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16. The Accumulation of Marginal Gains with Salim Rezaie


A conversation with Dr. Salim Rezaie on discipline vs stubbornness, working through depression, transforming his body from 260 lbs to super fit, the aggregation of marginal gains, and intentional living.





About our guest: Salim Rezaie is double board certified in internal medicine and emergency medicine. In addition to working clinically as an emergency physician, he runs one of the most popular medical education websites on the planet, Rebel EM.


Salim went from 260lbs (on the left with the koala) to fit and ripped. It wasn't easy and it wasn't overnight. It was protecting time for health and fitness, discipline, and the aggregation of marginal gains.



We discuss:


What has been most challenging for Salim while caring for patients in the ED during the COVID-19 pandemic [03:20];

  • It often feels like there is no rhyme or reason to why some patients fare much worse than others.

  • Unlike other disease processes, with COVID-19 there are no mental constructs or heuristics to guide us when managing patients.


The spark for Salim’s transformation from being “festively plump” to super fit [06:30];

  • When Salim became a junior faculty member, work was overwhelming. Wellness and physical fitness fell off his radar for 4-5 years.

  • The spark for change occurred when four close friends in their 40s had heart attacks. Two died.

  • He knew that if he continued with the fast-paced, fast-food lifestyle, he would be headed there as well.


Tips for embarking on a diet and exercise program, and the importance of actually scheduling time to do it [10:35];

  • Make it a priority to change your diet. Think of it as a marathon, not a sprint.

  • Pick a program that is sustainable for the long haul. (Spoiler: fad diets like keto, paleo, etc. are HARD to sustain!)

  • When Salim had the initial goal to lose 30 pounds (he ended up losing 65), a cornerstone of his dietary change was to remove items that were his vices: bread, pasta, and other complex carbohydrates. He cut these out early and drastically.

  • If you have a hectic schedule, block out time to exercise and commit to it.


How intermittent fasting was a way for Salim to engage in the cultural practice of Ramadan [15:45];

  • Salim eats only between 6 pm and midnight, fasting for 18 hours of the day.

  • While initially tough, his body adapted quickly.


“Discipline is doing what you hate to do, but doing it like you love it.” Mike Tyson

The distinction between discipline and being stubbornness [19:30];

  • While Salim’s transformation was initially successful due to stubbornness, it was sustainable because of discipline.

  • In The Subtle Art of Not Giving a F*ck, Mark Manson stresses the importance of figuring out what your priorities are. If you know your “big rocks”, you’ll know where you need to focus your energy. These are the things on which you eventually become disciplined.


“Get 1 percent better every day. 365 days of 1 percents add up really quickly.” Salim Rezaie

Why success relies on the aggregation of marginal gains [22:46];

  • As you start working on the things in life that you prioritize, you add layers and the internal growth begins. When that light bulb clicks, it becomes discipline.


Social media and how these tools are only as good as the person who uses it [26:00];

  • You have to decide how you want to use these platforms and be deliberate about it.


“Work hard in silence and let your success be your noise.” Frank Ocean

The lifestyle of instant gratification and how people often don’t appreciate the hard work that goes into something for it to be successful [26:55]

  • Remember that it takes more than one person to make something successful. It's always a team effort. Don’t forget the unsung heroes.

  • If you can master both ends of this spectrum, you end up becoming a better human being.


“Be humble in victory and gracious in defeat.” Christopher Earle

Why comparing yourself to others is the opposite of gratitude [31:00];

  • When your value is set by the comparison to someone else, that is the thief of joy. And for many, it can lead to depression.

  • All you can do is be the best version of yourself.


“Comparison is the thief of joy”. Theodore Roosevelt

The stigma of mental illness and 3 things Salim learned in psychotherapy [00:35:12];

  • #1 -- Talk openly about your feelings rather than internalizing them. Bottling things up can have a toll.

  • #2 -- Good sleep hygiene is important.

  • #3 -- Avoid comparing yourself to others. Let go of the ego image of needing to be “the best”. Who you are is enough.


“If I can be better than I was yesterday, that's a successful day. I pay attention to others, I just don't compare myself to them.” Salim Rezaie

The value of embracing failure equally as you would success [43:30];

  • Defeat is not necessarily giving up. Many times it is a choice to change directions.

  • If you think back to the things that you value the most in life, it’s often not the things that you were successful at right away. Instead, it’s the things that you struggled with, that you failed at, and that required work. That work added value.


Salim’s core principles and priorities [44:30];

Salim spends each December reflecting on his top life priorities.

  • #1 -- diet and exercise

  • #2 -- spending time with family and friends

  • #3 -- learning something new through reading a new book every month (example: Presentation Zen by Garr Reynolds completely revamped his mindset on public speaking).


The most unexpected book that Salim has read in the last year [48:20];

  • The 5 Love Languages by Dr. Gary Chapman has this premise: people express love in one of 5 different ways. This book helps you understand the type of love language you most appreciate. For Salim, quality time is the way he expresses and appreciates love.


And more.


Shownotes by Melissa Orman, MD


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