Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice. Since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello and welcome to the Doctorpedia podcast. I am Daniel Lobell. On the phone with me today, I’m honored to have Dr. Qasim Butt. How are you Dr. Butt?

Dr Qasim Butt: (00:34)
Good, man! How are you doing?

Daniel Lobell: (00:35)
Good! I’m excited to talk to you. We got to chat a little bit. I never really do pre-interviews for this podcast, but I got to do one with you the other day and man, it was just a lot of fun talking to you on the phone. So I’ve been psyched up for this interview. I’ve been excited.

Dr Qasim Butt: (00:50)
Cool, man. I was in love with you when I heard you were a stand-up comedian, because I’m a big fan of stand-up comedy. So if you’ve got some jokes, go for it. [Laughs]

Daniel Lobell: (01:00)
That’s good, because I’m a big fan of doctors. [Laughs] Hence the fact that I do this podcast. Your specialty is particularly fascinating to me. I don’t want to jump the gun because I do like to get into people’s backgrounds, but I will tease the fact that you are a kidney doctor and I probably won’t pronounce this right. Is it nephrology?

Dr Qasim Butt: (01:24)
Whoa, you got it right off the bat, man.

Daniel Lobell: (01:27)
Oh man!

Dr Qasim Butt: (01:27)
You got it. Yeah. I have this thing in the nephrology world – we’ll get into my background – but I like explaining things to patients and I think we need to get rid of the word nephrology, just because I think we just need to make things simpler for them. Just call it kidneys. I’m a kidney doctor.

Daniel Lobell: (01:42)
All of these terms are just there, I think, for like the ego of people in the medical world.

Dr Qasim Butt: (01:49)
[Laughs] Absolutely.

Daniel Lobell: (01:50)
There’s people who are on boards with Ivy League degrees and they love the word nephrology, I guarantee you because it makes them feel like smarter than everybody else who just says ‘kidney’. [Laughs]

Dr Qasim Butt: (02:03)
Yeah. But everyone else gets to say, when they say something about what they do and about their occupation, they automatically know what it is. “I’m a plumber, I’m a cardiologist. I’m an airline pilot.” And I think as a nephrologist, I have to go into this long spiel about, “hey, have you heard of dialysis before? Yeah, that’s me. That’s what I do.” [Laughs] I have to kind of go into this big spiel and try to explain what I do sometimes.

Daniel Lobell: (02:25)
I can’t wait to ask you to explain all of this because I’m really curious about it and it’s something I’ve thought about a lot as an overweight person who is often told that I’m at risk. I have a lot of questions, but first let’s start with you. I like to know the history of the doctors. I like to hear about your childhood. What made you become a doctor? Where are you from? Let’s start there.

Dr Qasim Butt: (02:50)
I grew up in New York city. I was born in ’77, so I grew up in New York in the eighties and nineties.

Daniel Lobell: (02:57)
Me too, man.

Dr Qasim Butt: (02:57)
Yeah, we connected on that, right? We can talk about how many times we got jumped and mugged later, I guess. [Laughs] What was your graffiti tag or your elementary school, we could talk about that as well.

Daniel Lobell: (03:11)
Did you ever go to Five Points in Long Island City?

Dr Qasim Butt: (03:14)
No. I was in Queens, Ozone Park. I was out there and I went to high school in Brooklyn at Brooklyn tech. That was before Brooklyn was cool, right? Before Brooklyn was gentrified and vegan cupcake stands and all that kind of stuff.

Daniel Lobell: (03:33)
Yeah. I lived through that.

Dr Qasim Butt: (03:33)
Wow. That’s the funny thing. Now you go to these gentrified areas and visit contemporary restaurants and the graffiti is perceived as art. Back in the day it was just straight vandalism. Right? But now it’s retro and it’s like, “Oh, look at that.” And I’m like, “that’s actually vandalism.” [Laughs]

Daniel Lobell: (03:52)
I wonder if old school art was like that, too. Like Monet and all of those artists, like it used to be vandalism. [Laughs]

Dr Qasim Butt: (04:02)
[Laughs] Like the Mona Lisa. On the streets of Paris some thug painted on a building. I left there without a criminal record in ’92 and then my parents actually moved to Midland, Texas, man. We moved to Midland, Texas.

Daniel Lobell: (04:24)
Wow. That must’ve been a huge culture shock for you right there.

Dr Qasim Butt: (04:26)
Yeah, I was 16 at the time. I went from Brooklyn Tech, which is in New York, to Robert E. Lee High School in Midland, Texas. I moved out there and it was crazy initially. But I look back now and I’m actually glad I had that experience. I think a lot of the political dynamic now has to do with misunderstandings of where you live in America. I grew up in New York City and I grew up partially grew up in small town America, so it’s kind of cool to have both there.

Daniel Lobell: (05:04)
Yeah. You have such a good perspective now on everything. I want to double down on what you’re saying – I try to keep this show nonpolitical, so I’m trying to think how to put this, but: just to your point, it is all misinformation. That’s the big word of 2020: misinformation. People don’t understand other people in this country at all and that’s on both sides. It’s good that you – like you said – it’s good that you have that perspective, especially as a doctor, because when you have patients coming in… I often wonder, when you go to a doctor, what political biases might they have? How would that affect your treatment? It must be in there somehow, right?

Dr Qasim Butt: (05:53)
Yeah. I think so, to some degree. Most doctors are pretty objective and just follow science or whatever it is. They do follow that. But of course we’re all subject to our political biases and if you’re in the OR for procedures or doing surgeries, doctors talk about their political biases. What I have a problem with is a lot of doctors actually voice their political beliefs online, on social media and stuff. I don’t mind it to some degree, if you’re talking about a particular policy – like if you agree with the democratic plan on healthcare versus the Republican plan – that’s not bad. But certain things I’ve seen where they’re saying mean things about the other person. As a doctor, you’ve got an MD behind your name. You may want to be careful what you do.

Daniel Lobell: (06:42)
For real. You’re supposed to be a carer and somebody who people want to trust their life with. So if people feel like you already don’t like them off the bat, why would they come to you? You know?

Dr Qasim Butt: (06:53)
Yeah. And I do use social media, but I think a lot of times people discredit themselves when they use social media because you have to remember that 50% of the people disagree with you, irrespective of what opinion is, whether it be political or religious or whatever. I think we talked about this before, we both grew up in New York, so I have a very sarcastic sense of humor.

Daniel Lobell: (07:12)
Me too.

Dr Qasim Butt: (07:12)
If I say something on social media, social media automatically makes you two dimensional if you just put a little blurb or a meme out there, and so I do not put my name out or anything.

Daniel Lobell: (07:22)
Tell me about it.

Dr Qasim Butt: (07:22)
Because now the interpretation is so gone. People take things so literally and can take anything out of context. It’s a little bit different for me now. But anyway, growing up in both and seeing both political parties and having both political views at some point in my life kind of changed the way I think of it. It kind of changed the way I think about things. Again, I’m not the perfect person. I still have my political biases one way or the other, but I can see it. There is beauty growing up in small town, America, there’s beauty growing up in New York city and they both suck in their own respects, too.

Daniel Lobell: (07:58)
[Laughs] Yeah.

Dr Qasim Butt: (07:58)
[Laughs] It’s a little bit different. We could talk about growing up in New York. I remember talking to ex-New Yorkers. New York is a great city to say you were from at some point, right?

Daniel Lobell: (08:08)
Right. [Laughs]

Dr Qasim Butt: (08:08)
[Laughs] To be in it at that time, it was like, “Oh man.”

Daniel Lobell: (08:13)
I have a joke, by the way, to what you’re saying about how New York City, the farther you get away from it, the more beautiful it is.

Dr Qasim Butt: (08:21)
Oh, absolutely!

Daniel Lobell: (08:21)
When you’re right in the middle of it, it’s filth. It’s disgusting. You just go one borough outside and you look at Manhattan, you’re like, “Manhattan’s beautiful.” You leave the boroughs altogether and you look at the boroughs, you’re like, “they’re all pretty cool.” The further you get away, all of a sudden you’re like in Canada or something, you’re like “New York is amazing.” [Laughs]

Dr Qasim Butt: (08:45)
[Laughs] Yeah, I agree. It’s like, the less you’re exposed to it. If you’re immersed in it, you’re okay. I’m nostalgic for Italian pizza. I’m a pizza snob at this point. I only like eating Italian style pizzas. My wife does not understand that. Just different things. Even the way I talk sometimes it’s kind of brash, which is kind of fun. I like doing that, but I don’t know. I grew up in New York and me and my my brother talk sometimes in front of my wife and she’s amazed because we’re talking about how literally you saw drug use right in front of you, like drug paraphernalia on the streets in New York, in the eighties. And we were in a middle-class neighborhood, man. I wasn’t in the ghetto.

Daniel Lobell: (09:26)
Or in LA, present day, Dr. Butt. Like I’m in LA right now.

Dr Qasim Butt: (09:31)
Oh yeah. I was actually talking to someone from San Francisco, this guy I know who runs some other startup company and he’s in San Francisco. You have to be in San Francisco if you’re in some sort of startup biotech world. It’s literally same thing. And I’m like, when he’s talking, I’m like, dude, this is like New York in the eighties, it’s kind of crazy. But anyway, it was a cool experience. I think it really added to who I am as a person. We moved to Midland, Texas and I loved it. It took me about, I want to say five to ten years to adopt “y’all.” I refused to adopt the term y’all but now I drop it all the time because it just makes sense. It’s the perfect conjugation. Right? You, all. You all, y’all it perfectly makes sense.

Daniel Lobell: (10:16)
I don’t think I could pull it off. I think I might need five to ten years. [Laughs]

Dr Qasim Butt: (10:21)
You can use the appropriate New York term “use.” Right? You can just say “use” like they do.

Daniel Lobell: (10:28)
It’s funny. As a little anecdote, when I came to LA, I had a story on This American Life and some film producer wanted to adapt it into a movie. It never wound up happening, but I went on this meeting and she was from the South and her writing partner was an Israeli guy named Eyal and she just kept calling him y’all I was just like, everything is y’all with people like from this out, like, Hey y’all.

Dr Qasim Butt: (10:59)
Yeah. I know. But then you pick up other terms, but I say, “fixing to”, like “I’m fixing to do that” – You just start saying things like that. I don’t say “get her done”, but things like that – one more game to fix.”

Daniel Lobell: (11:15)
I like fixing and fix ins like, “Oh, those are some nice fixings to go with that Turkey.”

Dr Qasim Butt: (11:20)
I actually trained in Louisiana, so I picked up some of that drawl too a little bit, I’d say one more game [laughs] and one more time. So it’s kind of funny.

Daniel Lobell: (11:34)
Yeah. So when did you decide you wanted to be a doctor?

Dr Qasim Butt: (11:39)
You know, there’s two ways to go about this, man. I can tell you the truth or I can tell you the bio.

Daniel Lobell: (11:45)
Let’s go with the truth. That sounds much more interesting.

Dr Qasim Butt: (11:48)
That sounds great. I am the oldest male in a South Asian family. So the oldest male in a South Asian family – we’re supposed to be the doctors. And so ever since I was in college, they told me, “You’re gonna be a doctor.” So I went into pre-med so it wasn’t like I was forced, but I was kind of forced. [Laughs.]

Daniel Lobell: (12:12)
Pakistan?

Dr Qasim Butt: (12:12)
Yeah. Is that in my bio somewhere?

Daniel Lobell: (12:18)
I don’t know. I just took a guess.

Dr Qasim Butt: (12:18)
Oh, that’s a good one, dude. Most people don’t get that one. They usually go India, India-ish. [Laughs.] So I went into medicine. If you notice, when you go to med school, between one third and one quarter of the classes are Indian, Pakistani, South Asians. It’s kind of crazy, but that’s kind of a group thing. And so we all went into it. I actually like what I do, don’t get me wrong, you know? But that was the inciting reason. It wasn’t like I had some sort of kidney experience or a kidney stone that drew me into being a kidney doctor, you know? [Laughs].

Daniel Lobell: (12:56)
[Laughs]. You know what you gotta do.

Dr Qasim Butt: (12:59)
It’s either that or engineers, that’s how you kind of go at it. And it’s weird. I feel like a lot of people put out this phony thing, like, “Oh, I just always wanted to help people.” And I’m like, “No, my parents told me to do this, you know? [Laughs.]

Daniel Lobell: (13:15)
[Laughs].

Dr Qasim Butt: (13:15)
So I might as well be honest.

Daniel Lobell: (13:18)
Parents. I love that.

Dr Qasim Butt: (13:19)
Yeah. Well, instead of arguing with your parents, it’s like, you’re actually beat? I’m sorry, did I just say that. [Laughs].You know – it was just a different mindset. And you notice that a lot of Asian cultures and different immigrant groups, they really respect doctors. And so that’s what they want you to become.

Daniel Lobell: (13:40)
And again, the kids respect their parents, which I think is amazing. I hope that somehow I can impart that to my daughter because that’s one thing I totally respect about Asian cultures, the respect they have for their parents.

Dr Qasim Butt: (13:58)
Well, yeah, it’s interesting. It’s like they’re very much into your lives, right. So when you would talk to either white, black, or Hispanic kids, they’re always talking about, “When you’re eighteen, then you can do what you wanna do.” I’m like “That for us is 35.”

Daniel Lobell: (14:13)
[Laughs].

Dr Qasim Butt: (14:13)
[Laughs]. You know, our parents are in the way when we are in our twenties, maybe thirties, and so it’s interesting. So it can go both ways. I don’t say it’s necessarily a better way of raising your kids. I think it’s a different way. And there’s actually great attributes about it, like Asian cultures and how they rear their kids, but there are some drawbacks to it as well. But either way, I think it’s great upbringing. The thing is that I can’t complain, I live a great life.

Dr Qasim Butt: (14:45)
I get to have a great career. But that’s the reason why I had gotten into it. And then, it was pre-med, I went to med school and then eventually did my residency at LSU in Shreveport, Louisiana. I went to St. George’s university, and in the Caribbean. So I spent two years in the Caribbean area and then two years in the New York, New Jersey area. So that introduced me back to New York in the 2000’s and New York in the 2000’s is pretty cool, still. I was cleaning nights. And I think I told you before, that’s why I was really cool to talk to you because that’s where I used to go to comedy clubs every other weekend in New York city and comedy clubs in New York city are just amazing. Right? There’s no other place like it for comedy clubs. Cause you always see the highest level talent even in the crappiest clubs, right?

Daniel Lobell: (15:38)
You probably saw me back then. I was around the clubs at that time.

Dr Qasim Butt: (15:42)
Oh, I said high level talent, man. I’m sorry. [Laughs.]

Daniel Lobell: (15:46)
[Laughs.] Nicely done. Nicely done. Comedy is not what it once was back then, but those were really fun times. Guys like Bill Burr were out every night – now they’re major stars. You know, I remember Dave Chappelle. I used to do shows with Dave Chappelle. Chris Rock came in a lot. Dave Chappelle did bring me onstage. I have video of it on YouTube, like back in the day.

Dr Qasim Butt: (16:13)
That’s awesome. I saw him at the Mohegan Sun Casino in Connecticut in 2003 or 2004. It was amazing too. He filled the stadium, you know? And that’s when he was at his prime with the whole Chappelle Show and everything.

Daniel Lobell: (16:27)
Yeah, that dude is amazing.

Dr Qasim Butt: (16:30)
No, he is like the funniest. I want to say, if you can put a GOAT on comedians, I would say he’s definitely the GOAT or one of the GOATs, right?

Daniel Lobell: (16:39)
I agree.

Dr Qasim Butt: (16:39)
Yeah. But even then, what was cool about New York clubs was, I remember like a lot of the big, big name acts. Like if you would go to New York comic clubs, especially the night shift and the 10 o’clock show or whatever the show was right after the 10 o’clock show, sometimes these big name comedians would come in and practice their new material.

Dr Qasim Butt: (16:59)
So they would sometimes just show up. Hey, you remember David Tell? He used to have a show up at Comedy Central back then, David’s House. One time I remember I was at a comedy club and when they were done, he came on, he just practiced some of the new material. And then when he was talking to some girl there at that club, she was like “last week, Dave Chappelle did the same thing”. So they utilized those clubs at night just to practice their new material.

Daniel Lobell: (17:24)
Tell is definitely another GOAT.

Dr Qasim Butt: (17:29)
Yeah. I like that whole crowd, Colin Quinn. I actually liked Colin Quinn back in the day. Almost everyone from the Comedy Central Roast. I love them. I love that type of comedy. Just raw kind of comedy. I think about five years ago is when we just started going down. What was it called? [Laughs].

Daniel Lobell: (17:50)
Destroying our comedians? I don’t know.

Dr Qasim Butt: (17:52)
Yeah. Just destroying the ability to laugh and increasing antidepressant use, you know.

Daniel Lobell: (17:59)
Yeah. The drug companies must’ve seen the comedians as a threat.

Dr Qasim Butt: (18:05)
[Laughs] Yeah. So what I do that is funny is I actually make my daughters, who are ten, nine, and six, I actually make them watch The Office. I don’t know if you watch The Office with Steve Carell? I make them watch that solid comedy just so they get used to it because Daddy’s going to make those kinds of jokes at home, you know?

Daniel Lobell: (18:23)
[Laughs]. Right. That’s clever. So you mentioned your parents kind of pushed you into medicine, but it sounds like you do like what you do. Am I right?

Dr Qasim Butt: (18:34)
Yeah. I’m not hating on it. It’s just like, what’s the ignition key or what’s the catalyst for you in medicine? I would have to say it’s my parents. You see what I’m saying? I could have done something else, I guess. I feel like somehow, nowadays everyone says “What’s your life goal?” or, they think that you must’ve decided this at high school or something. I’m like, “Dude, I actually have kids that I mentor.” So sometimes they’re in high school, sometimes they’re in college or even premed or med school or whatever. And I tell them, you know, you don’t have to all have it all figured out because even at my age, I’m 43 now I don’t sometimes have it all figured out.

Dr Qasim Butt: (19:10)
And I don’t know if I want to do what I’m doing for the rest of my life. So that’s amazing that we put that on 18, 19, 20 year olds that you have got to figure it out right now and take it there. And sometimes to me, it’s not just about having one destination — it’s about the journey. And along that journey, you take forks in the road and sometimes those forks in the road lead you to a different path. And so that’s how I got here. There was no one thing and kidney disease in itself didn’t inspire me to do what I’m doing. And in fact, I’m an interventional nephrologist. But if you told me about 15 years ago, that you’re going to be an interventional nephrologist, I would have said, “What the hell is that?”

Daniel Lobell: (19:48)
Is that where like you get somebody with a kidney problem in a room with their friends and family. And they’re like, we have to have an intervention.

Dr Qasim Butt: (19:57)
[Laughs.] You gotta put down the map

Daniel Lobell: (19:58)
What is it, what is an intervention? I mean, don’t all doctors intervene?

Dr Qasim Butt: (20:03)
They do intervene, but being an interventionalist means I had procedures under my belt. So what that means is as a regular kidney doctor, what I do is I actually take care of people with kidney disease, right? So they can have kidney disease where their kidney function, their kidney filtering capacity are down a little bit down or a lot down. And so what I do along that disease process is kind of help them manage it, manage your blood pressure, manage your diabetes, make sure there aren’t medications that hurt their kidneys. And if their kidney function fails, when it gets below 15% or so, and their kidneys aren’t functioning enough to maintain life, then we have to put them on something called dialysis. I’m pretty sure you’ve heard of dialysis before, right?

Daniel Lobell: (20:45)
Sure, yeah.

Dr Qasim Butt: (20:45)
Yeah. So there are essentially different modalities of dialysis, and I can go into that later, but basically you take the blood out of someone, put it in a machine cleaner form and then return it back to them. So then I have to manage them on that. Now, in order to do dialysis on people , you have to have either an access in the arm, which is underneath the skin or a catheter in your neck, which is like tube coming out of your neck. As an interventionalist, and that is not all nephrologists, I can do procedures like that. So I can put the catheter in your neck. I can also remove the catheter. There’s access in your arm. I can fix them if they’re not working, if they’re clotted, I can remove the clot. I can put stents in them. I can balloon them – all that kind of stuff. So I have these procedures under my belt that I can do to help people on dialysis and maintain their dialysis access.

Daniel Lobell: (21:31)
Wow. Yeah. I mean, it’s pretty fascinating. I never knew that that was a separate thing, but as you were telling me this, I was thinking of what I learned from your videos on YouTube, which is, I never really understood the kidneys as just basically filters, but it’s so weird that basically you’re just taking the blood out of the body and dialysis and using an external filter essentially, instead of like the built-in filter of the body. Right?

Dr Qasim Butt: (22:05)
Exactly. So that filter over time gets kind of destroyed slowly, right? So we have so much extra reserve of kidney function. Typically you have between 100% and 140% kidney function. As we age, that kidney function does come down. Now, if you have diabetes, high blood pressure and all these other diseases, that acceleration of your kidney decline is faster.

Daniel Lobell: (22:28)
I saw your video on plant-based diets and how it slows down the destruction of the kidney. Is there anything that we’ve seen that reverses the kidney damage and actually regenerates it?

Dr Qasim Butt: (22:49)
So what happens over time, unfortunately, is that the kidney disease, when the kidney filters are destroyed, they become scar tissue. So as of right now, there’s no regenerative capabilities of those kidneys. You can’t have improvement of the kidney function. If you start controlling your diabetes, control your high blood pressure, get off medications that are actively hurting your kidneys. There are certain medications that can hurt your kidneys. I’ve seen people get off those medications and over time the kidneys do get better. But as far as regenerative medicine, where it’s like actually improving the kidney function, then the answer to your question is no. The name of the game in nephrology is to sustain and slow the progression. And that’s typically done by controlling diabetes, controlling high blood pressure, putting you on proper medications or blood pressure medications called ACEs and ARBs and avoiding medications. Now, just so you know, 55 to 70% of kidney disease in America is due to diabetes, high blood pressure and vascular diseases like circulation issues. So those three things, diabetes, high blood pressure, vascular disease are preventable illnesses. Those are things that we’ve kind of exposed ourselves to through lifestyle.

Dr Qasim Butt: (24:06)
The other 30, 35% is the other diseases like the autoimmune disease, like lupus, IGN, all the vasculitides, polycystic kidney disease. All these weird diseases that occur less frequently. But when we’re talking about the masses of people on dialysis, we’re talking about the diabetics and the high blood pressures and our practice out of San Antonio. So diabetes is like candy, no pun intended. You know, it’s everywhere.

Daniel Lobell: (24:38)
Is that because of the Texas diet?

Dr Qasim Butt: (24:41)
Yeah. You can say everything’s bigger in Texas, right? They do eat more here. Also, what you realize is different populations by their ethnicities are predisposed to kidney disease, but also predisposed to diabetes and high blood pressure. So I trained in Louisiana LSU, and a lot of my population was black, probably like 50 to 70% were black. And their blood pressure, high blood pressure issues are horrible. You’d see people in their 20’s and 30’s on multiple blood pressure medications, four or five blood pressure medications and their blood pressure still not controlled. But I come here to San Antonio and you have a large Hispanic population that has a lot of indigenous blood in it. And the diabetes here is horrible and, it runs kind of rampant. And their diets are horrible too. So they eat tortillas all the time and a lot of processed foods and things like that.

Daniel Lobell: (25:35)
Tortillas are bad because they process in the body into sugar.

Dr Qasim Butt: (25:39)
Yeah. So you know how everyone was talking about low carb diets you have to break down carbohydrates into simple carbohydrates and complex carbohydrates. So complex carbohydrates are like salads and foliage, things like that, that are good for you. When they break down, they just don’t break down simple sugars. But simple carbohydrates break down into sugars. So things like tortillas that are made of flour, breads, pastas, potatoes, all the good stuff, all the fun stuff.

Daniel Lobell: (26:21)
It’s simple and it’s simple and it’s fun, but the complex stuff is much less fun.

Dr Qasim Butt: (26:28)
Exactly. It’s not as fun. And so what what we’ve done with our diets being so processed now is that we have exposed ourselves to so many simple carbohydrates. And once you realize there’s different groups, different people’s different ethnicities probably don’t respond well to the modern Western diet as well. So maybe, you know, a 40 year old white male who eats like crap for 40 years is, is fine. But that 40 year old, Hispanic male is the same person using the same diet in San Antonio may wind up on dialysis because of it. You see what I’m saying?

Daniel Lobell: (27:00)
It’s almost like a car that takes a specific kind of fuel, right? Like if you put the wrong kind of fuel in the wrong kind of engine.

Dr Qasim Butt: (27:05)
Yeah, that’s the way I think of it. if you guys go to the American Heart or American Diabetic Association, you can actually see breakdowns of diabetes rates in different ethnic groups in this country and around the world. And so I’m technically South Asian, right? So South Asians have very high rates of diabetes. Like I think around 13, 14, 15%, the same rates as Hispanics, but East Asians, like Koreans and Japanese and Chinese, they have rates closer to seven, eight, 9%. So it’s different. It’s closer to whites. Our diets suck, so I think if our diets did improve, we could overall have improvement in health. But what I’ve noticed is that different ethnicities do respond different to different diets, especially when it comes to carbohydrates.

Daniel Lobell: (27:50)
I’m a little bit familiar with the work of Dr. Dean Ornish, who talked a lot about plant-based diets and how they reverse the effects of heart disease. In your video, you said that you keep a mostly plant-based diet, but you still do have meat. Is that just because you like it?

Dr Qasim Butt: (28:13)
I would not say that. COVID has kind of ruined my diet, to be honest with you. So I’ve gotten fat, like everybody else in America. [Laughs].

Daniel Lobell: (28:19)
COVID has just destroyed everybody’s hope. [Laughs].

Dr Qasim Butt: (28:26)
[Laughs]. But yeah, and I’m eating a lot more carbs than I used to, and I think it’s just because you have this baseline depression where you’re like, I’m not going anywhere. I might as well have that sandwich or might as well have that donut? So I’m not terribly bad, but I’m like a little bit above my normal weight. Pre COVID, I was doing a more lower carb, lower simple carb diet. I tried to incorporate more fruits and vegetables into my diet in general. I did eat meat. , I wasn’t a perfect meat eater. I wasn’t just sticking to foods like salmon or lean cuts of chicken. I was eating steak and different things as well as cured beef. I incorporated a lot of vegetables into my diet and vegetables in general, just overall, are so good for you and unfortunately in America, what I’ve realized is so many people don’t eat vegetables. I’ve actually had patients telling me I don’t like vegetables and I’m like, “Dude, are you five years old right now?”

Daniel Lobell: (29:23)
Yeah. And then they’re probably on dialysis and you’re like, but you do like dialysis? Look, I can’t talk. I’m very overweight. I’ve been fighting it for most of my life. I’m still fighting and I haven’t given up the fight, but I know that being overweight puts you at high risk for diabetes. And it’s like always been my biggest fear that God forbid I would get diabetes and wind up on dialysis. To me, it just seems horrible. No offense to what you do. I think it’s great that you’re doing it and that you’re saving people, but it seems like a horrible thing to have to go through for the patient. Is there anything on the horizon, that people who are in need of dialysis can hope for or look towards? It’d be like, Oh, this is going to be a major breakthrough. This is going to change the game.

Dr Qasim Butt: (30:16)
Well, I think there are hopes now. I’ve actually done presentations on this and I am about to do another presentation at the university here in San Antonio on it. President Trump, in 2017, put in an executive order on kidney care. And so they’re changing the incentive models for kidney disease payments. And so what they’re going to be doing is stressing home dialysis, which is modalities at home, meaning instead of going to a center three times a week, which most dialysis patients do, they’re going to be doing dialysis at home. They’re going to be also incentivizing more kidney transplants. And they came up with a prize called the Kidney X Prize. And so they’re going to incentivize artificial kidney creation and innovations in dialysis as well.

Dr Qasim Butt: (31:04)
And so I think this new payment structure that they’re going to implement, it’s called value based medicine, is going to change the way nephrology is handled. And again, I think you have to change the payment structure in order to incentivize people to do things right. I also had this recent conversation with the professor at the UCSF and he’s doing research on the artificial kidney. He thinks there’s probably about 10 to 15 years away, but even along the way, let’s just say that it’s likely that they’re going to come up with innovations which will be applicable to dialysis itself So maybe the dialysis process could be a lot easier, simpler and smoother for patients.

Dr Qasim Butt: (31:47)
So I’m kind of positive on that. Now can I be honest? You know, I feel like we have such innovation in this country. We have really smart people here and we have all these people creating pharmaceuticals, awesome pharmaceuticals and awesome medical devices and biotech and all this but all this stuff – it’s funny. It’s like we’re just doing it to offset bad diets. We are eating these horrible diets and it’s causing massive inflammation in the body and causing all this damage in the body and we’re literally creating technologies to offset that. So I wonder if we ever had a conversation where we could actually address the diet? And how would we implement that? It’s not just about getting people food.

Daniel Lobell: (32:33)
But it’s so psychological, like you were saying, even you who is a kidney doctor, have been eating poorly since COVID, I mean it’s basically like, I’m guessing based on what you were saying, that you got a little depressed. Depression and diet are right there next to each other. So I think even if we change the American diet, does it have to start with mental health first?

Dr Qasim Butt: (33:02)
Yeah. I think it has to do with some sort of behavioral modification and cultural reasons. So San Antonio is just a bad town then, honestly. So in San Antonio, some of the doctors are obese. Nurses are obese, the dieticians are obese. But if you drive like 90 miles north to Austin, Texas dude, everyone’s in shape. And so it’s like those cities, like San Diego or Denver, where everyone’s kind of in shape. So they’ve created a culture of health. Whereas in San Antonio you have a culture of obesity and it’s accepted as normal. So I think we have to have some sort of a balancing act. But also I think the big thing now is something called social determinants of health where people talk about not having access to food.

Dr Qasim Butt: (33:49)
I happen to think that they’re kind of making it into a big thing. I think that’s a component, but it’s not the component. Let’s just talk about a poor population or even middle class, if you gave them a hamburger or a lean cut of chicken and grilled vegetables, what do you going to think they’re going to eat right off the bat? They don’t need that hamburger. They had the choice, they had it available to them, but they won’t. So I think it goes far beyond just availability because I think that’s just only one component of it. I think it has to do with behavioral modification. And how do you get people to incentivize their own health? Is that cheaper premiums, is that having a Fitbit on you, is that having some sort of incentive based model, not just for the doctors and the healthcare employees, but maybe for, patients themselves to take care of their own health.

Daniel Lobell: (34:45)
I was going to ask you specifically with kidney disease, what kind of lifestyle changes do you recommend patients implement to help with that?

Dr Qasim Butt: (34:55)
Are you asking how to prevent kidney disease?

Daniel Lobell: (35:01)
Yeah. How to prevent it or you can answer it however you want, because it might be interesting to people who have it as well.

Dr Qasim Butt: (35:07)
The main driver of kidney disease is diabetes, hypertension, and vascular circulation issues, all three of which are related to diet and lifestyle. There’s no one magic bullet. You may have seen that on my video on cranberry juice.

Daniel Lobell: (35:27)
You recommend against it.

Dr Qasim Butt: (35:29)
I’m not against it.

Daniel Lobell: (35:31)
There’s no proof that it actually helps.

Dr Qasim Butt: (35:33)
No proof that it actually prevents kidney disease. Now there’s some proof that it may prevent urinary tract infection, but most cranberry juice is loaded with sugar. Like if you buy you Oceanspray, you’re gonna get 35 grams of sugar in it. You might as well drink a Coke dude. So whatever nutritional benefit you get out of it, it’s lacking or it’s downplayed because of the sugar content. But in general, if you make good decisions, as far as, you know decreasing your simple carbohydrate intake, eating better, eating more of a plant-based diet, exercising a little bit more, you will offset diabetes, high blood pressure and vascular disease and therefore improve your kidney function.

Dr Qasim Butt: (36:19)
You have to stop thinking of the kidneys, like there’s a magic bullet just for the kidneys. The kidneys are oftentimes like a canary in the coal mine. And they’re affected by the body they’re in. So if the body’s in crappy shape, dude, what do you think the kidneys are going to be like? They’re filtering the body. They’re going to get filtered with crap. So that’s how I perceive it. I think that’s the main way. Now if you have kidney disease already, controlling your diabetes, controlling your high blood pressure is crucial as well. And so again, I’m a big fan of stressing weight loss to people and incentivizing them to lose weight. Unfortunately, in my practice, I just don’t have the time to dedicate to all that.

Dr Qasim Butt: (36:59)
Because losing weight is so difficult, I recommend most people go see a dietician and not just for kidney disease. You’re going to ask your dietician, “Hey, can you walk me through a diet? Can you help me get a food diary together? How can you help me implement this diet in my life and see how it can make those changes?” And what I always say, especially with diet modifications, is that you should start slow. We live in a country where you have either obesity or you try to do exercises that get you a six pack and get you shredded. It’s weird, right? I’m like, no, you can implement slow meaningful exercises- If you’re walking half an hour a day for five days a week, that’s going to get you a lot of progress.

Dr Qasim Butt: (37:40)
Especially if you’re coming from a completely sedentary lifestyle. So that’s how I would approach it. Now, if you’re in the category of the other 35%, that’s lupus and all that other stuff, that’s a different discussion. For kidney disease in particular, like that video I did about plant-based diets – Plant-based diets have been shown to actually slow down the progression and maybe reverse some kidney disease. So it’s something you may want to consider. And again, if you were to implement a plant-based diet, don’t go full vegan first day, dude! Start implementing slowly.

Daniel Lobell: (38:15)
You gotta do it in tiers.

Dr Qasim Butt: (38:15)
Yes, do it in tiers. Why are you going to jump into veganism? You’re going to hate it. You know, like just slowly increase when you do a plant-based diet, then maybe get a meat substitute in there. Maybe have meat once a day, then kind of wean yourself off of it. To some degree, you know? Again, having meat occasionally, it’s not bad. It’s just that maybe in American society, we just have it too often. I think the American diet is called the meat and sweet diet. Just like it doesn’t mean in the sense of sugar. So that’s what we have here.

Daniel Lobell: (38:46)
Yeah. I was vegan up until COVID for like nearly a year.

Dr Qasim Butt: (38:52)
How did that work out for you, by the way,?

Daniel Lobell: (38:55)
I lost 50 pounds so that was good.

Dr Qasim Butt: (38:58)
Wow.

Daniel Lobell: (39:00)
Then I put some back on when I started eating meat again, but now I’m at this place where I’ve cut sugar out. So I’m happy about that. And I’ve reduced my meat intake to like one or two times a week.

Dr Qasim Butt: (39:17)
Oh, that’s cool. That’s cool. Yeah. I mean again, you have to make that slow transition back. And again, I’m not on the camp of veganism or vegetarianism fully. I actually do eat meat and I do enjoy it, but I agree in an American society, maybe we do just eat a little bit too much meat. Yeah. Oh dude. You should come down. One day, you’ll come down and we’ll get you some beef brisket here. Oh my God. Oh my God.

Daniel Lobell: (39:44)
Dude, you’re in Texas. What did you get from talking to that kidney doctor? We’re going to get some beef briskets.

Dr Qasim Butt: (39:53)
[Laughs]. Just say, you know, I’m a foodie. I’m a big foodie. So I believe in healthy eating, but I’m not a food Nazi. You know, there’s some people that are just food Nazis. Oh, I would never touch that. Oh, that’s going to kill you. I’m like, dude, I’ll eat good Monday through Friday, but maybe Friday night or Saturday night, I’m going to make that hamburger. It’s all about doses, right? It’s not like if you’re eating the hamburger every day, that’s horrible for you. But once a week, once every other week, that’s not bad.

Daniel Lobell: (40:20)
I feel like people who become super obsessed with eating well often are only thinking about eating because it becomes such a big part of their personality that it’s not like, “Oh, eating is this thing I do to stay alive.” It’s just like all about even eating healthy. It’s just all about your mind being consumed with eating.

Dr Qasim Butt: (40:42)
Yeah. I think it depends on your personality too. Some people quit smoking and they’re fine. Some people would need to be weaned off with nicotine patches and all this kind of stuff. So I think it gets, it depends on your personality. So if you’re the type that needs to cut off all meat, just like that, maybe it’ll work.

Daniel Lobell: (41:04)
So you’re saying cut cold Turkey, cold Turkey.

Dr Qasim Butt: (41:08)
Good fun there, sir. That was almost, that was on the level of a dad joke, sir. That was a good dad joke, dude.

Daniel Lobell: (41:18)
I am a dad now. You called me on it. [Laughs.]

Dr Qasim Butt: (41:18)
[Laughs.] I think this is where you may have to bring in behavioral modification. Not necessarily a psychiatrist, but people who understand behavior modification.

Daniel Lobell: (41:34)
Where are those people? How do I find a behavioral modification expert?

Dr Qasim Butt: (41:36)
That’s an interesting thing. I’ve actually talked to different education platforms out there now about this, because I’m kind of getting into this space and it’s interesting. There’s a lot of things that you do or I do, and we’re incentivized to do them, but we don’t know how. So it was like persuasion techniques and learning techniques and all this kind of stuff. So you wonder if you implemented that into healthcare, how that would actually improve their outcomes? I’m a firm believer that even people that are in really crappy shape can really get improvement in health if they started eating right and lost weight. I’m a firm believer that they can have a very good outcome and improve their quality of life and not to mention, let’s just be honest, you can’t disconnect mental health and physical health.

Dr Qasim Butt: (42:20)
You will start to wonder why we have high rates of depression and anxiety now – partially that’s because, too much social media, too much TV, too much bipartisanship, but also do you feel good when you have an extra 50, 60, 70 pounds on you? You probably don’t, your self esteem is down. You know, all these other things that come. And by the way, I didn’t have to tell you I was a fat kid, right. Growing up in New York. I was a fat kid.

Daniel Lobell: (42:47)
Oh, that pizza – that’s that Italian pizza you were talking about.

Dr Qasim Butt: (42:51)
Yeah. That Italian pizza then. So I was a fat kid. And even then, like in my twenties, I had gained some weight and then I had lost about 30 pounds at the beginning. And my thirties, when I started in my job here, I started this thing – this is the greatest change that I ever made in my life. And I will preach this to everybody -I started working out in the morning. I started waking up at five o’clock in the morning and just working out. And I have done that almost daily for like 10 years now.

Daniel Lobell: (43:20)
5AM?

Dr Qasim Butt: (43:20)
5:00, well, sometimes 5:30. I hit the snooze button too, dude. [Laughs].

Daniel Lobell: (43:29)
I feel like if I keep challenging, you’ll say that you wake up at 10:00 AM [Laughs.]

Dr Qasim Butt: (43:35)
[Laughs]. I hit the snooze button a little bit, maybe 5:00, 5:30 around there. And sometimes six. But I will like literally exercise. Like even when going on vacation where I was at a hotel, I would go downstairs, just exercise a little bit. So I’ve implemented that in my life. And doing that in the morning really helps start your day. It gets it out the way, right? If after coming home. If I was going to tell my wife, I’m going to go out for an hour, she’d be like, where the hell are you going? So I’ve had to get it done in the morning. It’s kind of nice and you’ve accomplished something in the day before anywhere else has. Kind of gets your spirits up.

Dr Qasim Butt: (44:09)
And then you get into exercising. You start getting to the weight training and all this other stuff too. So to me, the best change I ever made in my life was just waking up early and exercise in the morning and then get it out of the way. I’m in shape, but I’m not in the greatest shape. I still got the love handles, you know, I’m a dad, I have a dad bod. I don’t have a six pack or anything, but to me was the best change I ever made.

Daniel Lobell: (44:34)
I feel like this is God speaking to me right now because you’re the second person today who told me, “You need to start waking up earlier and exercising first thing in the morning.” It’s weird.

Dr Qasim Butt: (44:48)
I’m not God for the record.

Daniel Lobell: (44:48)
Now that you’re a God, but I feel like God’s talking to me through you because you’re the second and the day is young. Two people today who have told me to do this now. So maybe I will try it.

Dr Qasim Butt: (45:00)
It’s the greatest change. Some people are just not morning people. I’ve never been the type that’s not a morning person. So I don’t mind getting up in the morning and just doing it. And so it’s changes your life, man. Honestly, I just think it changes your life. And even like, if you read these self-help books, you realize they are just people that do certain things in their lives, do great things, a lot of them wake up in the morning and exercise and that exercise doesn’t have to be like an hour of CrossFit. Again, you don’t have to go to the extremes- you can do 15 minutes on a treadmill, 15 minutes on the elliptical trainer, 20, 30 minutes on electrical trainer, whatever it is, start picking up some weights here and there and you start seeing that change in your life. So I think it’s a great thing to do.

Daniel Lobell: (45:41)
I’m going to try it. What time do you go to bed?

Dr Qasim Butt: (45:45)
[Laughs]. Usually around 10, somewhere around there. So like I tried to go from 10:00 PM to 5:00 AM.

Daniel Lobell: (45:53)
So we talked a little bit about what people can do, in terms of what changes they can implement to prevent or manage kidney disease. And you also touched a little bit upon your work with the Texas kidney foundation with the big brothers and big sisters program. I wanted to get into that a little bit more and also kind of expand on what you do as a kidney doctor. Cause we heard a little bit about it, but what is the day-to-day of a nephrologist?

Dr Qasim Butt: (46:31)
Let’s just start with the nonprofit stuff. So I work with the Texas Kidney Foundation. I probably worked for them since 2011, 2010, somewhere around there. I became a board member and treasurer. I actually left them in August of 2020. What I did with them was oftentimes free screenings for kidney disease. I oftentimes did public speaking and I love public speaking now, but it’s where I just did talks about kidney disease to the general public, the quick little 30 minute lecture, drop a few jokes here and there, but then just talk about kidney disease and what it is.

Daniel Lobell: (47:12)
With a kidney failure joke [Laughs] like what are the jokes that you put in there?

Dr Qasim Butt: (47:18)
The one I always did was about Diabetes mellitus, the term itself comes from Latin and it means sweet urine. And it comes from the fact that back in the day, the doctors actually tasted the urine to make sure it was sweet. And that’s how they diagnose you with diabetes. Yeah. And so nowadays of course we don’t do that. We have our nurses do that for us.

Daniel Lobell: (47:49)
[Laughs]. So that’s good. It’s a dad joke. Right? That’s like a one step above dad, I think.

Dr Qasim Butt: (47:59)
I agree.

Daniel Lobell: (48:04)
Like, I’m not sure if I have a kid, but. [Laughs].

Dr Qasim Butt: (48:08)
I’m paying child support anyway so I might as well. [Laughs].

Daniel Lobell: (48:15)
“The kid’s not mine” joke.

Dr Qasim Butt: (48:20)
So I worked with them for a while – I actually love doing that as a public speaking thing and going around and that was a lot of fun working with that kind of organization then, and then in Big Brothers, Big Sisters. I actually haven’t talked to the sucker in a few months now, but he actually just turned 18. But he’s a young kid out of the West Side and here in San Antonio, I’ve known him since he was, Oh my God, 13, 14 years old. So I’ve known him for a while now. I kind of hung out with them and just kinda mentor them a little bit here and there. And again, 2020, it was kind of weird because we weren’t hanging out because it’s 2020 and I’m a healthcare worker, so I didn’t want to introduce the virus to him and bring it home to his parents. He lives with his grandmother, but it’s cool watching a kid grow up, and when I joined Big Brothers and Sisters, I was telling them , “I’m going to use this like my template kit, you know, my kids are young. They’re like toddlers, right?

Dr Qasim Butt: (49:16)
Let’s see how this teenage thing works out. It’s weird with teenagers dude. Like you can never tell if they like you or not. I’m hanging out and taking them out and I’m thinking, “Do you even like me dude?” Yeah. … We’re talking, don’t get me wrong.”

Daniel Lobell: (49:30)
[Laughs]. Is this like a really insecure older brother program?

Dr Qasim Butt: (49:39)
The funniest thing is when you join this, it’s hilarious because firstly, I get recommendations where people are stuck. But also the whole process is like e-harmony. So you can literally pick your race, your problem list, all this stuff. You can say, I want a hot blonde or something, whatever. [Laughs]. You can’t say hot blonde.

Daniel Lobell: (49:59)
[Laughs]. I would imagine not.

Dr Qasim Butt: (50:04)
[Laughs]. But you have to pick your race, which is hilarious and I’m like, okay, this is a little racist but whatever, but you can pick. And the funny thing was you can actually pick your level of what you’re willing to deal with. So if they have drug abuse problems or other things. So what was interesting was I actually got a great kid. I pretty much selected a teen to mentor, saying, no, I didn’t really want that. I just didn’t really know how to relate to that, like drug abuse. And all that kind of stuff. I don’t want that in my life.

Daniel Lobell: (50:30)
Yeah.

Dr Qasim Butt: (50:30)
So I just got a kid that’s in a poor situation, but has a great grandmother that’s really involved in his life. And one wanted a male role model. So I got to ride them out. Now he’s about to go to college, which is super cool. and I He did just take his SATs. There was a rumors for this incoming class that their SATs wouldn’t count or something like that, or the colleges would use other attributes to judge them. But I’m not sure how true that is now.

Daniel Lobell: (50:58)
Interesting. Yeah. I mean, that sounds like it’s pretty rewarding work. It sounds pretty cool.

Dr Qasim Butt: (51:04)
Yeah. It’s pretty cool.

Daniel Lobell: (51:05)

You were also going to tell me a little more about nephrology.

Dr Qasim Butt: (51:09)
Yeah. The day-to-day of being a kidney doctor. Do you want me to talk about the groupies first or Ferrari’s and Porsche’s -which one did you want me to talk about?

Daniel Lobell: (51:18)
You know, so many of the doctors I talked to on here just love fast cars. So I’m not even surprised if it’s like that.

Dr Qasim Butt: (51:24)
Are you serious? I’m not. Okay, I have a nice car. I have a BMW six series.

Daniel Lobell: (51:32)
Dude, there we go.

Dr Qasim Butt: (51:32)
I just like cool cars. I was like, the car looks cool. See, so I’m not big into fast cars necessarily. And no, I don’t have any groupies. I don’t have a yacht, nothing like that. No helicopter pad yet. Day-to-day, I’m an interventional nephrologist, but I’m also a clinical nephrologist. So one week I’m doing clinical nephrology, which is again, seeing people with kidney disease in clinic, seeing people with kidney disease in the hospital or who have acute kidney injury in the hospital and also seeing people on dialysis rounds. So in a dialysis round, you have to see your patient four times a month on dialysis.

Dr Qasim Butt: (52:15)
I see them on different shifts and things like that. And the other week I’m doing interventional nephrology. So I’m working on dialysis access, like the accesses in the arms, the catheters and that kind of stuff. So what’s cool is I get a little bit of both worlds, I get to be cerebral and be a clinical nephrologist, but also get to use my hands and get that satisfaction of working with my hands and fixing up access and getting that immediate gratification. So it’s kind of cool.

Daniel Lobell: (52:42)
Yeah, that is really cool. So, when you’re working with your hands, what kind of things do you wind up doing? Are you operating on people’s kidneys?

Dr Qasim Butt: (52:51)
No. This is dialysis access, right? So by the time you’re on dialysis, your kidneys are shot. They’re not working. It’s just not dead weight, but some of them have some remaining kidney function, but not much. Not enough to sustain life. So you have to have an access in the arm. And so the access and alarm concern like a tube in the arm that connects to an artery and vein is constantly pumping. So if you touch the arm of a dialysis patient, they’ll have an either a fistula or a graph, which is that tube in their arm. In order to access that tube in their arm, they put the two needles in it. So one to get the blood out on the dialysis machine, the other to put the blood back in when they clean it.

Dr Qasim Butt: (53:27)
That access, that tube in there oftentimes could have narrowings develop, it can clot off, meaning stop working. It may need to stand, it may need to be ballooned up, be opened up. So all these kinds of complications happen, with dialysis access. So I can go in there and fix it up. Also, if they don’t have a dowel section in their arm, I can put a temporary access in their neck, which is a catheter, which is like a tube that goes in their neck. I can change it out if they have problems with it, things like that. So that’s how I work. I don’t work on the kidneys at all. As far as interventions, my intervention is not on the kidney. My intervention is on dialysis access.

Daniel Lobell: (54:09)
I got you. Wow. That’s pretty wild. That seems like such a intense thing to be doing, like putting needles in people’s necks. Is it terrifying?

Dr Qasim Butt: (54:24)
I’m fine, dude. I’m fine. [Laughs].

Daniel Lobell: (54:27)
[Laughs]. Just like you said, sometimes a patient has clotting in their neck. That seems like very intense.

Dr Qasim Butt: (54:33)
The clotting is not in the neck, typically it’s in the arm. I guess if it is your first time to expose it, it’d be kind of gross or intimidating, but I’ve done it for like 10 years now. So it’s straightforward. When you’re in this line of work, it’s vascular work, meaning you’re working on the circulation so you can get blood all over you. You can sometimes walk out of a case looking like like American Psycho, just like blood all over you. And sometimes you can get just a few on your Nike’s and that pisses me off. Cause I’m from New York and I hate anything, any sneeze, like any marks on my Nike’s, but yeah.

Daniel Lobell: (55:09)
You need to invent some kind of thing for doctors with nice sneakers to protect them.

Dr Qasim Butt: (55:14)
Yeah. I guess I have shoe covers on them and everything, but sometimes it’s soaked through, but it’s not that bad of a procedure. It’s not overwhelming. It only requires what we call conscious sedation. I don’t have to put the patient out. Like I don’t have to have an anesthetist to put the patient to sleep. I can just do conscious sedation where I just give them a little medication to kind of make them groggy and maybe put them to sleep a little bit. It’s not that involved as a procedure.

Daniel Lobell: (55:37)
Wow. Still sounds pretty impressive to me. I wanted to talk about how you joined Doctorpedia as a founding medical partner recently and chief medical officer of the nephrology channel. So I want to talk a little bit about your ideas, hopes and dreams for the channel and what you hope to accomplish.

Dr Qasim Butt: (55:55)
The way I got involved with Doctorpedia is I do video content and some of the people in Doctorpedia actually saw me – Rivki saw me and then actually, Dr. Douglas Walled, he’s a radiologist, he actually saw me too. And so they both reached out to me and then they explained to me what the platform is and how it works and what I was doing online for free – They want to make an actual education platform. So the fit actually suited really well. And then entered Jeremy, and you’ve got this cool British accent. [Laughs].

Daniel Lobell: (56:40)
[Laughs].

Dr Qasim Butt: (56:40)
And I just fell for him like, Oh my God, that accent. Aren’t you like automatically impressed with somebody has an English accent? It’s like, Oh, wow.

Daniel Lobell: (56:58)
Like a Cockney accent. Jeremy’s got that smooth, like James Bond kind of accent. He sounds intelligent – he’s got the smooth English accent. He’s not like the rugby player eating Heinz beans out of a can. [Laughs].

Dr Qasim Butt: (57:30)
[Laughs]. When I met Jeremy, he seemed like a really cool dude and thought I was a good fit. And they didn’t have a nephrology channel. So it was like a perfect fit for me. So I became the chief medical officer of the nephrology channel and a medical co-founder. So as far as what I want to do, I really want something that’s going to have good patient engagement. So what I’ve realized is with content, so many doctors and so many marketing companies put out this amazing content as far as videography. And it’s got a drone shot of your office and you’re in this fancy thousand dollar suit.

Dr Qasim Butt: (58:13)
And an angle of you with the patient’ smiling and all this nonsense. And I’m like, no one’s watching it, dude. You just paid the $2,000 for them to make the video, but it’s not engaging. And you may even have been talking about a subject at hand educating the patient, but it was so boring and blah, that it didn’t mean anything. So why even make the video? So to me, it’s about engagement. If you notice my videos, I try to be engaging and sometimes funny, but I want to have that engagement. I want patients to feel like, Hey, this is something I understand. So one of my goals is the nephrology channel. I have to talk to Jeremy. We may not need to call it the kidney channel, because I hate the word nephrology, and there’s another word called renal, which is another word for kidneys.

Dr Qasim Butt: (58:58)
I want those words out. So I want them to make it as simple as possible. I want the videos to be very straightforward. When I make a video, I always try to imagine myself as if I didn’t know a thing about kidney disease, or I didn’t know a thing about this subject, how would I want it interpreted to me, how I want it said to me. I don’t know if you’ve read those books for dummies like real estate for dummies, stock market for dummies, all those books. I think they do a great job of actually breaking down complex subjects into simple parts. And so they actually teach people well, so that’s my goal is to break it down simply so you can get those main points.

Dr Qasim Butt: (59:39)
I was talking to the other guys at Doctorpedia, I may want more patient engagement. I don’t know. Maybe we do a Facebook group. Maybe we have support sessions for patients with kidney disease. Recently I got into the biotech medical device space, maybe bring on new companies that are making innovations in kidney care and interview them. And talk about what’s coming up in kidney care. How’s it different? I can talk about the kidney health models and payment models that we are going to go into – a value based medicine and talk about it, not on a doctor level, but maybe on the patient level. So the patient understands, Hey, this is how they’re going to push me to home dialysis. And this is why they’re pushing me to home dialysis as opposed to doing in-center dialysis. I just want to make sure that the experience for the patient is amazing. And I want it to be like the premier channel for people who have kidney disease. Hey, I went to Doctorpedia yesterday. I saw, I learned this. That’d be a cool, cool thing to do.

Daniel Lobell: (01:00:45)
I think it sounds great. I love your ideas. And I think even people without kidney disease will get a lot out of it. As I have talking to you today. It’s been pretty cool. I learned a lot.

Dr Qasim Butt: (01:00:56)
Awesome, man. Cool.

Daniel Lobell: (01:00:57)
I like to round off these interviews by asking every doctor if there are any apps or technologies that they engage with to monitor their health, and then the general question, what do you do to stay healthy?

Dr Qasim Butt: (01:01:11)
So as far as apps, I used to use like, Oh my God, the calorie counter app, what was it called? My fitness pal or whatever. I stopped using that a while ago. but the one that I do use is I have a scale where I measure my weight every week and it’s Bluetooth connected. So it just connects to your phone. So it gives you a trajectory and keeps you honest. So I always tell my patients measure your weight at least once a week, when you start doing it every day, you’re going to drive yourself nuts. But once a week, you can kind of get an idea. And that app itself is really good. The other thing I recommend to a lot of patients. Can I name a specific brand? Is that okay?

Daniel Lobell: (01:02:01)
Yeah.

Dr Qasim Butt: (01:02:01)
So if you wanted to monitor your blood pressure, I really do recommend, the Omrin 10 series. I don’t work with this company at all, but I think it’s an excellent product. I actually made my dad buy it. It has Bluetooth connectivity and connects to your phone. So you can take your blood pressure at home. And then Bluetooth connect it to your phone. That’s awesome there too. As far as for myself, like we talked about, man, I wake up every morning, five, five 30, hit the snooze button, maybe once or twice and then work out for about anywhere from 15 minutes to 40 minutes a day, depending on that day. And I try to get enough sleep. I think people do not value their sleep enough. They think, “Oh, it’s just time wasted”, but it’s actually regenerative for you and recharges you and keeps you healthy.

Dr Qasim Butt: (01:02:48)
So try to get that 7-8 hours sleep. I try to get at least seven. And diet wise, always try to incorporate as many vegetables as possible. I don’t necessarily go plant-based completely, I still eat meat, but try to incorporate a lot of veggies in there, man, that’s always going to be helpful to you. And again, as far as low carb, I would definitely say avoid the simple carbohydrates as much as possible that are not useful for you to have no nutritional content. Those empty calories from a Coke, Pepsi, those are kind of useless to you. So those are my kind of general recommendations for people and what I kind of try to stick with as well. And during this time I just stared taking a multivitamin vitamin D as well too.

Daniel Lobell: (01:03:31)
Is that because of COVID? I heard that that helps.

Dr Qasim Butt: (01:03:34)
Yeah. So what’s interesting about vitamin D is like, I actually was very low in vitamin D about two years ago, three years ago. And if you have darker skin, you’re kind of predisposed to having lower levels of vitamin D. So I got mine restored, but now I just put myself back on vitamin D because of COVID and the immune response which helps you with your immune system. And then I started taking a multivitamin, there’s no harm in taking them and there could be some benefits. And what I’ve noticed is there was a New England Journal Medicine article a long time ago, with an editorial saying that mineral multivitamins don’t really help, but they don’t really hurt and that most people get most of their vitamins in their daily meals. But I have seen a lot of Americans eat and they eat like crap. I don’t see how you can get all your multivitamins in your pizza and your Doritos, hamburgers and your your fast foods. So I don’t see a problem in taking a multivitamin, but I don’t believe in super vitamins, where they have ultra mega doses and stuff.

Daniel Lobell: (01:04:41)
Like the “power of beets” commercials?

Dr Qasim Butt: (01:04:47)
Yeah. But the problem with the health industry is so much of it is so gimmicky. So I think it’s all about these small, subtle changes. We talked about this a little bit, walking, a little bit of cutting here, cutting there. But all of it’s designed to have almost like a magic bullet kind of thing, right? Like, Hey, my pill, my Ab-roller will fix all your problems. No, really it’s the small, subtle changes throughout your life that will make the biggest difference.

Daniel Lobell: (01:05:15)
I think that’s good inspiration for the listeners, make those changes, start forming new healthier habits, do it incrementally and make sure you check out Dr. Butt’s channel on Doctorpedia. This has been fun. I expect to see you doing standup at some point, because you’re funny. And I know that you’ve got an interest in it.

Dr Qasim Butt: (01:05:41)
I may have to do an amateur night somewhere someday.

Daniel Lobell: (01:05:45)
I’m only worried about all the patients that you’re helping, because I don’t want to see you saying “I’m done being a doctor – I’m out”, but you are funny. And you’re really engaging, like you said, on your videos and fun to talk to.

Dr Qasim Butt: (01:05:58)
Appreciate it, man. But my comedy may get me canceled, honestly, at this point.

Daniel Lobell: (01:06:04)
You’ll be canceled in five minutes. There’s no doubt about it. [Laughs]. You probably got canceled after this show. In comedy, anyway.

Dr Qasim Butt: (01:06:11)
[Laughs]. I think my career in medicine is done. I think the American Medical Association is going to hear this and be like, Oh, he’s out.

Daniel Lobell: (01:06:19)
No, definitely not. We need you. A lot of people depend on you. Thank you so much. Thanks for your time. I appreciate it. And I enjoyed this talk.

Dr Qasim Butt: (01:06:28)
That was pretty cool.

Daniel Lobell: (01:06:32)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

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