven't touched it in a while. I just started feeling weird and all of a sudden- I don't know, let's not freak ourselves out just quite yet. But I got a good breakfast. Got a good breakfast. I don't know what I got, but it looks good. You'll see, I want to surprise you and I'm taking care of you today. This is all about you and I- Maybe I should just stop moving as much because it's making my blood probably move faster. Probably. I should just take it easy and not lay, more lay upright. Did you still want to film at Tiktok or? Yeah, I'll be fine. You'll be fine? Yeah, my stitches are bleeding now, so. Oh, she's calling. Hello? Hey. Hey. How are you? Good, how are you? Good. No. Okay, so what prescription were you needing? So actually, I figured out the prescription. I just wasn't sure what time I should start taking it, but I just started taking the antibiotics last night and six hours from whenever they gave me the ibuprofen. I started taking- I took one tablet of the prescribed pill just because the pain was kind of a little worse. So I figured all that out, but I do have a question regarding my stitches now. Okay. So my head started feeling weird and I just took it a little tingly, probably because the medicine or whatever's wearing off. And yeah, I wore the nerves and I touched kind of where it felt like that and it was bleeding a little bit. Is it bad for the stitches to be bleeding a little? No. Okay. I can't fully see because they put gauze around my whole stitch and they said not to take it off until the nighttime when I go to apply a little more Neosporin. So you came in a bit off now. Okay. And these are but it shakes down today. Okay. It might also just be because of that because it's around my head really tight so maybe it is squeezy a little bit. Yeah. So I'll lose today and let it air dry. That can should be gone by today or tomorrow. Okay. Yeah. That's the other thing that I wasn't sure if I should have started it yesterday. So I did spray it once before I went to bed just because like- Yeah. Okay. I did make sure that it was completely like I stood under a fan until it dried last night. Okay. Because they said for it to like you have to wait for it to fully dry. Yeah, it's correct. Okay. That is right. But I won't do it now that I know that. But okay. You have to be not cleaning your head.  No. Okay. Okay. That's what I thought. Tonight am I able to dump the water or should I wait on that too? Just let it air dry though. Okay. All right. I think that's yeah. I think that's about it. I was just curious on those little details but I appreciate you calling me. I'm swelling can peak.   Do not ice directly on the grafted area or the suture line. Okay. I will call you when you're one week out but at any point if you have any questions or concerns you can always call me. Okay. Well thank you so much. I appreciate you all. You're welcome. Have a good day. Have a good one as well. I have a good day. Was that your surgery girl? No. I'm like the girl that's gonna be Oh keeping up with you. Keeping up yeah. Okay. Surgery girl is more. So we gotta take off after we eat let's take off your this and put some meal sporn on it. I wanna take this off now. I didn't know. That's probably why cause it's literally this.  It's like squeezing my head. Well we gotta also film that TikTok vlog of me taking off the wrapper for the first time. Oh my gosh. We have so much guys to process. All right we're gonna go eat and then we'll be back. Yeah we'll be back. So we are about to take off his wrapper. Don't do it yet because we're also filming a TikTok. So you guys are gonna see behind the scenes of our TikTok vlogs. All right ready? I'm ready to get this thing off. You want me to just film it in there? All right. All right take it off. Oh my gosh. Does it probably feel nice huh? Oh my gosh. Oh how's it feel like? Oh. Oh my gosh. Oh my gosh. Oh my gosh. Oh my gosh. Oh. How's that feel? That feels so much better. So much better. Oh my gosh. All the blood in my head. Look at that fresh hairline boys. My forehead's still gonna look pretty big because like we couldn't bring the hairline down because there was a lot of muscle here she said. But it doesn't really matter because you see like right here the hair will cover up to like right there.  Yeah. How about I'm gonna do 360 already. If you do not like stitches skip this video we're gonna show it really quick. Show it. Oh. Oh my gosh it looks like Frankenstein. It is time to put the neo-spawn on it and I'm honestly just like kind of freaking out. Should I do it with like- She has to touch it by the way. Should I put gloves on? Do you have like gloves that I can like- You don't have to wear gloves. Why don't my nail go like I wanna be able to like- I don't have any gloves. We only have two things that- I'm gonna freak out baby. I'm not trying to be panicky.  Don't obviously poke me with your nail but just go over it slightly like this. They did it. I mean they were wearing gloves. They're wearing gloves. They're professionals babe. I know. Just put it on your finger first. Oh I'm nervous. Why'd you got this? This is good practice for when we have kids and our kids need help. And also it's gonna look way better too because see all this hair.  So I just dab it on there? Yeah. Ha. I have a good hairline though now. Baby I'm nervous. I don't wanna do it with my bare hand. Spread it around a little bit on your finger. All right. That goes softly. It'll be good. Don't move please. You can rub. Slowly rub. Yeah. Slowly. And not hard. Not hard. Okay was it hard? You're like. I didn't mean to. I'm sorry. It's so hard. This is like scary. All right guys I did it. I freaking did it. I've never done that before in my life. And honestly it wasn't as bad as I thought. I think I was just more nervous cause I didn't wanna like hurt you and like I was just scared. I've never actually touched stitches before. That was like my first time. I've never touched stitches. I've never had stitches before. Really? And it's crazy cause I literally have like a whole 12 inches of stitch. It looks I literally look like I have a new head on guys. And what's crazy is you know all my hair that comes over my head that I had you know like my hairstyle it's still there. They clipped everything down with bobby pins. So don't worry my hair is also here whenever this is ready that I can flip my hair over. I'll look like normal billigan until this grows out. So how many times a day do I have to do your nails porn? Like once a day I think. Oh how many times a day do you? We'll do once, we'll do one more. Oh okay. We can get more nails porn. We should honestly do more. Maybe I'll do a little bit of a shipped order and I can get more. Yeah we should get more just to get we should probably do another one tonight. Okay.  Right? Yeah. That's not it or do you wanna? I just can't touch it. Yeah you just. I have to let it air dry. I would just rinse it. I think you should rinse it. I don't know should we show them the scar cause I don't wanna like I don't wanna mess like if anyone on here has like a problem where they don't wanna see like scars or something it's not bad it's just like. I can show you guys just skip this part. All right we're like literally we're only gonna show for five seconds a little scar it's not bad at all. There's really there's no red spots really. You're gonna see a Frankenstein looking scar so if you don't wanna see that just skip over like double tap the screen twice and it'll be done but I'm just gonna do a little twirl for the people that wanna see it cause I wanna be transparent with you guys that's why I'm even comfortable with showing you but I do have a good hairline. You do it's gonna look amazing once it's filled in. Even though my forehead's big like guys I don't know I was looking at my line guys like a lot of guys have big foreheads. I feel like small foreheads kinda look weird sometimes. No honestly just seeing the hairline once that hair grows honestly you're gonna look so good with hair even with the four it doesn't even matter how big your forehead is. I can do a man bun now.  And once I get the sides cause the sides are all like this once I get them either close to my head or shaved it's gonna look amazing. Did she say that she thinks you're gonna balm in the back anymore? I don't think so but I might have to get a touch up but this is the part ready? Okay. Alright skip this part if you don't wanna see it ready? Wow guys wow. Isn't that crazy? I feel insane. It's actually insane that I didn't even see what they looked like until I re-watched the clips from last video. If you did not go see our recent video make sure you go watch it cause it's crazy like when I saw it I'm like holy crap that's a lot of stitches. Yeah it is. I got a pee though. Okay yeah we don't wanna see that. No you don't. Guys Phil's mom just sent Phil the sweetest thing ever. Are you ready to see it? I already see it. Guys look yay the chocolate.  Okay it's got a little thinking of you Balloon. Well technically. You have the best mom ever. Technically she. Mama Colleen is the best. Technically she got it for me not for you. Well I could share it. Can I have some? Yeah you can. Since I'm helping I can have one or two. I know she. You can have the most of it. Guys show Mama Colleen's love in the comments.  Thank you Colleen we really love you so much.  Yeah I'm calling you sorry my head hurts.  Yeah. Oh you need to take more medicine. Yeah. Oh baby. So we're heading to bed and we wanted to show you guys Phil dumping the water on his head to kinda clean all the blood. He has been bleeding a lot from his stitches. I don't know why a lot. We're not gonna show you but like. I'm hoping by tomorrow that it's better because they said that it's not supposed to be bleeding as much. Right? Yeah basically. They said it's supposed to stop bleeding tonight. And it didn't. It's obviously it's not going to anytime soon. But it's in the same spot on both sides so I just think it's a really tension spot then. Maybe you're talking too much. No I don't think talking. I don't feel my thing move over to anytime I talk. Maybe when I sleep. Hold size. Ever since I took off the gauze thing I had been bleeding. Maybe it's getting a little cold. Yeah. I have to dump water on my head. But for four days I can't even wash the top of my head yet. So I figured out I think the word that's like people that don't like seeing holes and like clumpers, clumping stuff. It's called, I think it's called Trifobia or something like that. Oh yeah cause I've seen it on our YouTube. On TikTok too. And I'm like that. I'm like that. But it's you so I love you. But we're gonna show you guys really quick and then we're gonna end today's video just cause we're gonna have Bill shower. And don't worry I'm in my underwear so I'm not fully, you know, gone. But I need to kind of see what I'm doing though. Oh you kind of can see blood. Oh really? Yeah. Bubba you gotta get out. You're not scared. Hey. Get out. Get out. Back up. Back up. All right let's do it. You nervous? You want me to do it for you? Probably. No, no, no, don't look down. Oh yeah? You need to kind of like just like rinse it. All right so I'm gonna kneel down. MRI is gonna slowly pour it. Make sure not to touch my head. Okay ready?  Does that hurt? No, it's cold. I don't even feel it running now. Probably cause it's still numb. It's still numb? Yeah. Does it look cleaner? Oh it definitely looks cleaner. Ew you're showing them way too much. Yeah I know, sorry guys. But guys we're gonna let it air dry. He's gonna get in the shower.  It has been a long day. At least for me I've been like doing all like the work around the house and you know making sure and taking care of him so I'm ready for bed. Thank you so much. You're welcome. But I hope you're feeling better today and I hope you get a good better night for us tonight. I'm gonna feel better when it stops bleeding. Yeah I know. Cause like this stuff needs to like close up cause it's like hecka. Like if I put my finger on the back of my head right now it'd be rad. I think you just need to stop talking for the night cause maybe that's just what's going on. It's so weird like having my hair pull back and talking to you guys now cause like I never done that before.  Trust me like this is gonna look so good when it's grown in and I cannot wait to see the final result because like like it's just it's gonna fill in so well. Right now obviously it doesn't look amazing cause it's not supposed to but like I appreciate all of the like lovey comments all the support that we're getting across Tik Tok, our YouTube, Instagram everything you guys have been awesome also follow us on Instagram because I have been posting stories about this and if you wanna see more Do you brush your teeth today?  I don't brush my teeth right now but if you wanna see more follow us on Instagram as you can tell we're both really tired and I'm gonna try to get some better sleep tonight because last night I did not get that good sleep. Yeah, but guys we're gonna end the video here thank you guys so much for all your love and support we love you so much and we will see you in the next video. But until then peace, love you guys.