Vegans vs Meat Eaters: Who Will Live Longer & Why You Should Care! | Jonathan Reisman Pt 2
Dr. Jonathan Reisman discusses his experiences as an ER physician across remote locations, sharing insights about medical decision-making, the psychological toll of witnessing severe illness and death, and the complexity of understanding causation in health and nutrition. He also previews his upcoming book exploring chronic illness in ancient populations through paleopathology.
Summary
In this second part of the conversation, Dr. Reisman explores several interconnected themes about medical practice and human health. The discussion begins with how doctors make treatment decisions for loved ones, noting that emotional attachment can impair clinical judgment despite good intentions. Reisman reflects on the worst cases he's witnessed as an ER doctor, including a young man dying of terminal gastric cancer and instances of child abuse and suspected sex trafficking, while acknowledging that family reactions often make clinical realities emotionally concrete in ways that pure physiology does not.
The conversation then shifts to how medical professionals compartmentalize trauma and death. Reisman explains that humans are remarkably capable of walling off horrific experiences to function normally, using the example of Nazi concentration camp guards as an extreme illustration. He acknowledges that while this psychological mechanism enables survival, it may come with unknown long-term costs. When discussing his own mortality, Reisman expresses a preference for death via massive stroke at age 85 rather than prolonged decline, and notes he has a living will designating his bioethicist wife to make end-of-life decisions.
Regarding pain management and opioid use, Reisman advocates for conservative prescribing practices, preferring to exhaust over-the-counter options before escalating to stronger medications. He criticizes the medical establishment's past over-distribution of opioids and highlights the severe constipation side effects that frequently bring patients to the ER. He suggests that better public education about over-the-counter medications could reduce unnecessary emergency visits.
The discussion includes colorful examples of unusual ER cases, particularly foreign objects in body cavities, which Reisman notes are remarkably common. He explains the modern ability to use sedatives like ketamine to safely render patients unconscious while remaining self-breathing, enabling painless procedures that would be unbearable if conscious. He contrasts this with historical bone-setting procedures performed while patients were awake.
When discussing optimal diets, both speakers express significant humility about the state of nutritional science. While Tom Bilyeu expresses confidence in controlling blood sugar through diet and exercise, Reisman resists declaring causality about most health outcomes, citing repeated reversals of medical consensus. He notes that even a woman in a Himalayan cave living an ascetic lifestyle on simple food still developed early type 2 diabetes and hypertension, suggesting that factors beyond diet and activity level remain poorly understood.
Reisman then explores his travel experiences as a doctor in remote regions including Antarctica, the Arctic, Russia, Nepal, and Native American reservations. He explains how geography and climate create distinct disease patterns—seal finger in Arctic populations, specific autoimmune diseases in Native American groups due to population bottlenecks, diseases like malaria and dengue in tropical regions. He describes how medical professionals in these contexts must anticipate what conditions and injuries they'll encounter, carefully select medications and equipment, and make strategic evacuation decisions based on geography (like how altitude changes during evacuation affect pneumothorax expansion).
Finally, Reisman previews his upcoming book with a fascinating case study: an 800-year-old mummified five-year-old Thule girl discovered in Barrow, Alaska, who had alpha-1 antitrypsin deficiency. Through paleopathology—staining and examining ancient tissues—researchers diagnosed emphysema-like lung damage and liver disease in a child who also had growth arrest lines in her bones indicating episodes of severe illness. Evidence suggests she died of starvation with animal fur and soil in her stomach, leading Reisman to reflect on how ancient societies understood and responded to chronic childhood illness.
About this episode
<p>In the second part of this mind-blowing 2 part episode with Dr Jonathan Reisman, the ER doctor with a unique perspective of the interplay between health, diet, culture and nature, we take a deeper dive into AI’s potential revolution of healthcare and personalized medicine.</p><p>Dr. Jonathan Reisman is heavily influenced by his love of travel and nature. He doesn’t shy away from the unsettling aspects of life, and he approaches it all with reverence and curiosity. He’s also the author of The Unseen Body, a fascinating book I highly recommend.</p><p>In this episode we look at AI’s potential to revolutionize healthcare, the complexity doctors face diagnosing and delivering life changing news to patients and what was found in the stomach of an ancient 5 year old girl that’s inspiring his next book.. </p><p><br /></p><p><strong>Unique Perspectives from Jonathan:</strong></p><p>“A doctor’s decision making is warped and shaped by the worst things they’ve seen.”</p><p>“Like everything in medicine, do the benefits outweigh the risks, and nothing is risk free.”</p><p>“I’m very hesitant to apply causality when it comes to health and nutrition and lifestyle just because I feel like there’s so much that we don’t know and I wish doctor’s were tired of embarrassing themselves by declaring the truth and then seeing it overturned 20 years later.”</p><p><br /></p><p><strong>Follow Jonathan Reisman</strong>: </p><p>Website: <a href="https://www.jonathanreisman.com/" target="_blank">https://www.jonathanreisman.com/</a> </p><p>Substack: <a href="https://jonathanreisman.substack.com/" target="_blank">https://jonathanreisman.substack.com/</a> </p><p>Twitter: <a href="https://twitter.com/jonreismanMD" target="_blank">https://twitter.com/jonreismanMD</a> </p><p>Instagram: <a href="https://www.instagram.com/jonreismanmd/" target="_blank">https://www.instagram.com/jonreismanmd/</a> </p><p><br /></p><p>SPONSORS:</p><p>Get 5 free AG1 Travel Packs and a FREE 1 year supply of Vitamin D with your first purchase at <a href="https://bit.ly/AG1Impact" target="_blank">https://bit.ly/AG1Impact</a>.</p><p>Get $300 into your brokerage account when you invest $5k within your first 90 days by going to <a href="https://bit.ly/FacetImpact" target="_blank">https://bit.ly/FacetImpact</a>.</p><p>Head to <a href="http://www.insidetracker.com/" target="_blank">www.insidetracker.com</a> and use code “IMPACTTHEORY” to get 20% off!</p><p>Sign up for a one-dollar-per-month trial period at <a href="https://bit.ly/ShopifyImpact" target="_blank">https://bit.ly/ShopifyImpact</a>.</p><p><br /></p><p><strong><em>Are You Ready for EXTRA Impact?</em></strong></p><p>If you’re ready to find true fulfillment, strengthen your focus, and ignite your true potential, the Impact Theory subscription was created just for you.</p><p>Want to transform your health, sharpen your mindset, improve your relationship, or conquer the business world? 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Key Insights
- Reisman argues that doctors' emotional attachment to patients can impair clinical judgment even when the doctor intends to help, because emotions interfere with the dispassionate risk-benefit analysis needed for complex medical decisions.
- Reisman observes that the clinical reality of death often doesn't emotionally register for doctors until family members arrive and show devastation, suggesting that understanding suffering requires witnessing its social and emotional impact, not just its physiology.
- Reisman claims that humans are remarkably good at compartmentalizing traumatic experiences—including witnessing death, violence, and abuse—in ways that allow normal psychological functioning, citing this as a survival mechanism rather than evidence of psychological health.
- Reisman advocates for conservative opioid prescribing by exhausting over-the-counter pain management options first, arguing that addiction risk is often overstated compared to the real problem of severe constipation side effects that frequently bring patients to the ER.
- Reisman explains that ketamine is uniquely valuable for medical sedation because it renders patients unconscious while preserving their natural breathing drive, unlike many other sedatives that suppress breathing and require mechanical ventilation.
- Reisman expresses skepticism about the state of nutritional science, noting that medical consensus has repeatedly reversed on key questions like whether dietary cholesterol affects blood cholesterol, making him reluctant to declare causality in most health-diet relationships.
- Reisman observes that even individuals living ascetic lifestyles in remote locations with simple diets can develop metabolic diseases like type 2 diabetes and hypertension, suggesting unknown factors beyond diet and activity level influence these conditions.
- Reisman demonstrates that medical practice in remote regions requires anticipating specific diseases based on geography, climate, and local activities—such as bringing specific antibiotics for seal finger in Arctic regions—rather than applying universal protocols.
- Reisman notes that geographic factors like altitude changes during medical evacuation can affect patient physiology (pneumothorax expansion during flights over mountain ranges), requiring preventive interventions that wouldn't otherwise be necessary.
- Reisman explains that population bottlenecks in human populations—similar to inbreeding effects in purebred dogs—create higher frequencies of recessive genetic diseases in specific populations, observable in Native American groups and Arctic populations.
- Reisman argues that paleopathology can reveal disease narratives in ancient bodies, allowing clinicians to reconstruct how chronic illness affected children in past societies by reading physical markers like growth arrest lines in bones and protein deposits in organs.
- Reisman suggests that the presence of animal fur and soil in the stomach of an ancient starving child raises questions about whether parents were attempting to alleviate hunger pain or if the child was desperately consuming available materials, illustrating the interpretive challenges of ancient remains.
Topics
Transcript
Evening. Buyer's remorse. Buy a new car? I'll be moving in. Let's get started. Uh, sorry, I think there's been a mistake. I bought it from Carvana. You what? Yeah, great price. I even have seven days to love it or return it. So there's no... No, no buyer's remorse. More like buyer's rejoice. I guess I'll let myself out. Congratulations. I mean it. Buyer's rejoice. Buy your car today on Carvana. I mean it. Buyers rejoice. Buy your car today on Carvana. Limitations and exclusions may apply. See our seven-day return policy at Carvana.com. Welcome back for part two of my incredible conversation with Dr. Jonathan Reisman, the doctor who brings his medical expertise together with deep knowledge of…
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