Allan (03:13):
Aliza, Dr. Chin, welcome to 40+ Fitness.

Aliza (03:17):
Hi, thanks for having us.

Dr. Chin (03:19):
Thank you for having us. So excited to be here.

Allan (03:22):
Now, this is episode 420. And I thought it was apropos that I have a conversation about cannabis and CBD. So I was glad to see you had a book out there. It's called Cannabis and CBD for Health and Wellness. It's just perfect. So really excited to have the two of you on here. Enjoyed the book. I always like learning new things and obviously with cannabis and CBD just starting to kind of make a run at being somewhat legalized in some places and obviously illegal in others. You know, there's some things we've got to work through before we could actually even start this conversation, but where it is becoming legal in California, Washington, it's Colorado particular, I think is where they're opening the most. Florida I think is doing now some medical marijuana. So obviously some recognition that this, this does have a place in health and wellness and that cannabis is in fact a medicine.

Aliza (04:16):
Yeah, absolutely. The whole landscape has changed since just three years ago when I got into the industry. And this is Aliza, by the way. You know, I have a cannabis education company to educate women in particular about the health and wellness benefits. And when I first started out, there were fewer States that were legal and the stigma was intense. I was even afraid to tell anybody what I was doing. I was transitioning from the tech industry into cannabis, but I was experiencing a lot of health and wellness issues myself. Aging issues, 40 plus 50 plus. And cannabis seemed like a good natural alternative to some of the medications that they were trying to give me. So I really feel like we've come a long way in three short years, but we have a long way to go.

Dr. Chin (05:15):
Well, especially with the different States having medical programs now, I mean there's you know, 30 over 33 States when I started this integrating medical cannabis. I, I've been practicing this for over 10 years because I had the medical advantage of going or the educational advantage of going to medical school in California shortly after they legalized it. And that's over 20 years ago. So for me, I was in this middle of the Switchbox and I had the best of both worlds, learning, you know, conventional MD school, but also learning how to integrate cannabis with my patients. And now we have dispensaries, I'm in New York now. We have to spend stories that have a pharmacist in it and every dispensary and dispensing it like regular. So it has come a long way.

Allan (05:59):
Yeah. You know, I was coming from a corporate world a few years ago and I remember when they started legalizing in different States and making it recreational cause I was wondering, okay, if it's medical, they probably can't fire you for it. But if it's not medical, if it's just recreational then how does that play out? And I was talking to our general counsel and I said, so if someone goes to Colorado where it's completely legal to use this substance, they use it and then they come back here and obviously, you know, they're completely back down to normal and they're walking around doing their job. And we do a random drug test, can we really fire them? And he says, “Yes, absolutely.”

Allan (06:43):
You know, so can we talk a little bit about, you know, the legalalities of, and some of the stigmas here because you know, the whole point of it, and it's weird cause I'm down here in Panama now and the culture is very different from Arkansas as you might imagine. A lot of my friends use cannibis on a daily basis. And not just for medical, I mean they are clearly recreational. But can we kind of talk a little bit about that? Because it's interesting because it's, again, you know, against the law federally and it's legal in certain States and you know, it's just bizarre to me. It's really hard for me to wrap my mind around where people, where this is and why it's shifting so fast.

Aliza (07:27):
Well, so this is Aliza. I can tell you I'm living in Alaska and people don't know, but Alaska pretty much legalized cannabis in 1975. They absolutely decriminalized it and you were allowed to grow it in your home, carry up to an ounce on your person. It's a very different scene up here in Alaska, but pretty far removed from everything else. If you think about it, it's incredibly complex. So you mentioned federally illegal. Yes. That adds a huge layer of complexity over the fact that each state has their own set of laws, rules and regulations. Each state manages their cannabis retail growing retail, manufacturing, all in different ways. So no matter where you end up going, there's a whole set of rules. So one of the things I do is market cannabis and CBD companies and trying to navigate what's allowed and what's not allowed even from an advertising and marketing standpoint is very challenging.

Aliza (08:35):
But to your last part of the question, why is it happening so quickly? Well, there's a lot of money to be had. And where there's money, there's powering greed. I mean, it really boils down to that. We think about when the internet first became something available to the public, all the big companies came in as soon as they knew that people were there. So if people are consuming and people have access, everyone's going to be looking at this industry for the money. Whereas a lot of us, like June, like myself, I like many of the people we work with are looking at it for the health and wellness benefits. I mean, the money's there. We're not gonna ignore that, but I think that's a driver.

Dr. Chin (09:19):
Yeah. And it's really inconvenient for patients, for even continuity of care. For example, I have a 73-year-old patient who has Parkinson's and she finds cannabis quite helpful for appetite for her muscle spasms. She's able to feed herself at the dinner table, which is a huge, huge feat. And she has, she's a, she has a home in Boca, in Florida. She sees me in New York and then she has another home in Arizona. So she carries three different medical cards and has to see three different physicians you know, in each state. Cause she can't take her medicine that works for the Parkinson's too, when she goes down to Florida for them. You know, when she has New York winters and she goes to Florida. So she has to, it's really, really, really inconvenient for patients.

Allan (10:06):
Yeah. And you know, that's one of the things I was, you know, looking at, cause you did a really good job in the book of kind of going through the different ways that we can use the canvas. So like, you know, not just the smoking or the vaping not just the brownies. But then basically, you know now I guess they got, you said they had capsules and, and, and other means of getting it. But it's still, if you get caught transporting it at the airport, TSA, you're going to get busted.

Aliza (10:35):
Well, yes and no, but don't do it. I think TSA has actually in, in certain States, and especially from legal to legal States, I hate to say it, but they sometimes will turn a blind eye. I would never ever risk it and never, ever recommend that anybody do that or try that. But if you also look at some of the cases, like the grandmother who has the CBD tincture for her arthritis, getting caught, getting arrested, but then everything gets dropped and everything is returned to her because there's this ambiguity. So I think some of what June was talking about with patients, there's a lot of confusion for patients. There's a lot of confusion for anyone who purchases, consumes and may have it on their person. What can I do? What can't I do?

Dr. Chin (11:27):
What I, what I also do, and you made mentioned about employment is you know, if it's medically necessary and patients come to see me to get a medical card sometimes I'll write a letter the patient will ask that I write a letter to their employer, you know, saying, you know, if the drug test comes out positive, it's because you know, they're using the CBD or THC or combination of the cannabis. And I'll just write out my note, you know, patient will use it according to the employer's policies. So, you know, not maybe not during the work hours but after hours or a number, they're not on call, et cetera. And usually I haven't had any issues with any patients actually even with this letter, with a supporting letter.

Allan (12:09):
Okay. Well the other stigma I think is, you know, obviously we're going to have family members that are going to be like, okay, what are you doing? Why are you doing this? Why are you becoming a pothead? And you know, how do we have that conversation with them?

Aliza (12:25):
Well, you know, it's not even just stigma, it's stereotyping. So if you think about all of the media, even entertainment, the image of the stoner dude, I think it's really important for first and foremost for anyone who is comfortable consuming it, either in a recreational, as you say, sort of a relaxation and enjoyment fashion or in a medical fashion that they talk about it, that they're not afraid to do so. The more we talk about it and normalize it and show it is everybody from every different walk of life is potentially a consumer of cannabis, particularly on the health and wellness side. So if we can just get rid of some of those stereotypes, I think that would be extremely helpful. And as a mom, as a busy mom who doesn't want to be ever, ever altered or high around my kids, there are many different ways to consume cannabis. And now with the advent of CBD products, without getting that high, but getting the benefits, the nourishment internally for your systems to regulate hormones to help you with anxiety. I mean those are the kinds of things that are helpful to moms, but you don't have to buy into that stoner dude persona. You can be very successful, very productive, very active, and very engaged and still be a consumer of cannabis or CBD.

Allan (14:02):
Okay. Let's dive in a little bit and talk about how cannabis actually works within our body. What is actually going on when someone consumes or smokes cannabis.

Dr. Chin (14:14):
To understand how cannabis works with your body and your brain. I just want to go over the existing systems that we all know, what we have in our, on our body. And you know, we know about our circulatory system, our digestive system immune system, our central nervous system. You know, what gets us up and going in the morning. But there's another system that was more recently discovered called the endocannabinoid system. And we don't learn about this in medical school or science class, but the endocannabinoid system is our body's own system that makes cannabinoid like molecules. And that's why our body reacts well to plant based cannabinoids have coming from the cannabis plant because our body has a system that's equipped to react to it. And this system is so important, it actually modulates and regulates all the other systems. It interfaces with all those other systems that you've learned about.

Dr. Chin (15:07):
And that's why it seems like, Oh well, you know, I hear that it works for Crohn's disease and anxiety and migraines and PTSD and then Parkinson's. And it seems like, Oh, this is just a snake oil is magic elixir. But it's because this endocannabinoid system regulates all these different systems in our body. That is why the CBD or cannabis or different parts of the cannabis plant works so well for humans.

Aliza (15:33):
And also if you think about the chemical compounds within cannabis, we write a lot about this in our book, cannabinoids and terpenes being two of the most common chemical compounds in the cannabis plant. Well cannabinoids that June just mentioned that we naturally produce cannabinoids, they're called endocannabinoids when they're in our body, but phyto cannabinoids or plant-based cannabinoids are very prevalent in cannabis. So cannabis happens to have over a hundred cannabinoids that have been identified so far. And that is more than pretty much any other plant out there. So in a sense it's, it's like a super food or a super plant because it's just so rich in these chemical compounds and each one of them has sort of a different set of effects. And the one I like to really talk about and that appeals to me is linalool Oh, I'm sorry. That's actually it's terpene. I was just going to move into terpenes next. Terpenes though are other chemical compounds that are in foods, color, smell and taste of foods are the terpenes and lina lu being one of them is also in lavender. Myrcene is another terpene also in mangoes.

Aliza (16:57):
Back to the cannabinoids is a lot of alphabet soup. So it's, we know THC that is what alters your perception. We know CBD now and Cannabidiol. And that is sort of almost the antagonist and partner of THC in a way. They really interact with each other a lot. They're CBN that makes you really sleepy. But if you have too much of it, it makes you paranoid. So if you just think about it, there's all these chemical compounds in the plant that make it an effective medicine. And as June mentioned, it affects all these different systems and all these different facts. And that's why sometimes everyone thinks it's just too good to be true, but it really is just such a richness of chemicals that react well with our bodies and brains.

Allan (17:55):
Yeah, I think, you know, one of the key benefits as I'm not going to say that cannabis is mainstream yet, but it's, it's, it's, it's definitely getting there is that, you know, you're hearing about how they can, they can do different formulations of the cannabinoids and the terpines to get certain effects. So if you want to relax, so you're dealing with maybe doing some, you've got some chronic stress or anxiety there's a formulation that's going to work best with you to help address that specifically. And so you're not just saying, okay, I'm gonna take all the good and the bad. They're getting pretty good at zeroing down on some of these things, aren't they?

Dr. Chin (18:36):
Yes, we know the profile. So we know the different plant compounds. There's testing for that. We know how much there is. So here in New York, when we recommend medical cannabis, we're talking about milligrams down to the milligrams. And I chart how these cannabis medicines react with their prescription medications. So we keep track of that and we can be quite precise. So it's not take a bite of this cookie or a sliver of this gummy, but we're, you know, we're using oils that are measured, we're using capsules and tablets that are fast dissolving or Enteric Coated that might work in your stomach in a timed release. So there's really there, I think they're using pharmaceutical type technology when making cannabis medicine now. When they're doing topicals or using certain penetration enhancers and grabbing technology from the dermatitis dermatological field. So it's, it's come a long way.

Aliza (19:34):
And also the products that are coming out back to the cannabinoids and terpenes products are coming out that are emphasizing certain cannabinoids or certain terpines or combinations. So you might see something that is heavier in CBN as a sleep aid or something with THCV, which is a variant of THC. And that would potentially be for focus or even for appetite suppression, which is kind of weird because yeah, we think of the munchies if you have THC, but THCV can suppress appetite instead of stimulate it. So you're starting to see products that really narrow down the cannabinoid concentrations and terpene concentrations for also those specific effects.

Allan (20:22):
I think, you know, it was funny because let's say funny cause it was actually a comedy, but you know, the Cheech and Chong movies and the guys, you know, they're joking about you know, glaucoma medicine. You know, I think that was the big joke back in the 70s and eighties of, of what what pot was for. But it's, it's much better than that. It does a lot more for us as a medicine. Can you talk about some of the different things that we can use cannabis for as a medicine to include acute issues, chronic issues, and even some mental and emotional issues?

Dr. Chin (20:54):
The number one I think I see in my patients are chronic pain and chronic pain is a very broad diagnosis. It can come from fibromyalgia. It can come from low back pain, migraine deep and pelvic pain for women. Because it's, CBD is such a potent anti-inflammatory. And I talk about CBD and THC the most because it's the, well most well researched, but CBD is a very potent anti-inflammatory and what patients are finding for chronic pain is that it really gets to the root of the problem. So you're not just masking it by taking care of the pain and just taking a pain reliever, but you're getting rid of that underlying inflammation that's causing the pain in the first place. Parkinson's patients I had mentioned before,it's very good for the muscle tremors and also for the sleep and appetite. I see ALS patients, epilepsy patients, both pediatric and adults. I see quite a bit of epilepsy patients. Insomnia, anxiety, Crohn's disease, collitis. So it's a varied practice. Upatients usually come to see me after they've exhausted all options. Of course I see cancer patients cause it helps with nausea, appetite,and pain and the immune system as well.

Allan (22:10):
And one of the other things you mentioned in the book was it was good for gout.

Dr. Chin (22:16):
Yes. So gout is great because what do you think causes gout? Inflammation.

Allan (22:25):
Yeah! And so this, you know, and I think, you know, if you actually look at most chronic diseases, inflammation is kind of a basis for almost every one of them.

Dr. Chin (22:33):
Exactly. Exactly. So when you have chronic inflammation, that's when it becomes a serious disease. I mean, you look at you know, high blood pressure, diabetes, that all comes from inflammation.

Allan (22:43):
Now you know, a lot of people are going to go at this and they're going to do you know, self-medication, if you will experimenting. And then of course now with it, you know, becoming medically legal in most States or a lot of States they can, we start working with their doctors if their doctors are familiar or willing to get into this. Kind of talk about the contrasting of whether people should be doing the self experimentation or whether they should go to a doctor first when doing some of this stuff.

Aliza (23:11):
Well, I can talk about my personal experience and also because I mentioned elementa before. My company that educates women about using cannabis and CBD for health and wellness. The thing that we recommend most of all is see your doctor. But that's very, very hard if they're not in a legal state. And it's also hard if their doctor is connected to a hospital. This is something I learned from June. If they're connected with the hospital, the hospitals are federally funded so they cannot even talk about it. So you're really looking for either somebody in private practice, but in some of the States you also have natural paths who can talk about it. But from a personal standpoint, I'll totally let June talk about from a doctor standpoint. But from a personal standpoint, what I've learned is what is on the label. If you don't have a doctor available and you're not consulting with the doctor, what's on the label as a recommended dose, you should always start lower.

Aliza (24:07):
And the saying is start low and go slow. You incrementally add a little bit more over time until you get to that feeling that you want that relief that you want, the effect that you want, but that you don't just hit your body right away with the cannabis. I have gone from cannabis to CBD just because I find that a lot of what I experience is either anxiety or inflammation. And so I know that with CBD you can actually take a lot more of CBD than THC. You kind of need to in order to get an effect on the cannabis side, 2.5 milligrams is totally enough for me where if other people are like 15 to 25 milligrams or even more,uon the CBD side, 25 to 30 milligrams is more my sort of dose. So it's a lot of numbers is a lot of calculation. You really have to pay attention, but you can't overdose on either of them. You might get uncomfortable, but you can't actually overdose and die from either cannabis with THC or CBD as an adult, as a healthy adult.

Dr. Chin (25:26):
I think the take home message really here is that cannabis is unique because there's really no precedent. There's no other drug in the world that we're using recreationally and medically. And so patients really have to demand that their health practitioners get educated. You know, really doctors need to tell patients the difference between their opinion versus scientific fact. And with plant-based medicine, there isn't one size fits all thinking. And unfortunately with the medical model and what we're taught in med school, it is one size fits all. It's here's your pill, you know, here's five milligrams of your blood pressure pill. I expect to see you in a month and we'll measure your blood pressure again. But with plant-based medicine, it just doesn't work that way cause everyone will react differently with herbal medicine. And really this whole movement, I, I see it as a plant sort of going back to plant-based medicine, this medical cannabis movement, because it's a wake up call to the healthcare system. Patients are turning away from mainstream medicine and heading to support groups like Elementa or apothecaries that have CBD shops or a cannabis shops because these support systems are giving them what they need. They're listening, they're connecting better with their consumers or their patients and they're providing education and an alternative, a more natural approach to health and healing.

Allan (26:43):
You know, in the kind of the full circle of this. It's interesting because, you know, I guess the, the reason pot's illegal is because it's, it was, it was deemed a gateway drug to do these other things. But with the opiate epidemic, you know, basically, you know, now we're in pain meds and everything that people are taking. This might actually, this is a safer alternative for a lot of those pain issues that people are getting addicted to opiates.

Aliza (27:05):
Well they're calling it an exit ramp drug now. And the reason it's illegal though there's a lot of misnomers about why cannabis was made illegal. And it was not because it's a gateway drug and it was not because people actually proved that it was a gateway drug. It was really based more on historical, you know, greed propaganda control and power. It was not about the medical issues around it because it was being vilified back in the 20s, the 1920s and the 1930s. And so we just forget the history of why it was made illegal. It had nothing to do with danger at all. And so we've just sort of been brought up with these false narratives about it being dangerous and it is not, it is certainly not on the same level as heroin or cocaine even though it's been scheduled that way in the U S and it can help with addiction. And it's a healthier alternative to some of these very terrible drugs. It can really bring you back to balance and health and keep you away from some of these dangerous substances.

Dr. Chin (28:24):
Well also when you look at the history too, it was during the time when they started to create inexpensively manufactured, you know, precisely dosed, easy to swallow pills versus a tincture. You know, it was at 1898 Bayer synthesize aspirin from birchbark. And then we had barbiturates that came, that came in. So we really take pills and capsules for granted. But you know, before that time it was, you know, yes, here's a tincture, here's a drop of this, put this in your tea. So it was really, I think that a perfect storm, you know, in terms of politics, the anti-immigration thoughts, you know, caused by the great depression. And then there was a pharma.

Allan (29:05):
Okay, well Eliza, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well.

Aliza (29:16):
Well, having written this book, Cannabis and CBD for Health and Wellness, but also I, my previous book was the happy healthy nonprofit where we did a lot of research about what does it take to get well. And I know even for myself really important is sleep, getting a good night's sleep and moving your body. We're in such a sedentary world now sitting behind a desk at a computer, hunched over, your body is suffering and so much disease is from not moving around. And then the final thing is just be really mindful what you put into your body, what you put on your body. Because if you think about even when you put things on topically, your skin is your biggest organ is what I've heard said, and it absorbs things. So what do we put on our bodies? What do we take into our bodies? Be really super mindful about those things.

Allan (30:11):
Okay. Dr Chin. Again, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well.

Dr. Chin (30:22):
I would have to agree with Aliza. Number one thing that I always talk about with my patients more than anything else is nutrition. So not necessarily putting yourself on a restrictive diet, but really taking a look at what you are consuming. You know, how much sugar you're consuming, keeping a food diary. Meditation is a big thing that I also talk to my patients about. And exercise and exercise can be something small, a 10-minute walk to start with and slowly building up, but moving your body that gets the lymphatic tissues moving. So when we think of, you know, like, Oh yeah, of course diet and exercise. But think about how it changes the physiology. My Parkinson's patients, cannabis does not work for my Parkinson's patients unless they do rigorous boxing exercise. So for those that take the cannabis, if they don't do any exercise to cannabis starts to not work. But if for those patients that exercise rigorously, they have to be out of breath, the cannabis works double.

Allan (31:21):
Okay, cool. Thank you for that. So I'm Aliza and Dr. Chin, if someone wanted to learn more about you in the work that you're doing in this book, where would you like for me to send them?

Aliza (31:35):
Well for, for me it's elementa.Com. It's Ella for the French for her, and menta Spanish for mind. Her mind elementa.com.

Dr. Chin (31:50):
Wonderful. And you can find me at drjunechin.Com.

Allan (31:56):
And I'll have those links at 40plusfitnesspodcast.com/420. So Aliza, Dr. Chin, thank you so much for being a part of 40+ Fitness.

Aliza (32:06):
Thank you.

Dr. Chin (32:07):
Thanks for having us.

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch	– John Somsky	– Melissa Cardinali
– Barbara Costello	– Judy Murphy	– Tim Alexander
– Bill Gioftsidis	– Leigh Tanner	– Wendy Selman
– Debbie Ralston	– Melissa Ball

Thank you!

Another episode you may enjoy

Healing with CBD – Leonard Leinow

Less...

Dr. Axe: 02:14 Yeah, it is. You know, I think for me, one of the things I keep hearing is from patients I've worked with in the past and people today is that they notice the difference when they start working on their collagen You know, whether it be they're taking supplements that support their body's own collagen production or a collagen supplement or just drinking bone broth, which was really the first thing that I started to do that I had my patients do in the past that, you know, I've recommended so many supplements and super foods over the years, but the one that people kept coming back to me saying, wow, I noticed a dramatic difference in my health really, really had to be collagen. Now there are other things as well. I think there are certain herbs and spices and vegetables and probiotics that, and sometimes Omega3. So there are things that people can notice a big difference with. But for me personally, in my own gut health and joint health, I noticed a really big difference in collagen so I'm always excited to talk about collagen you know, I wrote a book on the topic but you know, I'd love to talk about today. Anything related to, you know, how collagen or you know, collagen, but also those other superfoods that support collagen production, how they can help our health.

Allan: 03:20 Absolutely. My wife has been having some issues with her knees and so she's been dealing with the doctors and doing the basic things that I think people our age over 50 anyway, start to do with their knees as you know, you get it scoped and then you, you go back in and they're going to do the little shots. And then she went this last time and the doctor gave her the prescription or not prescription so much. He gave her some collagen sold her collagen and said, you know, you need to be using this now. She felt it helped. She hasn't been on it long term I think going on now two and a half months. But it's, so she's taking it, having a little less, little less problems, but just the other benefits that she's getting from the collagen, she said my hair is growing and feeling so much better. My fingernails are growing, my skin. They're just so much healthier now than they were before I started this protocol.

Dr. Axe: 04:08 Yeah, it's amazing. You know, my, I've noticed the same thing. My wife and I joke around how fast and our fingernails grown, how thick and strong our hair is right now. My wife is pregnant. She's due here in April.

Allan: 04:22 Congratulations!

Dr. Axe: 04:22 Oh Hey, thanks so much. Yeah. And so we were just talking last night, but she was just saying, I mean even through pregnancy, I mean, she just feels really, really good and both of us eat a really good diet. But when she started taking collagen and consuming bone broth and these collagen superfoods, I mean she really noticed a difference in her skin, hair and nails. I mean, it is the number one ingredient if somebody is looking to improve their overall beauty as well. You know, a lot of times people today are using these sort of outside in products. You know, it's maybe it's hyleronic acid for the skin or moisturizers, essential oils and I recommend all those things and think they're fantastic.

Dr. Axe: 05:00 But at the same time, if somebody really wants to see the biggest difference, they possibly, or maximize the difference they see in their beauty, collagen is definitely the number one supplement. You know, this is kind of a shocking statistic. Once you reached the age of 25 years old, your body produces less collagen every year by the time people are in their 50s their own body produces 75% less collagen in their fifties than they did in their twenties and so that's why it's even more important because our own body is producing less. It's so important that we supplement collagen into our diet. And I had, somebody asked me recently on this,and said, Hey, it's collagen a fad. And I said, collagen isn't really a fad. It's one of the oldest superfoods that we were getting in our diet. Think about this. Our ancient ancestors all consume bone broth, which is 90% collagen. It's pure collagen that's what bone broth is and we aren't getting bone broth in our diet and therefore we're essentially missing a macro nutrient.

Dr. Axe: 06:00 And think about this. There actually are no essential carbohydrates. There are essential fatty acids and there are essential amino acids. There's also something called a conditionally essential amino acids. Now the amino acid you're going to find in collagen are considered more conditionally essential. They're not always considered. But this being said though, they are essential. We need them to be healthy. And the big thing to think about with this, if you're missing in your diet, a macronutrient, okay? Like for instance, protein. If somebody doesn't have enough protein in their diet, they can get thermogenesis Their muscles can waste. It causes major nerve trend issues. I had a patient one time, Allan came in who actually, this is interesting, he was my first patient ever when I was in student clinic and his doctor put him on a no fat diet for his cholesterol, which first we know today, anybody who keeps up with the medical research, that's crazy. But he was taking, consuming no fat and his hair was thinning and his nerves were degenerating. He was losing his memory, lose it.

Dr. Axe: 07:07 I mean he in a matter of three months, his entire body started wasting away from not eating fat. Now think about this. Collagen is a macro nutrient. It is a protein. We are completely missing this protein in our diet. So again, it's one thing, Hey, if you're a little bit deficient and a mineral, like it will affect your body. But if your, which is a micronutrient, but if you're completely deficient in a macro nutrient, your health is really going to suffer. And I think today a lot of people are suffering from conditions like leaky gut syndrome, chronic joint pain, thinning hair, chronic inflammation. They're struggling with these issues because they're not getting collagen in their diet. And when somebody starts consuming more bone broth, taking a multi collagen protein, supplement, consuming herbs and superfoods that support your body's own collagen, they really start to notice a big difference in their body when that happens.

Allan: 08:01 Now let's take a step back cause you're saying macro. And I think people know that basically we know the three macros are protein, carbs, and fat, but as we kind of go through that, we know it's a much more complex formula that there's an essential, amino acids, there's essential fatty acids. That's that we need. Like I said, there is no essential carbs, although we do generally have to make sure we're getting enough energy to support body functions. So we do eat a proportion of those. The way we break them down, whether we go keto or otherwise, we make some decisions on how we're going to allocate those, those macros rather than we're making decision to make the decision or we're just not making decisions. We're eating what we want. We're still making the decision of what we put in our body. But how is collagen, how is it that you're seeing your collagen is maybe a fourth macronutrient if we will, but what is collagen and why is it so important?

Dr. Axe: 08:51 Well, collagen is so important because it makes up one third of all of the protein in your body. Okay, so one third of it. Now I want to say this as well. If you think about if one third, so, so like our muscles, those are made up of more muscle building proteins like branch chain amino acids and mathiolene. Okay. That's what makes up our muscles. What makes up our ligaments, tendons, fascia, connective tissue, our skin, our hair, our nails, our bones, our discs, our gut lining, our arterial walls. If a pregnant mother has a placenta, their body's creating that's made up of collagen so all of those areas I just mentioned are made up of more than 90% collagen for the most part. And here's another interesting fact. Listen to this. There is more collagen in your bones then calcium and all other minerals combined, and so we don't think about these things, but collagen is so critical for us to be healthy.

Dr. Axe: 09:56 It's like, well, why do we think calcium is the most important thing for bones? Because the dairy companies found it was the top mineral in your bones. But there's also magnesium, there's phosphorus, there's all these other things. But because of marketing, that's why we feel like it's so important. But really today, if we were looking at your bones and what's most important, it's actually collagen. So all that being said, collagen is so important for so many areas of your body. Think about this for your arteries to be, you want them to be elastic and not hard. When you hear something like calcification of your arteries, that's hardening of your arteries. You don't want that. You want to have soft, supple arteries, which are made of collagen when they're healthy. So all of these areas are just, it's so important. And collagen also will spare muscle.

Dr. Axe: 10:45 It supports your metabolism. So for fat burning and weight loss, it's important. But just in general, like it's important for, it's kind of like the glue that holds your body together. So if you want to be healthy, especially your joints and ligaments and tendons to be healthy as you age. Like I had a grandfather who was 96 years old and just passed away last year. But up until he was 96 he had joint pain. None of his muscles hurt though, but his joints hurt. And that's because he really, for the good part of his life, up until the last couple of years when I had him start taking it, he really never took collagen. And so again, I think for us it's the biggest thing we're missing in our diet. And I think if people start using it or consuming a diet and listen, it's not just taking a collagen supplements more than that, it's consuming vitamin C, which is necessary for collagen production, not just any vitamin C, an absorbable vitamin C that comes from super fruits like Camou-Camou, ascelroa cherry, amla berry or certain foods, broccoli, citrus fruits, also like red bell peppers, you know, so there are certain foods and then we get into, there are other foods that support collagen production that helped boost cells in the body.

Dr. Axe: 11:54 And those are really unique types of adaptogenic herbs. And the other thing you want to do, not to keep going in this, but you want to protect your body's own collagen production and there are certain herbs that help you do that. Matcha green tea, tumeric powder is amazing for this resveratrol found in the skin of blueberries and grapes, but again, collagen is just really important for us because over 30% of all of the protein in our body is made up of collagen. And if you don't get it, think about this. Imagine trying to build muscle like a bodybuilder or trying to put on muscle without eating protein. It's hard to do like they're not really not going to see results versus it's the same thing if you're trying to heal your joints, if you're trying to have a healthy gut and digestive system, if you're trying to have beautiful skin and you're trying to do it without collagen, it's going to be very difficult.

Allan: 12:43 And so the, the basis of this is, you know, if we're, if we're just eating standard protein sources of muscle meat, maybe some eggs and things like that, we are getting a lot of the amino acids, we're just not getting the right mix of amino acids to optimize our, the collagen production opportunities in our body because we're just not giving it the natural resource to do what it's supposed to do. Well, if we're not getting the right amino acids, because the collagen is basically just built out of select amino acids like glycine and others. And so with those amino acids, if we're making sure we're getting those in our diet, we're giving our body the natural resources that it needs to build the body that we have.

Dr. Axe: 13:23 100%.

Allan: 13:25 And then if we're getting those other nutrient and we're getting those other nutrients, like you said, vitamin C and some of the other things that are basically kind of the, the things that make it all happen so that our body optimizes that production.

Dr. Axe: 13:36 Exactly.

Allan: 13:37 Okay. Now the interesting thing was I thought of collagen as just a thing. And you know, I as a one singular thing, you can talk about the different types of proteins. We know if we get plant proteins or we get protein from meat or protein from eggs or a protein from say whey or case in that they're, they're different mixes of amino acids or different structures of them. And so they're, they're all a little different in a, you know, well we'd all we call because we're getting all the essential amino acids, you know, we, we call it the perfect protein, but there are multiple types of collagen that I was not actually familiar with. So could you take a little bit of time to talk about the different types and in particular the ones that you call kind of the five or I guess is six key ones.

Dr. Axe: 14:20 Yeah, so I would say when we're talking collagen, I think five in particular, type one, two, three, five and 10 those are the most important types of collagen we should be getting into our diet. Now I'm going to bring this up to say there was a principle in ancient Chinese medicine and that is if you eat the organ of an animal, it supports your organs. Or if you eat a food that looks like an organ or a system in your body, it actually supports that system. Let me give you an example. A Walnut looks like a hemisphere of your brain. Beets are red and actually look like blood and we know by the way, walnuts are full of Omega threes and colene and all these amazing nutrients that really support brain health. We know beets actually boost nitric oxide in your body, which is super nourishing to your blood.

Dr. Axe: 15:04 We know that certain things like carrots, you cut in half, it looks like an eye and we know according to thousands of clinical studies, carrots and beta carotene and vitamin a support eye health, reishi mushrooms like identity to your kidneys and your adrenal glands so they support your adrenal health. All. That being said, there is a principle that when you eat a certain area of a body or or so like if you eat a chicken breast, it supports muscle meat because that's the area, that's what it is of a chicken. It's pure muscle. It's going to support our muscles. So with different types of collagen type one and three collagen make up, primarily your skin, hair, nails, bones, discs, and then some of your gut lining. Type two collagen makes up your ligaments, your tendons, your connective tissue, and all of your facia. Type five and 10 collagen really helps support areas like your cardiovascular system and your veins and arteries.

Dr. Axe: 16:02 And so this is also why when people are buying collagen as a supplement, it should always say multi first. That's going to be the highest quality. They should be buying a multi collagen protein, because if you're only getting one type of collagen, you're not necessarily as strongly possibly supporting all the areas of your body you should. So I really think that, again, when you're doing collagen, like chicken broth contains mostly type two collagen beef and fish collagen contain mostly type one and three and eggs contain a little bit of collagen or the egg shell membrane, the inner part of the egg egg shell that contains type five and type 10 collagen. And so all that being said, I think ideally we're getting multiple types of collagen because they are subtly going to support other areas. And I will say this type one and three collagen different types of collagen can definitely still be used to create other types or areas of collagen in the body. And it's a misnomer for people to think when I consume collagen and literally just goes to that area and becomes collagen in my body. What happens when you take a collagen supplement, your body breaks down that collagen into individual amino acids like proline, hydroxy, proline, glycine, and then it works with things like vitamin C and hyleronic acid and glucosamine and chondroitin, and it works with those things to create new collagen within your own body. That's kinda how that works.

Allan: 17:27 Okay. Yeah, that was actually kind of surprising to me because in the past, you know, I would pride myself on being the guy who cooks the Turkey for Thanksgiving at my mom's. And so every year I'll buy a grass fed pastured. I mean, you know, grass pastured Turkey, organic Turkey for for dinner and now I'll cook the Turkey and I'll take all the bones and I'd make a bone broth. And then when that wasn't available to me, and I'll, and I'll admit I wasn't getting my servings a day, but I would have bone broth every once in a while. And then when that would run out, I then go to the market and I, you know, the farmer's market and I buy chicken feet, you know, I'd make again make some bone broth. I didn't realize though that I, I was actually only touching on a small portion of the, of the collagen benefits that I could've gotten and that I should have also probably been buying some beef bones as well to make some beef broth, a bone broth as well. I didn't realize that I was still missing out on opportunity, just not having that full understanding and appreciation of the different types of collagen.

Dr. Axe: 18:23 Yeah. You know, it really is crazy how, I'll just say this, you know, I like I, I've taken so many supplements and I've eaten very, very healthy for a long time, but I could still notice a difference when I started this collagen diet. You know, when I started doing all the research and reading up on these ancient like ancient diets. And if you look at Japan today, they have one of the most simple diets in Okinawa. Japan, the top foods they consume on a regular basis are fish broth, rice and fish. They consume a lot of green tea as another one. But, but those are three other top top foods. It's fish and fish broth, it's rice and it's green tea. And I want to mention to, you know what's so amazing about fish broth? It's loaded with collagen and fish, is full of Omega, you know, has these healthy fats like the amegas.

Dr. Axe: 19:13 And then you've got matcha, which is one of the most protective herbs on the planet. And they just consume a lot of herbs, also consumed seaweed, which also is good for collagen production. So sometimes people wonder, I don't know if you've heard people talk about this. I have a friend of mine who is, he is Asian. And he talks about how all his relatives, like even when they're, you know, his grandfather is a 70 and he's like, he looks like he's 40 like very, very young. And I said, you know, a lot of times people will say, sometimes Asians look younger than other nationalities. And he said, well, I think the biggest reason is their diet. He said in the Asian diet today, especially in Japan, he said, you know, the amount of bone broth, the amount of matcha green tea, seaweed, these collagen boosting supplements they consume every day is a very, very high. So I know it might be other things as well, but I just thought that was interesting. In Asia, the amount of, that's what I, as I did all my research, they probably consume the diet that is friendliest to collagen production in college and protection than any diet they're on the planet. And so anyways, I I think that if somebody is looking to see a big turnaround in their health following a full on collagen diet is really going to help.

Allan: 20:24 Yeah. And I, and I think the other thing to go back to what you said is that the Okinawans are probably eating so much more like their ancestors than the American is today relative to our ancestors.

Dr. Axe: 20:37 Exactly. It's an ancestral diet. It's one of the closest, if not the closest that I can think, give, you know, when you look at the blue zone diets, if you've ever read any of the articles or books there, it's interesting because really that's what I would say sets them apart as cultures is they're eating as close as close to their ancestors and listen, not all their diets are the same. You know, their diets are different. The one common denominator is they're all eating real food and they're all active, they're moving, they also practice a lot of spiritual or sort of faith. Like it might be a different faith, but they're also practicing things that are faith based, community based. It's really amazing when you look at what supports lifespan. But those are, you know, those are all factors.

Allan: 21:16 Now in a book an, we've talked about this a little bit here, there are other nutrients that we would want to consume just to make sure we're setting our body, priming our body to have what it needs to be successful in building the collagen and using the collagen that we're taking or eating. Can you talk about some of those, I mean, you've talked about macha tea and some others can. Can you talk about those and how they're helping this process.

Dr. Axe: 21:38 Yeah, so for starters, let me hit on three categories. We have foods that protect collagen. We have foods that boost collagen, and we have foods that just generally help your body create new and healthy tissues. So first, the foods that protect collagen, these are going to be high foods that reduce oxidation. And so it's going to be antioxidant rich foods. I'm talking berries to start blueberries, raspberries. Blackberries will be very high on the list. One of my super favorite super fruits. Goji berries will be high on that list, asaii Berry Maki Berry, but doing berries are going to be fantastic for protecting your body against collagen degradation. I talked about matcha green tea and other forms of green tea, matcha, very high in antioxidants. It also contains a compound called an EGCG, which has the anticancer properties but matcha really high up on that list. I'm also going to throw in that list foods that tend to be like dark blue, dark purple, dark green, so even like spinach and chard, green leafy vegetables, they're going to help protect your body, but I wouldn't say those antioxidant rich foods, especially herbal teas and berries are going to be the ones that you can just do on a regular basis. So for breakfast, maybe you do a collagen smoothie with one cup of berries, one scoop of a multi collagen protein, a little bit of almond milk or coconut milk.

Dr. Axe: 22:59 That's a perfect anti-aging smoothie to have in the morning where you're going to get some of those super foods and then maybe a glass of green tea in the morning as well. That's going to help. Now, some of the foods that are going to help your body in protecting collagen are going to be those foods that reduce inflammation as well. So tumeric is going to be very high on that list. Tumeric contains a compound called curcumin, which reduces inflammation. Interestingly as well. It also can support collagen production because it has a compound called tumor own which support your body and creating more STEM cells. Now along with that, some of my other aunt favorite anti-inflammatories that can help will be, Rosemary also contains Rosemaric acid, which is great. Ginger root, another fantastic one, another one that's great. CBD oil. CBD oil also has anti-inflammatory properties and then any food that's going to have Omega3s, wild caught salmon, other fish like mackerel and tuna, grass fed beef, chia seeds, flax seeds, hemp seeds, but those omegas along with those anti-inflammatory herbals, those are going to really help with reducing inflammation and preventing collagen degradation and breakdown.

Dr. Axe: 24:10 And last but not least is this this category of super herbs and foods that support your body and creating STEM cells and that tends to be the ones that really are known also as adrenal tonics and that lower stress hormones. Reishi mushroom is amazing. Ashwagandha, which was an Ayurvedic herb that's used today especially to treat hypothyroidism really is incredible. I'll also throw out there herbs like astragalus Rhodiola Rosea, but at the top of the list I would put Rishi mushroom and ashwagandha. Those two in particular help lower lower stress hormones. They support STEM cell production and two of the best out there are reishi and ashwagandha for STEM cell production

Allan: 24:53 Now, so we get these nutrients and we kinda sorta, we're changing this, we're getting this as a part like so we have our our smoothie in the morning or we're, we're now going to incorporate some of these other foods in our daily repertoire, our daily menu and you have meal plans. I think that's one of the cool things about your book is that it, it doesn't just say here's the information, go fourth and do it. You actually have meal plans and some ways that we can do this, but what are some basic ways that we can just ensure that we're getting enough collagen each day?

Dr. Axe: 25:22 Yeah, so I would say for starters, to make sure you're getting enough collagen every single day, one take a collagen supplement or a bone broth protein supplement, you want to supplement with it. So for myself, Hey, maybe if I'm having a big bowl of chicken broth that day, you know, maybe you don't need to know. I still do. And in fact, I recently talked to Dr. Joseph Mercola, who's a, who's a friend of mine and he's a him and myself run two of the largest natural health websites in the world. And I asked him, I said, dr Joe, how much collagen do you consume a day? And he said, I consume 60 grams. That's the equivalent of three to six servings every single day. And so that being said, I consume at least two. So I consume about 30 to 40 grams a day myself. So I'm getting collagen every day.

Dr. Axe: 26:08 And I want you to think about this. If one third of the protein in your body is made up of collagen, if you're like, I'll share for myself, actually I consume about 40 grams a day and so with that, like I consume about 120 grams of protein a day myself. One third of all my protein intake is collagen and that's what it should be. Just like people have heard this balance of Omega three and Omega six fats, you know like you're supposed to have about between a one to one and one to four ratio of Omega three to Omega six fats to have healthy levels. This same goes for collagen, building proteins to muscle building proteins. You need a balance. So that being said, every person on the planet should be consuming. If you're not consuming bone broth, a large serving every single day, you should be getting collagen protein.

Dr. Axe: 26:56 And what I do is I do one scoop of a bone broth protein. The reason I do bone broth protein in addition to a collagen protein is bone broth protein contains it's bone broth in powder form and it also has hyleronic acid, glucosamine chondroitin. These are compounds that support collagen production in our own bodies and so I think they're critical for that reason. So I do one scoop of bone broth protein, one scoop of a multi collagen protein, and that's what I use to get my collagen every day. Now, in addition to that, like this a, yesterday I made a big bowl of what I call immunity soup and what I put in there was two big jars, probably about 30, 30 grams or so, probably equivalent to like six cups of bone broth. I put in some chicken thighs. I did a big bag of kale, I did cauliflower, I did Shataki mushrooms and I did a miso. So I did this chick pea miso I put in there and sometimes I'll do also, I'll put in some garlic, a little bit of sea salt and some, sometimes some white beans and I did this big bowl of immunity soup.

Dr. Axe: 27:59 Anyways, all that being said, it tastes amazing, but I'm also getting chicken broth in that meal as well. So I think everybody, the best place to get collagen, number one is going to be just as a supplement because a lot of us are just not getting it daily. Number two is do it as a chicken broth or a bone broth, like a real homemade chicken vegetable soup. And I would do a combination of a multi collagen protein in your smoothies and your coffee and your tea. It's, it's very close to like, it's pretty much a tasteless powder. And in addition to that, getting just chicken broth and beef broth, but those are the, those are the best places to, to be getting collagen.

Allan: 28:37 Well this is, this is definitely the time of year to be eating immunity soup because flus or anything else is going around. I just met with a business colleague and he was he was coughing at the table and I'm like, Oh man, I gotta, I gotta go do something here. So I don't take it with me, but yeah, so definitely this is good. And that recipe is in the book, by the way, so you can check that out. So we take the soups. We do that now. I'll tell you, you actually convinced me. I actually went out and bought a couple of things. I have collagen powder to take back with me to Panama and I will definitely be looking for opportunities to make more broth, bone broth. We have some limited resources with some of the things that are available to us on the Island, but I'm, I'm going to step it up a good bit. Absolutely. I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?

Dr. Axe: 29:27 Oh wow. Well I think people want to take care of their body, their mind and their spirit. So I'm going to start off here. One of the things, ways I start every day for myself is doing what I call my spiritual triathlon. And so I wake up in the morning and I spend time just getting grateful saying I'm grateful for. And I know everybody pres a different religious background, but for me like I just praise God. That's how I start my morning and say what I'm grateful for. Number two, I read a book to help me grow. And so this year I'm reading a lot on leadership. I'm reading a lot on spiritual growth. And so I read either my Bible or like a John Maxwell book or Simon Sineck, some book on leadership. And then I'll spend some time, the next little bit and all visualize and I'll meditate or pray.

Dr. Axe: 30:08 Okay? So that's what I do. I do my spiritual triathlon and it's, it's gratefulness, it's reading. And then it's spending some time in prayer and meditation. And I'll tell you when I do that Allan, I just, it really changes my day. Like I'll read something about love, then I'll think, how can I love others better? And love is sacrificing yourself. It's serving others. It's giving something. But how can I serve and be kind. And so that's how I start my day every day. And the second thing they can do, and I want to challenge everybody to do this, is a lot of times people try and change everything at once. Here's what I would say. If you want to be successful in your health and you, so this is something everybody can do. Just change breakfast. Think about this. If you just change breakfast, you're changing one third of your diet.

Dr. Axe: 30:52 That is a huge step and if you can do that all year, you're going to see a transformation in your health and I recommend that everybody do what I do for breakfast and that's do a collagen boosting smoothie, three simple ingredients, one cup of berries, one scoop of multi collagen protein and one cup of coconut milk or almond milk. That's what I do, Allan every morning for breakfast and I feel incredible. I've had people follow that recipe and they've said no other meal that they've ever changed to have they noticed that big of a difference in their health. Three easy ingredients. Now, Hey, if you want to spice it up and add some other things all add in some cinnamon sometimes or pumpkin pie spice. I'll add in a handful of spinach to get some greens or a green superfood powder. Sometimes I'll add in other things, but that being said, three simple ingredients, berries, collagen, almond milk.

Dr. Axe: 31:44 That's it. And so if people can make that change, that's going to be huge. So eat a good, clean, healthy breakfast. And number two, I would say change your mindset to Food is medicine. This is the message I have preached for years almost since the beginning of my career, is that if you think about when you're eating, not what's going to satisfy your immediate desire, but what is going to be as a medicine to your body. And listen, this can be different for different people. In fact, Ellen, I don't believe that there's one diet for everybody. I do believe though that most people generally speaking, are collagen deficient. We're missing collagen in our diet. And I think if people can follow the diet plan that I have in my new book, the collagen diet where I outline [inaudible], how to eat collagen, pancakes, collagen chocolate chip cookies, collagen brownies, you know, but I, these recipes are made with things like almond flour, coconut flour, simple homemade ingredients.

Dr. Axe: 32:42 They're going to help people heal. I think that would go a long way as well. So I would say again, if people want to change work on your spiritual and mental health through doing that spiritual triathlon number two, just change breakfast to that college and boosting smoothie. And number three, change your mind to focusing on food being your form of medicine. And what I found too, Alan is that you know what, like I'm not taking any foods from you. I think if you have the mindset of like in my book I teach people, it's not that you can't have cookies, it's you just need to use a different type of flour. It's not that you can't use oil, I'm just going to recommend avocado oil, coconut oil,G and olive oil or grass fed butter. Like those are what I'm going to recommend. And so I teach people how to make easy swaps to collagen, boosting foods, to healing foods that help them live longer, happier lives. And so I would say those would be the three takeaways that I would take action on.

Allan: 33:34 Thank you. So dr Axe, if someone wanted to learn more about you, learn more about this book, The Collagen Diet or the other books that you have, where would you like for me to send them?

Dr. Axe: 33:44 You know, Hey, I encourage everybody to check out my Instagram page. It is a doctor Josh Axe on Instagram. Also my website, dr axe.com you can just go to [inaudible] dot com and you can also just search my name on Google, start searching Dr Axe Collagen Diet. You can go to amazon.com as well. I just wrote a new book, check out the new book there. But yeah, I would just search my name on Amazon, search my name on, on Google and I think you'll find a lot of exciting things on both of those resources along with Instagram and Facebook.

Allan: 34:15 And I'll have a link to that on our website, 40plusfitnesspodcast.com/419. Dr. Axe, thank you so much for being a part of 40 plus fitness.

Dr. Axe: 34:27 Hey Allen, thanks for having me.

All right. We are a whole month into the year 2020 kind of crazy how fast this first month of January just flew by, but now it's February and I'm happy to announce that I'm opening up three slots for one-on-one clients at 40+ Fitness. So you can go to 40plusfitnesspodcast.com/apply and that'll send a message to me to let me know that you're interested and we can have a conversation about rather one-on-one trainings for you with one-on-one training. You get everything that you would get from a personal trainer except counting the reps and that makes it very cost effective. I have an app, so you'll have workouts that'll give be given to you through your app. You'll have constant contact with me with the messaging and email through the app. So again, go to 40 plusfitnesspodcast.com/apply to learn more about working with me at 40+ Fitness.

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch	– Jeff Baiocco	– Melissa Ball
– Barbara Costello	– John Somsky	– Melissa Cardinali
– Bill Gioftsidis	– Judy Murphy	– Tim Alexander
– Debbie Ralston	– Leigh Tanner	– Wendy Selman

Thank you!

Another episode you may enjoy

The bone broth diet | Dr. KellyAnn Petrucci

Less...

Allan: 01:00 Dr. Shah, welcome to 40+ Fitness.

Dr. Shah: 01:04 Thank you. Thank you for having me on the show.

Allan: 01:06 Now I really enjoyed reading your book, the book we're going to talk about today, Heart Health: a Guide to the Tests and Treatments You Really Need. Part of the reason is, you know, being in my fifties, this is kind of the time when a lot of the conditions that have us thinking about our heart start popping up, you know, heart attacks, and all the other things that can go wrong with your heart, stokes and things like that. We're reaching that age where we're seeing it happened to our friends and family that were right around this age. And in some cases people lost their parents around this age. So we start to think about, well, how healthy am I? You know, you would just think, well, I'll just go in and get these tests done every once in a while and then I'll know I'm good. But that isn't always the case.

Dr. Shah: 01:53 Absolutely. And that is one of the key points of the book that just because we get a test done and the test says you're fine, doesn't necessarily mean that nothing will go wrong. We have progressed quite a lot in that understanding of heart diseases. However, there are things that we can predict and things that we cannot and even after a normal test, people can have problems. And on the other side I would say just because you have a normal test doesn't mean that you are looking at an impending doom and gloom. You have a lot more control, you have lots more time and you've got to use it effectively to gather all the information before reacting to it.

Allan: 02:49 Yeah. I think that's really kind of where that when you start talking about heart disease and particularly when it's happening in the moment, it is really hard to kind of take that step back and think about it objective. Because everybody just knows when the last beat of your heart is the last beat maybe. And so people tend to want to fix it now versus taking that step back and thinking about it. And that's what's really cool about the book. As you had stories in there of individuals that were, we're going through different things and then different protocols were promoted and they either did it or they didn't. But some of them were rushed into decisions and some, you know, had the wherewithal to get the second opinion. So if I go into the doctor and the doctor tells me there's some problems and they want to do a procedure, it could be, you know, putting in a stent or do even a bypass, we should get a second opinion. Right.

Dr. Shah: 03:45 So you started off really good you said you go into a doctor's office and that is a critical thing to remember. You went walking into the doctor's office, that's a different scenario and he pointed out to be a good place that you have enough time to get a second opinion. Now if you went into the emergency with chest pain and the EKG show or showed that you have, you're having an active heart attack, that is not a time for us. So that's the book tries to give you the new one's version of it, but you're absolutely right. You go to the doctor's office, tell them, you know, I've been having chest pain when I walk but I'm under a lot of stress and the doctor says, let's go ahead and do a stress test it's a noninvasive test. They're not going to poke inside your body. They're not going to put gas.

Dr. Shah: 04:49 Very good test to start. However, even in this situation, we're trying to get a second opinion and slow down the crane. In some cases, you know, I have known 40-year-olds who have been running five, seven miles a day, no problems at all, and then they started a different exercise and now they're having chesting pain the rest to a stress test and that patient the same stress test may not be necessary. However, somebody who does not exercise that much and starts exercising and starts noticing chest pain with exercise stress test may be necessary so in either case you have enough time to get a second opinion.

Allan: 05:38 Yeah. One of the things I think that was was really important as I started going through the book and you stress this time and time again is if, if a procedure is recommended, you really want, you want one or two things to happen as a result of that procedure. You either want to know that because of this procedure I'm going to live or and or that I'm going to have a better quality of life. Can you talk a little bit about that?

Dr. Shah: 06:03 Yes. Thank you for giving me these two very critical things. As a doctor, there are only two things that we can do for you. We can either prolong your life or make the quality of life of your life better. So no matter how bad the pictures are how fabulous the technology is. As a patient, you really have to know does it need one of these two end goods live longer or live better? Then so if you went into the doctor for what I would call a well baby checkup, annual physical or a wellness check, meaning thereby you do not have any symptoms, any tests that is being recommended you really have to ask, is this going to make me live longer? Because remember, if you do not have symptoms so the patient can, the physician cannot make the quality of your life better, but if we can improve the quantity of your life, meaning that they are longevity, then you don't want to undergo that test.

Dr. Shah: 07:18 That test is not going to make a difference. You really have to question, no matter how fabulous the technology is, how convincing the logic is. If you do this, then this happens, then this happens and this happened. All of that becomes more and more farfetched at the bottom of the day. You want to know does this make me live longer and if you are having symptoms, will this take away my symptoms? Is it likely, particularly my symptoms and only then you want to undergo that and you know, I would say even with that, you do want to ask the physician is there a simpler way to accomplish the same thing and you would be surprised how often a more simpler approach can sometimes accomplish exactly the same thing. We know from studies of the studies now that in majority of the cases, medications accomplish exactly the same as a bypass surgery with medication. You know, so you always will, ask the physician, is there a simpler way to accomplish the same group?

Allan: 08:28 Right. So, you know, being older, you know, I do go in for wellness checks and if my doctor had recommended to me, Hey, you know, you're over 50 now, let's, let's do a stress test. And no, I haven't had any symptoms. I haven't had any problems. I only had one incident where I thought I had a problem, but it turned out to be basically my sodium got too low and I went into the emergency room with chest pains. And that was really because I had had an episode of a seizure. And then during that seizure kind of strained my chest. And so to me it was, you know, I was feeling really bad because my sodium was low and as soon as I went in and you say the word chest pains, it leads to a whole, a whole set of protocols.

Allan: 09:11 You're taken straight to the back. You're given a nitroglycerin and they're putting you on a drip there. They're checking your heart rate. They've got you on a machine like that. And so it turned out it was just, it was dehydration and low sodium combined was what mine was. Now had they told me after that you probably should go do a stress test. I wouldn't have known any different. I would just said, okay, well my doctor said I need to do a stress test. So I think it's important to know that, you know, do you have symptoms that are okay? There are some of the heart attack symptoms, but if I have to agree, okay. The doctor says, okay, you should go get a stress test. And I agree. Tell me about what, what does a stress test entail? You know, what does it like and what's it going to tell us in the end?

Dr. Shah: 09:52 Right. So a stress test is performed to increase the activity of the heart, so as to increase the oxygen requirement of the heart itself. And under that stressful situation, if the heart muscles which are now requiring increased oxygenation do not hold up, then it indicates to us that there are some blockages to the blood flow. To the heart itself and the way to accomplish that is ideally to walk the patient on the treadmill, well connected to the EKG machine and look at how the EKG or ECG changes take place. And if there are some changes then that is concerning. However, if the patient is able to walk 10, 11 minutes and has no chest pain whatsoever, the EKG does not show any abnormality. Then they know that their heart is able to work under this stressful situation. Beach indirectly tells us that there are no blockages.

Dr. Shah: 11:05 So the idea of stress test is where you would maybe walk on the treadmill with EKG connected to you and somebody's observing the EKG or blood pressure and your heart rate. Sometimes there are additional testing added on to it where you get injected with radio active dye which is injected when you are at the peak of your exercise and then you're put under a camera where the emission from the radioactive dye is picked up and it hurts us. Understand if there are parts of the heart that are not receiving blood supply. Once again, that indirectly tells us that may be blockages in the heart artery. That's the typical stress that is performed and it is performed to figure out if there is a chance that you have blockages in the heart artery.

Allan: 12:02 A lot of times if someone's had an issue in the past or a doctor just feels uncomfortable and you're going to go in for a surgery for something entirely unrelated, they may make you required once you to do a stress test. Should you try to get a second opinion, should you try to talk them out of it if you've had no symptoms or is this something that maybe you just want to go ahead and do?

Dr. Shah: 12:21 No, I think I'm American college of cardiology and American heart association is very clear about the fact that in rare high-risk surgery you need a cardiac clearance and a stress test prior to that. Outside of those rare surgeries for 90 to 95% of surgeries, you do not need a stress test, to undergo orthopedic surgery or a back surgery or what have you. And so for majority of the cases you do not need a stress test. And I would strongly urge you to get a second opinion before you undergo that stress test because the chances of that stress test veering you away from what you really require, which is that surgery, it will just point to a different direction. And as you've read in the book, it will lead you down a path that you will not want to go. And that is why American college of cardiology is very clear about the fact that majority, I mean the overwhelming majority, 90 to 95% of surgeries do not require a stress test prior to undergoing the surgery.

Allan: 13:37 Yeah. You had a story in the book where a woman had torn a ligament in her knee and as a result, she wasn't able to be active like she wanted to be. And obviously if you're not active, you a trophy and, and so she couldn't, she couldn't walk with her friends. So she was missing the social aspects and the fitness aspects of it because she failed a stress test.

Allan: 13:58 Then they were like, okay, well, you know, I think she went on for other procedures and, but she had to wait a year before she could come get that surgery. That's, you know, a year of, of inactivity. Scary. And so that was definitely not going to extend her life or improve the quality of her life. It was really of cause the exact opposite.

Dr. Shah: 14:17 Exactly. I mean, she been for a stress test that was not acquired then she had, she was asked to undergo this cardiac catheterization and she had complications from that. And from that point forward it just went into this cascade of negative events where she was not able to get surgery that she required for almost a year and had she not gone through stress test like it is recommended by the American college of cardiology. She would have gotten the ligament surgery and went on to be active back again, which would have done more good than all this additional testing.

Allan: 15:01 Yeah, so if I go through as far as stress test and the doctor finds something abnormal and they say, okay, we need to do this next procedure. As the cardiac catheterization you spoke about, can you talk about what that is and how they do it and what we can find out from it?

Dr. Shah: 15:15 Yes. A catherization test is an invasive procedure, meaning that the doctor is going to get inside the body, they will number the area around the groin where one of the major artery is, sometimes they can use the major artery in the arm. And once they get access into the artery, they put a catheter, a small, tiny long plastic tube that goes into the heart artery and they inject dye into it by taking pictures of the flow of the dye under the camera. And by getting several pictures we understand where the blockages in the heart arteries, based on where the blockages are we can further prescribe the right type of medicine or discuss the possibility of stints or discuss the possibility by-pass surgery, depending on the pump or not the blockages it tells us a lot about the blockages in the heart.

Allan: 16:25 And again, it's one of the things I really like about your book is after you've had that, you know, that initial test or you know, then the second follow up the catheterization test, your book goes on to say, okay, here are some of the options that you might be presented. There's medication, sometimes there's bypass with medication and it gives you the questions to ask your doctor. So as you're facing these things, I think your book's an awesome resource for someone because it answers a lot of questions very, very easily. And then you can ask your doctor the right questions, you can get your second opinions and you can make sure you're doing the right thing to increase your longevity and quality of life.

Dr. Shah: 17:02 Absolutely. And thank you for bringing that up because on the web, what I notice is that there are a lot of generic questions which may or may not apply to your specific situation. So I have wanted to equip my readers with very specific questions for that particular procedure, which is pertinent so that the patient in the position exists, that willing to be an active process. You are willing to be part of the healthcare team and not just a passive sit here.

Allan: 17:36 And let's hope, again that's your physician is a, is a main role to you having that and being a part of that team. Cause if that physician is not you, you might need to find that another physician.

Dr. Shah: 17:47 Absolutely. I agree with you completely.

Allan: 17:49 Now you, you, you kind of mentioned Dr. Google, you know, people love to go on dr Google and self-diagnose. We also love, love, love to wear these tools to measure everything. You know, so the Apple watch and some of the other things that are out there, you can know how well you sleep. You can know how many steps you take in a day. You can know your heart rate every single day, including, now I guess Apple watch does an EKG for you. If someone has one of these watches on and they start noticing and an abnormal rhythm or you know, something going on and their watch is kind of, is that something they just definitely need to walk into the doctor and start having some conversations or is it something that they should just sorta say, okay, I get it. I don't have any other symptoms but the watch is telling me there's something amiss.

Dr. Shah: 18:38 Yes. So there are a few aspects to it. I will mention. So if you are having symptoms and it correlates with the EKG section or the heart rate section of your wearable device showing abnormality, if those two concur, then there is good reason to go to the doctor and get checked out. Secondly, there is a condition called atrial fibrillation. Unfortunately, as we age, a lot of us become familiar with that term atrial fibrillation. And what we know is that people who have atrial fibrillation have an increased risk of stroke. And so if the Apple watch is talking about the possibility of atrial fibrillation based on the EKG, then you do need to get checked by a physician. Maybe get another monitoring gadget that they can look at and figure out if it is indeed interpolation. And if so, how does it need to be treated because of the increased risk of stroke.

Dr. Shah: 19:54 There are things that we can do to decrease your risk of stroke. So from that standpoint of is critical. However, the other aspect I would also say is that people don't need, to me these variable devices, the source of their anxiety. Please know that nature has given you one of the best gadgets to assess how your body's feeling and that is your own self, your own understanding of your body. If you notice that every day you've been able to walk five months and for the past two weeks at two miles, you're just getting by tells you're huffing and puffing. That is enough reason. That is more of reason to be concerned well and beyond what the Apple watch tells you. I think we understand some of the technology, we understand some aspects of how the heart functions and how our body functions, but it is all in combination.

Dr. Shah: 21:05 Just the heart rate by itself doesn't tell you the complete story. Just the EKG by itself doesn't tell you the story. That is where physicians can put things together for you and say, is this critical or is this not critical to be addressed. And sometimes the treatment can be worse than the disease itself. And I want the listeners and the readers to be open to a conversation that isn't something that is so bad that the treatment will make it better. Is if six or one and a half dozen of another well was treatment as well.

Allan: 21:46 You know another interesting thing that comes out of these wearables, it's a conversation I've had with one of my clients. He has a resting heart rate in the low 50s and I have a resting heart rate in the high 70s. And so, you know, if we go and we look at that formula where our bodies, and our watches are saying, you know, stay in this zone. He can't, he can't get to the zone. He can go 100%. His perceived effort level is 100% and his heart rate just will not get up to pass one 41 50. It just, just won't mine, I could get my heart rate up pretty quickly, but I also don't feel full exertion at 177 or 180. I can actually exert past that for a sustained period of time. And, and I try to, you know, I try to explain to folks, it's like, okay, this is a formula that works for a lot of people, but not everybody. So can you talk about where this max heart rate thing came from and how it kind of blew up into this,fitness craze of people thinking that they have to be in this magical zone all the time?

Dr. Shah: 22:48 Absolutely. so that is a very interesting story. You know, in the 1930s and 40s, doctors have promoted this idea that any kind of activity is bad for your heart. Patients with heart condition used to be told you need to rest. You can't exert yourself too much. You can't have too much stress. You can't argue with people and so on. And then as time went on in the 50s, the people started realizing that people are actually doing better when they're exercising. So the world promotion of exercise came into be a jogging was promoted and so on. And at that point in time, burning question in the physician community and cardiologist community specifically was what other heart patients who have had surgery for the heart condition, what kind of exercise can be recommend safely. So that was a burning question that was brought up time and time again.

Dr. Shah: 23:54 And the health services department knew that they would be asked this question during a certain meeting. And so at that point in time, what they did was the junior colleague was asked to collect some data regarding that. So he took into consideration 10 papers written about cardiac patients, young heart patients who had undergone heart surgery and what was the safe level of exercise and when they assessed this data in a very preliminary manner. They said, you know, there is this easy formula that we can come up with. It is 220 minus the age,based on what they observed. And so they went and spoke at the conference and when they were as expected as how much exercise can somebody do. Yeah. After having had heart surgery after having had heart disease, they said it seems that the safe level is to get to a heart rate of 220 minus age.

Dr. Shah: 25:00 Now even the people who were recommending this knew that even among the heart patients, people who had undergone heart surgery, this was a wide range. This was just a general guidance given. Just like what is an average human height. And we would say in the US it is 5'9″ or 5'8″. That doesn't mean that if I'm 5'7″ I need to get looked up about it. We immediately recognize that. And so then the experts assume that this would be recognized that this is not hard. And it's true. And this was the data only for patients who had a hand be at a young age. Father had significant heart disease. But as it happens, numbers are attractive. You know? So it just took a life of its own. So people put up posters in the fitness centers and gymnasiums and so on.

Dr. Shah: 26:07 And then there was wearable device made and show enough that industry has just exploded. So the drum beats of measurement and quantifying has just taken on a life of its own. Though this was never meant specifically for, this was never meant for the general population. So it is good to have a general guidance. However, do not let yourself be restricted just because of this. As I mentioned, nature has given us a much parameter, which is how do you feel? Are you feeling alright? Then go for it. Exert yourself a little more. If you're not feeling alright, it doesn't matter at what heart rate you are. That's body's way, nature's way of telling you that maybe there's something amiss and you need to stop.

Allan: 27:01 I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay, well?

Dr. Shah: 27:11 Number one I would say look at home care more than healthcare to make you healthier. And what I mean by that is regular exercise, quitting smoking, and eating a healthy diet. That would be the first and foremost thing that you can do at home to get the most bang for the buck. Now step number two would be to get a good assessment and control of your blood pressure and if you're a diabetic, of your blood sugar. That would be my step two. And step three would be to practice optimism, mindfulness and graditude. And I see all these three based on solid research evidence, which has shown that all these three things, to give you a much healthier heart, much healthier heart than otherwise. There has been tremendous research on optimism, gratitude and mindfulness and then to live 5 to 10 years longer and happier life compared to the pessimists. So I would strongly recommend your audience to consider these home care steps before approaching the healthcare system.

Allan: 28:52 Those, those were really cool. Thank you for that. If someone wanted to learn more about you, learn more about the book, Heart Health: a guide to the tests and treatments you really need, where would you like for me to send them?

Dr. Shah: 29:04 So my book is available anywhere books are sold. Amazon.Com, Barnes and Noble, Booka a million, etc. If you want to learn more about heart and all these tests and treatments, want to explore it a little more. Want to know a little bit more about me or want to communicate with me. I have a website called JShahmd.com where I have lot of information about heart conditions, pictures with videos and even if you're being advised for procedure, you're we have videos and written material that is not difficult to understand and so it could be worth looking.

Allan: 29:57 Okay, this is episode 418 so you can go to 40plusfitnesspodcast.com/418 and I'll be sure to have those links there. So Dr. Shaw, thank you so much for being a part of 40+ Fitness.

Dr. Shah: 30:09 Thank you very much for having me. Really appreciate it.

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch	– Jeff Baiocco	– Melissa Ball
– Barbara Costello	– John Somsky	– Melissa Cardinali
– Bill Gioftsidis	– Judy Murphy	– Tim Alexander
– Debbie Ralston	– Leigh Tanner	– Wendy Selman

Thank you!

Another episode you may enjoy

The heart is more than just a pump with Dr. Thomas Cowan

Less...

Allan: 00:59 Janet, welcome to 40+ Fitness.

Janet: 01:01 Hi Allan. Thank you very much for inviting me on your show.

New Speaker: 01:04 Now your book Medical Tourism is something that's been kind of top of mind for me lately because I get a lot of questions about why I moved to Panama. But before I get into that, I have to get into the subtitle, which is Surgery For Sale, How to have surgery abroad without it costing you your life. That was brilliant. It opened some eyes and I like that because we moved to Panama to save money in healthcare. And a lot of people ask why and how that works and if they have to move to a country to get those same benefits. And my short answer is no. But there's a lot of things to consider before you just decided to get on an airplane and go get some surgery.

Janet: 01:46 Definitely. And basically medical tourism is when people are thinking about traveling internationally to purchase medical care. And we're usually talking about surgery. So, and the thing with that subtitle of my book is that most information people see about medical tourism is the headline. A person comes back from surgery abroad and dies of something. So that's that information there.

Allan: 02:15 I remember reading about this decades ago when it was, I guess South Africa was kind of marketing themselves as the plastic surgery capital of the world and people were flying into South Africa. They would get their plastic surgery done and granted they needed about a week or so for recovery. So they're out doing African safaris as far as any of their friends or family or maybe even doctor knew, they basically just went on a Safari and came back two weeks later looking a lot happier, tanner and maybe with a smaller this or a bigger that. Yeah.

Allan: 02:56 So let's talk about medical tourism. Cause I'm really what I would call a medical tourist. I'm a medical resident, not a medical resident in the state of actually working at a hospital. But we traveled to Panama, we were looking at our, our health insurance, me being self employed and just the overall cost structure of what was going on with the rates, everything going up every single year, double digits in the United States. And you know, I was saying, well before I'm eligible for Medicare or any assistance whatsoever, I'm going to get costed out of this model and there's just no way I can afford medical insurance itself. Not to mention medical costs under my new profile of living. And so we looked around and Panama was one of those locations where medical care is high quality, it's low cost. And I can, I can tell some anecdotal stories both that we've experienced and others have experienced here that really are kind of our model now for healthcare. But when we're talking about medical tourism, we're actually talking about traveling to another country for the purpose of having a medical procedure done. Like you said, usually surgery and then heading back home typically to finish out the recovery there.

Janet: 04:06 Very true. Yeah. And it's usually because people are frustrated with the wait times for surgery in their own country. You know, it's like, and the wait times, they have serious consequences. You've got the increased pain, suffering, mental anguish, and sometimes poor medical outcomes because the longer you wait for something, there's the potential of that disease or illness turning into something that's irreversible and you've got a permanent disability.

Allan: 04:33 I had a colleague that was working with me and he was having shoulder issues and he was like, he was in a lot of pain and they gave him some pain pills and they helped with the pain, but he couldn't drive his vehicle and he couldn't focus on work. And so he went back to his doctor and his doctor's like, well, it's a six month wait for this surgery. And he was just at wit's end and he's like, I can't not work for six months. And while I don't know about the medical leave and how that actually works in Canada, in the United States, it's 12 weeks. And so he, you know, if he said he had to be off work on a doctor's note, so he can't work for 12 weeks, that's fine. If he has the time off and can afford to be away from the office that long, most people can't.

Allan: 05:20 So he was at wit's end of, fortunately being in Canada, he was able to fly from Calgary to Toronto to find a doctor that could do the in a place that could, they could do the surgery sooner. So we didn't have to leave. He was actually looking outside of Canada to have that procedure done because he just knew there was no way he could bear the pain and there was no way that he could do the pain meds and keep his job. And that was unfortunate. But it is just kind of a reality of healthcare today.

Janet: 05:49 Well that's true. I mean, and that's the thing, you know, people have to lose their wages while they're waiting for the treatment. And so the economic cost just adds to that stress and it's terrible. And just for some data in 2018 Canadians expected to wait four weeks for a CT scan or 10 weeks for an MRI or maybe four weeks for an ultrasound. And in that same data set in 2018, they were talking about 30% of patients who required hip or knee surgery or cataract surgery didn't have the procedure done within the recommended wait times. And so what you find is that people that have the time and the financial resources, they don't want to wait. They want to get ahead of the game and they want to go and they, that's why they're looking internationally for these things.

Allan: 06:38 And then in the United States, I think the base story is that well we have the affordable care act and I don't want to get into the whole politics of, of that. Healthcare is not really affordable. We paid much more for the same procedures, for the same medicines than we would elsewhere. So the opportunities for us to save money by traveling is pretty significant.

Janet: 07:01 Yeah, it can be very much. And the other thing, you know, what we find here in Canada, you know, it's a very diverse population and sometimes people would incorporate going back to their home country and staying with relatives to have surgery or procedures. So they, they will travel abroad, they'll, they know that that country, they could get their hip surgery or cardiac surgery or whatever much more timely and they've got the family support there that they need for recovery.

Allan: 07:31 And I think that's key. That's what some of the things that you brought up in the book because it was not a direction my thought process went naturally being a resident and having access to lower-cost healthcare, it wasn't something that I thought about, but obviously one I would not take my wife or myself to a clinic that I didn't feel was capable of taking care of us. And this, one of the things I can say is in doing research on this some of the things I found is like here in Panama, if you're concerned about the quality of care, one of the hospitals that I took my wife to here to have some work done is basically a Cleveland clinic. And people from the United States might not know that name, but it's basically one of the top medical establishments in the entire United States. They have an outlet in Panama. The doctors there are the same caliber. In fact, our doctor had worked in the United States including the U S military for over 31 years. And so the quality is there. Obviously, you know, our, our hospital here on our little Island, not necessarily all of that, but if we need something, we know where to go and it's not that difficult or time crunch for us to get to high quality care. And that's going to be the case in a lot of countries, particularly the countries that are really investing in medical tourism.

Janet: 08:48 Yeah. And when you're looking at the different facilities, you know, one of the things that we're concerned about is that if someone is considering being a medical tourist, is that they actually get informed consent about the medical procedures that they're going to receive abroad. Because what you find with most of these sources of information is that it's a marketing focus and they don't actually provide enough insights into the risks involved, not just with the surgery but with the travel and things. And so that's another factor to consider when you're looking at locations and doctors and things like that.

Allan: 09:26 And I want to go down that line because you, you mentioned a lot of really important things in the book. The like I said, kind of being a resident didn't really, they didn't initially think about was what if you have a doctrine in United States and that doctor says, okay, I'm willing to do the surgery in six weeks. That's when my next availability is and you find that you can go to say Mexico and enjoy a week there and have the surgery done come back. Is your doctor actually going to want to do post-care on a surgery he or she didn't do.

Janet: 09:59 Usually, no. You have to have a very good relationship with your doctor, whether it's your GP or your specialist before you go away and there's various reasons people are told they can't have surgery as well. So it might just not be a factor to do with the wait lists. Sometimes people are told that they're not considered for surgery because they have other, what we call co-morbidities, wherever other health concerns where a surgery wouldn't be good for them at that particular time. And so it's not necessarily just the doctor said you can't have this, it's you can't have this because it would affect this, this and this and this. So then if someone jumps and goes abroad for surgery and has surgery when they come back, these things that have been a concern in this country before they go, you know, might be exacerbated. So that's the other thing to consider. But definitely having that followup care arranged before you go, whether it's with your doctor, with a specialist, a physiotherapist, you might need ongoing counseling. So you're gone for bariatric surgery. You definitely need a lot of support when you come home from like a dietician or a forum, some kind of chat group where you will get that support because it's a huge lifestyle change.

Allan: 11:22 Yeah, I think a lot of people, if you're going in for something fairly simple, which most of the time that's not where you're going to get your bang for the buck. That's worth buying an airline ticket. Most of these are going to be surgeries and in many cases a pretty major surgeries like bariatric surgery or hip or knee replacement, something like that. Maybe even some plastic surgery, but usually again, something probably a little bit bigger. The recovery is something that's really, really important to think about. And are you going to have the family support to get you through that?

Janet: 11:52 Well, that's right because if you haven't got that psychological support, especially if we're talking about bariatric surgery, you know, if you go and have the surgery and you come back and you've got these extreme changes in diet that you have to comply with, but you've got someone in the family that's always saying, well, I've made this for you, eat this, or why don't you try that? It's defeating the object. They'll just wear you down and then it won't be successful. But if you've got people at home that are supporting you and encouraging you with the diet, with the exercise, with looking after yourself, when you come back you'll have a much better recovery and a much better outcome.

Allan: 12:30 Yeah, and another thing I got into you got into is a little bit about talking about your employer and obviously you're going to have to take time and potentially a good bit of time away from work because you've got to mix in the travel time along with the recovery time along with the surgery time. And I got to thinking we would, we would let someone off of work if they had a doctor's note and say, okay, I'm going to be out for three weeks for this surgery, but is your employer going to accept the doctor's note from a doctor in Thailand or do they think you're taking three weeks to vacation on, on FMLA, you know, and I'm on medical leave.

Janet: 13:04 Well and also do you want your work to know about it? If it is a plastic surgery or something, do you want work to know? So that's the other thing is it might be something that's very important to you, but you might not want everyone talking about it around the water jug. And the other thing is if you might have already been off work with whatever's causing you to have the surgery and then the surgery, you've had the surgery, but during your recovery you might need some kind of accommodation, reduced hours or working back into the system. And is your workplace going to be able to accommodate that?

Allan: 13:39 Yeah. Well under I know under us law there's a, there's a thing called family medical leave act, FMLA, and it specifically kind of puts the parameters of how an employer treats an employee relative to their medical care to include. Then there's HIPAA. So if you have a medical issue, you should be able to go to your HR or whoever that is that would be handling that for you and your company. Give them the basic information that they need to know along with communication with your doctor and that's supposed to be a very protected area. That information is not supposed to be circulated. So it's not water cooler stuff, but just recognizing that the law is pretty specific about, you know, coming back to your job, how long they have to hold your job open, what kind of accommodations are they required to do and which ones are they not. So working carefully with HR to understand what your rights and responsibilities are, I think is a huge consideration as you go into this.

Allan: 14:39 So someone decides, okay, I definitely want to have this procedure done. My knee is bothering me, my doctor says we're not going to do this surgery until you're 63 and that means for like, if it were me, it's like that's 10 years of constant pain in this knee. If that were the case, I don't, I don't have any problems with my knees, touch wood. But if I did and the doctor says I'm not willing to do this surgery until you're 63 and then I find a doctor or find a physio and say, okay, I'll do the followup. If you go get the surgery in Panama or Thailand or wherever, Mexico, how do I decide, because again, I just listed three countries. There's different costs, structures to those. Obviously different doctor facilities available. There's just a lot of information to kind of pour through. How, how do you decide what doctor, what location and when, how do you, how do you do that?

Janet: 15:32 Well, that's what I say. I'm think one of the first things we need to touch on here is that does someone want to organize this themselves or not? Because if someone can organize their vacation really well and they always have great places to stay and stuff like that, that's great, but if you're someone that every time you book a vacation, the hotel you get is half built when you get there and there's no taxi, you have to really consider are you going to do this yourself or are you going to get something what they call a medical tourism facilitator to organize this for you. And that we can talk about afterwards as well. There's, there's a whole other problem associated with that, but things that you want to look at is how far away is the facility and will the travel to the facility you're thinking of determined, you know, it'd be detrimental to your condition before and after surgery.

Janet: 16:22 Because if you are going to be on a flight for six, seven, eight hours, just in normal fly in, there's the chance of deep vein thrombosis, which is a clot you can get in your leg and that can cause all sorts of problems. Now if you're already having problems with joints and things like that, that long flight is going to be a problem to start with. And a long flight before you're going for surgery is definitely gonna be a problem. And then after the surgery, depending on what surgery you're having, you can't fly straight after surgery. Like if you've had gastric surgery, you can't fly within a few days because the gas that they put into your abdomen for the part of the surgery has to be completely dispersed because otherwise the pressure in the airplane can create problems. So there's things like that. How far is the facility you're looking at to travel to. And also if you're going to another country, do you speak the language?

Janet: 17:22 So if you don't speak the language, how are you gonna communicate with the staff? If they have limited English is your first language. If they have limited English, how are you going to communicate them, especially when you're stressed and you're in pain. So it's things like that. And then again looking at the facility, are the surgeon and the staff licensed to be practiced in in the country that they're practicing in? If they've got the right credentials. And is the condition and the related surgery a familiar position, or procedure for them or is it something that they are just doing for a few months just to make a bit of extra cash. And then do you have contact with the surgeon pre and post op. So it's really nice to know who's doing your surgery and lots of facilities, whether you're doing it yourself or through a medical tourism facilitator.

Janet: 18:17 You're quite often have like a Skype call or at least a phone call with your surgeon before the surgery so you can get some kind of feel for, you've got some rapport with them. And then when you're looking at the facility, you want a facility that's accredited by an international certification agencies, something like joint board, international, Canadian international standards because you want that facility to be run to the highest level as far as cleanliness, staff certification and follow up like that. And then when you've had your surgery, will you be given reports of your surgery in a language you can understand to bring back home because that is going to be really crucial to your followup care. If you go to Mexico and you have a surgery and they give you your surgical report and it's in Spanish, you know, and no one can read it. Or if it's handwritten and no one can read it, you can't get your full out care done until that's been translated and transcribed. So it's things like that that you have to consider.

Allan: 19:25 Yeah, and so it's not just location. It's cool. You can say, I want to go to South Africa and have this cosmetic procedure done and then after the recovery or during the recovery time, I'll still be able to do this safari and I'll be able to go and see the beaches and then I'll travel home with a little bit of a tan and, and the surgery done. But if your recovery is going to be much more difficult than that, you have to consider that in the whole math of all of this because it's not just a pick a doctor and go, you've got to kind of do your homework.

Janet: 19:56 I think as well, you have to dispel the fact that it is a holiday. It's not a holiday, the phrase is medical tourism. This is not a holiday. This is not a vacation. You shouldn't even plan to be looking at the country and doing it. Because I think as we touched on briefly when we were talking, if you start doing trips tourist type trips before your surgery, there's a potential for you to get some kind of acquired effect infection while you're wandering around. You might eat the local food, drink the water, you might get some kind of infection or illness and that will delay your surgery. And you also got to consider most people take a caregiver with them, a companion. And what happens if your companion goes off and does touristy things and they get sick while you're away. And that's a whole nother level of stress.

Allan: 20:48 You took me on this great trip to Panama and then you got sick and I had to look after you. I basically get to sit in a hotel room and hang out with you. I don't get to actually see anything. So yeah, I totally get that as like, Hey, come down to Panama with me. It's like, Oh no, I don't want to just sit in a hotel room with you. I could do that anywhere.

Janet: 21:11 Well, and also you have to be very careful about who you choose as your companion because this is a medical procedure. You're going to be talking about some very personal things and do you want your golfing buddy, which is great to play golf and sit in the bar afterwards and yak up a storm, but you want that person in when you're being asked about your bowel movements or things like that.

Janet: 21:34 And also do you know this person will actually function in a medical facility because there's lots of people that they're the good guy, the good woman or whatever, and they walk into a medical facility and they just close up. They are totally overwhelmed with it. They don't deal with it. And so you really need to be sure who's going with you that they can be your advocate, that they can speak up for you when you can't because we'll beyond the facility.

Allan: 22:01 We've talked about this before we got on the call and it's true. Most Americans have no desire or ever will travel outside the United States. They don't even own a passport. And so you take someone who's never been outside the country, doesn't speak the local language, and while you might be able to speak the language fluently and you gave them a medical power of attorney, when the doctor comes out there and starts speaking to them and trying to explain to them what extra thing needs to happen, are they going to be able to handle the stress of being in another country having to deal with, even if it's not a language barrier, just a pronunciation issue that's asking a lot.

Allan: 22:40 So this has to be someone that you really trust, someone you know that's going to be comfortable in not just the medical perspective, but just being out of their element. Because traveling outside the United States, if it's your first time is already pretty stressful.

Janet: 22:53 Very true.

Allan: 22:55 So you talked briefly about medical tourism facilitator, and this is a little bit more than just a travel agent. Obviously they'll do a little bit of that for you too. But their job is to kind of make this process of the looking and doing the research and understanding what's going to happen and how it's all supposed to work, that they'll do a lot of that work for you.

Janet: 23:17 Definitely. And again there's all ends of the spectrum involved in this. What you want is a well established medical facilitation company and so ideally someone that's not just linked to one facility because you want someone that's got your best interest at heart that it's not that they're just sending you somewhere cause they're on commission for it. So you want someone that when you go to them and say, look, I'm looking for knee surgery. I've been thinking about going to Panama. What can you suggest? They need to discuss with you? Well, why are you thinking of Panama is an eight-hour flight away, whereas this is other hospital that's four hours away from you. Where are we could get something similar. It's someone that's got your best interests at heart, so they're looking for the best deal and the best surgery and your best outcome. Not, okay, I'm going to put you into this hospital because I get the commission from this and from the airline, from the hospital or from the taxis, whatever.

Allan: 24:17 Yeah. And so understanding who you're working with, and one, how are they getting paid, who are they loyal to? Those are all really, really important. And again, like you said, they're experienced in doing this.

Janet: 24:30 I mean, because someone, someone can be a travel agent but they can't arrange the surgery and someone can work for the surgical facility, but they can't arrange the travel. So you want someone that's got that qualification where they can put both of these together. And there are lots of really good companies where you have the initial conversation with you, they set you up, you decide what facility you're going through and from the choices they give you, you have the conversations with the surgeon. They have, sometimes companies have someone that will go with you. So instead of you find it a companion to go, they have someone that will travel with you and be with you through the procedure and come back with you and they take care of making sure that you have all the documentation to bring back with you and that it's translated and they sometimes do followup for like six months so that they check in with you afterwards to make sure you're getting that follow up.

Allan: 25:26 Not to even mention visas and everything else because that's a whole other animal as you're traveling internationally is making sure that your, when you land, they actually let you stay. Now we talked briefly, you're in Canada, so you're under a program there with your national government, in the United States we have national, when you get to the age of 63 or 65 or 67 I forget where the age is right now that you'd be eligible for Medicare, but because it just seems like 10 years, 15 years from now, I don't even know. But one of the main reasons I came down here was because when I got my insurance quotes, it was $1,600 a month and I'm going to count it by trade. And there's a rule of 72 which basically says that if something's going up a certain amount, you can expect it to double based on multiplying that by 72 so at a 10% increase, which was conservative, I was looking at my insurance doubling every 7.2 years.

Allan: 26:25 So if my insurance doubled every 7.2 years before I was eligible for Medicare, it would quadruple. It would double and then double again or even more. And so I was looking at healthcare costs well in excess of $5,000 a month. And that's, that's not even the medical procedures, copays, percentages, anything. That's deductibles, that's just for the insurance. And I was like okay, that's, that's not sustainable. I can't just keep staying in this rat race. That's part of what I was getting out of it for. And I don't want to make my wife have to do the rat race cause she doesn't want to either. We want to live simpler lives and that was part of the choice to come to Panama.

Allan: 27:06 We were talking to a realtor here and one of the cool things he said was he broke his ankle. Not cool thing, but he went over to the mainland. It's about a 30 minute boat ride from here. He went into the clinic there, they x-rayed it, they set his ankle, he went back for two follow up visits. So he did have to ride, drive his boat over there and back a few times. I'm not difficult. Like I said, half an hour, easy boat ride. He did that and his total costs for the entire procedure, including the X rays and everything was $250. My wife had x-rays for x-rays of her knees and total costs with x-rays was $130 and now she's still having problems with the knees and she wants to go in for an MRI. The MRI is $400 so out of pocket is sustainable here. Which is part of what we love about it now, we did buy these international insurance plans. Basically it works everywhere, including United States. So if I went into the United States and had a medical procedure, I've got a $5,000 deductible, so I hope I wouldn't hit that. But if I did, I know I've got insurance for something catastrophic. So I'm buying this catastrophic plan that I wouldn't be able to by living in the United States.

Janet: 28:16 Right. And I think one, one of the things about people that are looking for surgery abroad, one of my big concerns has been is what insurance they get to cover them when they're abroad. And for six years I've tried to find places that would cover them, all the big companies and that and no one would touch it. And just a couple of weeks ago I found a company here that actually has medical tourism coverage and benefits and it's really interesting because when you talk to people, as we said earlier, most people think, Oh, I'll just get travel insurance and that's it. But that's not going to cover it. You really need something where you're saying you're going for a surgical procedure and that insurance is actually going to cover anything that might go wrong where you need to come back, whether it's you or whether it's your companion and not just flying you back but covering you for maybe six months afterwards because something could happen that you get a complication, you know, a few weeks, a few months afterwards and does that insurance still kick in and this, this coverage actually seem to do that.

Allan: 29:21 And so I think that's one of the cool things is that as medical tourism is kind of growing, these insurance programs are coming about when folks do hit Medicare age. One of the programs we can buy into here is basically medical evacuation. So if we have a heart issue or something significant and just don't want to go to Panama city for it and we want to go back to the United States and utilize Medicare for example, we can have a policy that basically says in the event I have a problem, heart attack or stroke or whatever, I can be medivaced and my spouse with me to the United States and they'll take me to Houston or Miami, whichever is the most cost effective, and then I can be admitted there and they can deal with the issues. So there are these opportunities, they're forced to use the insurance.

Allan: 30:08 And I think it's something that you do have to think about because you may say, I've got the $7,000 in the bank to go down. I got my airfare, hotel, lodging, everything covered, food and the surgery. But if you end up having an infection or a complication during the surgery and you're going to spend an extra five to seven, 10 weeks, whatever, in the hospital there, do you have that? And so insurance is something to consider as you get into this because your insurance from the United States, and probably from Canada may not cover those costs and you're out of pocket on all of those.

Janet: 30:42 Very true. Yeah.

Allan: 30:44 So if someone's thinking about this and considering this, what are some of the most critical points that they should consider as they really get into it, cause we've talked a lot about talking to your doctor, making sure your family is engaged, having someone there with you, understanding the true cost of what this is. Because it's not just how much is the procedure, but what would you say if they're going to do this, what's the most critical aspects that they should just have top of mind throughout the whole process?

Janet: 31:10 I think I would say safety and that insurance coverage I think is a very good blanket too to wrap themselves. But also that checkout the facility, talk to people that have been there if you can and people that have been there recently, not someone that was there five years ago, someone that was a last week, last month, and find out what their experience was because staff change, things change. Find out about the travel arrangements, where you're going to travel. Are you going to be staying in a hotel before your procedure? Then you're going to be in hospital. Then you're going to be in a hotel for a few days afterwards. When you're in the hotel, is there someone going to be coming to check your dressing? Are you going to have drains associated with your surgery? Someone coming to check them and take them out? Will you see the surgeon the day of the next day after your surgery? Who will be telling you when you can travel home? What physiotherapy do you need? What changes of diet? These are all the things that you have to take into consideration.

Allan: 32:10 Yeah. And, and one of the cool things, like I said, in the community here in Panama, there's these open forums, these forum groups. And so you can get out there and I'm pretty certain on Facebook and otherwise there's forums of people that are doing exactly what you're trying to do, exactly where you're trying to do it. And there are a wealth of information. The same questions get asked over and over sometimes on these forums, but we put up with it and we answer the questions. But you can search these forums. Facebook's made that a lot easier to do these days. So take some time, do that base research, get to know some people. Because what I've found is internationally people just really want to help each other out. If they've experienced something that they want to share that information and help others. So reach out. You'll find folks that have gone through exactly what you're trying to do and they'll be able to give you some really good information, really good tips and steer you away from some potential problems.

Janet: 33:00 Yeah. And I think it's also very crucial that people make sure they've got followup when they get home. That they've arranged that there is a doctor that's going to see them when they come home or a surgeon, you know that someone is going to check their dressings if they've still got them, they're going to get the physio therapy cause it's usually takes a while to get into these appointments. They need to book their physiotherapy for the followup when they come home, if they've had kind of joint things happening and they have things in place. I mean and it's the day to day things as well. If you're coming home from surgery, is there going to be someone there? Is someone going to help you with the shopping, the cooking, the laundry, the cleaning. You're going to need to go to medical appointments. Who's going to take you there while you're away? Who's going to look after your home? If you've got pets, they look after who's going to water the plants. It's all of these things because you don't expect anything to go wrong, but if there is a problem, you want to know that everything's taken care of at home while you're away and also that you're taken care of when you get back. You have to line all these things up. It might be as simple as if you know that when you come back, you're not going to be able to reach the top cupboards of the kitchen. You move stuff down in the kitchen so that you can work on the top surface or the lower cupboards. Basic problems like that that people don't ever consider.

Allan: 34:18 Well and they need to. I think that's what we're really kind of coming out here is there's like a huge opportunity, opportunity to save time to get things done sooner, opportunities to save money. But you do have to do the homework. You do have to think through these and be really logical and get really deep on understanding what your process could and may look like because it's not necessarily going to go to plan. So are you in position where you can actually manage through all that? So it was a lot more considerations than I actually had originally thought this conversation was going to have before I read your book. But I really appreciate that you took the time to really go through that in detail. And so the book is called Medical Tourism and I do encourage anyone that's considering it to check out that book. But I have one last question for you, Janet. I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay well?

Janet: 35:15 I think we have to be easy on ourselves. I think all of us can improve our health in some way or another. And I think it took us a while to get to the state we're in where we think we need to improve our health. So we need to be easy on ourselves and take small steps towards changing lifestyle and eating habits. Because if you do things drastically, you're not going to do it. If you're going to cut out everything to make these huge changes, you're going to resist it. You're not going to do it. And I think that you need to be working every day towards that health goal. So if you're thinking about increasing your exercise, you know, you might be thinking about walking, so park your car a couple of blocks further than where you're going and increase the distance you walk and increase that distance every day, every week or every month. Use the stairs instead of the elevator. Take it gradually so that if you're on the 15th floor, you don't try and do 15 floors in one day, but go up a few flights at a time, you know, then take the elevator, just work up to it. And that mindfulness, I think we all need to have some quiet time. We need to take some time each day to be away from electronic gadgets if possible to do maybe 15 minutes of meditation. And that just kind of resets us and of course really important to get enough sleep.

Allan: 36:29 If someone wanted to learn more about you, more about your book, Medical Tourism: Surgery For Sale, where would you like for me to send them?

Janet: 36:37 I have a website, so it's www.areusafe.ca and that's got information about my books on there. There's also, if you go on there, you can register and download a free checklist of questions that you should be asking for a facility and there's information about the medical tourism company that I mentioned so that that's on that site as well.

Allan: 37:09 Okay. Go to 40plusfitnesspodcast.com/417 and I'll be sure to have the links there. Janet, thank you so much for being a part of 40+ Fitness. Thank you very much. Good to talk to you.

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Tim Alexander	– Judy Murphy	– Melissa Ball
– Barbara Costello	– Debbie Ralston	– Leigh Tanner
– John Somsky	– Anne Lynch	– Bill Gioftsidis
– Wendy Selman	– Jeff Baiocco

Thank you!

Another episode you may enjoy

Undoctored with Dr. William Davis

Less...

Allan: 01:00 Dr. Agatston, welcome to 40+ Fitness.

Dr. Agatston: 01:03 Great to be with you Allan.

Allan: 01:04 Your new book. It's called The New Keto-Friendly South Beach Diet and I want to say, okay. I knew about the South beach diet, but it came out at a time in my life when I didn't really have to think about what I was eating or what I was doing, so I was familiar with it being, you know, kind of a more of a whole food protein style diet. Not dissimilar from some of the other stuff that was out there like Atkins and whatnot, but still very effective. A lot of people that I knew that did the South beach Diet really got good effect.

Dr. Agatston: 01:33 Yes, and I must say you weren't that interested the I was not that interested in diet. I was always thin until I realized I was, well I didn't realize it then, but I was addicted to sugar and I was pre what I call pre pre-diabetic even though my blood sugar is, everything appeared normal. But I, once I got off the bad, carbohydrates and sugar, I lost weight and it was I guess in my early fourth reason. I know, I love your show that 40 plus fitness because things change as we age, we get more fat, less lean body mass, less muscle and bone and exercise. The proper diet becomes more and more important as we age. Although our youth today are in big trouble with their diets. So it starts early, but it is tougher, is tougher as as as we age.

Allan: 02:35 Yeah. And I definitely want to get into some of the warning flags and things that we can look to before we get there. Because again, yeah, the doctors are going to say, Oh, you're a A1C is fine. Keep eating the way you're eating. That's not necessarily the answer. Because historically, I mean if we look back and you think about it and you, you talked about bears hibernating, but you know, in a, in a sense, human beings, we went through feast and famine ourselves, you know, and we would get into that. We get into that same season when when the bears fattening himself up and we're finding the berries and the nuts and we're, we're just gorging on that stuff. So our, our bodies were kind of pre-wired to put us into, for lack of a better word, what you call it. You were doing it like bingeing like you would eat a part of a blueberry pie and then you'd go back and eat the rest of it. I think that's just natural for us to do.

Dr. Agatston: 03:28 Yes, I love the, I do love the grizzly bear analogy. We're always either storing food for either an overnight fast when we're going to sleep or you know, in our history it was more often for times of famine and it's all mammals, but it's really almost all living. Ever since we became multicell cellular organisms, we had a, have a way of storing energy to use when there was no energy available from the environment. And so the fat storage mode where when we eat, whether carbohydrates, sugar turns into fat, other than what we're burning for our immediate needs and it's stored as fat and to some degree has starch or glycogen in our liver and our muscle. And usually we needed that not only when we slept and more eating, but we never had the luxury of three meals a day.

In most of our history. We were in a sense doing intermittent fasting, which gave us time for our insulin levels to go down when we ate our insulin levels go up, we store, we store storage in fat, and when it goes down, we burn it for energy. And that important survival mechanism has been totally upside down. When we have only the feast, we don't have famine. And so we're storing fat indefinitely and really creating physiologic problems that we never had in our natural existence. And it's most recently it's the abuse of sugar, high fructose corn syrup, which is, has been important because when it was introduced, it was ubiquitous really in everything and often a hidden killer in a sense. And our intake of sugar went up tremendously, really starting in the 1980s at the beginning of our obesity epidemic.

And people didn't realize they were consuming all the sugar and it was turning into fat being stored for a famine that never comes. And that's what really messed up our physiology, caused all the modern diseases. Yeah. We think of obesity. We think of diabetes, we think of heart disease, but it's cancer, it's depression, it's Alzheimer's. And every time we bring our standard American diet called the sad diet to another country, whether it's Dubai, Mumbai, Beijing, Tokyo, they get all the Western diseases, not just diabetes and obesity, but increased rates of cancer, again in Alzheimer's, autoimmune disease, all our chronic diseases. And when, what we often see now is when people came from more traditional diets like Asians, the Japanese had been studied carefully when they moved from Tokyo to Hawaii, to San Francisco. The rest of the United States, they, we've known for years, they get increased heart attacks, but they also get increased cancer, particularly breast cancer has been very well studied in Japanese women from Tokyo to the to the Midwestern United States. And so the cancer goes up as well as the obesity, the diabetes, and the heart disease.

Allan: 07:25 Yeah, so one of the things that you got into in the book is, okay, so you had, you know, we had the South beach diet and for a lot of people that was very useful because they went through a phase where they kind of allowed their body to change its insulin mode and effectively. Then after that short phase, they could go on and start reintroducing some of the food, say before until they kind of found that balance of a whole food diet that was basically much more nutritious for them. But you've adapted that so that the new South beach, new keto friendly South beach diet is just a little different. Can you kind of compare and contrast those and and why you use the term keto friendly versus just making it a keto diet?

Dr. Agatston: 08:05 Yes. I'm one of the first things that in the original South beach by the first phase, which was the low almost Keto phase only went for two weeks and what we know now, once it did get rid of cravings, the other thing that happens when you're low, you're low carb, low sugar, low processed foods is when you run out of your starch, your glycogen stores in your, in your liver and your muscle. You then have to get fat adapted, which means you really turn on the hormones, the enzymes that break down fat and make it useful. One of the best examples is the traditional marathon lovers who get hydrate loading on the night before the marathon and the idea was to fill their livers in their muscle with as much starch glycogen, that's the storage form of sugar if they could, because within two to three hours running the marathon, they would run out of the sugar glycogen stores and they had to burn fat and they weren't good at it, so that was called hitting the wall and they ran out of energy.

Now long-distance runners have learned to be fat-adapted and that takes one to many months and it continues. And I've had that experience myself. So instead of just the first phase being two weeks, we'd go for one to many months of low processed carb, low sugar so that we can learn to use our fat for energy. And the first fat that goes is the belly fat. And today it's interesting the long endurance runners, the people doing triathlons and even more than marathons are going low carb and they don't hit the wall, they burn their fat very well. Now for the rest of us, you know, it takes 12 hours to a day. It's individual where you, you deplete your Icogenics stores and you begin to burn more, more fat and become fat adapted and allowing for that is very important.

When I first became really strict and good, it's when I realized I, I was truly addicted to sugar and I went cold Turkey once. Once, by the way, I understood that I was truly addicted to sugar, that when I cheated, it wasn't a lack of self-discipline. And what would happen to me is I could lose my cravings on the first phase of the South Beach Diet. But when I went to the second phase, I would invariably have a fruit or maybe even a whole grain bread, but I would, or a dessert and I wouldn't sop and now we know it's not a lack of self-discipline. It's truly and addiction and many Americans, especially overweight Americans are addicted. But once I got off that addiction and stayed on sort of the traditional phase one the South beach diet, I did my first, I was, I started the diet while on vacation and I came back and I returned to my, to my boxing, which I did regularly. And I still, I recall vividly, it was a Tuesday morning in late September, hot in south Florida. And normally I would take a round or two off when I did my boxing and all of a sudden I didn't have to take around off. I went continuously for eight rounds and now I can 12 rounds, three minute rounds with a minute and a half rest.

Allan: 12:12 I do have to say this, if you haven't done boxing as a workout, three minutes is an eternity. I have some clients I do some boxing with and you know, we'll go for a minute. I've gotten one, I'm up to about a minute and a half and they're, they're done. You know, like I need a break. And so going, just even going a three minute round is saying something. But for you to have the endurance to be able to, you know, go round after round with what about a minute rest between rounds. That's, that's pretty impressive.

Dr. Agatston: 12:40 For my tender young age, I take an answer 30 seconds in between rounds.

Allan: 12:45 No, but still three, three minutes is a lot of time to keep moving.

Dr. Agatston: 12:49 Yes. And I couldn't in hot, difficult conditions, I would always take rounds off and since I'm fat adapted, I don't, I feel better physically and mentally and that much more than the cosmetics of losing my belly. And then remember I was a diet doctor. My wife used to say, Author, no more TV for you only radio. You get rid of that little belly and so, but it's much more the way I feel and since we've been, we've been more flexible with our patients. The results we see are incredible and besides the fat adption, the longer sort of phase one, the other idea is you don't have to be in full ketosis. Actually, when we're in the fat burning mode, we're often in ketosis. It's the levels we can't measure easily by current methods, but you can, you can lose the belly.

You get all the benefits without actually being in ketosis. The big advantage of ketosis, particularly for people who are diabetic, who really want to jump into something strict, is you can measure your ketosis and you can document compliance and that's, that's good for us often and our patients. But to make the diet a lifestyle, there still has to be more flexibility. We also encourage either time-restricted feeding or intermittent fasting. And we do suggest that with full keto, with fasting that you do it with a nutritionist, to health coach or your physician, your physician so that you can avoid problems such as what's called the keto flu. But so we are flexible in our approach depending on our patient, the needs, the desires and you can even be a vegetarian low carb as long as you're having whole foods and not having other process carbs. It's tougher but you can do it. And of course traditional societies that like the Asians with rice and not the Okinawans with with sweet potatoes, they were some of the, well particularly the Okinawans were some of the longest lived populations in the world, but they didn't eat snacks all day frequently. And now to the degree that sugar has shown its ugly face in all these societies, they are becoming overweight, diabetic and all the Western diseases that had been in the United States for decades.

Allan: 15:48 When you put this together, I mean cause like one of the things you said and I think that's really important is, well a couple of different things, but one that I thinks is really important is that we all are gonna have different needs. We're all going to be slightly different from a biology perspective of how we want to apply this. So there's, there is a lot of flexibility to this to say, I know, okay if I need to lose 30 pounds or I am diabetic, I'm probably gonna stay in phase one and be a little bit more strict and probably get to a point where I am in ketosis if not completely, at least most of the time I'm eating at that low of a low carb. But you have 12 rules for what you call keto friendly eating. Could you just kind of go through those rules with us? Cause I think that'll make a lot more sense to folks when they see, okay. It is really kind of flexible. It 12 rules sounds like a lot, but they're just the basics of if you're eating this way, you're going to be much more healthy.

Yes. And by the way, yeah, you got it exactly because the flexibility is we all come with different degrees of we call the thrifty gene and the tendency towards becoming diabetic ultimately. And so the rules are first minimize sugars is number one. And we might say no sugars, but you know, our parents and grandparents who had the sugar cube in their coffee was a lot different with the amount of sugar we're getting today. And so you can burn some sugar without having stored it. It's the volume that is totally off the charts today. And refined carbohydrates are absorbed more rapidly than whole grain or high fiber carbohydrates. And by being absorbed more rapidly, they, it's called the incorrect in effect, but they increase our insulin levels out of proportion to just the increase in blood sugar, blood sugar alone.

So if you give blood sugar a certain amount intravenously through the vein, the blood sugar goes up a little bit and the insulin goes up a little bit. But when you consume it, then you stimulate hormones. It's something called GIP, which causes an exaggerated increase in insulin. And that's, that's the problem with frequent feeding. And snacking, which we used to say, like everybody said, when you went to the South Beach Diet, have frequent snacks to stabilize your blood sugar, your insulin levels. That was just plain wrong. So the third rule is, is limit snacking. You want to give time for your insulin levels to drop and that's where having very low glycemic foods, whole foods or nothing for breakfast and lunch, that allows your insulin levels to go down. And that's when you can start burning fat. When your insulin levels are high, you block the burning of your fat stores.

So you can be once the, insulin levels stay high and you can't access your fat stores, you can be starving and you run to the fast-food restaurant or you have a coke that doesn't even suppress, doesn't even, doesn't even fill you up. So you want to give time for your insulin levels to drop by not snacking, having fewer larger meals, which is the next in the 12 rules or having foods that are absorbed further down in the intestine and don't increase your blood sugar and your insulin levels. We say maximize the healthy fats and one of the things is while some people I know don't like dairy cause they're sensitive to it, well saturated fat in meat, in dairy, we now know raises your large LDL bad cholesterol particles and they do not cause heart disease.

This is relatively recent knowledge but it's done. It's been repeated in several large studies. It's the small LDL particles that cause heart disease and they come from sugar and bad carbohydrates. And one other point that out the bad carbohydrates is again, it's volume. Because when you have a bad carbohydrate, you either burn it or if it's glucose, not sugar, you can store it as glycogen, as starch, but only so much about 700 calories. Then you then it turns into fat.

Allan: 20:50 Yeah. But that's part of the problem is these processed carbohydrates are process to basically make us eat more. That's what the food manufacturers are doing. If you don't eat, let's just say you're not going to eat one Pringle. You could eat one Pringle and maybe you'd love the taste of it and that would be all you needed. Your body could absorb that and you'd be fine, but invariably it's a long sleeve and you're not just going to eat one.

Yes, absolutely. And one of my favorite books by Dr. Robert Lustig from UC San Francisco, the Hacking of the American Mind, and he talks about how the food companies make us addicted. And yeah, I mean sugar. I seen another friend, Dr. David Ludwig, did a study where they gave Cokes to teenagers before they ran into a fast-food restaurant and they ate more, not less because fructose, the sugar in the cokes does not suppressed. There's not suppress your appetite. It actually increases. And again, those processed carbohydrates including sugar are absorbed at the beginning of your small intestine or you get that bad incretin effect where your insulin goes way up, and sugar is not turned into starch or glycogen in your liver. It's either burned or it's turned into fat right away. So a high sugar diet is a high-fat diet. And then we say, you know, limit the Omega six vegetable oils.

Of course, the original vegetable oils, and they're not made from vegetables. They're made from, from seeds. The first were made from cotton seeds now soybean and many other types. And they originally they were hydrogenated for shell finding and that was shown not to be healthy, to be very unhealthy. They were outlawed. But instead of going to just traditional saturated fats such as lard, butter, coconut oils or olive oils there going into nonhydrogenated vegetable oils. And Americans were never, humans, in general, were never exposed to naturally. We need small amounts of these or else they're called on your Omega six oils, which today are the vegetable oils and small amounts are fine, but when you process them and create the salad dressings, the cooking oils, we were never meant to have that many oils and it throws out our Omega six inflammatory measures to Omega three oils which are anti-inflammatory.

So where our ratio of omega six to omega three should be from one to four to five to one in most Americans its greater than 10 to one. And so you should be avoiding all vegetable oils as far as I'm concerned, it's proinflammatory but your vegetables and you know the nonstarchy vegetables, asparagus and brocolli, Brussels sprouts and green leafy vegetables, the spinach, those are all good. Yet when the problem is when we always talk about fruits and vegetables because a lot of fruits have a lot of fructose, particularly the tropical fruits, so fruits have anti oxidants that could be good for us when it's a whole fruit in the form of a Berry, but a lot of people think they're being healthy cause they're having a lot of fruits and they can overdo it because of the sugar and the fructose that makes the fruit sweet so we shouldn't be always loving vegetables and fruits and fruits together and then a wide variety of needs, poultry, seafood all very nutrient-rich and eat primarily whole foods.

The best example of this I think is the field cut truly whole grain oats versus instant oatmeal and with actually the same amount of fiber when you have the steel-cut oatmeal, the sugar or the or the starch core of the oat is surrounded by fiber. It takes a while to digest and releases the starch, the sugar into the blood stream slowly and you stimulate the enzymes further down the intestine that are good when you have processed instant oat meal. Even if you have the same amount of fiber, it's not surrounding the starch core and so it's absorbed much more rapidly. The enzymes, the hormones have direct access to the starch, it turns to sugar instantaneously and that increases your insulin levels rapidly and you're much hungrier. The studies have been done, you're much hungrier sooner than if you have the steel cut true oatmeal.

So, and that's true of eating whole foods and that means whole foods adding the fiber in separately. There's just a lot less evidence that that's helpful. And flexibility. It's more important not to be snacking and not to be eating frequently often than sometimes what you eat if you're eating in a relatively small window or during intermittent fasting. I hate to say, you can get away with more because you do increase your starch stores and your insulin, but then you have a long period of time to burn off that starch and the fat that's been consumed. So we prefer whole good foods all the time. But if you're going to be, if you're going to cheat, cheating in a short window is much better than if you're grazing and eating all day. That's disaster. There were snacking very well documented where we're eating many more times per day than we were in the 1970s and it's cause we're walking around hungry all day because our blood sugars are swinging around and our insulin levels are high and we don't have access to that big store of fat in our bellies.

Allan: 27:38 Well, and I think flexibility is important, but this is not, we're not talking about a license to just say, okay, I'm going to allow myself to have a piece of cake every night because I can, I'm only having, you know, two big meals a day and therefore I know I can have, and that's great. But if you're wanting weight loss, if you're diabetic or prediabetic or as we're going to get into in a minute pre pre-diabetic, then you have to understand, or you no you're addicted to sugar. You really have to think hard about how you can approach this and use this diet as a tool to get yourself healthy, to get yourself off that addiction because it's possible. But if you're going to start the game cheating, you probably not going to get there very fast.

And by the way, I mean that is the mistake that I frequently made without knowing. But even now, I mean, in the holiday season, if I'm acting in a fair, and this has happened and I, you know, and I eat the wrong food, the addiction comes back so quickly. And other than that, knowledge of I I can't do this or I can't keep doing this and I can get back on the wagon pretty quickly. But you're, you're, you're absolutely right. This is not a license to be cheating every night. I mean, the good thing if it's once a month or you know, somebody loves their pasta meal and there's a good amount of protein with it. And that's, that's again, depending on the individual, some people will immediately fall off the wagon and get into big trouble. Others, I always have patients who don't have the sweet tooth I have and they can have a bite or something and have a bite, you know. In Miami we have, we have Joe's stone crab and their key line pie. And I generally can that have just one bite. So I don't have it at all. And others can, including my wife. So that's knowing how each of us are as individuals.

Allan: 29:44 And that's one of the things I liked about your book was it took that into account and said, you know, because now you've dealt with thousands of patients and yourself and it's like we're all going to have to approach this slightly differently and we're going to figure out what works for us and we're just going to have to be self aware that you know, if we have this addiction, if we have this issue. One of the things you had in the book, which I thought was really, really important because by the time you go to the doctor and your A1C is over six and they're going to start now diagnosing you with diabetes, you're way down the road and you talk about some tests, some things we can look at before we even get to that point. And so these are tests I'm actually kind of interested in having done because my A1C is great. My blood sugar is great, but that doesn't mean I'm out of the woods. It just might mean that right now my body's creating a ton of insulin and it's able to shuttle all of that blood sugar away so I don't stay in a high blood sugar state. So one of them you call was, it was basically the insulin resistance test or you know, insulin. And then the other one was called the Atkinson calcium score.

Yes. The first, as far the points you've made about insulin are so, so important. So in fact, if we take in America healthy young, 20-year-olds, not overweight today versus the 1970s their hemoglobin A1C, maybe five are they're very normal. They're fasting. Blood sugars are absolutely, absolutely normal. They give a glucose tolerance test where you take a drink of 75 grams of sugar, glucose and wait two hours, their blood sugar comes down. But if you measure the insulin levels, it's taking four times normal insulin levels to keep their blood sugar normal. And that's already hacking fat into their liver, if you anybody, even teenagers, if you see a belly on anybody, a little protrusion, it means they have high insulin levels and they have excess fat in their liver. That's where it all, it all starts. So the test that we do, we call it the insulin secretion test, your insulin-resistant test.

It was actually developed by Dr. Joseph Kraft in the 1970s he died recently at age 94 and unfortunately, he did great work. Unfortunately, it was not recognized by the nutrition establishment, including the American diet. I thinks its an association. Partly, you can only measure insulin levels. In the 1960s the developers undercut the Nobel prize and hasn't been measured clinically until very recently. But he did the measurements when it was very expensive, but on 15,000 patients and he found that he called it diabetes insight too. I call it, it's kind of a medical term, I call it pre prediabetes because anybody with high insulin levels is having problems already, whether they know it or not. Including depression. There is an epidemic of colon cancer in young people, breast cancer, which are related to high levels of insulin. And so the real tests you need, which I'd like to give Kraft credit, called the Kraft test, is you take the insulin, the glucose drink, which was given in the traditional oral glucose tolerance test.

All pregnant women today get the oral glucose tolerance test, and instead of just measuring blood sugar, you measure insulin levels. And so, so many people who have bellies and some, are what do you call it? TOFI. There's thin on the outside and fat on the inside. If you look with a CT scan, cat scan of their belly, they have belly fat. Even though from the outside you would never realize it. And so you can really only tell, you could do it if you do a special MRI of the liver, but that's too expensive and not practical. The Kraft insulin secretion test, it's not expensive. The main thing is it's done over two hours. You do a fasting in some level, then you drink the glucose and then you repeat it at 30 minutes, 60 minutes, 90 minutes and two hours. And so we see patients who already have plaque in their coronary arteries, they have all kinds of chronic illness and their A1C is normal.

And so the fact is it takes years to develop. The fat is not only in your liver, it's also in your pancreas, and it's not till your pancreatic beta cells that make insulin, that synthesize insulin, become injured by the fat in the pancreas and you can't make enough insulin to keep your blood sugar normal. That's when your A1C, your fasting blood sugar goes up. And that's when we diagnose you have a problem pre diabetes or diabetes. But in fact, 10- 20 years before you can measure high insulin levels and people are suffering from again, skin problems to having cancer to heart disease when they're told your blood sugar is normal, don't worry about it. So that's, it's so important to understand. If you have a belly, you have high insulin levels, you're at risk of having heart disease, diabetes and cancer and Alzheimer's. Even though your doctor say your blood sugar is normal. So it's very important to get that word out right.

Allan: 35:43 And then the calcium score is basically going to tell us how much plaque is built up already.

Dr. Agatston: 35:50 So yeah, the calcium score I developed with my colleague Warren Janowitz. And if you're heading for a heart attack, if say you're 40 years old and you're heading for a heart attack when you're 50, 55, 60, you already have plaque in your coronary artery. And with the calcium score, it's inexpensive. In Miami, it's $99. At Johns Hopkins, it's $75 to have the test. You can,uand it's essentially no radiation. It's a cat scan that has some radiation, but you get more radiation when you, when you fly in distance. So the radiation is not an issue for cost is really not an issue. And even though your cholesterol might be normal, things can look normal.

But again, if you have a lot of small LDL particles and other problems that are hidden, you may be developing plaque and you can't tell with a cholesterol test, LDL test or any other tests. Here you're looking directly in the coronaries with a safe, inexpensive test and that tells you what your risk is of a future heart attack. But it also, it predicts all cause mortality because it indicates how the various risk factors for chronic disease are mixing in you as an individual. So the one thing that we see now is we see people whose hemoglobin A1C, their blood sugars are normal, but they have high insulin levels. They may have some other genetic markers that we look for cause you're my practices is cardiac prevention. But those tests are not so difficult to get either. But the main thing is that with the high insulin levels, the sugar and bad carbs they're consuming is turning into fat in the liver and they're overloading the liver with fat.

That causes a lot of problems. But one thing it does is it turns the normal LDL in to small dense LDL, small LDL particles that are not cleared by the, in the bloodstream easily. They don't fit into the usual receptors. They become oxidized and the oxidized LDL sticks to the vessel wall. It gets underneath the vessel wall, builds up the plaque and we again can see with the calcium score, you can see the build up of that plaque and the result of the high insulin levels years before you get chest pain or a heart attack and you can monitor it and then can prevent it.

Allan: 38:36 And I think that's huge. You know, so many of the tests and the things that we get diagnosed with, we're already sick and this is an opportunity for you to catch it much, much earlier, even if the other tests are coming out relatively clean these are really cool. I, I really appreciate this cause I was having, I mean I remember interviewing Dr. Fung and his, his book about the Obesity Code, and back then and he's like, you know, it didn't make any sense to measure insulin because you're doing it fast and you're doing it one time. But you know, here's some advancement where we're saying, well let's, let's go ahead and test the other side of this. The sugar is glucose equation. Basically using the same test, just looking at the actual insulin response, which I again, I think that's just brilliant.

Dr. Agatston: 39:17 And I yeah, I admire Dr. Fung a lot. And but you can't just measure the fasting insulin. We have people with normal fasting insulins and I'm particularly young people are at at 30 minutes after the glucose load their, I mean their insulin levels are in the hundreds, whereas their fasting glucose is normal. In older patients, you get more and more of the delay in the insulin, which indicates dysfunction of the beta cells in the pancreas that are making insulin. And that's because fat, we know that you get a fatty liver years again before you're diabetic or, or even pre-diabetic. And the fat is also going into your pancreas and interfering with the beta cells. And so you get a delay in the insulin secretion. So we can see both the degree of insulin resistance and the degree of what we call beta cell dysfunction, the pancreatic dysfunction that eventually is going to lead to the high blood sugars when you can no longer make enough insulin to keep the blood sugar normal.

And the other thing with this delay in the production of insulin is the insulin peeks hours after a meal and it stays high and that's that high insulin level that is locking in the fat after a meal. So when people get up in the middle of the night starving, even though they have all these fat stores in their belly, in their liver, in their muscle, the problem is they have sustained high insulin levels that blocks the enzymes that breaks down the fat and gives you the energy in the hibernating bear late in the fall. The bear is, they're eating the fruit that's become ripe. That's why fruit is seasonal and they are ravenous, depleting the forest of blueberries and other berries, even though the bear has already put on 400, 600 pounds of fat, but they don't have access to the fat because their insulin levels high. So they can continue to put on the fat for the winter hibernation.

Once they're hibernating and they're not consuming that fruit and the fructose in the fruit, then their insulin levels drop. Now they have access to the fat and that's how they hibernate the whole winter without eating because its that fat that is helping their brain, their kidneys, their heart to continue to function while they're asleep. So normally when we sleep every night we're not eating, so we're accessing our storage starch and fat. But what our insulin levels are high, we can't. So the blood sugar falls and we may wake up in the middle of the night starving and go to the refrigerator and have whatever sugar and carbs are there to bring our blood sugar back up. So it becomes a really vicious cycle.

Allan: 42:36 Yes it does. And so I think this is, you know, we're, we're into January here and I think, so this is kind of a great time to look at something like the Keto Friendly South Beach Diet because it's going to help you regulate your insulin. It's going to help you kind of go through a good period now where you can be thinking in terms of the bear or humans and what we would and wouldn't be eating. The rules are pretty simple. You do have meal plans in there and recipes so it's all put together very well. So again, I think this is an excellent opportunity to take something that worked. The South beach diet definitely was one of those things that people, when they follow it, it worked and you've improved it, which I think again is just wonderful.

Dr. Agatston: 43:16 Well thank you. Thank you so much. And Allan, I mean you obviously you really got it. And it's part of the book is certainly understanding the principles because even for me, who was the cardiologist diet doctor telling, putting my patients on diets for years, but I didn't understand the addiction aspect. Once I did it made such a difference for me and it is, it is for my patients. So this was not necessary eating differently. I mean it was the understanding that made me stick to principles that I already knew. So understanding the role of insulin and how it's different for all of us and understanding flexibility, understanding that America is not overweight because we all of a sudden lost our discipline or for that matter have stopped exercising. Exercise is very, very important. But what causes, what's caused the obesity and chronic disease epidemic is mainly, it's mainly the way we're eating.

Allan: 44:22 I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and sta well?

Dr. Agatston: 44:32 I would say understand insulin, keep it down, don't snack between meals, try some intermittent fasting and others is getting a good night's sleep and this enters in. Of course, if you're overweight and have sleep apnea, you may not be able to sleep proper, but we know a lack of sleep. Again, it stimulates enzymes and hormones that lead to high insulin levels and the other is regular exercise. And exercise is not going to be a solution from the calorie burning aspects. They prove that on the Biggest Loser for your, for your brain, for insulin sensitivity, for keeping up lean body mass. And you know I, you know, I love your podcast and the and being well over 40 plus that we have to keep our muscle and our bone. And you know, when we weigh ourselves, it's the weight, the BMI doesn't really mean anything because that includes, muscle, bone and fat under our skin, when we call the subcutaneous fat, it's only the fat in and around or origins.

That's the dangerous fat that we have that we have to worry about. And regular exercise, it improves our brain function, improves our sensitivity to insulin. So it decreases insulin resistance and it helps us age. We sustain lean body mass and on balance and so many things that's part of healthy aging. And I agree with you. Wellness, we use the term optimal health and it's, it's your vitality. And again, what's kept me on the changes in the diet that I made is I vitality, my ability to exercise, my ability to concentrate, get rid of the brain fog. And it's all those things. My belly was often hidden, people couldn't see it where I was wearing clothes but I knew it was there, but it's because I feel so much better with this and this type of lifestyle. So sleeping right, my exercising right and eating right.

And as you age you have to be more and more concerned about each of these elements. And so I really applaud for what you do with 40 plus as we age, we do become more insulin resistant and it becomes tougher and tougher and you have to get enough sleep, enough exercise and eat the right foods and not eat too often.

Allan: 47:18 Great. Thank you for that. So Dr. Agatston, if someone wanted to learn more about you or learn more about the book, The New Keto-Friendly South Beach Diet, where would you like for me to send them?

Dr. Agatston: 47:30 South beach diet website changed recently.

Allan: 47:36 Okay. That's good. Yeah. Just send me the link and I'll make the show notes so you can go to…

Dr. Agatston: 47:41 Agatstoncenter.Com is our office, our website. It has all of information too.

Allan: 47:48 Cool. Well you can go to 40plusfitnesspodcast.com/416 and I'll be sure to have those links there. So Doctor, thank you so much for being a part of 40+ Fitness.

Dr. Agatston: 47:58 Thank you Allan so much. It was really enjoyable.

It's that time of year. It's the time of year when everybody is thinking about health and fitness. Maybe you've set some resolutions, maybe this is the year that you want to get healthy and fit and if it is and you need a little bit of help, check it out at 40plusfitnesspodcast.com/coach you can come on as a group client and I can help you lose weight, get stronger and make 2020 something special. Go to 40plusfitnesspodcast.com/coach.

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Tim Alexander	– Judy Murphy	– Melissa Ball
– Barbara Costello	– Debbie Ralston	– Leigh Tanner
– John Somsky	– Anne Lynch	– Bill Gioftsidis
– Wendy Selman	– Jeff Baiocco

Thank you!

Another episode you may enjoy

Keto for vegetarians and vegans with Dr Will Cole

Less...

Rest of Text

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Tim Alexander	– Judy Murphy	– Melissa Ball
– Barbara Costello	– Debbie Ralston	– Leigh Tanner
– John Somsky	– Anne Lynch	– Bill Gioftsidis
– Wendy Selman	– Jeff Baiocco

Thank you!

Another episode you may enjoy

Keto with Maria and Craig Emmerich

Less...

David: 03:54 And so to go back to your point, one of the most insightful moments was when I built that hideous spreadsheet and I called all four of my doctors. I had one in Boston, I had a couple in Canada, I had some in California. I put all my blood tests in a spreadsheet and that was a lot of work. You gotta be a pretty serious health nerd to go through an exercise like that. And Allan it sounds like you did the same. So we're kindred spirits there. But the first thing that happened was I could see the patterns and I'm like, wow, my doctor can't even see these patterns. You know, he's got one of these PDFs there's another six that have my medical history. And there were trends happening in the data that would be impossible to see otherwise, trends that actually needed attention.

David: 04:40 And I discovered those trends as a patient. And that was the moment where I realized how powerful the data can be when it was centralized. And that was right around the time that we were starting to get access to tools as individuals that were very, very sophisticated. And these were consumer grade devices that could do things like measuring heart rate variability, which 10 years ago you needed to go to a hospital to get and get hooked up to a massive machine. And now all you need is a Bluetooth heart rate monitor and a good HRV app. So I started seeing all of this information that we as individuals could monitor on ourselves, which was awesome. And then I saw how I could overlay it with my medical records. That's ultimately what helps us determine if we're really doing things properly or not. And I just became obsessed with building this system and making it available to everybody. And it's just kind of taken over my life since then.

Allan: 05:39 Yes, I can imagine.

David: 05:41 I guess that's the typical getting bit by the bug. It just becomes all consuming and you want to build this and create this and bring it to life. You know, you talked about people who've written books, and for me it's, I've written a piece of software.

Allan: 05:58 Yeah, and I think there's a, there's a ton of value there that is, it would be, it would be otherwise missed. I mean, you know, everybody likes simple, simple rules, you know, complete the circles on my Apple watch and I've done a good thing today. So you're getting a little bit of gamification, a little bit of information there. But that's just one little PISA data in just this huge sea of data that's coming at us. And there's more and more every year, you know, the watch that can look at your sleep patterns and the, you know the watch that can look at and do an EKG on you and obviously your lab results and, and you know, you go into your doctor and your prescriptions and you know, see you change your prescriptions and you see a change in your, in your trends. You know, what those prescriptions are doing to not just the symptoms that you're feeling, but your actual health markers. So I really liked that it's tying all of that stuff together in a way that is interpretable. I think that's the key. And that's where you've probably been spent spending a lot of your time, not just with, cause there's a ton of integrations, but then also just making sure that the data is interpretable.

David: 07:05 Yeah, we spent a lot of time on our user interface so that we could in essence, demystify a lot of these numbers. You know, how do you make it really simple for anybody to set up a dashboard and just look at some basic health stats even if you're not technically savvy. And you know, one of the interesting things Allan, is that our most active users on the system are actually the least technically savvy people out there. But they have a health issue. And we've made the dashboard intuitive enough that people can make some basic connections. They can test their blood sugar in the morning after they had a pizza the night before. And see how that's different from when they test their blood sugar in the morning after they stopped eating at 5:00 PM and just had a steak with veggies.

David: 07:49 And then these aha moments start happening for people. And these are aha moments that they may not actually get guidance on from the regular doctor. And that becomes exciting and that becomes fun. And then you get more into it and it starts to become very fun and rewarding. And you're basically just nerding out on your own health. And that's a win because I think the reason so many people are in a predicament right now with their health is because they haven't had the information and the insights and the tools, and they haven't had the knowledge about some of the risks of the foods we're putting in our bodies. And so we were kind of blindsided up to this point and now it's like, Oh wow, I have, I've got this microscope into all my health data and I can start figuring some stuff out myself. So making it simple and fun and easy and intuitive with big numbers, big buttons, easy charts, we just wanted to democratize it as much as possible. And as you know, we started this four or five years ago and I still read every single email that comes in our support queues. Most of our product direction is directly from our users. And we have our own private Facebook group where our loyal users are in there and they're testing the software and they're giving us the good, the bad, and the ugly, and, and we build in accordance with our users.

Allan: 09:09 Yeah, it's Drucker that said what what gets measured gets managed. And you're, you're providing a pretty valuable tool for folks that really want to get in there and manage their, their health. I was interviewing Dr. Will Cole last week. Yeah. We had him on and he, in his book he talks about the kind of the bio-individuality of us and how each of us is going to operate differently. Know even when we're doing things exactly the same. You know, I sleep eight hours, you sleep eight hours, you know, I have a glass of orange juice for breakfast. You have a glass of orange juice for breakfast. My blood sugar shoots up over a hundred. And your stay stable as a rock. You know, this is going to give us some of that data if we're checking our blood sugar and putting it in there for taking the time to, and some of this is automated. So if I go to a certain lab to get my blood tests, I can actually have that auto connected. So it's going to integrate right on in. So there's not the data entry to build those massive spreadsheets. And then there's the ability to interpret it on the backend. As far as the business, one of the reasons that I, I think this is kind of top of mind for me today is my wife and I moved down to Panama and we were going to go to a doctor here instead of going back to the United States to see her normal doctors, she's going to try to get a doctorate here. Um and she's like, well, I just saw my doctor, you know, three and four months ago and I have the labs for men. I'll just, I'll just call my, email my doctor and say, Hey, send those to this doctor. And they're like, no, we need a signed form and we need to either do that, do it in our office or fax it to us.

David: 10:44 And yeah, I mean, let me plug in the old fax machine there.

Allan: 10:48 Go find grandpa or somebody on this Island that has a fax machine for us to fax that document. And then fortunately there are some, but it was just such a pain in the butt. So just get the data and I told my wife, I'm like, let's just pay for another blood test because you know, I don't want to fly somewhere just to get to a fax machine, just to sign a piece of paper to ask your doctor to do something that you know you're asking them to do. They know what you and you know. So when you're, when you're doing these interactions, obviously, you know, we're, we're connecting a lot of things and we're pulling a lot of data in and that's a convenience. So you know, in a ways your service is a convenience. How is that data protected then? Cause I think that's what the concerns are. The doctor's like, well, I've got HIPAA and I've got these other regulations. That's why the fax machine, we need that security. How do you manage some of those security issues?

David: 11:44 Well, we don't use fax machines, unfortunately. Allan. Our system is, is considered a personal health record. And so the FDA treats that as being data that is owned and operated by the individual and the individual themselves. So if I am inviting my doctor to access my profile, that's a patient initiated action and that's different than the doctor initiating the request to the patient for data. So those are treated a little differently under HIPAA. That being said, one of the benefits of being a startup nowadays is we can build everything from the ground up on state of the art, HIPAA compliant technology. So all of the services inside Amazon AWS are HIPAA compliant and they use absolute state of the art technology. We have a very, very small footprint inside of Amazon. So we use all their HIPAA compliance services. We have to play by the same rules as everybody else does.

David: 12:54 One of the things we're working on starting in Q one is going to the next level of certification beyond HIPAA, which is called high trust. And that's an even more robust layer of security and compliance than HIPAA is. So we, we do everything we can on the security and the compliance side. We don't ever use the data for external use marketing purposes or anything like that. And that's all really, really clear inside of our terms of service. It's yours, you share it with whoever you want. And that's how we run the business. We're not in the business of making money on people's data. We make money on your monthly subscription.

Allan: 13:38 Cool. So you know, we've talked a little bit about tracking health data. Can you talk about some of the sources of health data that would reside in a tool in your tool? Uh,I know, you know, like we're talking, you know, certain integrations with things, certain things with upharmacies, but you know exactly what data would I be collecting and putting into your tool?

David: 14:00 So that's a really, really great question. And we look at the world and we categorize the data into three buckets. And the first bucket of data would be things that Allan is tracking at home. And so that's also called patient generated data. And that could be the heart rate data from your Apple watch. It could be the measurements when you step on the scale in the morning. It could be your blood pressure, maybe you're measuring that periodically. It could be your blood sugar, it could be more sophisticated health tech, like some of the new wearables like woop and bio strap and or ring.

David: 14:38 All of those do really, really sophisticated analysis on how well we sleep. How much cardiovascular load we're putting on our bodies during the day. So there's heart rate variability, which is becoming very popular because it helps us measure our stress. So everything you measure at home that helps you essentially gain biofeedback about yourself, the devices, the apps, the watches, everything like that. And so that's kind of what we call lifestyle data. That tells Allan, okay, how much am I sleeping? What's my calorie intake? You know, what's my blood sugar been over the last week? So that's the lifestyle data or what we call a patient generated. The second part is what you talked about earlier. Your wife's data, the clinical data. When you go to the regular old doctor and they run the blood work cholesterol, HDL, hemoglobin A1C white blood cell count inflammation markers.

David: 15:34 That is, that is the second bucket of data. And that's also really, really important because as you change your lifestyle habits, what you can measure in bucket number one, you're going to see the numbers in bucket number two, change. You know, prime example of that is hemoglobin A1C. And if you go on a really low carb ketogenic diet, you, you could easily just through dietary change alone have a significant impact. Maybe you bring it down from 6.5 to five or below just through a dietary change. So that's where one, you're looking at your, my fitness pal logs and your blood sugar from bucket one and your hemoglobin A1C from pro bucket two. So that's how that feedback loop goes. And then there's a third category of data that we focus on inside Heads Up that is a little nuanced and that's what I would call functional health data.

David: 16:26 And Dr. Cole probably may have mentioned this, but that would include things like heavy metal testing for some people is an issue. Mold exposure testing. It would include things like your microbiome and a lot of people who have digestive issues and they're testing the microbiome. It may include your genetic data. So that's like the third category, functional health organic acid testing. There's, there's a ton of information in urine and stool, which can be really helpful for people who have tougher cases with their health. So we're working with a lot of individuals and health coaches who do functional testing as well. It's not something you can get from your regular GP that's going to bill insurance, although insurance might cover some of the testing. So it's lifestyle, clinical, functional. Those are the three categories that we, that we integrate.

Allan: 17:23 Cool. And this is the tool that you've built out, not just for the end user to have access to share and use and see their data and analyze it. Practitioners can also use this with their patients, right?

David: 17:37 Yeah. Health coaches. We're, we're really focused Allan on the the cash pay wellness market. So these are doctors that you pay cash, functional health doctor, nutritionist an integrative specialist personal trainers. So we have a coaching portal where, and these are the people who want to see your Fitbit data and they want to look at your functional health data. They're going to spend an hour with you during your console and they're going to go over all of this stuff. And in a traditional medicine world, that system's not really built in a way where that data is, I would say, as valued or as part of the care plan.

David: 18:16 So we have a portal where health coaches can log in and they can log in and very quickly look at who of their clients need some extra help in terms of blood sugar. And they can look at dietary intake and personalize a protocol and they'll have access to Allan's labs going back 15 years. So your wife could show up to a functional doctor and, and provide access to the Heads Up profile and all the data. Is there all the labs, not just the most recent ones. Yeah. So we, we have a portal for health coaches as well and we want to be able to use the information as part of the treatment plan and there's awesome data out there. My doctor to look at it. I want to ask him like, why was my HRV higher this day versus that day and why, how, how do I personalize this?

David: 19:05 You've got my genetic data, you've got my lifestyle data, you've got my medical tests. Like they can dial it in for you.

Allan: 19:13 Yeah, that's, that's awesome. Now I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay well?

David: 19:26 Oh, that's a great question. Three strategies and stack and tactics to get and stay well, I would have to say that understanding how to regulate your metabolism would be number one in terms of getting and staying well. And I say that because so many of the illnesses we have are metabolic in nature, sugar and foods that destroy our blood sugar and then cause a host of downstream effects. So getting a staying well means healthy blood sugar regulation. That will be my number one number two would be a high quality sleep and that's high quality sleep that you're measuring with something that can tell you the, there's a subjective component to sleep where you may think you're getting a great night's sleep, but you might have severe sleep apnea and you don't even know it and your sleep is actually incredibly disrupted.

David: 20:26 So getting really high quality rest would be the other one. And then the third one I would have to say would be probably related to community and spirituality. And I think that's essential. Having people around that love you and being able to give and receive love to people. It doesn't have to be a partner, it doesn't have to be a family member. There's lots of ways to give and receive love. It could just be through volunteering. But having community and ways to express and offer and receive love. I would say that's more of a spiritual than it is anything quantifiable and I think that's really important. So that will be my number three.

Allan: 21:09 Okay. Thank you David. Thank you for sharing that. If someone wanted to learn more about you, learn more about Heads Up Health, where would you like for me to send them?

David: 21:18 Well, first of all, I offer everyone to just contact me directly. I'm an open book. My, my inbox is a little backed up, but I'll do my best. I'm David Heads Up Health and if you're interested in the software we provide, it's at Headsuphealth.com we have our own podcast, Data Driven Health Radio where we break down a lot of these numbers and demystify them and teach people how to use them. So much like yourself, Allan we're providing educational content and then you'll find us on all the regular social media channels. We share all the good information we find out there on the interwebs as well. So there's lots of ways to track us down. And if you want to give the softwarea try, it's 30 days. You can try it free. There's no credit card required, just no pressure. If you like it, hopefully it can make a difference in your health. The data was hugely transformational in my own health and so that's my life's work at this point.

Allan: 22:11 Good. So you can go to 40plusfitnesspodcast.com/414 and I'll be sure to have links there in the show notes. So David, thank you so much for being a part of 40 plus fitness.

David: 22:23 Thanks for a great discussion.

David: 22:31 Did you know that we have a 40+ Fitness Podcast Group on Facebook?

Yep, we sure do. You can go to 40plusfitnesspodcast.com/group. That's a great place to interact with me and other listeners of the show. I'm on there all the time. Trying to put out great content, trying to make it fun. It's a really cool place. We have weekly challenges. Go to 40plusfitnesspodcast.com/group and request to join the 40+ Fitness Podcast Group

Patreons

The following listeners have sponsored this show by pledging on our Patreon Page:

– Tim Alexander	– Judy Murphy	– Melissa Ball
– Randy Goode	– Debbie Ralston	– Leigh Tanner
– John Somsky	– Ann Lynch	– Bill Gioftsidis
– Wendy Selman	– Jeff Baiocco	– Jay Collins

Thank you!

Another episode you may enjoy

Undoctored with Dr. William Davis

Less...