#48: How Examine.com Became One of the Biggest Nutrition Websites on the Internet – Kamal Patel

Erica Julson: I am really excited for this episode. I got to interview one of the founders of Examine.com, which if you aren't familiar is a super awesome website that reviews research on various supplements, and organizes all the evidence into these easy to read summaries and tables. Tons of dietitians and healthcare professionals reference their site all the time. They get over a million visits to their website every single month. I just have to pinch myself that I have the opportunity to do this interview for the podcast.

Erica Julson: Cool story of how this came about, one of my RD friends put me in touch with Sol Orwell, the other co-founder of Examine.com, who I had only briefly interacted with on social media and some SEO threads in the past. We were chatting about a new product that Examine was coming out with called Examine Personalized that offered monthly curated research summaries on different nutrition topics for a monthly or annual recurring fee. I was given complimentary access to check it out. I loved it, by the way, since as you all know, I'm a total info hoarder, and I just love keeping up with the latest research, hence why I have my own membership site that keeps up with the research in functional nutrition.

Erica Julson: I decided to become an affiliate for their program, and when they launched in I think it was July of this year, they were offering a special limited time discount. I shared that promo with my Facebook group and my email list using my affiliate link, and 41 people signed up, which I think was a big win, win, win for everyone. Sol reached out via email to say thank you, and we were just brainstorming ways that we can continue to collaborate, and he volunteered to do an interview with me on the podcast, which is so obvious in retrospect, it just shows how green I am about pitching interviews to people.

Erica Julson: Here I am like, "Hmm, how could we work together?" And he's the one bringing up the idea of interviewing on my podcast, like duh! Anyway, since I usually interview nutrition professionals, and Sol is more of the marketing guy, he then connected me with his other co-founder, Kamal Patel, for this interview because he's the nutrition guy. It was so much fun to chat for an hour with one of the brains behind literally one of the biggest nutrition websites on the internet. In this episode, we chat about the origin story of Examine.com, what the website and business model looked like in 2011 versus today, how they grew the site to what it is today, how they run their business behind the scenes, where they see their platform going in the future and some of the biggest lessons Kamal has learned from running this website for nearly a decade.

Erica Julson: If you have any interest in checking out Examine Personalized, and would like to go through my affiliate link, you can do that by going to theunconventionalrd.com/examine. That will take you right to the Examine homepage where you can check out Examine Personalized. If you do purchase through that link, I will earn a commission at no extra charge to you. If it's easier, I will also put the links in the show notes to this episode, so if you're familiar with that, I make notes for all the episodes on my website, theunconventionalrd.com. You can just click the podcast tab, find this episode, episode number 48, and you'll be all good to go.

Erica Julson: Just click on my affiliate link for Examine Personalized, and you can choose to register if you'd like. I hope you enjoy this episode. It's actually going to be my last one for 2020. I'm going to take the last two weeks of the year off to do some bigger picture business planning for 2021, and of course spend some quality time with my hubby and puppy. With that being said, let's get right into the episode with Kamal.

Erica Julson: Hi, Kamal. Thank you so much for being here today. I'm so excited to talk to you about your experience founding one of the most popular nutrition websites on the internet, Examine.com. I don't know if all the people listening are familiar with Examine, so could you start by maybe giving us a quick summary of what Examine.com is and the type of content you publish?

Kamal Patel: Sure. Examine is basically everything about nutrition and supplementation. We had a struggle as to whether we can really be everything. You can't target both researchers, and lead people, and people want to learn basics and advanced stuff, but we try to do the best we can. We use research to just summarize every issue, every supplement, every diet that we can think, and then we present the results in a somewhat systematic way in our research database based on typically double blind, randomized controlled trials.

Erica Julson: I love that idea. I reference your website all the time as I know many of my colleagues do. On this podcast, I interview people in the nutrition field with unconventional careers, and I myself teach a lot of blogging strategy and that type of stuff. This is right up my interest alley in terms of hearing about how you freaking grew this website into the behemoth that it is today. I know people are going to be super inspired to hear how this all went down.
Maybe we could start by getting a little bit of more insight into your background. What got you interested in nutrition? I know at some point you were pursuing a PhD. Can you give us more insight on that?

Kamal Patel: Sure. I think the first time I really got interested in nutrition was maybe around sophomore year of college. I had a guy in my dorm who was just really jacked. I never lifted a weight before, so I think I asked him something about weightlifting, but he was really intellectual. He said, "What matters most is not sets and reps, but what you learn about nutrition." I took that to heart. I went to the stacks in the library, because it was more like physical journals then. I just went around and tried to read stuff, and I eventually learned as much as I could.
I started lifting weights. I was interested in sports nutrition, and then that changed maybe about five to 10 years later, I got into public health, because of two things. One is that I realized that there was a limit to sports nutrition. You could supplement your way to 5% or 10% greater gains. It would marginally help you, but it wouldn't really help the populace in general. I mean, there's definitely benefits for supplementation for sarcopenia and stuff like that, but really, it's other public health strategies that matter more.
I got into that, and then personally, I got more into other aspects of nutrition when I had some joint issues and surgeries and trying to figure that stuff out. Now, I'm interested in everything. I try to figure out what I do know, what I might know and what I should learn more about.

Erica Julson: Where did that analytical interest in the research... Not everyone likes to read research papers, so where do you think that came from?

Kamal Patel: My self conception is that I love reading research, but in all actuality, I probably don't. If I could outsource that part of my brain to somebody else, and then just find out the results, I would do that, but I guess that's what we do for people who read the website. It's a necessary evil, because I'm sure your listeners get this too. You can't understand a ton about nutrition unless you know at least a little bit about research.
For me, it was a necessary evil to learn about epidemiology and biostatistics and research methods, so I could actually read papers, because you can only have somebody tell you so much and explain it on five terms before it just gets a little bit too complicated. I try to learn about research because I have to.

Erica Julson: Then at some point, you went back to get a PhD in nutrition?

Kamal Patel: Yeah. I concentrated in nutrition and in an MPH program, and then it was also in business school for a nonprofit stuff. Then I went back to school for a PhD, and then after a few years, I had a bunch of joint problems, and I was trying to get into powerlifting. I just kept breaking down, and I had a surgery, and that went poorly. Then I had some more surgeries, and they all went poorly. Then I went to a geneticist, and was diagnosed with a condition called Ehlers-Danlos syndrome, which is basically lacks hypermobile joints.
Then because of various pain issues, I took a long medical leave and an indefinite hiatus. That's where I stand now. Ideally, I'd like to go back, but it's a slog. There's lots to do per exam, and so mostly about that.

Erica Julson: Before I went back to school to become a dietitian, I thought I wanted to get my PhD, and I worked. I was a lab manager before that, so I get it.

Kamal Patel: It's not anybody's idea of fun or most.

Erica Julson: What shocked me... or not shocked me, but what hit me in the face was the harsh reality was you don't have so much control over where you get to live. It's like wherever there's a position open, you gotta go. Then, "Oh, well, you got your post doc. You're moving all the time." It was just a lot.

Kamal Patel: All your friends already started their jobs and are living normal lives.

Erica Julson: Exactly. Totally. How did the actual idea for Examine.com come to life?

Kamal Patel: It came about through Reddit, actually, so my co founder is more of the tech side. He was involved in domain name buying, and he got this Primo domain name examine. He had lost a lot of weight using basic evidence-based principles, like increasing walking and having occasional treats, but not being too extreme and yoyoing. Then he wanted to use that logic to help other people. Examine was the natural extension of that, but making it systematic. At that time, there were websites that still exists now that have a lot of nutrition articles, so like bodybuilding.com and T Mag or T Nation or whatever it's called, and then the newer ones like Healthline when they acquired Authority Nutrition and some of the other ones.

Erica Julson: I used to write for them.

Kamal Patel: They dominate now in terms of search results, but back then, it was mostly bodybuilding stuff, and then Mayo Clinic and some other websites had outdated information. Examine was the one that had new information, and tried to be more analytical and systematic. We started small with the main supplement entries and got bigger and bigger. Now we're at a point where it takes so much effort to update one page that we need more money, but we don't sell supplements, so to make more money, we have to try to figure out crafty ways to make money, because we're never going to really sell out.

Erica Julson: I want to talk about that later, but I admire that about your website. I'm sure that makes a difference in terms of being able to claim your objectivity and stuff like that. For people listening, they might not be familiar with us, but there's a tool called Wayback Machine where you can type in someone's domain, and then there's-

Kamal Patel: It's the best.

Erica Julson: You can spy on what people's websites used to look like, which don't do that for my website, please. Anyway, I thought that yours first came about in mid 2011-ish. I like to frame this for people, because sometimes they see where people are at now, and they're like, "I could never do that, because..." It's been almost a decade that you've been at this, so people should not be looking at Examine.com, and be thinking like that's where you started, because everyone starts at much more basic levels.
Like you said, you had list of supplements. It seemed like it almost was like a contributor site at first. It said, "Oh, it's like Wikipedia, except we check everything." How did you come up with that idea, and then what led you to change that maybe a year later?

Kamal Patel: That more or less failed. I mean, it wasn't terrible, but in an ideal world, there would be some way that you could get contributions from everybody who knew about topics, but everybody has to be on the same page regarding research. Even if there is a slight discrepancy, then analysis can be different, so if you read a paper and you say, "This is how we judge whether we're going to include this paper," it has to be a controlled trial and blah, blah, blah, blah. Then somebody who doesn't have as much experience working with you comes in. They might know a lot about epidemiology, but they might be like, "Well, this is an observational study, and it has 200,000 people, so that should be good enough."
It's much bigger than this 20% pilot trial, and then they include it. We might mention it, but we won't include it in our database per se, because it would muddy the waters. That's even just like the most basic issue, then there's dozens of little things that we talk about every day. That couldn't work. We might get back to a point where we can get more contributions from other people, but we only get paid contributions now. There's no longer freely suggesting studies and commenting about stuff, because somebody has to parse all of that, and it's not going to be me.
That didn't work. It didn't really become a Wikipedia, but that doesn't mean that we can edge a little bit closer to that in the future.

Erica Julson: No, that's helpful. I like to hear people's thought process like, "Oh, we thought we could build this," but then in reality, the hard reality of what that means on the back end.

Kamal Patel: Everybody's a dreamer until you wake up.

Erica Julson: Then at some point, you started doing a frequently asked question section. Did that work out better?

Kamal Patel: Yeah. The frequently asked questions worked out pretty well, so we should really expand that. Our website is maybe 80% supplement and diet pages that have the database, the human effect matrix and 20% frequently asked questions, but probably people just want to know the answers. We like to be systematic and make those databases, so we have at least 100 or 200 questions now. We should have probably 300 to 400, because every little thing that I wonder about, I know everybody else wonders about.
Whether it's little questions about gut health or metabolism or what have you, everybody has same questions, so we should just get down to it. But again, then we need to hire people and then take them in.

Erica Julson: For sure. I know you just mentioned the human effect matrix. Could you elaborate maybe on what that is for people who haven't been to your site yet?

Kamal Patel: Sure. It's basically a table that orders the evidence by outcome. Let's say that intervention is fish oil, and the outcome is cardiovascular disease. Then the human effect matrix would only have human trials, and it would show the effects in the matrix, but nobody remembers that name, so we're going to change its name. It's been on the list for a while now. We just can't figure out the perfect name, but you can sort the matrix by the level of evidence, so how much evidence there is, how many papers by the direction of the effect, so whether fish oil increases, decreases slightly or majorly or is neutral towards heart disease, and then also by a couple other things.
Then we have notes for the different types of studies, and we try to enter all the randomized trials that exist, unless they're really, really old.

Erica Julson: It's so helpful. Seriously, if you're listening right now, and you've not checked out Examine.com, that's a great place when you get questions about supplements in particular as everyone does.

Kamal Patel: It's funny because it's really good for health professionals, but it's not that great for lay people. We know that, but we keep adding to it, because it's pretty useful for health professionals, but it got to a point where... We didn't really use to make much money. We had one product, and then we need to hire more researchers, so then we ended up having to hide the notes for studies, so you have to pay by being a member, but then some clinicians ended up using the evidence very directly like, EPA had this percentage change on cardiac events.
I'm going to recommend that my patients do this, and that's worth a lot. It's just that we can't make that very clear. We have to hire better ad people or something to make it clear that like, "Hey, this is actually really useful," but I don't think people super understand that right now.

Erica Julson: When you first started it, though, was it just like a hobby? What was the vision?

Kamal Patel: Well, I was previously working for Tufts Medical Center. I was in school at Tufts for a PhD in nutrition. While I was on medical leave, I started working at the Medical Center, so I could pay rent. They needed a couple people to come in and help with the project on vitamin D, because they had been hired as evidence-based practice center to work on the upcoming guidelines in 2008 or '09 or whenever that was. The Institute of Medicine was getting different studies from different centers, and we were doing the one on vitamin D and bone health and then vitamin D on all outcomes.
People had to grind through hundreds of studies. I went through maybe 100 of those. As I was doing that, I would always read nutrition websites, and I knew Examine existed, but it was small, and we were just doing a very small amount of stuff, right? We weren't doing really comprehensive analysis. Then I was like, "Well, I think I'm going to leave this job, and just do all Examine," because I was helping this project have more evidence on vitamin D, and then later fish oil and some other stuff, but it was just rote data extraction. Then the government wasn't going to change their levels, right?
It was predetermined that that's what their recommendations were going to be. I was like, "Well, I'll go full time Examine. We'll try to get more employees." It was a slog. It took years and years to try to figure out the right business model, but now we're at the point where it's fairly sustainable, and we can plug and play and think of a new supplement or a new lifestyle intervention and start that matrix, but it wasn't easy. We changed the human effect matrix over the years.
We changed the way the site is organized, and now we're reorganizing the entire website by main uses. We just came up with about 25 uses, autoimmune disease, muscle gain, that kind of thing so that when you go to the website, it's not just how it is now, where you're fending for yourself, and you just have to depend on the search bar to find what you want. It's been progressively getting better, but it's a big website, so it's a slow progress.

Erica Julson: I imagine. I think that's a good idea, though, in terms of organizing it by what people are looking for help with. I think that will help especially for lay people probably.

Kamal Patel: Yeah because everybody usually has one thing they're really interested in.

Erica Julson: Looking back, I was scoping out how the site transitioned over the years, because I'm just personally interested. I also have a membership site that I'm shutting down similar-ish, not focused on supplements, but more like functional nutrition recommendations for different health conditions that we make notes and posts for dietitians, but it's all behind a paywall. I'm sorry, I'm doing the opposite, and I'm focusing on other things, and it's just going to become publicly available.
I'm just interested in the monetization strategies and stuff. I see that you made your first paid product, which is the supplement guide in, I believe, 2013, so maybe two years in. I think it was $39. It was supplement recommendations organized by health goals. How did that go? How did you even come up with that as an idea to put out, and was it successful?

Kamal Patel: Well, so the site wasn't monetized, and we had to make money, but it would take money to hire people to make the product, so we're a little bit in a bind. The supplement goals referenced was basically a downloadable PDF of the entire website. Then as we built more pages around certain outcomes, heart disease would list all the supplements, but then we ended up making a human effect matrix in the heart disease page that listed the supplements and then those outcomes, so kind of a cross tab. The supplement goals referenced or whatever is all at the time ended up being like 1,000-page downloadable PDF, which people actually wanted back then because internet connections weren't as fast.
People wanted to download it, so they could quickly find what they wanted without having to search the whole page. Then at some point, we also hid those outcome pages, so then you could see the human effect matrix, but not the entire thing. It's partly hiding and partly providing a service for download ability, and then we will notify you when things were updated. It stayed that way for maybe two to four years. That made some money, but it provided some value, but it wasn't anything new. It was just mostly the website.
Then our next product was the supplement guides, and that was our first new one. That took a lot of effort. We worked on it, and we brought in somebody from one of the other one or two big databases that dietitians and other health practitioners use. We just cranked out the supplement guides for some of the main uses, where we covered the supplements that have enough evidence to possibly be recommended, the ones to watch out for and some safety warnings. Then that did really well, but that took a ton of effort, because we brought in pharmacologists to see if we were on track for certain supplements for the safety warnings.
Then we really had to be on our games, and then we had to make graphics, so we had to include that infographic angle. That was tough. That took time. Combining those first two products were really our first five or six years.

Erica Julson: I can imagine that's a lot of work, and then you're like, "Okay, we're done," and then new studies come out, and you're like, "Dang it." I can relate to that, for sure. Was that enough, though? You're like, "Okay, this is a business model." Did it at least fund what you needed it to fund for the site?

Kamal Patel: It did. It funded it, but then we ended up being susceptible to, like everybody is, Google search result. At a certain point, our traffic went down a lot, first, 10%, and then 40%.

Erica Julson: With that big update, that was a nightmare, oh my gosh.

Kamal Patel: I was like, "No," and then I guess we got looped in. Not looped in, we got roped in with all the alternative health websites that aren't... There's this weird gray area where somehow if you talk about evidence for supplements, but then somebody else talks about supplements as well as crystals for healing, then you could get looped in together. We ended up getting that, and we went from being in the top 10 search results for certain pages like creatine and fish oil to on page eight, which nobody scrolls to. Then we were in trouble.

Erica Julson: I remember people were up in arms on Twitter. They were like, "Why is Examine.com being punished?"

Kamal Patel: It was not cool, and then the other co-founder was trying to get in touch with Google, but you can't just do that. Google's this monolith in the background. We tried and then it took a year and a half. I don't know why, but we got part of our traffic back. But in the meantime, we had to figure out how to make up some money, right, because we have employees, and we couldn't just fire them. Then I had been wanting to do a membership, and we hadn't had a membership. We had a research digest, but we didn't have a membership for lay people.
I knew that consumer reports on membership, and they did okay, and then I guess didn't do as okay and whatever, but I was like, "Well, I think we're in a different business niche because there is no membership for lay people interested in nutrition." There's the Harvard health letter, the top nutrition letter, Berkeley letter and stuff, but there isn't something where if you want to know about nutrition, and you want updates systematically, how can you get them? We started something, Examine Plus, which was basically a rebranding of the supplement goals referenced, but it didn't focus on the downloadable PDF. It focused on the human effect matrix.
That was really cheap, and then we came out with a big new product, Examine Personalized, where you would get month by month updates in the areas we're specifically interested in. We would summarize the latest studies really simply in two to three paragraphs, so then you learn about the hot new studies, all the studies that apply to. Then a few months ago, we were in a position where we had both of these products, and we were financially doing okay, despite of COVID, but then I didn't think it made sense.
We had this artificial product, the plus product that was a rebranding of a previous product. Then we had a really cool new extra useful product, Examine Personalized. I was like, "Well, plus is making us a lot of money because it's cheap, but should we keep it around, because it's not helping people as much as the other products?" We ended up getting rid of it and merging it into personalized. That was risky, and our profit went down for a while, but hopefully it's on its way back up.

Erica Julson: I mean, I'm subscribed to Examine Personalized. It's really helpful.

Kamal Patel: I'd like to just get it to where we have fewer products, and we focus on making them good, because we fragmented a bit too much, but I think as long as things are useful, people eventually buy it. You don't have to have a domain name like Examine.com, because even the big players, before it was incorporating the Healthline, Authority Nutrition was not this one word awesome domain. It was just a guy working really hard, and then eventually hiring other people. The same is true of most other websites in this area.
I think it's mostly working hard and getting a very simple useful product out there and cranking away. We have the advantage of a good domain name, but then we screwed up by floundering with different products for a few years. Now that we're simplifying, hopefully, we can go forward and do what most people should do from the beginning, which is hard work on a limited product offering.

Erica Julson: What I like about Examine Personalized is if you do any sort of writing... I used to freelance for Authority Nutrition and then Healthline after it got bought, but even when you're doing stuff like that, it's a lot of work to keep up on what's current. I like that you summarized the different studies, and then they're organized on the website, so you can actually log in and be like, "Okay, I want to check out what's going on about this in the last few months." It's all right there, whereas...
I mean, I'm also subscribed to some other things like Science Daily, where they email you 100 links a day of just stuff, which is great, but it's not really that organized. I find it helpful to have a place to go and check to see what's most relevant and new, so I can include that in my articles.

Kamal Patel: The whole goal is to make it as easy as possible. We're maybe halfway there now. Right now, you can pick out of the 25 categories. Let's say you pick autoimmune disease, muscle gain, and cardiovascular disease. We will cover all the important studies. We might do it that month or the next month, but we cover all of them, because we have a really long PubMed search string for all the different categories. Then we're always altering the search string to make it more or less sensitive to make sure we get the right studies.
The dashboard is fairly easy right now, but the dream is to know the most important study that applies to your habit change that you're considering. If we could make that easy, then that would be awesome. For example, my issue is chronic pain, so if I wanted to know if there was a supplement that helped this certain aspect of chronic pain in a trial that applied to people like me for over three months, and I wouldn't be notified right away and get even maybe a push notification on my phone, that would be worth so much.
I almost wouldn't care about anything else, because then I would know that I could use that right away. Right now, the best way we do that is through our supplement guides, but there's always going to be a lag there because we have to accumulate the data, copy edit it, review it, external reviewer, publish it and make the infographic. But if you get the study right away, especially if you're a dietitian, because then you can tell your clients, then that'd be awesome, but we're probably six to 12 months away from that. Maybe it'll happen.

Erica Julson: No, I love that idea. I do think that would be valuable for sure, especially for people on the ground working, because who has time? I mean, you like to think that you have time to go through and comb the current lit, but not usually.

Kamal Patel: Nobody really has time. That's so universal nowadays.

Erica Julson: With all the other monetization possibilities like display ads or affiliate links and stuff like that, why did you decide to not use those?

Kamal Patel: It was basically a bet that we could make enough money without monetizing in normal ways to keep our objectivity. The bet had okay odds, but not great odds, because by far, the easiest way to make money is through having ads. It's also a fairly reliable source of money, because other websites have to sell product, but we thought once we had one ad, then we would make money, but then eventually people would be like, "Hey, if there's this ad for this company supplement on your supplement evidence page, how can I trust you?" It was a long play.
It's paying out now, because for several years, we were doing okay, and then breakeven, then terribly, then terribly again, and trying to figure out how to scramble and make money and then better. Now, I think we're somewhat sustainable, hopefully. Although when COVID started, we were like, "Uh-uh," but I don't know. We'll see this winter. I have no idea what's going to happen. I hope everything works out vaccine wise and stuff and the economy. It's all basically the same issue, but if things go okay, then I think people will be okay to use the website, possibly personalized or whatever that they find useful to help their health.
We have a COVID category, but we're not COVID experts, right? We have a page on COVID. We had a page on COVID masks. We had a little bit on COVID supplements, but all people wanted to know at the beginning in March and April was, "Should I take elderberry for COVID?" They would email us. We'd be like, "We can't tell you what to do, because there's literally no studies. This is not a cold. It's not a flu. You can't really use previous studies," so we have a section and personalized for studies on COVID, but it tends to be studies about non supplement related things, because there haven't been that many studies on supplements for COVID.
People just want to know the answers, but we can never really provide those answers. Even on the supplement guides, we don't give recommendations. We just say, "This is like a certain tier of supplements that have at least a few randomized trials of legitimate methodology, and then you might want to consider them."

Erica Julson: Actually, I like that about your site. I think I wrote this down somewhere. You basically say like, "No one knows everything." You know what I mean? Like, "We're just trying to be objective and show you what's out there." You can make your own deductions, basically, but I think that's really a good reminder, because there are so many people out there who are almost acting like they know everything when science is not even like that. It changes all the time.

Kamal Patel: I mean, one scroll through Twitter, Instagram, and there's roughly a billion experts on crosstalk.

Erica Julson: Well, before we move on to... I do want to hear more about how Examine.com runs day to day, but going back to when that big giant Google update happened, I know you might not know all the answers to these questions, but did you guys restrategize with all the emphasis on EAT and expertise, authority and trustworthiness? Did you change anything in terms of what you present on your website and all that?

Kamal Patel: We've changed maybe a couple small things. Our first reaction was to panic, and then we asked for SEO advice. Then my co-founder started in this space, domains, SEO and stuff, and I started in nutrition. I was like, "What do we do? Everything just keeps going down." He was like, "Well, there's nothing really obvious to do," and I was like, "Well, we have to hire somebody. Let's hire somebody for a quick contract work to see what we might be able to do, and then we would hire this person and that person for little jobs. They would give all these recommendations, but there weren't that many that actually seemed like they would make a difference, or if we try, then they would.
We ended up splitting the supplement pages into two, where there was the main page that had the summary and the human effect matrix. Then we made a separate page that had all the extra detail to maybe make it more easily browsable. Then we had the about page linked somewhere random on the site. I always hated that. It came back up to the top, so that's something maybe, and then we might have done one other thing, but everything else failed. Nothing changed anything. We don't even really know why we regain part of our traffic.
We regain maybe 30% to 40% of the traffic that we lost, which is I can't complain, but we don't know why. The Google black box only tells you so much.

Erica Julson: I know. It's so hard. It's so hard to know, but that was a very shocking time. I remember when all that happened, and everyone's websites were like...

Kamal Patel: Everybody's looking to the overlords like, "What did you do? How can we fix this?"

Erica Julson: It does seem like at least your site is at least partially recovering. Not everybody's did, so at least that's a good sign.

Kamal Patel: I wish I knew some simple steps people could take, but I don't know if there are any simple steps. At that time, we were not angry or maybe a little bit angry or resentful, because we would previously be ranked for one of our more detailed pages. Then when you would search, you would get these really generic pages from vague, generic websites that hadn't been updated in many, many years. We just felt like Google was preferring safety, which is fine, but then when you cast too wide in that, then there go the individuals.
It's something that I don't love in general, because we've been approached by investors like, "Hey, are you interested in selling this portion of your company or whatever?" I don't have a lot of money, right? I probably have less money than most of the people listening, and I also have a ton of loans. I would love to take money. I'm in LA right now, but even LA is too cold for me. I get almost borderline Raynaud's or whatever. I love to get a little condo in Hawaii, and go there and get a personal assistant, but we haven't taken money, because the hope is that we can grow it and have control of our own things, so we're like a small time success story.
The odds always seem long, because now that COVID happened, big companies get huge, and then small companies stay the same or get smaller or go away. You have to try extra hard as an individual, but I do think there's something to be said for if you're a solo entrepreneur for just a couple people, outsourcing something either to an assistant or somebody in charge of logistics can be a huge help. My co-founder got somebody, and then got another part-time person. That's cleared up enough mind space where we can think about these bigger issues that we've been talking about.
Even just working super hard to get to the level where you can afford somebody like that, I think, is really worth it.

Erica Julson: I struggle with that too in terms of outsourcing. When I was freelance writing, it was easier because it would be like, "Okay, no, I'm getting XYZ amount, so I can take this percentage, and outsource it to this person, and I'd never be in the red," but with other types of business models, it's not so cut and dry, especially when it's all on you.

Kamal Patel: Nobody can really tell you what to do either, which is a tough part. There's no heuristic for once you work a certain number of hours a week, then outsource this. You just have to make up your own rules.

Erica Julson: Currently, it seems like you do have a lot of people. On your website, it says you have researchers, reviewers, editors, advisors. Are those all people being paid on your team? Are they volunteers, or how is it all organized?

Kamal Patel: On our Slack, we have 18 people. Those are maybe half to two thirds full time, and then the rest are part time. Then for the research digest, we also contract with five to seven additional researcher writers that only work on the digest and to reviewers, external reviewers who double check our reviewing, and then we occasionally bring in some little bits of part time help. Our team has around 20 people, let's say, roughly, and then maybe about two thirds of those are research leader, then the rest are tech or logistics or graphics or that kind of thing.

Erica Julson: What's the workflow like? Who comes up with the topics? Do you do any research to come up with the topics, or how does that go?

Kamal Patel: Originally, it used to be like, "Oh, I'm interested in this," and then I would write about it. Somebody else would write about it. Then now, it's only slightly more rigorous than that. It's like if somebody on the team is interested in something, then we'll bring it up, but we see what search results were sent to us, but then come up with a hit, or search on the website and then come up with a hit, but then we're not always sure whether we should cover those things. An example is I've wanted to have a low FODMAP page for at least a couple years.
I was at AND, the conference maybe two, three years ago. I remember getting a flash drive from the researchers there with all the FODMAP studies. I was like, "Okay, this is a sign. I gotta make a page," but there's so many other supplements and diets and nutrients, and then two or three years passed, so then we have some social media. Should we do a low FODMAP page or a page on kratom or kratom? How do you pronounce it, the opioid substitute, the natural? It was totally split. On platforms where there were more dietitians, it was FODMAPs. On ones where there's more laypeople, it's kratom.
Then I was like, "Hmm, which one should we do?" Then we ended up instead now doing menstrual cups, because thinking changed. At a certain point, I was going back through old notes from team meetings and distant years in the past. I was like... We had this discussion where I was like, "We have all these guys on our team." At that point, we had literally one female. I was like, "We have a very narrow perspective here. We're mostly guys in our 20s, 30s, and then now it's 40s." Then we brought on another female, but then still, we mostly covered...
If we covered hormonal issues, it was always testosterone. A few weeks ago, I was like, "Maybe we should just make a page on menstrual cups." It's something that people wonder about, and I don't think there's an evidence page on the internet. There went low FODMAP again, pushed again, but this menstrual cup page should come out soon-ish. I hope it's useful. I'm never sure whether we should do literally what makes us the most money, which would probably be to have a new testosterone page every month, because people pay infinite amounts of money to increase their testosterone, or do what I think is best.
When we were in the first two or three months of COVID, then I wrote a page about inequalities, and then another page about differences between genders and effects. We got so many angry emails. It was like, "Stay in your lane. Don't get into politics." I was like, "This isn't politics." There's this thing called COVID that's really important right now. No, people don't want to hear it. They just want to know about muscle and fat. I don't know. I don't know what the right answer is, but we have to get some balance.

Erica Julson: I know. I love the suggestion about looking at what people are typing into the search bar and what you don't have yet, because I'd totally do that for my site too. That's one of the main ways, and obviously keyword research, but at least for my membership site, it's all behind a paywall, so that doesn't matter so much yet. Cool. Well, that's insightful to hear. I'm just trying to wrap my head around the bigger picture. You pick a topic, and then basically, your researchers are like, "Okay, I'm going to get on it." Then they just crosstalk.

Kamal Patel: Step one is pick the topic. Ideally, the plan used to be that we would have update signals for picking a topic to either make a new page for or update for. I think that might actually be a term used in research, update signals, where there's a certain number of new trials, or the effect might have changed by this amount, so then that's how systematic reviewers might figure out how to make new systematic reviews. Then when the researchers start for us, then they do a PubMed search, like everybody else does, and we start with meta-analysis so that we don't duplicate work.
Then we go down from there, but the hardest part is conveying the findings. We could get research robots from whatever school, whether it's epidemiology or dietetics or whatever, and then spit out findings, but it's really making this summary really finely tuned so that people don't get lost in it, and writing about things that people care about enough but not too much. When should we not talk about confidence intervals or variability, or should we never talk about that?
Then what different sections should we have? If we talk about intermittent fasting, should we group together 16, eight fasting with other types of similar fasting, or should we have separate pages on the different ones? Those are the things that we're never super sure about, so we debate back and forth on Slack all day, every day.

Erica Julson: How long does it take would you say to put a new page together?

Kamal Patel: It might take about a week and a half or two weeks. That includes doing the research, writing up the page, entering this studies into the human effect matrix, and copy editing and reviewing. That's a best case scenario. Usually, it's more like two to three weeks.

Erica Julson: That seems pretty fast to me, honestly.

Kamal Patel: It's fast, but then some of the pages from days long past would take eons. Fish oil or cannabis or something with hundreds of studies, that could take months.

Erica Julson: Did you always have a multidisciplinary team, or did you expand as you started to realize like, "Oh, we're going to talk about this. Maybe we should consult with this XYZ type of expert?"

Kamal Patel: We tried to be multi-disciplinary from the beginning, but we could only afford to do so much. We would ask people for advice and help, but we found out you have to pay people to get them. We started out with what minimum we felt is necessary, and now, we have most of our bases covered. As long as there's two to three people that are renaissance people that have fingers in the pies of different research areas, then we can figure out when we don't know enough and need to bring in outside help.

Erica Julson: How did you even find those people?

Kamal Patel: I started out in forums on the internet, and I was in a paleo forum. I know it's passe now, but at that time, I was in school for nutrition. I was reading some stuff about saturated fat, neutral studies, studies about replacing with polyunsaturated fats. It's about not replacing it, and I was on this paleo forum going into details about it. Eventually, I posted so much that they were like, "Just be a moderator." I was like, "Fine, I'll do this free labor for you," and then there ended up being a couple experts in there, but the thing is, most of the experts were people with stuff to sell.
They weren't just academics. But through those people, I found other people. An issue is that like the experts seen in the mainstream, Dr. Oz or whoever, they almost certainly are not experts experts in many of these nutrition areas. Then the experts with a ton of Instagram followers often are also not experts experts, because the amount of time it takes to post all day every day could be taken doing research. Then in the middle of those two people, how do you actually find these people in the battles?
They can be on Twitter. They used to be in forums, but not anymore, but then there's also just word of mouth. There's websites that either employ or are in contact with various people who generally know stuff, and one of them is Precision Nutrition. They have or had a decent amount of rational writing, and then Authority Nutrition, then Healthline is similar. There's things to nitpick about for all websites, including ours. For ours, you could say it's just too much stuff sometimes, or maybe it's not updated at times when we start to navigate.
For Healthline, you could say maybe it's not deep enough. There might be more coverage than for Precision Nutrition. They don't even try to be systematic, but that's the way it goes, but just getting some sense of who the people are that are balanced is really the first step. But nowadays, really, even some previously balanced people seem to have opinions on literally everything. It's hard to get followers and stuff saying like, "Yeah, sometimes it's good to use a low carb diet." That's not good enough. You have to really stick out your claim.

Erica Julson: Yeah, the perils nutrition. Well, speaking of the strengths and weaknesses of all the different websites, I got your email a while back when you sent out. I'm like, "Oh, these are all the things that we see as mistakes on our website," and you listed it out in different categories like, "Oh, content, mistakes. Oh, I don't think we're focusing enough on chronic health conditions or presentation mistakes." We'd like to do more audio and video, or even organizational stuff like improving the diversity of your team and stuff like that.
When I got that, I was like, "Oh, this is awesome." I've never seen a company do that. I don't know if the feedback you got was good or not, but I thought it was awesome.

Kamal Patel: It was mostly good. There was one or a couple of haters. One person sent me an email saying like, "You can stop the virtue signaling." I was like, "Well, you literally can't do anything then with the virtue signaling." We could say like, "Here's all the mistakes, and here's them corrected, and we'll update you right away if there's something you're interested in," and be like, "Virtue signaling," but mostly, people liked it. It wasn't my original idea. I took it from one of our external reviewers. Stephan Guyenet also works for a nonprofit philanthropy aggregator evaluator called givewell.org or .com or something.
They had a similar thing where they listed mistakes. It was different than us because we're an evidence-based whatever, but I like that. I don't quite have the money to donate lots of money, but I was like, "If I ever get money, then I'll use that website to figure out how to donate best." Similarly, here, I was like, "Well, people might be interested in the journey a little bit," and then it's also a little bit of vulnerability. If you look at the website, websites always seem like, "Hey, here's this new thing," and it's true, but what if it's not true, or what if some of the previous things weren't true?
I'd want to know. We put some of them. We try to update it quarterly. But again, it's that push and pull. People thought it was cool at first, and then on our third iteration, some people were like, "I don't care. Post about testosterone." They don't really say that, but I want to update it, because we can't really, really have a roadmap per se because things change quickly, but I at least want some accountability for us. We will update it, and we'll try to let people know maybe three times a year.

Erica Julson: Totally. That's exactly where my mind went, because if you use software programs, they always have... or not always, but most of them have a roadmap of where they've been and where they're trying to go, and they update it. You can check in and see like, "Oh, they added this feature, and this is what they did." I never really see that with informational products, so I thought that was helpful.

Kamal Patel: For the masses, it might be a flaw. If it's important to be very confident, then that can take you places, but I'm the least confident person I know. That's probably why we have this page.

Erica Julson: Well, now that it's been almost a decade, really, since you've launched this website, do you have any really big lessons or takeaways that you've gotten out of this experience?

Kamal Patel: There's a few. I think maybe the biggest one is when working with other people or hiring people or whatever, then fit is way more important than I could have possibly imagined. Right now, we're looking for a medical editor/medical copy editor. I was making the application form the other day, and I made three sections. One was about their writing ability. One was about their science knowledge, and one was about fit. I put one or two questions in fit, and I was like, "I need to put a lot more, because I need to know that they're not a robot, and they're chill."
When we talk about stuff, then they can display weakness if they need to. You can talk about life or memes or whatever. We've hired pretty good people, but it would have been good to know that in the beginning. It doesn't matter if you spend 10 hours or 15 hours a week reading studies, but if you're really cool, it's worth way more than if you're... Maybe you don't want to interact with them in real life, only online. That was pretty important, and also, just starting simple. I think we still sometimes fall into the trap of making things a little bit too complicated.
We're editing our Black Friday, Cyber Monday emails right now, and we have this discussion about how long to make them and how many emails to put out and stuff. It's always me against my co-founder, because he comes from the business side, and I'm from the research side. Then even though I went to business school, I'm still like, "That's not my forte." I'm always like, "Let's just do as minimum as possible," and then he's like, "Let's try this, and let's try this way around it."
The right solution is usually exactly halfway between us, is to do one step beyond as little as you can do for marketing logistics and stuff. I'm usually not correct, and if you build it, they will come. He's usually not correct, and that if you do this marketing hack, then 10 more people will come. It's usually halfway.

Erica Julson: That's really interesting. I can imagine. I bet it's a good balance between somebody who's more in the marketing side and the more in the trenches of the nutrition.

Kamal Patel: If there were two of me, it wouldn't work out if there were two of them, and one working.

Erica Julson: Where do you guys see this going in the long run, maybe in the next 10 years?

Kamal Patel: In the next, at least, year or two, we're hoping that the membership becomes more widely accessible, and that involves paying a company to do ads for us, because we failed doing that. If that works out, then at least there will be more awareness of that. Then if we can, using terrible buzzwords, leverage that into becoming more of a household name, then we can get into not just laypeople and clinicians becoming aware of us and using our stuff and eventually buying our products if they're interested, but also companies. We did have a large, prestigious academic center three years ago approached us to see if we're interested in making something for them, so they can use our database on a proprietary basis for their doctors.
That didn't work out first, because I didn't really feel comfortable with it, because we have too many errors on the website. Even if there are small errors, I don't feel comfortable, because if we're on the hook for some proprietary service we give to academic medical center, then I don't want to be responsible for that. But then the other thing is the stakes are really high then, then it's beyond me and my co-founder. You have to get somebody in there to do this stuff for you.
We're not at that stage. If we ever get to this stage where we're consistently above a certain level of profitability, and then we can hire enough people to round out all of our webpages, then we can maybe hire a businessy type person to help us do this. But for now, it's just us. We're still this ragtag team of just normal people. I love to get to the point where we can hire businessy type person, but it's probably going to be several years.

Erica Julson: Well, I admire your perseverance. I think it's a good reminder for everyone listening, starting a business takes time, especially websites. It's not like, "Oh, 12 months in," you're rolling in the dough, and you got millions of visitors. You know what I mean?

Kamal Patel: Starting really big like us like, "Hey, everything about nutrition supplements," probably not a good idea, but if you actually start a website, then going that specific route nutrition for kidney disease or whatever is awesome, because then you can always expand out if you need to.

Erica Julson: That's really good retrospective advice. It's a very common trap, though, I think that people... They want to be everything for everyone, and then as you get into it, you're like, "Oh, shoot, you can't really be everything for everyone."

Kamal Patel: I was just doing that earlier this week, where we're starting to make more audio visual content. I was making a video, and I was like, "Well, we could cover this and this and this and this." Then it ended up being really long. I was like, "Nobody's going to watch this video," so I'm cutting it down by myself and this video editor right now. I'm like, "If I would have just started with something really small a few years ago, we could have had a YouTube channel now and gotten it growing, but no."

Erica Julson: Well, thank you for all the hard work that you are doing on the supplement research and stuff, because I don't think anyone else really is doing that, so it is valuable. I guess to close out, I just want to give you the opportunity to explain even more what Examine Personalized is and how to sign up for it if people want to check it out.

Kamal Patel: Sure. Examine Personalized, the original name was like plus or... no, pro or something. I was like, "No, let's just call it what it is." It's a way to examine your personalized health issues. Whatever it is, lupus, rheumatoid arthritis, bad skin, whatever, everybody has at least one health issue, unless you're at a young enough age where you're lucky. But if you have a health issue, and you're a human being, then you want to help it, and medication can be helpful, and surgery can be helpful, but doing it naturally is typically the best way, whether it's diet or supplements or whatever.
We don't care if you buy supplements or don't. We'd rather you not if you don't have to. But if a study comes out on a diet or a supplement or a lifestyle intervention, we want you to know it. We take every study, and we summarize it, and it takes about an hour to summarize the study. We read the full text, not just the abstract, and then a copywriter goes through it. Then I go through it. Then if I need to, I get another reviewer to go through the summary. The summary is only three paragraphs, but we really go through it to make sure it's true, and then we listed out in that category.
For example, for this coming month, we have something like 12 to 15 studies under the autoimmune category of various autoimmune conditions for heart disease. We have different ones. More of those are about diet and supplements. For autoimmune, it's typically more supplements and diet, I think. Then we summarize all of those, and there's a dashboard where there's collapsible sections. You can check off as many sections as you're interested in. The average person checks between four and six, and then we have different clusters that you can pre check. If you're interested in fitness or in aging, then there are certain clusters you can check.
Just from now until you drop your membership, you get notified every month of the most important new studies on that topic. It's just useful. It's probably the most useful nutrition thing I've ever seen, especially if I had my own website, because it gives you content. There's nothing else that gives targeted content like that, that is pre checked and true. Otherwise, you would have to read the full studies yourself. We don't even always fully understand the full studies. If there's a study that, for example, started with the mouse study, then it also did a small study on 10 people, but then it contradicted the study the same research group did a year ago, what to make of it?
I have no idea. That's why I have to ask somebody on the team to go back and do that. We do that all for you, and we try to make it in relatively easy to understand language. As time goes on, as there's more studies, we start referring back to other studies we covered. There was a study on non-alcoholic fatty liver disease and curcumin. It was a systematic review in our second month in July. Then there was another systematic review a month or two ago.
Then the question is, "Oh, if somebody has either fatty liver for this reason or this reason, then should they consider curcumin, and how does this systematic review differ from that one? Was it people with more severe conditions?" Then we go back and we say, "We covered this in a previous issue. This is how this study is different." We're evolving over time. We hope it gets more and more useful because of that.

Erica Julson: I mean, I teach people how to create content for their blogs, and one of the tenants is that you should go back at least annually to update it and include the recent research. In my opinion, that's one of the greatest uses of Examine Personalized, because you don't have to do your own necessarily crazy lit review, and read every single paper. You can get us jumping off point of what to look at, because you guys did that already. I like it for that. I'm not working with any clients one on one, but I can imagine if you are working with people one on one, that's a great way to keep up on what's current, especially if you have clients who bring those types of questions to you.
You can be like, "Oh yeah, I did see that and blah, blah, blah," and you're already up on it.

Kamal Patel: People email us all the time seeing studies. I think with everybody being on their computer all the time now, it's very easy for somebody to just see a study and ask you what you think. At least knowing the most important studies is important. Unfortunately, every month, there's about 150 important studies, so at least just knowing what exists, if not reading the summaries, is good enough.

Erica Julson: Then also, you can always say like, "Oh, I'm not sure, but let me check, and I'll get back to you." Then maybe the studies are already on Examine Personalized, and then it's a lot easier for you. Cool. Well, thank you. Where should people go if they want to check out... Is Examine Personalized just very clearly on the homepage of Examine.com?

Kamal Patel: If you go to Examine.com, it says membership with a red bar that says new, even though it's not new. It's several months old. But if you click on membership, it will go to the personalized page. Then if you want to contact me, then all the contact form entries on the website eventually go to me, so any questions or comments, I'm always open to hearing. We always try to have one dietitian on staff working on personalized so that we get some perspective on the ground. Any additional perspective is always welcome.

Erica Julson: Cool. Well, I'm also an affiliate for Examine Personalized. I've sent out, I think, an email about it to my group of followers before, and a lot of people jumped in, so yay. I'll also include my affiliate link somewhere in the show notes for this podcast episode.

Kamal Patel: If you sign up, don't do it directly through our website. You do it through that link, because this isn't one of those things where somebody's selling something that's questionable. I swear, this is really pretty useful. If you're interested in research, there's nothing else in the world like this, because nobody else can make enough money to do it.

Erica Julson: Well, thank you for all your hard work, seriously. I love it.

Kamal Patel: It's really my pleasure.

Erica Julson: I hope you enjoyed that episode as much as I did. Thank you seriously for being such a wonderful listener this year, and hopefully subscribe. If you're not subscribed, click that subscribe button, so you're getting all the new episodes right when they come out. You've seriously made my year or my first year ever of podcasting such a joy. We've actually doubled in size with our listenership over the course of the year from just 2,000 something monthly downloads way back in January to over 5,000 monthly downloads today. Not a single episode that we've put out has gotten less than 500 downloads, so that's freaking incredible.
Seeing that growth week after week is what keeps me motivated and excited to show up for you every Monday. If there's something I could ask of you for the holidays, it would be to share this podcast with at least one friend who you think could benefit. That would seriously make my whole year. You can send it to them on social media or email, or even show them how to listen on their phone if they aren't familiar with how podcasts work, and even help them subscribe right there. These next two weeks, since I'm taking a little hiatus, would be the perfect time as well to catch up on some of the most popular episodes from this last year or just any episode that you might have missed.
Just so you have them on hand, the top episodes of 2020 were the first two episodes, no surprise there, of the podcast because a lot of people go back to the beginning and just listen from episode one. In those two episodes, I talked about six ways to make money online as a dietitian, so those two episodes are the most popular. There's also episode number five, How to Skyrocket Your Website Traffic with SEO, episode 16, Building a Six-Figure Virtual Private Practice with Tony Stephan, episode 17, What to Do when You Don't Know Your Niche, and episode 43, The Story Behind a Successful 60K Plus Course Launch with Melissa Groves Azarro.
Definitely check those out if you have some spare time, and happy holidays to you and yours. I will catch you in the New Year. I hope you have a wonderful closing out of 2021 as much as it can be for this crazy year, but seriously, thank you, love you all, and I will see you in a few weeks.