Renowned nephrologist at Apollo Hospitals and motivational speaker on fitness, Dr Ravi Andrews shatters the “gym equals sudden death” fear-mongering myth and emphasises the importance of a balanced diet and fitness regime for a heathy life. Speaking to TNIE team during Hyderabad Dialogues, he also highlights the dangers of heeding advice of social media influencers, taking random supplements and painkillers, and more.
Excerpts:
Dr Andrews, my first question is about fitness. I understand the idea of being a ‘Homo Shapien’ in the healthiest sense. But what should an average man or woman do to stay fit, without necessarily going to a gym? Because these days, many people are afraid. I’ve seen a lot of fear — if not in most people, at least a significant number — around issues like blood clots and sudden heart attacks. So, what should someone do to stay fit?
I don’t think it’s possible to stay fit without some form of physical activity — whether it’s going to the gym, doing yoga, walking or playing a sport. You have to move your body. Now, some people say, “I’ll diet, that’s enough.” No, it’s not. Others say, “I’ll exercise, but I won’t diet.” That’s not enough either. Diet, exercise and lifestyle changes are complementary. The stories we have been hearing about people who suddenly collapse while working out – yes it is happening. Let me draw an analogy: we’ve heard of people who go to bed at night and pass away in their sleep. Does that mean we should stop sleeping? No. Similarly, the idea that “gym equals sudden death” is often fear-mongering, sometimes used by people as an excuse not to work out.
The real issue is technique. It’s not the gym — it’s incorrect technique, combined with unpreparedness. This fear that gyms cause sudden death—let’s not focus on that. The real focus should be on doing it right.
Now, about general fitness: you need three pillars—diet, exercise and lifestyle. Lifestyle includes managing stress. How we manage stress? The key is exercise. The biggest excuse people give is “I don’t have time.” But we all have 24 hours in a day. Assume your day is 23 hours long. That one hour is reserved for exercise. There’s something I call the Time Matrix. The Time Matrix helps you find time in your personal life. You divide your personal time into four quadrants:
* Things that make you happy and you cannot give up
* Things that make you happy and you can give up
* Things that don’t make you happy but you cannot give up
* Things that don’t make you happy and you can give up
People want to be fit, but they often lack the will to stick to it. You’re also a motivational speaker! If someone says, “I’m unable to do it,” would you give the same answer?
I don’t think anyone of us really lack motivation — we just haven’t directed it the right way. It’s not a lack of discipline, its just that they don’t understand the importance of discipline. Once people realise how essential their health is, they’ll find that motivation.
Now, post-Covid, we’re seeing a rise in people popping multivitamins. Gym-goers take whey protein and other supplements, often based on YouTube advice. Are these supplements advisable?
No, they are not advisable. Let’s talk about multivitamins — one pill gives you just a few milligrams or micrograms of vitamins. You can easily get more from a proper diet. There’s a saying: “Expensive multivitamin pills make expensive urine”. They’re excreted by the body and don’t do much. They are definitely a NO.
Next protein supplements: Most of the youngsters come and ask me which protein supplements I should take. I say don’t take any because all these protein supplements contain creatine, which converts into creatinine— a waste product your kidneys must eliminate. When you take a lot of creatine, your kidneys are overburdened.
Another concern is anything that comes off a shelf is preserved. The most common universal preservative is salt. And high salt leads to high blood pressure, kidney and heart problems, water retention. Fitness and health are two different things. The only way to bridge the gap is to go natural. For vegetarians, there is tofu, soya, paneer, milk, dals, nuts. For non-vegetarians, there is egg whites (safest), lean meats. For professional athletes or bodybuilders, protein supplements may make sense—but they’ll often pay a price later. Arnold Schwarzenegger has had multiple bypass surgeries already.
You mentioned salt earlier. We all use it in our daily food. Some people even try to completely avoid salt. Is it really healthy to cut out salt entirely?
It all comes down to balance. In certain medical conditions — like someone with both kidney and heart failure — we may recommend a zero-salt diet. But for the general population, like you and me, a small amount of salt is perfectly okay. Salt is an acquired taste. Babies aren’t given salt initially; we don’t actually need it. But as we grow, we reintroduce it, mainly because it’s used as a preservative and to enhance taste. High salt intake is linked to high blood pressure, kidney, heart problems and even certain cancers. So minimise, don’t completely avoid it.
You mentioned supplements earlier. What about multivitamins like Vitamin B12 for vegetarians — don’t they usually lack Vitamin B12 and Vitamin D?
For vegetarians, Vitamin B12 can be a concern because it’s mainly found in animal products. Pure vegetarians may develop symptoms like burning or tingling in the feet, sleep disturbances, visual problems or low hemoglobin. But not all vegetarians develop B12 deficiency — some manage to absorb what little they get. Vitamin D is another common deficiency in India — not because we don’t get enough sun, but because of melanin in our skin. Darker skin reduces absorption of UV rays needed to make Vitamin D. So, even though melanin protects us from skin cancer (which is more common in fair-skinned individuals), it also makes us prone to Vitamin D deficiency. It’s a trade-off. To manage this, check your Vitamin D levels. Vitamin D toxicity can cause more harm than deficiency. Always check levels and consult a doctor. Eat a balanced diet, exercise, and don’t take random supplements.
What about breathing during exercise? People often do it incorrectly.
To simplify things during exertion, exhale. So for biceps — when you lift the weight (the effort part), exhale. When you lower it, inhale. For triceps, it’s reversed. When you’re pushing back (the effort), exhale. Every exercise has its own exertion phase — identify that, and exhale during it. But the bigger mistake is holding your breath, especially during heavy lifting. This is dangerous. It causes a spike in pressure that can reduce blood flow to the brain. So, focus on not holding your breath.
And water? There’s a lot of confusion about how much water to drink.
Ah, the million-dollar question! The answer is really simple — two to three litres of fluid per day recommended — for both men and women. If you feel thirsty, drink. If you’re not thirsty, don’t force yourself. Some people overdo it — drinking 7, 8, or even 10 litres a day. That overworks the kidneys and can dilute essential chemicals like sodium, potassium, magnisuium in blood. Low sodium can be life-threatening. A classic case is Bruce Lee. There are many theories about his death, but some experts now believe he died of low sodium from drinking excessive water. Stick to two to three litres.
A lot of influencers are talking about diets — what to eat and what not to eat. How should people decide what’s right for them?
Now, I don’t know whether regulations exist already, but they should. YouTube, for example, should require anyone giving medical advice to display their qualifications and say why they are eligible to give that advice. Everyone is giving gyan (advice). People need to be smart enough to check whether the person giving advice is actually qualified. It took me 15 years after 12th grade to become a nephrologist. Even now, I think 10 times before saying anything.
Take the recent trend—people taking painkillers as if they were candy, which pain killer is safest?
From a kidney perspective, if you ask me, Dolo is the safest painkiller. I also recommend it to patients in pain. But taking it casually for a temperature of 99 or just because you might feel pain after playing a game — that makes no sense.
I have a friend who needed a kidney transplant. This was about three years back. There was some programme, but you can’t really do anything — you have to wait for your turn. Ultimately, he got operated on in Singapore. What is your analysis of the situation?
The problem with doing kidney transplants in our country is that the regulations are strict. There are only three types of transplants possible. One is a live-related transplant. This means a first-degree relative — your mother, father, siblings, husband, wife, or children. If your first-degree relative is fit to donate and the matching is done, you can proceed directly without needing any permission. The second is live-unrelated. About 10 to 15 years ago, anyone like a friend, close acquaintance, or someone working with you for many years could donate, citing emotional reasons. But now, regulations are much stricter. Only second or third-degree relatives (like mother-in-law, grandfather, cousin) are allowed. There are ways to prove this — surname, ID cards, addresses. If it’s a friend claiming to be close since childhood, we might ask for school-leaving certificates or do separate interviews — like asking the name of a childhood pet. If the story matches, we consider it. In live-unrelated transplants, we must get government permission.
The third is cadaveric or Jeevandan transplants. Every state has this programme. In Telangana, the apex body is at NIMS. Only dialysis patients can register. The hospital does all investigations and applies through NIMS. Once registered, your name goes on both the hospital list and the NIMS priority list. If someone dies and donates a kidney, NIMS checks which hospital is next in line, then matches with the patient priority list.
So, your friend who waited for three years — that’s a typical waiting period. One to two years is normal, and sometimes it gets accelerated if a hospital skips its turn. But there’s also a radical one. For example, in Iran (as per information from 15 years ago), it’s like buying land. It’s all government-controlled — someone wants to donate a kidney, it’s registered and done legally. The seller decides whether to go through or not. Whether that’s right or wrong is hard to say. Someone is dying for a kidney; someone else is dying of poverty. So philosophically, maybe it makes sense. But it’s also open to misuse.
Doctor, why did you get into this profession?
Okay, I’ll be honest. As a kid, we had just three options after 10th: Arts, Science, or Commerce. If you chose Science, it was either medicine or engineering. My father was an engineer. I was weak in math in 5th and 6th, so he’d teach me—and he was a brilliant but impatient teacher. I got yelled at a lot. So when I had the choice between engineering and medicine, I thought — if I go into engineering, he’ll start teaching me again and make my life miserable. So I chose medicine — something he knew nothing about. Also, my mom always wanted me to become a doctor. That’s how I got into medicine.
How did music become a part of your journey?
Music I’ve been into since childhood. In 10th standard, in 1982–84. Our only aim was to attract the opposite sex. That’s it. For that, either you had to get a bike, build your body, or play music. Gyms weren’t there, bikes were expensive, and music was cheaper. A guitar cost just 500 rupees, one-time investment. That’s how it started. Now, to make ‘Homo Shapien’ more interesting, I added music. Talking about exercise becomes boring. So I thought, why not introduce myself with music? I make people jog in place. Without music, they get tired in a minute. Then I play Eye of the Tiger, and suddenly they get energy. That’s the kind of music I add to Homo Shapien.
I saw one of your podcasts where you mentioned avoiding rice. I hear this a lot, especially among diabetic patients. But what is the scientific reason behind this?
Yes, we’re talking about diabetes. There’s something called the glycemic index (GI) — how quickly food raises blood sugar levels. High-GI foods like sugar and rice release glucose quickly into the bloodstream. In diabetics, these sudden spikes are more harmful than a consistently high level. These spikes can damage organs — that’s how diabetes kills, not by sugar itself, but by damaging other organs. High-GI foods also lead to weight gain, as the sudden spike pushes glucose into tissues. So, for diabetics and those trying to lose weight, rice should be avoided. Personally, I eat rice twice a day, but I exercise regularly and am not diabetic. If I were, or if I wanted to lose weight, I would avoid rice.
Since childhood, my mother told me not to eat tomato and palak — she said it causes kidney stones. Is that true?
She is right. That’s solid medical advice. You shouldn’t mix palak (spinach) and tomato, or palak and paneer, because paneer has calcium, and tomato has oxalates. If someone has a genetic tendency or a past stone, these combinations raise risk. Moderation is key. You’re not eating palak and tomato daily, right? Once in a while is okay.
What’s your view on alternative fitness forms like yoga or tai chi?
All forms of movement are good. We’re not here to build six-packs. We’re here to stay fit.
We have a colleague here in our office who’s been trying hard to lose weight. I found out he’s on a fruit diet. He eats rice in the afternoon or something like that, but every night he’s eating only fruits. Is that even advisable?
I’ll tell you the cliché — eat breakfast like a king, lunch like a prince, and dinner like a beggar. It’s actually valid. So he’s right. And also, it’s not just about dieting. If he wants to lose weight, he has to exercise too and build muscle. That will help him lose weight. Even if he doesn’t lose weight — say he exercises enough — he’ll gain muscle, so his weight may stay the same. If he exercises regularly, regardless of his weight, he should stop focusing on hitting a specific number (in gym). It’s not pure weight loss that matters — it’s overall health. If he feels good, is exercising regularly, and eating less at night, then he’s doing the right thing. Weight is not the issue— those metrics are.
Some people prefer Ayurveda for treatment.
Ayurveda can cause kidney problems — it’s well documented. There’s something called interstitial nephritis, seen in people taking Ayurvedic medicines. Some patients ask about homeopathy. I say okay— if you want to take it, continue your regular medicines and we’ll monitor your kidney function. But I don’t fully buy the claim that something with no side effects can have effects. No side effects usually means no effects. That’s basic pharmacology.
What are some other common myths you see people falling prey to?
One, of course, is the protein supplement myth — which I hope I’ve busted. Second: people switch off the AC when they work out because they want to sweat. They think sweating helps lose weight. But actually, when you sweat, you only lose water. It’s not like fat melts and comes out in your sweat. You’re losing water and minerals. That’s another myth — that you should only exercise in a hot atmosphere.
TNIE team: Kalyan Tholeti, Prasanna RS, VV Balakrishna, Bachan Jeet Singh, Reshmi Chakravorty, Aarti Kashyap, Nitika Krishna, Siddardha Gattimi