How to simplify your health with Dr. Lucas Ramirez

Let's Say Hello

[00:03:25.750] – Allan

Hey, Ras. How are things?

[00:03:27.770] – Rachel

Good, Allan. How are you today?

[00:03:29.980] – Allan

I am tired. But.

[00:03:33.490] – Rachel

Yeah.

[00:03:34.930] – Allan

Tammy took our granddaughter back to the States. And since we're on reduced hours for our staff and one of our staff is on her month long vacation holidays, they get paid vacation for one month. And we opted to not have them here for that month rather than just pay them a 13th month, which is what some people do. So that was me by myself this morning doing all of it. But I was late getting on this call because I was actually folding guest laundry. We have a laundry service that we do, and so guests turn in laundry, and I was like, okay, I got to get this done, got to get that done. So we make certain promises like wash, dried, and folded by dinner if you drop it off at breakfast time. So I do have a deadline. But also something pretty interesting happened. One of our guests was going out to a chocolate farm, and when I reached out to the guy who was running the chocolate farm to get information and my guests were just about to leave, he said, look, I got this animal that is hurt, and someone brought it to me, and I can't take care of it.

[00:04:34.900] – Allan

It's got problem with its jaw. And can you ask the taxi driver, the water taxi to bring the animal back? And I said, well, let me ask my guest, because they'll either be willing to do it or they won't. So I ask my guest and they were. So they brought the animal back in a box. It was a tyra, which is like a type of weasel tyrant thingy, just cute. But we got it back here, got it into the local rescue. They tried to do some surgical work on it. But not knowing the anatomy of a tyra, I don't know anybody that does, but they knew some people in David, which is a town about 5 hours drive from here. And so they got the animal to David. And I tried to get a catch up on what happened, but the guy that runs the rescue, he's got dengue, so he's out for the count. Dengue is not dissimilar from what you would deal with any other kind of virus or anything like that. So it's almost like the flu or as it's like a flu. Most people get over it fairly simply, but, yeah, he has dengue, so he's not answering his messages.

[00:05:48.410] – Allan

So I don't know exactly. But we do know that we got it somewhere where they can take care of it well. And it seems healthy. It just struggles a little bit with eating, but it can't eat. But it wouldn't be able to hunt for itself or do the things that it would need to in the wild. So it will have to be taken care of. But they told me it was a baby, but it was pretty much full grown. Now, when they're bringing you an animal you're like, well, I got to know what this is. So I started doing all the research on Tyra.

[00:06:18.650] – Rachel

How fun, man, that's so interesting. You guys have some really interesting wildlife there.

[00:06:24.430] – Allan

Yeah, Michigan has their fair share, too, but you've got snakes and turtles and frogs, and sometimes you don't have the frogs because there's a snake.

[00:06:36.830] – Rachel

Yes, we still have our snakes hanging around. Not too pleased.

[00:06:42.050] – Allan

Yeah, well, there's a cycle. There's a cycle.

[00:06:45.250] – Rachel

That is true.

[00:06:46.730] – Allan

So what's going on up there?

[00:06:48.650] – Rachel

Just enjoying the summer. It's going by way too fast. July went out, like, just too fast. So much going on, and I feel like August is going at the same rate. In a couple of weeks, we'll be on aisle royal, and then it will be September. So just trying to eat up as much as I can, just sunshine and get outside and do what I can when I can.

[00:07:10.530] – Allan

Yeah, well, good. All right. Are you ready to talk to Dr. Ramirez?

[00:07:14.660] – Rachel

Sure.

Interview

[00:07:53.870] – Allan

Dr. Ramirez, welcome to 40+ Fitness.

[00:07:57.170] – Dr. Ramirez

Allan, thank you for having me.

[00:07:58.660] – Allan

So today we're going to talk about your book, Simplify Your Health: A Doctor's Practical Guide to a Healthier Life. And I can say two things, really right off the start is I like simple. I think everybody likes simple. We're always looking for simple and then practical, and your book delivers on both of those.

[00:08:18.660] – Dr. Ramirez

Thank you. I appreciate that.

[00:08:20.160] – Allan

Now, you had a quote, or it's just not a quote as you said it, but I'm going to quote you in the book just to kind of put this together, because I think this is really the crux of someone must understand what this book is all about. And you said, “by targeting a few simple lifestyle choices, one can make a world of difference in overall health by decreasing the risks of stroke, heart attacks, cancers, and more.” I think this is an approach that a lot of people are not familiar with. I mean, I think anyone that's listening to me is, but a lot of us wait until one of these things happens and then we get the care versus your book is saying, okay, we have an opportunity here to make sure these things actually don't ever happen.

[00:09:15.760] – Dr. Ramirez

Absolutely. I'm a stroke neurologist, and I can say first hand it's much better to prevent rather than to treat.

[00:09:22.510] – Allan

Yeah. Now, when we talk about staying healthy, because I think a lot of people look at their ancestors and they say, okay, well, my grandfather died of lung cancer, geo cancer kind of thing. My grandmother had a stroke when she was in her late 30s. This happened to that family. This happened to that family. Some of us just feel like our genetics are cursed. So how much control do we really have over these things?

[00:09:53.130] – Dr. Ramirez

Yeah, I'd say for the vast majority of us, we have a surprisingly a big amount of control. I mean, obviously, there's inevitability in life, at some point in life, we're going to get sick. That's life's journey, and like they say, there's only two guarantees, is taxes and death. But within that journey of life, there are some things we can definitely control. We can separate risk factors into two broad categories the non modifiable things we cannot control, and the modifiable the things we can control. Some examples of non modifiable are age. Obviously, somebody who's 90 is going to have more risks than somebody who's 30. And things like genetics are rare conditions that, unfortunately, is difficult to manage. For example, african americans have more chances of sickle cell disease. Caucasians have more chance of cystic fibrosis. These are realities of life. But outside of those small genetic variations, we have a lot of control over what we do in our lifestyle habits. For example, globally, 87% of strokes are due to modifiable risk factors. So these are things that we can change simply by adjusting our habits. And it's not just strokes. There's a lot of conditions that are due to modifiable risk factors.

[00:11:40.770] – Dr. Ramirez

Eight out of ten COPD deaths are due to smoking. About 90% of lung cancer deaths are due to smoking. About 30% to 50% of cancers can be prevented by lifestyle changes, including not smoking, managing weight, and doing screenings. And in terms of accidental trauma, car accidents are major portions of accidental trauma, and about 40% are due to alcohol. So we can see that of these five top causes of death in the US. Many of them are preventable by lifestyle changes. And in terms of stroke, 80% can be prevented by targeting just five specific habits, and they are not smoking, managing high blood pressure, managing your weight, so avoiding obesity, eating well and exercising. And there's some data that these five underlying causes are actually, quote, the true causes of death in the US. It's pretty hard to find up to date data looking at the specific topic, but in 2005, there was a paper that looked at the, quote, true causes of death in the united states, and the leader was smoking, followed by high blood pressure, followed by overweight/obesity, then physical inactivity, and a combination of poor diet. So these are true causes, and they are modifiable causes that we can really adjust.

[00:13:10.890] – Dr. Ramirez

And I look at these things as the big five, the foundational principles of health. Everybody's house of health will be different, but you want to build a good foundation and then you can put your modify your own house on top of that.

[00:13:25.560] – Allan

Yeah. Now, you mention smoking a lot and if anybody's missed that memo, I mean, in the UK, they actually stayed on the side of the pack. Smoking kills. They don't play around with it. In Malaysia, they actually have pictures of babies, like black tar babies that have died in childbirth because of smoking. So it's pretty clear. And if you're smoking, that's the first thing. Just quit. Whatever you got to do to quit, make it happen, because this is probably the big one, smoking. The cancers associated with smoking kill almost half a million people a year in the United States alone. So this is a big one. But I think a lot of people will then say, well, these E-cigarettes, they have to be safer for me because there's not the tar and the chemicals, it's not burning something. And you talk about that a little bit in the book. Can you talk about why E-cigarettes might not be the savior we're looking for?

[00:14:24.610] – Dr. Ramirez

So it's a great discussion. Just like you said, it's a little different because you're not burning, you're lacking that combustion that we have with smoking and other forms of inhaled smoke. Now, despite lacking combustion, there are some negative effects that we're starting to see. Now, this is a relatively new product, so we don't have all the information, and it's going to take some time to see all the long term effects. We didn't see, or at least we didn't clarify the severe negative effects of smoking until the 1960s with the Surgeon General report. So it's going to take a while. But what we do know so far is that there are higher odds of strokes and heart attacks with Ecigarettes. Maybe it's related to impaired endothelial function, but we do know there are higher odds of strokes and heart attacks. There is an association with seizures and other neurological problems, and this I've seen personally in the ER. There is associations with chronic cough, phlegm, bronchitis, possible increased risk of some cancers like bladder and lung, but again, these are not completely solidified. For sure there is a really bad entity called Evaly the Ecigarette or vaping associated lung injury.

[00:15:38.290] – Dr. Ramirez

Now, the more robust data I've seen was back in 2020, where at that time, it was over 2700 people hospitalized and 60 confirmed deaths. And this was just as the pandemic was starting. So COVID, I think, kind of put this on the back burner. We do see in related to COVID, there's worse culvert outcomes than people who use e-cigarettes. And a lot of it may be related to nicotine itself in terms of some of these overall poor outcomes because of the association with nicotine and the potential promotion of cancer, metastases of plaque progression, some adverse effects of reproductive health, and of course, acute toxic effects and high amounts of nicotine, in severe cases, seizures, which again, with e cigarettes. I've personally seen this as well, but some of the substances within the e cigarette liquids, some of the vitamin E, and other things were thought to be the causative factors of this Evaly entity. And of course, it's addictive. That was the main reason on the explosion of ecigarettes, particularly amongst the youth. But thankfully, it seemed that after 2019, some of the rates of ecigarette use in the youth have decreased. But even in 2021, still 2 million high schoolers and middle schoolers were using e cigarettes.

[00:16:57.160] – Dr. Ramirez

And the problem there is that you're more likely if you use ecigarettes to smoke traditional cigarettes, seven times as likely to try cigarettes, and eight times as likely to be current cigarette smokers if you have a history of vaping. And the problem with that is, if you smoke as a teen, three out of four times, you're going to also smoke into adulthood. So that's just increasing the risk there, and so much so that in June of just this past year, FDA banned Jewel products, one of the big makers of ecigarettes.

[00:17:26.770] – Allan

Yeah, they have a big portion of that market. And I guess the thing is, the base point of this to take away is that e cigarettes are not necessarily safe. But you talk in the book about how and I know this is a strategy one of my friends used about how you can use these cigarettes as a kind of a bridge along with maybe gum and patches to get off of cigarettes.

[00:17:50.410] – Dr. Ramirez

So there's definitely some evidence that e cigarettes can increase the rate of smoking cessation, but there's also evidence that the majority who tried to quit using ecigarettes end up using both. So it's a little bit difficult. But what I can say is, if you have nicotine gum, nicotine patches, if you have other medications, probably better to do that rather than using e cigarettes, because it seems like e cigarettes are going to have some other potential side effects. But others will say if you had to choose e cigarettes or smoking, probably ecigarettes is safer, though ideally we would use alternative products.

[00:18:35.760] – Allan

Okay, now the other one that comes up a lot, and it's more and more because it's becoming legalized in a lot of our states, in the United States is marijuana. And it's interesting to me how many people think that marijuana is just completely safe. No one's ever died of it. No one's ever. And obviously, because it's been illegal for so long in the United States, this isn't something doctors could go out and just study. Well, let's study how safe it is. And look at people who are traditionally long term marijuana smokers. It's not like someone can show up for that study, because if they did, the DEA would be sitting right there around you up. So can you talk a little bit about marijuana and some of the data we have on how safe that might be.

[00:19:24.660] – Dr. Ramirez

Yeah, so I'll connected to a prior comment about lighting. So the combustion, combustion occurs anytime you kind of like a carbon containing product. It could be a tree part of forest fires, it can be coal when you barbecue, it can be tobacco with cigarettes, or it could be marijuana. And when you look at combustion, the smoke byproducts of combustion have toxic effects. And two specific chemicals within it are free radicals and particulate matter. I saw a piece of data that I really liked to bring to light. And in terms of particulate matter, when we look at air quality, the WHO rates good as less than 25 micrograms per meters cubed. So that's good air quality and hazardous is greater than 250. Now, if somebody is smoking and you are the back seat or a backseat passenger within the car, the particulate matter will exceed hazardous levels by 100 times. That's 2500 particular matter per micrograms per meter cube. That's 100 times hazardous levels. And that's if you're a passenger of somebody who is smoking in the car. So imagine if you're directly smoking, that's just a lot of particular matter. And free oxygen radicals, one could look at it as oxygen that we breathe is in o2.

[00:20:53.140] – Dr. Ramirez

You have protons, neutrons, and you have electrons that are typically paired. When they become unpaired, they become highly reactive. They are damaging, they are damaging to fat, to proteins, to DNA, and more. So, the combination of having free radicals and particular matter are damaging to arterial walls. They modify cholesterol, they cause secondary inflammation. And all this can lead to plaque build up. And if you have plaque build up in the heart, that's heart disease. Plaque build up in the neck or the brain, you can get elevated risk of strokes. Obviously, if you have damage to DNA, you have risks of cancer. And is there a great connection long term or early studies that correlate marijuana to these risks? As of now, there is nothing great to say with a guarantee. But similar to Ecigarettes, it's going to take time to see some of this data. But this is what we can say for now. One, marijuana in and of itself smoked is not healthy. That's just a misconception. But chemicals within it, if they're purified concentrated, can have beneficial effects. We do know that it helps for certain types of seizures. We know for Dravet syndrome, for Lennox Gaston syndrome, FDA has approved CBD specific CBD for the treatment of that.

[00:22:20.980] – Dr. Ramirez

It seems to have beneficial effects in pain management, for nausea and vomiting, especially if chemotherapy related, for spasms, for appetite and weight gain. And there's some interest in Parkinson's, interest in migraines that they're studying. But the delivery method is not smoked in these. They can be in pills, they can be vaporized, they can be powder, they can be nebulizers, but they're not smoked because you don't want that combustion by product. Now, clearly there's negative effects. There's emerging evidence of increased heart disease and stroke potentially related to inflammation of the blood vessels, which makes sense because of combustion. There's some association with chronic bronchitis respiratory symptoms unclear of asthma or lung cancer, but again, this may take time to solidify. Now, most profoundly, there are clear cognitive and psychological effects, and there's substantial data with temporal association between cannabis use and future psychosis. In general, roughly, we can say you have more than two times the risk of future psychotic disorder with use. It's worse when you're younger and worse with more frequent use. For example, daily use in general has a three times increased risk of psychotic disorders in the future. And higher potency THC increases it five times.

[00:23:42.120] – Dr. Ramirez

And there's other mood consequences such as depression, anxiety, and cognitive consequences. And there's even MRI evidence of atrophy in the hippocampus. And the hippocampus is the center of learning and memory of the brain. Now, with all this said, the reality is most adults are not going to develop these conditions with occasional use. But one thing I do clarify and reiterate is occasional and adults. Now, schizophrenia affects only about 1% of the population. So I would say only adults who are psychiatrically healthy, who use it occasionally and who use lower THC content unlikely to develop any of these side effects. But for somebody who has smoked before and they've had the effect of some type of psychotic issue thinking that cops were after them, or if they have a family member with schizophrenia or anybody who is young, I absolutely would worry about continuing to use. And obviously I would choose forms that are not smoking gummies, cookies, other type of forms.

[00:24:49.890] – Allan

Okay? Now, I want to shift focus to food because I actually think this is even though, again, we look at the data and we see, okay, it's smoking that's killing us the most from a practical perspective of what we can measure. Were you a smoker or not? Food is a little harder because we all have to eat, we can't cessate food. And you had a quote in the book that I think it's probably my favorite food quote ever because it's perfect. I couldn't even think of a way to improve this, but it's by Michael Poland and it says eat food, not too much, mostly plants. And that's kind of the approach you're taking in the book as you're talking about how we should eat and again, to avoid some of these diseases.

[00:25:36.010] – Dr. Ramirez

I love that quote as well. I read Michael Poland or two of Michael Poland's book, the Omnivore's Dilemma and the In Defense of Food, and I love this approach. It was simplified in an era where there are so many different diets and things can be confusing. And I think just simplifying it to build a foundation that again, one could build upon is the best way to approach it. So that quote has seven words and those seven words, I think, can really guide somebody in terms of how to eat. And just like you said, eat food. Not too much, mostly plants. And that translates to eat less processed foods, portion control, more fruits than vegetables. So we can talk about processing of foods. In general, highly processed foods have more calories, more sugars, more sodium, less protein, less fiber, less vitamins, less minerals. And aside from having the actual nutritional products that are less healthy, there is data correlating more highly processed foods to health outcomes. Eating more and high amounts of highly processed foods does increase your risk of heart disease or stroke and just higher risk of overall mortality. The second part of that is portion control.

[00:26:56.170] – Dr. Ramirez

The average daily calorie intake in the US in the year 2000 was about 300 calories higher than in the year 1985. And just mathematically, that's the equivalent of 31 lbs of excess calories. In general, just food portions have gone up. Plate sizes are bigger. The actual area of plate sizes are 44% bigger now. So Portion control is just one of the underlying recommendations. And lastly in that part is eat more fruits and vegetables, and only one in ten US. Adults get enough vegetables, two in ten adults get enough fruits. And both vegetables and fruits are filled with vitamins, minerals, phytochemicals, antioxidants, flavonoids, which there's over 5000 bioactive compounds there. They're nutrient dense. They have less calories, they're low in fat, they're high in fiber, and they're just products that are just extremely good for us, and we don't get enough of it. So rather than trying to get specific diets, just this overall concept of portion control, eat more fruits and vegetables and trying to have less processed foods is the underlying message of how one can kind of adjust their habits rather than dieting. And we can go into more data if we wish there too.

[00:28:14.420] – Allan

Yes. The core of it is this. You want to eat nutritionally dense food versus calorie dense food. And this succinctly puts you on that trail to avoid the diet traps and everything else. You just know, okay, is this real food? Do I know what a portion is? And am I not overeating it so I know I'm full? And then finally, yeah, just plants and some proteins. And what I found is that I can tell someone is you can't overeat fruits and vegetables. It's physically impossible. Try to eat 5oz of spinach. Just try make a salad with 5oz of spinach and try to eat it.

[00:29:00.400] – Dr. Ramirez

Yeah.

[00:29:01.020] – Allan

Sweating. You'll be sweating. I promise I do it. I do it all the time, but you'll be sweating. You can blend it and process it again. And then, yes, drink it down with other stuff, and it just seems to go really easy. And you can cook it down and eat it, and it seems to go really easy. But eating whole foods and paying attention to what you're putting in your mouth is really important. So I do appreciate this opportunity. And you went into the book. I don't really want to go deep into it because it's an important issue. And that's why I encourage people to get the book, is you do also talk about obesity, the connections to some of these diseases. And then, of course, we have the whole concept of how people feel about this word and the way things are. And I appreciate that discussion in the book. And so I encourage someone to get the book to go through that because I think it's really important. But I want to step out for just a minute because there's one area that you highlight in the book is maybe beyond the other things that we can control, that maybe is one of the more important ones that gets ignored because it has no outward symptoms until it does.

[00:30:08.450] – Allan

And that's our blood pressure.

[00:30:11.090] – Dr. Ramirez

Yes, for me, blood pressure is probably the easiest thing you can do and the most impactful thing you can do because it doesn't really require, let's say, running 5 miles a day. It requires sitting down, putting a cuff on your arm, noting if it's elevated or not and seeing your physician. And this is something that could completely change somebody's life. It's the leading contributor to preventable death in the world. In the US, it contributes to 500,000 deaths per year. It's the leading cause of stroke in the world. And it's not just stroke. It's the leading cause of brain bleeds. It's a leader and burst aneurysms of heart disease, of chronic kidney disease, of a subtype of dementia called vascular dementia, of heart failure, of atrial fibrillation, of much more. And the higher the blood pressure, the higher the risk. And it causes all these things because it has such potent effects on both the large and the small arteries. And the large arteries, it can lead to plaque formation. And in the small arteries of the body, it can lead to thickening of the small arteries. And in the large arteries, again, if it's in the heart, there's heart disease.

[00:31:24.920] – Dr. Ramirez

If it's in the neck and the brain, there's strokes in the small arteries. There's a lot of small arteries in the head that could also cause strokes and vascular dementia. But some of these small vessels are also present in the kidneys, and that leads to chronic kidney disease. You have increased resistance. So when the heart is pushing on the resistance, it can thicken, and you get left ventricular hypertrophy. You can get diastolic heart failure, you get remodeling of the heart, which could lead to atrial fibrillation. So it's just a lot of negative effects on it. But the good thing is that some of these effects in the arteries start really early in life. And one would say, why is that good? Well, if the fatty streaks start in our teens and we have an opportunity to prevent this very early on and try. To halt the progression early on before it causes damage. And the problem here is that about a third of young adults don't know they have high blood pressure. So by checking early, we can really prevent some of the devastating consequences that has long term. And just like you said, we don't have any external showing of high blood pressure.

[00:32:35.630] – Dr. Ramirez

It's silent because it has so many effects. It's deadly. And that's why the very famous kind of saying it's, the silent killer, exists. Now, if you have blood pressure, going to your physician treating you either medically or lifestyle changes drastically improves outcomes as well. By decreasing your pressures by five points, you decrease the risk of cardiovascular events by about 10%. So not just prevention, but treatment, if you have it, is paramount. And for anybody who may not know what's considered high, normal blood pressure is 120 over 80. Typically, they say high is 140 over 90. So target at 140 over 90. And below certain individuals, we aim for less than 130. But if you're seeing readings near the one forties or above, just reach out to your physician and see what plans you can make. I would emphasize I personally have a lot of patients who don't like medications despite having strokes. And I really try to tell them, don't fear medications if they are necessary. Yes, you want to change your lifestyle, and I would change your lifestyle while starting medications if that's what a physician recommends. And you can work your way off medications.

[00:33:53.170] – Dr. Ramirez

There's some data showing that with diet modification, like the Dash diet, managing weight and exercise, only about 15% of patients still need these blood pressure medications. So I would just think of it as the most important supplement you've ever had or needed in your life, and maybe you can come off of it.

[00:34:12.180] – Allan

Yeah. When I first started my reversal of my health, trying to get myself back together, yeah, I had high blood pressure, so my doctor put me on medication to get it down. You go into a doctor's office and they kind of expect an elevated blood pressure because you're in the doctor's office. So that's why they're going to say 140 over 90 is probably fine, because there's an expectation that when you go home and you're in a better environment, that your blood pressure drops. And what I can say is, if you're in a very stressful job and you have a very stressful life at home and other things are going on, it might not drop as much as you think it does. And so you're going to be happy to hear that I just put a blood pressure monitor in my Amazon cart, so the next time I check out, I'll have one of those. And you talk in the book, it's like, don't just wait till you do your annual check up. These are not expensive. I think my unit I went for a slightly higher price unit it was still, like, less than $60.

[00:35:13.250] – Allan

And it's there. Or you can walk into a drugstore or go over by the pharmacy. And Walmart, they typically have one of these little machines there. And I believe you said in the book that the differential of what they have is not significant. So you can kind of rely on that to see if there's at least a problem, if there's a trend, and know that you need to go talk to your doctor. But I completely agree with you. Take the medication until your lifestyle changes allow you to get off the medication, which is the path I took.

[00:35:43.250] – Dr. Ramirez

Good. And I'm thrilled to hear that you bought yourself one. That's the main thing. Just something so easy. We want to monitor themselves at home. So if I impacted one person, I'm happy.

[00:35:55.450] – Allan

Well, I'm 56 years old. So as you start looking at your health, you're like, I'm not invincible. I may have felt like I was invincible when I was in my 20s and maybe well into my 30s, but there's a point where you realize it's like, okay, data can be valuable. And this is a data point that, quite frankly, is easy to measure. It takes less than five minutes. You just sit down, you rest for about five minutes. You put the cuff on, it blows up, and then it shows you a number. If you don't like the number, sit there for another five minutes and do it again. But it's not like the scale. This is actually telling you how healthy you are.

[00:36:30.530] – Dr. Ramirez

Yeah. It's non invasive, it's quick, it's cheap. So I would tell everyone and anybody, get yourself a cuff or go to your local store and measure it there and just write down the trends and reach out to your physician if it's elevated. So this is extremely important. I would emphasize it to anybody. And I'm thrilled that you purchased one.

[00:36:52.210] – Allan

Yeah. And another thing that you had in the book that I think is really important is don't get the finger one or the wrist one is get the one that is a cuff and make sure that the cuff is the right size for your arm. I have a slightly larger arm, so the cuff I got goes up to 17 inches. So I'm safe for at least the next few months unless I decide to bulk up a little bit. And I'm not going to get my arm to 17 inches again. I'm pretty sure my age. But that said, make sure you're getting a good thing, and the book will give you some details on how to select. Make sure it's a cuff and make sure it's the right size. And there's a whole lot more in there.

[00:37:27.240] – Allan

Dr. Ramirez, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?

[00:37:36.950] – Dr. Ramirez

So I think that's a great definition. I define it as kind of longevity, quality and the control of risk factors. If we just want to break it down to just solely three, obviously there's more. But three specific tactics, I would say one, nutritional changes. I don't endorse dieting, I endorse an overall change in how we look at what is on the plate in front of us. And like the quote we discussed, eat food, not too much, mostly plants that would go for smaller portions, eat more vegetables, less processing, water over other drinks, try to lessen the juices, soda, so water over drinks. Within the umbrella of nutrition, I would go for less alcohol. So alcohol in moderation if you already drank, but there's no need to drink if you don't do so already. And even within that we can say if financially one is able to try to add more organic products. There may be some benefit in organic products grown in better soil. So overall nutritional changes as one the second more physical activity. Find an activity you enjoy, one that you love, one that's not a job to try to do and build from there.

[00:38:56.500] – Dr. Ramirez

Even five minutes of moderate activity a day has health benefits. So just try to do it as much as you can, even if it's only a small amount, and work your way up to minimum goals. The minimum quote guidelines is 150 minutes a week. So 30 minutes, five times a week. Try to add some resistance, exercise at least two times a week, but find what you like. I like calisthetics, that's my base and then I build outside from there. For anybody who has some physical limitations, you can still be more active. Something as easy as walking as benefits. 6000 steps a day has been shown to have benefits, especially people over 65 years old. And even if Ambulation or walking is difficult on YouTube, there's plenty of exercise regimens for people who can't walk seated exercise regimen. So try to stay active as much as you can within your limitations. And I would try to add balance as well. That's something I included in the book since balance at training can reduce falls and falls as a leading cause of traumatic injuries in the elderly, leading cause of hip fractures leads to 800,000 hospitalizations a year.

[00:40:07.660] – Dr. Ramirez

So adding a little balance, especially as we age, can minimize the risks of falls and the health effects that come from it. So the first two nutritional changes, more activity. And the third, I would just use the broad saying of check your numbers. One, blood pressure. I think within that number, that's the key thing to know and two your BMI. So you're seeing where you land in the context of obesity. Are you healthy? Weight, are you overweight? Are you obese or above? I know BMI is not the perfect number, but it is one that does correlate well with adipose tissue and more importantly, with health outcomes. So check your numbers and within that discussion. Obesity is the second leading cause of stroke worldwide, one of the leading causes of preventable death. So it is a very important number to know right there with blood pressure.

[00:41:05.870] – Allan

Thank you for that. Now I want to close with one more thing. You said this is kind of your core message of the book, and I love this, “Longevity and quality can allow one to enjoy life and all the beautiful things it brings.”

So thank you for sharing that. Doctor, if someone wanted to learn more about you, learn more about the book Simplify Your Health, where would you like for me to send them?

[00:41:29.740] – Dr. Ramirez

Again, thank you for having me. I would have anybody go to Simplifyyourhealth.Live. There's more information on the book, where to get it. There are other links to some of my social media pages. I have become more active on Instagram based on recommendations of others. It's Dr.RamirezMD for Instagram and Twitter, and I give some health facts, some health tips, some quotes, and other things for benefits. But it would be simplifyyourhealth.Live for more information on the book, okay.

[00:42:05.310] – Allan

You can go to 40plusfitnesspodcast.com/551, and I'll be sure to have the links there. Dr. Ramirez, thank you so much for being a part of 40 Plus Fitness.

[00:42:15.210] – Dr. Ramirez

Thank you so much for having me. It was a pleasure.

Post Show/Recap

[00:42:24.090] – Allan

Welcome back, Ras.

[00:42:25.480] – Rachel

Hey, Allan, wow there's a lot of really great information in that interview, but let's start with the Simplify. Simplify Your Health. I love it. We make things so much harder than we really need to.

[00:42:37.230] – Allan

Yeah. That's why when I was looking at doing it, when I created the kind of a temperature check and I was looking for, okay, what are the things I know that work, and what are the things to try to put together something when you want to check in with yourself, what is the most valuable takeaway? And it isn't, okay, here's three areas your movement, your nutrition and your self care. And it's not sitting there saying, okay, what are five things I can do for all three of these to move the needle? It's like, what's one intention? Just one thing next week? And you kind of start with that. That's just the one thing. And what you find is once that one thing kind of becomes automatic for you, then yes, adding another one thing and then another one thing. And it's not just one plus one. I think that's what a lot of people think. That's just slow. No, each one of those is an exponential of the thing you did before. So if you've improved your nutrition this week and then next week you add additional movement, that's an exponential shift. That's not just a one plus one.

[00:43:43.170] – Allan

And so if we just realize that those simple one step, things that are the next big rock, then that's what's really going to move the needle for you. And it's going to get you where you want to go a lot faster than you thought you could.

[00:43:58.850] – Rachel

Oh, for sure. I also like too, for people to choose the thing that resonates the most with them. Some people can easily swap out a soda pop for water, and that could be their one thing. Or some people might be more comfortable going for a walk in the morning before work. You just need to choose the one thing that really resonates with you, something that you can stick with, something that you look forward to doing, and that would really give you the most traction to get that ball rolling.

[00:44:30.540] – Allan

Yeah, it will.

[00:44:33.510] – Rachel

And you guys spend some time talking about blood pressure. That's the one metric that I often overlook myself, because my blood pressure is always normal when I go to the doctor's office. But you're going to get yourself a blood pressure cuff?

[00:44:47.130] – Allan

Yeah, I've got it. It is actually on its way.

[00:44:51.700] – Rachel

Good.

[00:44:52.460] – Allan

Yeah. So I put it in my car, and it's kind of one of those things because I do live on an island, I try to order two or three or four things at one time, and then I do the Amazon ship it all together. So I'll wait an extra week kind of thing just to have less packing material, less weight as I pay by the pound for what they bring here. And so it's just trying to get them to put it all in one box and make it easy. So it shipped. And right now it's probably in Miami or somewhere in between. Here in Miami.

[00:45:25.320] – Rachel

Oh, good. Well, I'm glad you're getting that because I think that's probably one of the best metrics for heart health.

[00:45:31.950] – Allan

It is. Well, even brain health and all of it, because if your blood pressure and kidney, if your blood pressure is high, it's putting pressure on your kidneys, it's putting pressure on your brain, it's putting pressure on your heart. And so stroke and heart attack and kidney failure, they are directly related to you having high blood pressure. And as you said, it's the silent killer because you don't necessarily know when your blood pressure is elevated. And it's the one thing I can say that more than anything, walking away from my career lowered my blood pressure down to normal. I was having to take medication when I was working full time for a corporation, and the stress level, my blood pressure was always elevated, so I had to take medication to get it down to the normal range, and I could not get it down. Even after losing all the weight, even after getting myself really healthy and fit, my blood pressure was still elevated until I got laid off and I told my wife, I'm not going back. And my blood pressure dropped down to normal. And I've been to the doctor several times since then, and it's always normal when I walk into the doctor's office.

[00:46:49.910] – Rachel

Now, that's fantastic. I'm glad to hear that. I don't think that we really realize how detrimental stress can be on our bodies.

[00:46:59.970] – Allan

It can beat you up. And so just that self awareness. I had worked on nutrition, I had worked on movement, I had worked on sleep. I didn't set alarm. So I was getting plenty of sleep. I was eating well, I was moving well, but I couldn't get the stress done. And then I went through a period of time just before the layoff where I did like three or four episodes on stress because I wanted to read their books, my own stress.

[00:47:30.110] – Rachel

Sure, absolutely.

[00:47:31.580] – Allan

And they all had different spins on it. And yes, the breathing techniques helped a little, but that was a temporary fix, because as soon as the next fire, the next problem, the next phone call, even the next phone call, was enough to send my stress level up. And then, of course, I was laying people off and there was just all that turmoil of that. My stress levels were really high at that point for my health. The next big step, the next big rock. We talked about simplify, sounds like a big move, but that was figure out a way to not go back to corporate.

[00:48:12.660] – Rachel

Wow.

[00:48:13.130] – Allan

And so, yeah, it was a big step, but it was the thing, it was the big rock. And until I could get the stress thing done and you know, some people have great resilience and they do great with stress, but I just found the older I got, the less resilient I was with stress. And that was just me. I'm fully put it out there. It's just stress beat me up more as I got older. And so I wasn't going to get healthier no matter what. No matter what.

[00:48:43.240] – Rachel

You checked all the other boxes, eating, exercise, sleep and all that, so I'm glad you were able to find a solution for that.

[00:48:50.390] – Allan

Yeah.

[00:48:51.870] – Rachel

And then you guys talked a lot about marijuana.

[00:48:54.930] – Allan

Yeah, I haven't covered that topic. And there have been some books that came out. I reached out to the authors, but I guess they were off getting high or something because they didn't respond because they're not really driven.

[00:49:12.370] – Rachel

They get back to you because I think it's in the emerging stages.

[00:49:17.230] – Allan

It is. I will say, based on the titles of the books that are out there, they're very pro marijuana. And I knew, of course, reading this book and he gets into it, that he was not going to be pro marijuana, and he's not there are uses for it, and they're studying for more uses for it. But he said the vast majority of people don't need to be smoking marijuana. It's not healthy. People say, well, it's healthier than I'm like, okay, so getting hit by a motorcycle is healthier than getting hit by a car. You can justify anything as healthier than because there's always something less healthy. And if you want to compare ourselves with something that's less healthy, same thing with e cigarettes. We know that they're not healthy, you know they're not healthy. And so maybe edibles are healthier than smoking it. And if that's the case, then tell the does not equate to healthy. And, you know, so that's just the takeaway from that. I have tried edibles and one of two things happens. I just go to sleep and then I feel like I wasted a whole lot of money on an end or I eat everything in the kitchen.

[00:50:45.070] – Allan

I mean everything. And so, yes, if I had cancer and needed something that would make me hungry, yeah, that would do it, because I'll eat everything in the kitchen and so it's not a substitute for anything and it wasn't enjoyable. And so from that perspective, I don't value it. And I know that some people use and they love it and they feel like it does the right things for them, but there's a health downside to it until you really acknowledge that you're fooling yourself.

[00:51:20.530] – Rachel

I think here in Michigan, it is legal both medicinally and recreationally. And I'm not sure how many states we have now that have approved it for either or. I'm not sure what the current state is.

[00:51:33.100] – Allan

It's a growing number, and I would say probably the majority of states now at least approve it for medical use. But let's just be honest. Doctors will write you prescription for anything you ask them for. So if you want medical marijuana recreationally, just get a doctor to write a script and you can go get it. So it's not like it's really controlled like that. Maybe in some states a little bit more so than others, but for the most part so the vast majority of people in the United States can either get marijuana legally as a recreational drug or as to a doctor. And then again, it's hard to get if you want it. You probably know the dealer guy down on the corner or wherever. It's not hard to find someone to give you this stuff if you want, but that's it. If you're looking at improving your health, yes, substitutions are a way, but not a permanent way to say I'm healthy because I do these things.

[00:52:38.390] – Rachel

Sure, I'd like to see more science come out on marijuana and the use. I'd actually like to see it be a good competitor to big pharma. I'd really like to see something different going on. We have some experience right now. My husband Mike has kidney cancer. He's taking some chemo drugs. And the side effects of these chemotherapies are just ridiculous. They're just ridiculous. If you've ever watched a commercial on TV for literally any medicine out there, the side effects are ridiculous. So I'd like to see if medical marijuana has a leg to stand on in alleviating some of these symptoms that people are experiencing as compared to the big pharma alternative?

[00:53:26.170] – Allan

Well, the odd thing is probably I remember this from when I was younger, is that they always called marijuana, like for glaucoma.

[00:53:33.170] – Rachel

Yeah.

[00:53:33.630] – Allan

And Dr. Ramirez says there's actually no evidence that it helps with glaucoma.

[00:53:39.610] – Rachel

I've not heard that. I don't know.

[00:53:41.680] – Allan

Yeah, but the whole point is they will, because more people are using it now and it's easier to get then scientists are more likely to study it. It is very hard to get a study approved when you're using a class one narcotic. It just is. They don't want this out there. They don't want people using it. And so getting it approved and getting it through the FDA, federal against the law, is just going to be really hard. And unless you have a really compelling hypothesis for it, it's just going to be hard. But that said, more people are going to be using it, there'll be more anecdotal evidence, and then with the anecdotal evidence, someone will say, okay, look, I run all these places here in California that sell this medical marijuana. I will fund the study for this and they fund the study. Now, will the FDA then approve it for that use? Maybe not. But if the study is done and it's done right, at least at that point, doctors have some form of evidence to know, okay, I can do a counter indication for the marijuana for this thing. And over time, the doctors will finally go to the FDA and say, hey, we're doing this because we legally can counter indicate a medication for somebody else.

[00:55:06.810] – Allan

And since this is medical marijuana in our state, we've been using it for this thing and it's working. And if the FDA does the right thing, but they're pretty close to pharma, but if they were to do the right thing, then they would say, okay, provide the evidence from the studies, do more studies, and we'll consider it. And at least at that point, you got a toe in the door.

[00:55:34.370] – Rachel

The one last thing I want to mention on marijuana is that I'm allergic to it. And I'm not the only one out there. And I see an allergist and we've talked about it. I have an EpiPen because I've had some really poor reactions being surrounded. I've never even used it outright. I've never smoked it or ate it. I don't even use hemp and I'm afraid to use CBD. I just don't want to be near it because I have such a terrible reaction. And I know I'm not the only person out there. So if anybody's going to use it, just be smart and keep it in your own home because I can't even smell it. I can't even walk by it.

[00:56:12.870] – Allan

Yeah, all right, well, Rachel, stay away from pot.

[00:56:19.010] – Rachel

You know I will. Yeah.

[00:56:21.870] – Allan

All right, well, you have a great week. We'll talk next week.

[00:56:24.700] – Rachel

Okay, take care. Thanks.

[00:56:26.340] – Allan

Okay, bye.

[00:56:27.360] – Rachel

Bye.

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