Dr. Shabnam Das Kar and Brain Health

Dr. Kar: 0:01

So I'm Dr Shabnam Das Kar. I'm a functional medicine doctor, a brain health coach and a certified tiny habits coach. I help people improve their focus, get rid of brain fog and prevent dementia down the line.

Judy Oskam: 0:16

Welcome to Stories of Change and Creativity. I'm Judy Oskam and I'm super excited to interview Dr Shabnam Das Kar. She's a doctor, a specialist in functional and metabolic medicine, and an international speaker. Before transitioning into functional medicine, she was practicing as an obstetrician gynecologist for more than 20 years in Mumbai. She lives in Calgary, Canada, and Mumbai, India. I hope you enjoy our interesting conversation. .. Tell me about how you started in medicine. I always like to know. You know this is about change and creativity and I'm always curious about how did you end up in this? When you were a child, did you always think you wanted to work in medicine?

Dr. Kar: 1:08

Not really. So this was a long time ago and I grew up and spent, of course, a lot of my life in India, and back when we were making career choices, it was very simple Do you like biology or do you like physics and maths? Now, maths was never my strong suit, so I said, ok, I like biology, physics not so much. Chemistry is OK. So it was medicine. So back then it was like medicine or engineering, and then all the others. Now, of course, people have so many more choices, so it was kind of I would say it was kind of made for me in that sense.

Judy Oskam: 1:47

Yeah, yeah.

Dr. Kar: 1:49

Yeah, but fortunately I like what I do and I am, I'm, I really feel grateful for that, because it just could have been. I didn't like it at all, sure.

Judy Oskam: 1:58

Sure, sure, well. Well, tell me a little bit about what functional medicine is, and did you start in that arena? Or did you start more traditional and then shift more into functional? Define that. We hear that a lot.

Dr. Kar: 2:14

Yeah, so no, I got into functional medicine much later, so I trained as an OBGY in India. So I was in medical. Practice is a little different there, so I was attached to hospitals delivering babies, doing surgeries and back that. At that point in time I was much younger, I loved it and the way practice in India is if I'm taking care of a patient, I have to be at her delivery or you know when if she has an emergency. So I was essentially on call 24 seven and in India most OBGYs don't know a different life if they are in private practice. So I didn't think there was anything different or wrong with that, because everyone needs that. But then, of course, then I had.

Dr. Kar: 3:02

I was at a conference where I heard a doctor who was practicing in the US. He came and he was talking about bioidentical hormones and I thought I am an OBGY and I've never heard of bioidenticals. So, to cut a very long story short, that is where my journey started. So I did a fellowship from the American Academy of Anti-Aging Medicine and back then I was in Mumbai. So I did the fellowship online and I just had to go to Dubai to appear for the exams. And that dramatically changed my thinking because I was used to regular medicine. I mean, you know, in obstetrics, gyneac it was. It is a wonderful time in a woman's life that we were sort of part of something that is quite natural, but of course a lot of things are not natural now, so most of my patients were not ill, if you mean, I know, in hair course. It was a wonderful time and anyway.

Dr. Kar: 4:02

So functional medicine journey was a very different way of thinking. So in medicine we are used to thinking of the body as different organ systems. So as an OBGY I used to only look at, as I say, stuff below the belt, so the uterus, tubes and ovaries and vulva and vagina, whereas everything is connected to everything else. Vagina, whereas everything is connected to everything else. In functional medicine we look at the whole person and we look at, you know, all the different organ systems are connected to each other.

Dr. Kar: 4:35

So what is happening in the, for example, my specialty was ovaries and tubes and uterus, so all the ovarian hormones, for example. They have an influence on heart health, on brain health, on gut health, on bone health. So in general, everything impacts everything else. But somehow in our medicine journey and again, that was necessary because these organ systems are complicated, so it's humanly impossible for one person to know everything about every organ system, but at the same time we couldn't forget. You know what was going on with everything else. So that was the major change in thinking as a functional medicine doctor versus my traditional role as an OBGY.

Judy Oskam: 5:20

So how did that come about? Were you in Canada by then, or were you still in India when all of that happened? You were still in Mumbai, right?

Dr. Kar: 5:31

Yeah, I was still in Mumbai at that point, so we moved to Canada in 2015, and then I realized that I'm not going to go through residency and all of that and get licensed as a physician here, and by that time, thanks to technology, I could continue doing, you know, telemedicine practice and because I was a functional medicine doctor, I was not doing now.

Dr. Kar: 5:56

Obviously I couldn't do OBGY through telemedicine. So that was like the advancement in technology helped me a lot so I could sit here in Alberta and Canada and take care of patients in India, but then, of course, I had to make sure that they had a primary care doctor taking care of them, sure, sure. So that was one of the big things. And I also work as the director of medical education in a clinic here in Calgary. So my associate there she's also a functional medicine doctor and so basically meeting her was, you know, was one of the great things that happened in my life, because I thought what am I going to do in Canada if I'm not a doctor? And I'm sure you know many other international medical graduates who you know have this experience of what am I going to do in a country where my qualifications are not ?

Dr. Kar: 6:52

So that that was the next part of the journey and, like I said, thanks to technology, it has helped me continue to do what I do and actually I like medicine a whole lot more than I did when I first started off. You know, and that is not the experience with a lot of people I see a lot of my colleagues. They said I'm tired of doing the same things over and over again and I find that there are new things happening all the time in medicine. It's hard to keep up, but there are a lot of new and interesting things and things that can impact people in a in a much bigger way Thanks to all the newer developments.

Judy Oskam: 7:31

Yeah, and to me the functional focus just makes sense.

Dr. Kar: 7:36

But I know it makes sense to me now, and now I think, oh my God, like how? Why were we not taught all this in med school? And even today, actually, med school education does not think of the whole patient. We're still thinking of the neurologist is separate, the brain doctor is separate, the OBGY is separate, the gastroenterologist is separate.

Judy Oskam: 7:59

Sure, sure. Well, and what are some of the biggest challenges that your patients come to you with? What are they coming to you for your help?

Dr. Kar: 8:13

So the commonest ones are usually it's like I am never the first port of call so they have been to multiple doctors. They are not feeling well, they have anxiety, they have depression, they have mood issues idea that the perimenopausal period, which is the eight to 10 years before menopause, is a time of major transition in a woman's life and gut issues, bloating and you know, pain and foggy thinking. It's not, and each of these things are interconnected to everything else. So those are the main things. Then problems of you know, blood glucose control, even if they don't have diabetes, weight, blood pressure, so basically sort of almost everything that family doctors would see. But as a functional medicine doctor, I'm sort of like a super generalist. I take care of people with thyroid problems as well. I take care of people with thyroid problems as well, gut issues and everything together.

Dr. Kar: 9:29

And when you ask about challenge Judy, the biggest challenge I feel I have realized now is in making behavior change. Both of us are trained in the tiny habits method and I thought this should actually be a part of medical school curriculum. It should, because what we thought as physicians and even today a lot of people think that is you know what we think that we just give information to people and they'll automatically take action, as Dr BJ Fogg calls this the information action fallacy. But the fact is people do need some information, but then the most important part they need, which is what they struggle with, is how are they going to translate that information to habits, to actions, to behavior change? So exactly, it's like this is the part of my journey. I'm thinking why didn't I reach her earlier?

Judy Oskam: 10:21

Well, because behavior is what we measure. You know, behavior is what, what is the action item there? And giving the information is never enough. I know I was working with someone and she had been told go meditate. You've got to meditate every morning and it was too much. It was too much for her and that's too much for me if someone tells me I have to meditate every morning right out of bed. And so just breaking that down into a very small, into a very small. So one habit that we came up with was after, I feel, stressed, I will take a meditative breath, because she was struggling with the word meditate and that was too big and too heavy. So we combined a little bit of it with just take a breath and that seemed to work.

Dr. Kar: 11:17

So yeah, and you know, Judy, now that you know, as certified Tiny Habits coaches, we know so much more about behavior change that it seems like is. Shouldn't this have been obvious? So when you said meditation, and I laughed, this is a wrong impression. People have that just because meditation, mindfulness or you know whatever you want to call it has helped, maybe that particular person, or has a lot of data yes, mindfulness has a lot of scientific data and it doesn't have to do anything, have anything to do with religion, but maybe that's not the right strategy for this person. Exactly, it's. I didn't know this. Nowadays, I ask you know patients and tell you doctor, I know I need to meditate because I'm very stressed. I said, like, is it something you want to do? No, my, my husband things, or my wife things, or my daughter things, I should meditate. I said no, then that's not the right strategy for you, but you did. That has been a journey. It would not have been a few years ago.

Judy Oskam: 12:18

Yes, of course you need to meditate is what I would have said Sure, sure, but just just understanding that and being able to work with someone comes to you and I think, having that whole mind body connection of the functional medicine focus, I think that's really. I wish I'd met you 10 years ago because I was going through some of that pre-menopausal stuff and, oh my gosh, terrible. But well, what are some of your habits, that you that habit recipes that you feel like, and we might want to stop for a minute and explain what is a tiny habits recipe. Do you want to take that one and kind of explain the ABC model?

Dr. Kar: 13:04

Okay. So for those of you who may not be familiar with the tiny habits method, it is a method that came from the research of Dr BJ Fogg, who's the head of the behavior design lab at Stanford, and so what, judy, you're talking about is the ABC. So any new habit we want to create, we have to anchor it to something that already exists in our routine. So, for example and I'll give you my favorite habit, which actually finally, you know, changed into something much more transformative so my habit was after I switch on my tea kettle because I am going to switch on my tea kettle, and it has to be very specific. It's not like after I make my tea, now, after I make my tea, I'm going to drink it. I'm not going to drink the milk Right Now, after I make my tea, I'm going to drink it. I'm not going to do dumbbell curls. So after I switch on my tea kettle and while I'm waiting for the tea to boil, the water to boil, I will do two dumbbell curls.

Dr. Kar: 14:05

So that is the action, the behavior, anchor behavior, and the C part of it is actually what I resisted for a long time. Me too, me too resisted for a long time, me too, me too. So the c is an instant celebration meaning, and it's there are in the book. There are more than a hundred different ways to celebrate and when I looked at the you know the list, I thought no, this is not me, this is not me, like, I am not one of those who type of person.

Dr. Kar: 14:33

So finally, I was reading and then I came across something that I could relate to. It was Right curls and my celebration would be imagine these imaginary fireworks. Now, of course, one important thing here is this is where the tiny habits method gets into, sort of the detail, and that is what actually helps it to become such an easy way to acquire new habits is I had to make sure my dumbbells were in the kitchen next to my kettle, or at least nearby. Now if my dumbbells were in the basement in a box, then of course that habit would not have. That recipe would not have worked.

Judy Oskam: 15:24

Sure. So environment really does make a difference too and setting up the environment too.

Dr. Kar: 15:29

Yeah, I think that has the biggest impact actually and that is not always I. In at home, we can change our environment, Like. I got rid of my office chair a while ago because I realized I was spending a lot of time sitting continuously, and sitting continuously is actually worse than smoking. So I had to change the environment because and of course, I had to get get a-stand desk so that I could stand and sit, of course, when I needed to.

Judy Oskam: 16:00

But, that was changing the environment, getting rid of the chair, so how did you get into that area from your OB-GYN days and you focus now on the brain and you work with people. You have a podcast on brain health and everything. So how did you get into that area?

Dr. Kar: 16:27

So my focus into brain health has been somewhat more recent, actually, maybe three or four years, maybe less than that actually. So I realized that, you know, dementia is one of the biggest problems that we have today and one of the factors, of course, we are living much longer. So that is one reason, but the unfortunate part is dementias like Alzheimer's. Now, alzheimer's is the commonest form of dementia, but there are others as well. Conditions like Alzheimer's don't have any curative treatment. That means there are no medications or surgeries that can cure this condition. Yes, there are medications to manage symptoms, but they don't cure the disease.

Dr. Kar: 17:12

Now, as I got to know more about brain health and preventive health, so what? Recent studies have shown that Alzheimer's don't start suddenly after someone is 65 years old or whatever definite specific age. The problems start 20 to 30 years before anyone develops any symptoms. So our midlife health and actually, Judy, the interesting part is, because I'm a former OBGY, I think preventive medicine actually starts before a woman gets pregnant. So a lot of influences in the uterus, on the baby, which actually start many of the disease processes. So that was actually, you know, thinking of long term health and this is the other problem. Just this morning I was talking about it. In medicine we've been looking at someone comes to me today with a problem. I just solved that problem that day and you look at the symptoms.

Dr. Kar: 18:11

Yeah, so it's like a bandaid, but I'm not thinking that whatever medication I'm recommending or surgery I'm recommending has a lot of long-term consequences. That was not how we thought and we thought we're solving the immediate problem. Right now we have to provide the best solution, and most prescription medications have the potential for. Yes, of course, without prescription medications we can't do, but at the same time, many of them have the potential for side effects or long-term consequences, particularly if they have to be used for a long time. So these are not like a surgery, or a prescription medication is not a simple decision. Always, you know, sure, but we were not taught that way. We were like, oh, just get the prescription pad and, you know, write this. So why focus on the brain health? I realized is, as a functional medicine doctor, I have an opportunity of 20 to 30 years, before someone develops symptoms, to help them change, because a lot of the preventive strategies that we use for prevention of dementia are lifestyle related.

Judy Oskam: 19:22

Well, give us some examples. We have to know them. You have to share this.

Dr. Kar: 19:28

So one of the most important things and again in the tiny habits world, we never say there is a should, but if you think that there is, what is the one most important strategy I need to improve my brain health and prevent dementia is physical activity. So physical activity, we can look at it in many different ways. First of all, I always look at, you know, reducing continuous sitting. It's because of the nature of our work nowadays and there are so many tiny habits recipes that we use. One of the ones that are very popular with my patients and clients is I will.

Dr. Kar: 20:07

If they use a lot of phone calls during their work day, as soon as my phone rings I'm going to use my ear pods and walk or stand at least, and not like sit and take the phone calls. That is something a lot of people have. A lot of phone calls they have throughout the day and of course I tell them you don't want. You know the phone next to your ear and brain and you know, roast your brain with the cell phone, so get. And also, it's kind of painful to keep on holding your phone to years.

Dr. Kar: 20:38

So get ear pods or earphones, I mean something, some device that makes it hands-free. That is one of the favorite recipes. So interrupting continuous sitting is extremely important and, judy, I'm sure you see this as well as I do, because I actually ask my patients to do an assessment of their sitting time. So it is the commuting time, it is the time in front of the TV, it is the time in front of screens, and it does add up to a lot. So when I talk about movement and another favorite recipe which I started recently is after I use the washroom, I see the back of the door. I'm going to do two, uh, you know, wall.

Judy Oskam: 21:24

Yeah, that's good.

Dr. Kar: 21:26

Yeah and uh. So that's again. You know, throughout the day I use the washroom multiple times, so I'm not doing 20 wall pushes at a time, but incorporating movement into the daily. You know, rather than setting aside some time for I'll go to the gym and then I don't have time to go to the gym. It's like incorporating movement into the day. But for the brain, actually, the best movements are moderate to high intensity. And you know, Judy, as you know, if someone is into physical activity already, they go to the gym often. That's wonderful. Most people are not that way. So best thing to do for the brain is number one interrupt continuous sitting, add movements. And this is where I think the tiny habits method has such a unique, you know, way of handling this. Most people, if you ask them why, what do you think gets in the way of exercising regularly, they would say I don't have time. Now, we know that it's not always time. It's also many of them will say I don't want to go to the gym and exercise with a group of people.

Dr. Kar: 22:34

So, in the tiny habits world, we say what would you see? What do you see yourself doing? You know right. Yes, the ideal world. I would have a home gym and have a trainer coming home. But that may not be practical, right, you know right now.

Judy Oskam: 22:49

Right.

Dr. Kar: 22:50

Slowly, gradually, as we do more and more tiny habits, our motivation goes up because of those little successes and feeling the celebration and shine and that is what helps us to move from, you know, tiny to transformative. And the other thing is, judy I'm sure you've seen this in your life as well that you don't realize when it has become something bigger, right right, right, and it's so simple.

Judy Oskam: 23:18

Right, right, right and it's so simple. And what I find I have to tell people give them sort of permission to think super small, yeah, and they tend to think, well, I have to go somewhere to do something, or it has to be a big deal or it will, and that relies too much on motivation and we don't know, is not reliable, which we know does not work. So, keeping it super tiny. And one of my recipes is, when I hit my coffee Keurig on, I do the two counter pushups. Oh, it's just become so easy for me to. I don't even think about I'm at the office and I'm doing them in the office, you know. So it just is something so simple and people think it needs to be hard and difficult and it really. That's, to me, is one of the major differences with tiny habits is not only is it super tiny and doable, but it's fun too. It's just fun.

Dr. Kar: 24:14

Oh yeah, and another mistake I think, judy, a lot of people make is they think the secret of the tiny habits recipe is that it's tiny. That is not the secret. The secret is because of the celebration we feel good. So emotions create habits, as Dr Fogg says, not repetition, not like someone else motivating you or, worse, your doctor telling you you're going to die early.

Judy Oskam: 24:39

Yes, that's not very motivating Well, and you realize with your background how that rewires the brain and what that does to the brain when you have that positive endorphin or whatever.

Dr. Kar: 24:56

Yeah, the reward pathways you know there's so many of them. So the positive reinforcement, or whatever you want to call it, I mean anyone who resists a celebration, like I did, until I told myself this is based on Dr Fogg's research. It's not like something he just, you know, thought up one day and I thought why am I resisting it? Let me try it.

Judy Oskam: 25:19

Right right.

Dr. Kar: 25:20

I always tell people you know, are you a celebration resistor? If you are one of them, just go by, just do it.

Judy Oskam: 25:27

Yes yes, yeah, yeah, I think that's great. Well, and I'll put a couple celebrations in the show notes so people can see that and they can reach out to either one of us and we can send them the list of 100 celebrations to do so well, so I, you know, I'm a Gallup Strengths Coach and I always ask people what do you feel like, is your strength in doing all of this and helping others? I mean, what is it that keeps you going and what is it that sort of drives you with that? And I would translate that into one of your strengths.

Dr. Kar: 26:04

So I should actually do that assessment.

Judy Oskam: 26:07

I haven't done that we can do that, but you know what you're naturally good at, I think one would be.

Dr. Kar: 26:14

You know, my curiosity is what I would say and I think this thirst for knowledge is another one. Now, knowledge alone is not going to do anything. So application of that knowledge and this is a conversation sometimes I have with my adult son. I said one thing I think as doctors, because we have to study for so many years, obviously every day is not an exciting day. There are days when it's kind of boring and dull and there's a lot of paperwork and things like that. I think the tolerance for the mundane is also a very important thing, and not feel discouraged and oh, this is not what I want to do, kind of thing.

Dr. Kar: 26:54

Every day is not exciting. It's not like every day I've helped someone achieve something fantastic. Some days, a patient's saying, doctor, nothing seems to be working.

Judy Oskam: 27:05

Yes, that happens, and it just hasn't hit right, you know. So they don't have it yet. But well, so look ahead five years. If we look ahead five years, what do you see yourself doing, and do you see yourself doing, and do you see yourself doing more outreach in this area? What are you thinking? Look ahead five years for me.

Dr. Kar: 27:27

Okay, so that's a great question, Judy. One of the areas in brain health that I'm really interested in is the management of hypertension, high blood pressure. Of course I have a personal story because I have hypertension. My mother's side of the family everyone you know, all her brothers, sisters, everyone died of strokes and hypertension is one of the risk factors for stroke. Now, worldwide, more than 1 billion that is with a B people have hypertension. Most of them don't know they have hypertension and those who know, their blood pressure is not at the optimal level. So one of the challenges with hypertension is because very often there are no major symptoms. There's no warning sign right.

Dr. Kar: 28:18

No, sometimes people don't know they have hypertension, and particularly younger people. They think hypertension is problem of my parents generation. Sure, so hypertension is poorly managed and that gives us a huge opportunity, because if we manage hypertension better, it not only helps with brain health, that is one of the leading causes of death worldwide. So, looking at one of the ways of measuring hypertension, there are some newer devices that have come up which does not. Now, if your listeners anyone doesn't have hypertension, you won't know what hypertension management involves. So it's checking your blood pressure at home wearing a cuff device. Now, that entire process, judy, is so irksome. It's like you have to sit still for five minutes no coffee, no talking, both feet planted on the ground with your back supported.

Dr. Kar: 29:12

And that thing hurts on my arm and you put the cuff and take three measurements and an average of three measurements, and I thought no, there has to be a different way of doing it. I tried to use the tiny habits method. It didn't work, like, unless I measure, I won't even know whether my blood pressure is at target, and that is what has what happens, even with my patients. So then I realized okay, finally, a device came out. Now this device is from, it's from from Europe. It's not launched everywhere in the world yet. It will be there in the US very soon and Canada as well. So this is a wearable which you wear all the time. See, this is where behavior you know how the environment and, I would say, devices change behavior. So this is something that is measuring blood pressure in the background change behavior. So this is something that is measuring blood pressure in the background. All I have to do is put it on once and, of course, make sure it's charged and all that, but I don't have to keep putting that. Exactly.

Judy Oskam: 30:08

And stopping and all of that yeah.

Dr. Kar: 30:10

Yeah, so one is the change, the advancement in the measurement that is having a huge impact. So five years time, I do hope I am able to make some difference in that. And so we've started some smaller trials and we're waiting for approval for a bigger trial. This is a clinically validated device, so it'll take a while so yeah, but the interesting thing is it is available and people can.

Dr. Kar: 30:38

People are already seeing a lot of like the. It's so fascinating, judy. I wake up in the morning. There's an email saying look at my blood pressure. See, this is where it is where it was and this is where it is today. I had no idea my blood pressure was high until I started wearing this device. It's like that is what I'm looking at. Oh, that's great. That's great. It's like that is what I'm looking at.

Judy Oskam: 30:58

Oh, that's great. That's great. Well, any last words you have for our listeners who might be kind of in your target audience wondering they've been to doctors before. They don't really know what to do. What's their next step?

Dr. Kar: 31:15

One thing I would like to say is a lot of people have this wrong impression that dementias like Alzheimer's are part of normal aging. So no, it is not part of normal aging, and no one is too young or too old to start focusing on improving their brain health. And brain health is not unique to just the brain. You know, if you improve brain health, your heart health gets better, your bone health gets better, your mood gets better. So that is the exciting part about you know, lifestyle change One positive change impacts all the systems.

Judy Oskam: 31:51

I love that. I love that. Well, thank you so much for joining us and sharing your wisdom and your expertise, and we'll put some information in the show notes so people can find you and listen to your podcast as well.

Dr. Kar: 32:04

Oh yeah, Thank you, Judy. It's a great pleasure. I had a wonderful time it was fun.

Judy Oskam: 32:08

It was fun. Thanks a lot. Well, thanks for listening to Stories of Change and Creativity. The big takeaway for me on this episode get moving and it's never too late, so check out the show notes for more information and remember if you've got a story to share or know someone who does. Reach out to me at judy. oskam. com. Thanks for listening.