September 26, 2023

Men’s health with Dr. Neil Baum

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Men have a lot more going on downstairs than it may seem. On episode 609 of the 40+ Fitness Podcast, we bring back Dr. Neil Baum to discuss issues around men's health including the prostate, osteoperosis, and telehealth from his new book, Men's Health Guide: Expert Answers to the Questions You Don't Always Ask.


Let's Say Hello

Note: Because Coach Allan is on vacation, there is no hello session for this episode.


[00:02:49.430] – Allan

Dr. Baum, welcome back to 40+ Fitness.

[00:02:52.950] – Dr. Baum

Allan, it's so good to be back and talk with you about something near and dear to me, and that is my baby for the past two years. It's very interesting. When you write a book, every person who's a good cook, someone says, you ought to open up a restaurant, or every doctor who's approached, oh, that's really a good idea. You need to write a book. Well, let me tell you that you don't open a restaurant or you don't write a book with the idea that it's going to take off and you're going to be on the New York Times bestseller list. It doesn't work that way. And also, it takes longer to write a book than to have a baby. So when I say, this is my baby, you know, I really mean it?

[00:03:44.730] – Allan

Yeah, I do. When I wrote my book, I got it done in a little over nine months. And that was fast. Everybody's like, how did you write a book? Well, I didn't do anything else. I mean, this was all I did was write a book. So when that's all you're doing, it can seem like it's pretty fast. But if you're actually trying to live a life and enjoy yourself and actually get some other things done, it is a lot of work. And the books that you've put out, it's like, okay, I know a lot has happened in science and technology and in the medical field in the last five years, but this was really good. I learned more about my body in this book than I think anything else I've read in a long, long time. And the interesting thing was, well, as a guy, we've got this really interesting organ in our body. It's called a prostate. And what seems like a fairly benign function that we like to use as often as we can, but it can go wonky when we get older and cause us a good bit of grief as we get older.

[00:04:54.280] – Allan

And as a man, and I deal with the same thing every other man does, is we don't want to go to the doctor. We don't want to complain about things. And so sometimes this prostate can get in our way and make our lives really uncomfortable and deadly. At some levels, it's the second largest cancer or most common cancer is prostate cancer. And while it doesn't kill as effectively as, say, lung cancer or pancreatic cancer, it is still a very dangerous thing and something we've got to be very careful about. And I just really like the way you put this book together and some of your other books that I've read in that you're giving us the guidance to ask the right questions because each of us has our own journey as we deal with these issues. We have to have information to make good decisions, and your book gives us great tools to do that. So I appreciate the opportunity to talk to you about your books today.

[00:05:49.650] – Dr. Baum

Well, thank know that is really kind of one of the reasons why I wrote the book, because most men all over America have an attitude. If it ain't broke, you don't have to fix it. And that may apply to your car, but it doesn't apply to this wonderful body that we've been given that we have to take care of. And most men tend to shut down when they go into the doctor's office. They just zip it up. They don't ask the right questions. The majority of men over the age of 50 have heard the word prostate. They don't have a clue where it is and what it does. And so that's why I think a book like this is really important and why I'm so delighted to participate in this podcast because we have the opportunity to get the word out, to help educate men, to make them informed so they can make good decisions about their health.

[00:06:58.550] – Allan

Now, the first thing I want to talk about is I want to talk about the kind of almost aging natural thing that's going to happen, and that is that our prostate is likely to enlarge as we get older. The symptoms we most frequently recognize are I have to go to the bathroom a lot more often. And so it's kind of the old man of okay, or you're waking up a few different times during the night to go to the bathroom, and then you're up again to go again more often than you probably should be. So let's talk about why the prostate enlarges and what we can or should do about that.

[00:07:32.200] – Dr. Baum

All right, let me start by describing a little bit the anatomy of the prostate and its function. The prostate, normally up until the age of 50, is a walnut sized organ, and it surrounds the tube going from the bladder to the outside of the body. That tube going through the penis is called the urethra urethra. And that tube is surrounded by the prostate like a doughnut. And the tube goes inside the doughnut. As men get older, for reasons not entirely understood, that prostate gland enlarges. And as it enlarges, it presses down on that tube that goes through the penis. As a result, men, the bladder has difficulty squeezing and getting the urine out. And now the man starts to have the symptoms. They start to dribble. The stream is not as strong as it was when they were younger. So a young man in his 20 or 30s can stand a foot or two away from the toilet or the

[00:08:58.200] – Allan

Don't do that though. Your wife will hate you for it. So just stand close.

[00:09:02.830] – Dr. Baum

Yeah, or for sure, when you lift up the seat, put it down. Yes, both of them. I am constantly reminded that I got to put the seat down. So we have a decrease in the force of the stream and we have to stand closer. We dribble after we're done. And so a man who's wearing khaki pants, and he goes to the bathroom and he thinks he's done, and he walks away and he'll have a little circle on his pants reminding him that he wasn't quite done as he thought he was. So now we have the stream. And because the bladder is squeezing harder, it doesn't empty all of its contents. So imagine a gas tank. And the gas tank is always half full, so therefore you don't have to put much more fluid in before you have to go again. So you go frequently. But the issue that really impacts men with this benign condition, it's not malignant, it's benign. Growth of the prostate is getting up at night to urinate. If a man gets up once or twice a night, no big deal. When he starts getting up four or five times a night he doesn't sleep as well.

[00:10:33.160] – Dr. Baum

His sleep is interrupted when he wakes up in the morning, he doesn't feel like he's got a good night's sleep and it's the getting up at night that really impacts the man's quality of life. And often that's what sends him to the doctor for assistance. Most men over the age of 50 start to develop mild to moderate symptoms and it doesn't impact their quality of life. And as a result they tend to have if it ain't broke, don't fix it and they don't get help. However, the majority of men over the age of 60 and 70 have these symptoms and it does affect their quality of life. And as a result they do turn up to the doctor's office and they often seek treatment. The treatment usually in the beginning is medication. There are drugs that are available that can shrink the prostate. There are drugs that can also open up and relax the muscles. But these drugs have side effects. Side effects which include problems with ejaculation. So instead when a man ejaculates, the bladder muscle squeezes and the fluid from the prostate goes outside the body. When you give those medication that relaxes the muscle.

[00:12:19.990] – Dr. Baum

That relaxes the muscle. Now when the man ejaculates, the fluid goes back into his bladder, doesn't hurt anything and it comes out when he urinates. But most men like the fact that the fluid comes out when they ejaculate. It is important to them. Now when the medications don't work or the side effects are uncomfortable, there are now procedures that can be done usually in the doctor's office, that can use lasers, they can use pins to tap the prostate up and widen the opening and decrease the resistance of the flow of urine. And so almost all men who have this problem can be helped. And the majority of it's very common. And the majority of men over the age of 60, 70 and 80 are going to have these symptoms that can significantly impact their quality of life. And the important thing I'd like to get across to our listeners is that it is treatable. Now let's go to prostate cancer. You mentioned you were correct, it's the second most common cause, second most common cancer in men, particularly over the age of 50 second only to cancer of the lung. Both prostate cancer and lung cancer are lethal.

[00:14:04.610] – Dr. Baum

But prostate cancer is very slow growing. The incidence of prostate cancer is about a one in eleven and it usually is the point I want to make if there's anything I'd like to get across during this interview is that early prostate cancer has no symptoms. There are no symptoms. The urination problem is not indicative of prostate cancer. If the prostate cancer grows and it starts to have bleeding and it spreads to bones and other areas of the body, that's too late. And then it's difficult to be cured. And so I want to point out it's a disease of aging, not very common in men under the age of 40. Really very uncommon, a little more common in 50 and 60 by the time someone is 80. Almost all men over the age of 80, if they were to look at their prostate after when they die from heart disease, diabetes or another cancer, and they look at the prostate, they find cancer in the prostate. So my message is that you don't die necessarily from prostate cancer, but you die with it. Now, the good news is that there are screening tests, a blood test, it's called PSA, prostate specific antigen.

[00:15:53.310] – Dr. Baum

It's a very simple blood test. It can be done as an outpatient. And if it is elevated, then there are additional tests and oftentimes a biopsy is required. Now, the important thing to remember is that this is a screening test. It doesn't mean a man has prostate cancer. There are many situations that can increase the PSA. The PSA can even increase if a man has sexual intimacy and has an orgasm and ejaculates the day before the test because the prostate gland squeezes and that can elevate the PSA. Let me back up a second. I never did mention the role of the prostate. When a man is younger, the prostate creates the fluid that allows the sperm to go. And at the time of sexual intimacy, the sperm is in this nutrient fluid, the prostate fluid, and allows it to inseminate and to start the fertilization process and for the couple to have a child. So that's the purpose of the prostate. As we get older, we're not interested in reproducing anymore. The prostate really has no function. It really is bothersome, particularly from the benign enlargement. But the point that I would like to make is that a man should have a discussion with his doctor about screening.

[00:17:45.770] – Dr. Baum

Would the patient want to know that if he is at risk for prostate cancer and the risks are age, the older you are, the more likely you are to have it. African American men have a higher risk than Caucasian men. And the other risk factor is if you have a close relative, brother, uncle, even cousin, it's less with cousin, brother, uncle or father with prostate cancer. That places you at a higher risk. And you probably should start PSA testing earlier, late 40s or early 50s.

[00:18:31.140] – Allan

Now there's also, if I understand right, in the book you were talking about, there's a particular in our genes that's common for women to know that they're at higher risk for breast cancer. And that same mutation also puts us at higher risk for prostate cancer. Is that true?

[00:18:50.040] – Dr. Baum

Yes. The broca gene. Yeah. And it's particularly useful in women because if they have it, they're at increased risk and they need to get mammograms more frequently. If it is used as part of the screening for men. If they have it, then they are at higher risk for prostate cancer, and they too, need to be screened more frequently. When I say screened frequently, it's once a year.

[00:19:21.680] – Allan

Yeah, I had a doctor that wanted me to do the PSA pretty regular, and then I had an incident, actually was an infection not long ago. And the doctor, of course, that's kind of one of the standard things. They sent me in for the PSA. So I've known about the PSA for quite some time. But one thing I learned in your book was that there's more than just PSA. It's a deeper, deeper thing. There's Free PSA. There's Pro PSA. Can you talk a little bit about those? Because I think there's a lot more screening out there than just this one simple little blood test.

[00:19:53.150] – Dr. Baum

Well, it starts with the PSA test, and if that is elevated, they can measure two types of PSA. There's free and bound PSA or free and total PSA. And the free PSA is circulating with not being bound to protein in the bloodstream, and they can take that ratio. And there's a cut off at 25%. And if it is greater than 25%, therefore, that places you at a higher risk for prostate cancer, and you may need to go to the next level, which is a prostate ultrasound and possibly a biopsy. I also point out that part of the examination that a man should have on a regular basis, and I think we are going to talk about healthy lifestyles, and that is the annual exam, which includes what's called the digital rectal exam.

[00:21:04.390] – Allan

Now, heads up real quick. When they say digital, we're not talking electronic. No, that's a different digit. Yeah.

[00:21:14.890] – Dr. Baum

The digital rectal exam. It's uncomfortable? Yes. Painful? Not really, no. It would be equivalent to a woman having a pelvic exam. Women don't like to have a pelvic exam. But it is not painful. It is uncomfortable. And the same thing. Men just don't have things placed there, and it feels like a foreign object in there, and it's uncomfortable. And it lasts 3 seconds.

[00:21:47.330] – Allan

Yeah, at most.

[00:21:49.650] – Dr. Baum

Suck it up, guys. You can handle the digital frequency, so that's part of it. And I recommend that men over the age of 70 stop getting a PSA test. If you have prostate cancer at age 70 or 75, you don't need any treatment. Treatment is not necessary.

[00:22:14.490] – Allan

That's somewhere I wanted to go because you brought up something I think was really important in the book, was this isn't always. I mean, we think cancer and we think, oh my God, I got to do something. But sometimes just actively monitoring yourself is actually the best thing to do because of the downside risks that some of the surgeries could have on us. Can you talk a little bit about that? When would we know? Okay, this is something we definitely need to deal with now, versus we can comfortably sit back and know, yes, I've got the cancer, but it's not going to harm me in the next 5, 10, maybe even 15 years.

[00:22:50.710] – Dr. Baum

You're talking about the advice of active surveillance. So let's say a man has an elevated PSA and he gets a biopsy, and a biopsy has shades of gray. It's not just black and white. There's shades of gray and there are various scores that the pathologists will give. And so there's very almost normal cells that are cancer called well differentiated cells. And then there are highly malignant cells. And if you have well differentiated cells and PSA is mildly elevated between four and ten, mildly elevated active surveillance is definitely appropriate. But that means coming back to the doctor every four to six months and getting a PSA. And if it jumps up significantly and then you might have to have another biopsy. And if that shows more aggressive cancer, then you might have to proceed to definitive treatment. And we can talk about the side effects of treatment and the treatment. Usually if the disease is confined to the prostate, no spread outside the prostate. The two options, common options are surgical removal of the whole prostate gland or radiation therapy. Both of these have adverse events or side effects. And it's often these side effects that discourage men from having the surgery or the radiation.

[00:24:50.020] – Dr. Baum

With the surgery, it'll affect their erections. Their ability to achieve and maintain an erection is diminished. And they can have a problem of loss of urine, which is terrible situation that it can ruin a man's quality of life, and he has to wear a diaper or he has to have additional surgery because of the loss of urine. It's embarrassing. The man often becomes reclusive. They can become depressed. It's a terrible situation for a man, but he needs to know that if he's going to have the surgery. It doesn't occur with radiation, but they can also have a problem of impotence. So let's just say a man 60 years of age, he's sexually active, he has a very low malignancy PSAs between four and ten. Active surveillance, if he's committed to close follow up, is definitely appropriate. Now, take a man 70 years of age, and if he has comorbid conditions, he's let's say diabetic, heart disease, high blood pressure, and has got other medical problems. He has COPD, chronic obstructive pulmonary disease. He has shortness of breath. He probably isn't going to live five years with all those core morbid conditions. In that situation, I wouldn't recommend that he have surgery because the quality of life that he will have afterwards could be severely affected.

[00:26:52.750] – Dr. Baum

He's already having problems. He's already short of breath. He's already taking five to seven pills a day. Okay? So that man would not be, in my opinion, would not be a candidate for definitive treatment. On the horizon, Allan, are new treatments called focal therapy. Instead of treating the whole gland with radiation or removing the whole gland. They can just go in and do an equivalent as what's called a lumpectomy in a woman with breast cancer. Instead of removing the whole breast, there are certain situations where you just remove the lump. Well, this is the equivalent called the nickname for it is a male lumpectomy that's on the horizon. And there are studies being conducted now and following these men and it looks very promising that if it's caught early enough, listen, if it occupies the whole gland, well, then you remove it. But if it occupies one little tiny area and they can localize that and they can focus on that particular area and destroy that cancer in the prostate, I think that's going to be the way to go. And that's going to be, I think, go mainstream in a very short period of time. Studies are being conducted now for focal therapy.

[00:28:35.950] – Allan

Well, it definitely makes sense because you're going to have fewer side effects and risks associated because you're not removing as much and you're not touching on some of the sensitive areas as much. So it sounds like a really good breakthrough when they get that out there. But what I wanted to come away with in just this whole conversation about the prostate is that when you go in to work with your doctor, you do need to educate yourself so that you can make the right decision with your doctor's guidance. The doctor is not there to make your health decisions for you, but you got to do your homework. You can do a little bit of work here. The good thing about the prostate is that the cancers aren't typically that aggressive. And you do have time, you have time to think, you have time to sit down. It's not a panic kind of situation. Whereas some of the others, when you catch them, you usually have symptoms. You catch those. Now you got to make some decisions, you got to make them pretty quick and your doctor is going to tell you got to make them pretty quick.

[00:29:30.070] – Allan

They're not trying to rush you because they want to do the surgery. They're rushing you because they know it's necessary before it spreads even further. But with prostate, you do have a little bit more time to think about it and make the right decision for you and your family. I want to pivot a little bit because there were a few things that you got into in the book that albeit rare, I think it's so rare. I mean, it's not as rare as we think it is, but it is rare. But it's something we wouldn't even think would ever happen. And I want to get into all of it because there's a lot of them. But one of the big ones was osteoporosis. Men know that women suffer from osteoporosis when they get older because they start out with less bone mass, bone density. They experience it usually earlier and worse. But men can very much suffer from osteoporosis. Can you talk a little bit about that and what's going on there? Because one of the statistics that you had in the book, which was fascinating and scary as heck, is that men are more likely to get hip fractures and have a bad health outcome as a result, much worse so than even women.

[00:30:34.570] – Dr. Baum

Osteoporosis is, in the past, is a disease that women have. Women have osteoporosis when they go through menopause. The lack of estrogen affects the bone mineral density and weakens the bone. The same thing happens in men. Not estrogen, but testosterone, the male hormone. And as a result, bone is always undergoing breakdown and rebuilding. Breakdown and rebuilding. It's in a constant balance. And as long as any bone cells are no longer useful and are replaced by good bone cells, a man's bones are in good shape. However, about one in eight men will have a situation where the breakdown of bone is greater than the remodeling or new bone, and the bone becomes less dense. And osteoporosis in men is a silent disease. The only time they start to have symptoms is when they get a fracture. And they get the common fracture in men is the hip bone and the vertebral bone, the back, the spine. Those vertebral bodies can become crushed, and that can affect the nerves that go in between the two vertebral bodies. And that causes severe, severe pain and discomfort. And there are various risk factors that men need to know about that can result in osteoporosis.

[00:32:26.130] – Dr. Baum

First of all, it's a disease of aging. The older you are, the less your body is going to make new bone. It also has to do with smoking. Smoking significantly increases the risk of osteoporosis family history. If you had a relative, a male relative that had osteoporosis, you're at an increased risk. And testosterone, as men get older, they lose testosterone about 1% to 2% a year, starting around they start losing it around age 30 or 40. So by the time they reach 60, they may have a 40% reduction in testosterone. And that affects the bone. And as a result, these men are at risk for a bone fracture, a hip fracture and the collapse of the vertebral body. Some of the signs of this are a man loses height. A man, let's say, is five foot ten at age 40. At age 60, he may be 5'9 5'8 and a half because those vertebral bodies get smaller and get shrink and the height of the man decreases. They're also the posture of the man, they're a little more bent over. And in bad cases, you can see it in their back. Their back sticks out. The appropriate diagnosis is made by a scan called the DEXA scan.

[00:34:20.280] – Dr. Baum

This is done in most radiology departments. And they can look at that hip and they can tell you, hey, you are really at increased risk and you need to start taking calcium and vitamin D because those are promoters of bone health. You take 1000 milligrams of calcium per day and 600 units of vitamin D. Also, you can get vitamin D for free by sunshine. You go outside and the skin makes vitamin D if you're exposed to sunlight. But if you're at risk for osteoporosis and your DEXA scan indicates that, I would still recommend that a man take vitamin D. And there's other drugs that are available, but those are the simple things. And it's also the recognition if you're at increased risk, you should get this DEXA scan. It's not uncomfortable. Insurance pays for it for the most part. And you can identify those men who are likely to get this and can start supplementing them with the vitamins, the calcium and various medications that can help control it.

[00:35:53.330] – Allan

There's another way to control it's also a lot cheaper resistance training. Within the realm of where you are. Obviously, if you have thin bones and you got issues, you're not going to start throwing a bunch of weight on your back because that's exactly how you get one of those fractures. But being active, doing some resistance training with what you can where you are, that additional resistance training is going to train the bone to be a little bit more dense.

[00:36:18.290] – Dr. Baum

We're talking about like using weights or bands.

[00:36:23.700] – Allan

Or bands.

[00:36:24.590] – Dr. Baum

Or bands, yeah, or walking. Getting outside and having a brisk walk or jog can help. And then also you can be very proactive and protective and avoid high impact exercises like jogging. Instead, convert to swimming. I just bought what's called a rebounder. It's a trampoline. It's about 3ft wide and it has a bar and you can run on this trampoline and watch TV or engage in exercise. And you're getting a kind of a good workout and it's joint protective

[00:37:10.810] – Allan

and it's moving lymph through your system. So you're helping keep your body properly detoxified. You don't need a detox, you just need to move your body because your muscles are going to do everything you really need them to do if you move around enough.

[00:37:23.330] – Dr. Baum

Well, we're going to talk a little bit, I think, about health and fitness and longevity. And I would like to throw this out there that we are able to make people live longer. We can increase the lifespan of people, but our real goal is to increase the health span of people. And I'd like people to think about focusing on movement, mobility and marbles. And those are the two things that I think add to good health and increase the health span as we get older. If you're able to ambulate without a walker, a cane or a wheelchair, that's a real plus. If you're able to engage in communication and have your memory is still intact, that's a plus. And I think so much of what we're going to talk about in terms of longevity has to do with mobility and the marbles. Our brain and to preserve the marbles leads to enhanced quality of life. Quality of life is terrible if you're confined to a chair, you're sedentary and you can't remember to take your medicines or what you had for breakfast or who your loved ones are. That's a sad state of affairs. It doesn't have to be that way.

[00:39:16.300] – Allan

I agree. Now, there's a lot of bad things that happened in the last few years since we last talked with COVID and everything there. But kind of one of the, I guess the silver linings that have come out of the whole COVID thing is that there's been a seismic shift. In my opinion, moving from the way things used to be with going to your doctor's office and sitting in a waiting room for however long going to a second waiting room where you wait for the doctor for however long you're going to be there. The guy comes in, reads your chart, says, okay, looks like you've lost a little bit. What about lost some weight? Gained some weight. You need to do this, you need to do that. What's your problem today? Oh, you got a sore throat or you got this or that? Well, here's a script. I'll see you. Goodbye. He might even shake your hand before he takes his gloves off.

[00:40:02.850] – Dr. Baum

But I hope he washes his hands first.

[00:40:06.820] – Allan

Yeah, either way, he's in there for such a short period of time and if you're not prepared, you're not asking the questions that you need to ask. But with the advent of telemedicine, I'm not driving the 45 minutes to get to my doctor's appointment, getting there early so I'm not late, but then still having to wait until it's late. And so I'm losing three or 4 hours of a busy work day to go see my doctor and then he's going to give me the prescription. So now I got to go by the pharmacy and pick that up. Now I'm getting home late. And so it's like, well, let's just stop by the fast food and have dinner because we run out of time to cook dinner. We're all busy and it's really hard to prioritize our health when that's what we know is in front of us with regards to most doctors visits. But we've moved and transitioned over to where telemedicine is approved and utilized a lot more. Can you talk about telemedicine and how we can lever that to make sure we're getting done what we need to be done with all the other busy stuff we've got going on in our lives?

[00:41:09.510] – Dr. Baum

You use the word seismic shift, is.

[00:41:12.170] – Allan

That I think so, yeah. I think it's significant.

[00:41:15.690] – Dr. Baum

I think it's a tsunami. It really has changed the course of medicine in the past, five years ago, before pandemic, the doctor says, I've got to see the patient, I've got to touch the patient, I've got to look at body language. Bunch of crap, really. Bunch of crap. A doctor. I can see you now I can talk to you now I can see you. I can take care of 50% of urologic problems over virtual using virtual medicine. If you have enlarged prostate, I can talk about your symptoms in your medication and I can make adjustments. If you have erectile dysfunction, I can talk about the risk factors and about getting your diabetes under control, and I can write you a prescription and I can follow you. If you have a urinary tract infection, I can send you to the lab to get a urine culture and then I can prescribe an antibiotic. And then a few days, seven to ten days later can contact you again on telemedicine and I can follow up. If you've had prostate surgery and you are having a normal course and you're off of your medications and you need advice about when you can go back to activities, I can give you that advice over using telemedicine and video conferencing.

[00:43:07.830] – Dr. Baum

If you have incontinence, I can manage that oftentimes using virtual medicine. Point I'm trying to make is that there are so many conditions that can be managed this way. And we have now come to the realization that the doctor can practice good medicine. Good medicine without having to touch the patient and without the patient having to go to bricks and mortar offices. The doctor has to recognize, just as you said, trip to the doctor could be four to 6 hours out of your day for just a routine follow up. Four to 6 hours until you leave your office, travel there, find the parking, get in there, fill out the paperwork, wait in the reception area, wait, and then go get the prescription and come home. It can be four to 6 hours, and that's time when you should be productive at work. And the doctor hasn't realized he sees them in ten minutes. Well, that's ten minutes for the doctor. That's 4 hours to the patient. I also want to point out that another boon to telemedicine is the doctor now gets paid for it as if it were an in office visit. So that has become a motivator.

[00:44:50.260] – Dr. Baum

But now I think doctors have learned that they can be good doctors. You're not blowing the patient off. You can have a longer, more comfortable visit. You can have the patient monitor their blood pressure and their weight at home. They can do home testing for glucose. There are so many things that now with fitness trackers and sleep monitors there are so many ways that you can care for the patient. And telemedicine is really a big plus for patients and for doctors. And also I have found that when you do telemedicine, the patient is on time and so is the doctor. In the past, the doctor was late and he was 45 minutes, an hour late. The doctor got away with it. Just say, oh, I was in the emergency room at a sick patient. Now, when you have a telemedicine, I said to you, I'll be available at 02:00. You knew I was going to be on time, and I knew you were going to be on time. And that's the way telemedicine works. And so it's much more efficient. Much, much more efficient. And it's good medicine. Yeah.

[00:46:20.090] – Allan

And a lot of times people won't follow up. And because of that same thing, it's like, okay, well, I don't feel anything bad right now because I got done what I wanted, I got the script, I feel better. And they want to go back to their lives, but the doctor says, okay, we'll set a follow up appointment for two weeks. And you don't do that follow up appointment if you're feeling okay, because the problem,

[00:46:40.910] – Dr. Baum

especially men, especially men, women are much better at follow up. Men are derelict.

[00:46:47.640] – Allan

And so this is a good opportunity with the doctor, particularly if you're going to look at going to a new doctor or specialist, have the conversation with them. Do you do telemedicine? Can I set up appointments and do this over video? It's going to save me a ton of time. It's going to save you a ton of time. And we're going to be able to communicate a lot better because I'll be prepared heard instead of being all flustered. And the other side of it is I can put a blood pressure monitor sitting in my own living room. My blood pressure is going to be a lot lower than having driven across town walking into a doctor's office. It's going to be more natural to how my normal afternoon would be if I don't have to go to that trouble.

[00:47:22.750] – Dr. Baum

My advice to people embarking on a new physician is to interview that new doctor. Ask pay for the interview. Usually they don't charge for it. You pay for the interview. You read my book

[00:47:38.610] – Allan

Yeah, there's questions. You've got a whole script in there. Here's what you say when you walk in the door. Here's what the doctor is probably going to ask you to sign this waiver, basically informed consent form. And so these are the things you're going to expect. And you laid it out in the book very clear. When you go in, ask these questions. If they don't feel comfortable with the answer, go back to your insurance company, find another doctor on the list that you can interview well.

[00:48:04.920] – Dr. Baum

And also, you are correct. You want to ask, would you agree to telemedicine for the first visit? I really don't think should be a telemedicine visit. I think you need to develop rapport with the doctor. It can be done. My art style was to visit the patient for the first time and examine and touch my hands on the patient and examine the patient. But then you are finding, does the doctor do telemedicine? Does the doctor do email? Does the doctor return email and phone calls within 24, 48 hours? You don't want to wait two weeks to get a report. And does the doctor have a portal? The portal is that this records the results of laboratory testing and imaging that becomes transparent between the doctor and the patient that it's put up on the portal. It's encrypted, which means nobody else can look at it. You have to have a username and password.

[00:49:19.590] – Allan

And I think most of us, we've used online banking, so we're very comfortable with logging into a website and seeing things that we don't want other people necessarily see. There's all your transactions laid out. This is similar. Your details are going to be there. So when your doctor tells you, well, okay, yeah, your cholesterol is a little high, your HDL is really good, your LDL is a little elevated, your triglycerides are down. Here's what I feel the course of action should be based on what I see in front of me. And you can see it too, and you can say, well, okay, that makes sense based on what I see and what the doctor says versus, yeah, you got to wait, get a piece of paper. When you walk in the office, you're scanning through it and trying to figure out what the doctor is going to ask you and talk to you out. And there's so much going on because they're weighing you and then they're taking you to a little room, and now you're stuck. Versus if there's a portal. You go in there, you look up your details, you kind of have some questions that you know are on the top of your mind.

[00:50:11.760] – Allan

If the doctor doesn't bring it up, you bring it up. So it's a much fuller and better prepared conversation on both sides.

[00:50:18.220] – Dr. Baum

I would like to mention that the health care for patients is so much better if they prepare for the visit. And that means writing out what questions do you I used to give out a card, a three x five card. It says, what three questions would you like to ask the doctor today? That avoided me thinking that I'm done managing the patient. Put my hand on the doorknob, ready to walk out and say, wait, I got one more question. And that's not a good way to ask the question. You write it out, you think about what you want to accomplish on your visit, and you share that with the doctor, and the doctor appreciates that. If you write it out, give the doctor the papers that I'd like to cover these three things today. These are three questions I would like to ask you. You're a better patient and you're going to have a better health outcome when you are proactive. Women start from a pediatrician, and then they start having reproductive in their 20s and 30s, and they start seeing the obstetrician, and they do get women are much better at breast self examination than men are with testicle self exam.

[00:51:48.370] – Dr. Baum

And the point that I'm making is that women have a relationship with their doctors from the time of their pediatrician till their middle age. A man at the age of 18, when he goes off to college, he's done with the doctor, and he doesn't see a doctor till he's 50.

[00:52:09.050] – Allan

If he's lucky.

[00:52:11.050] – Dr. Baum

If he's lucky, he'll get to see the doctor at age 50. But men really don't have the same health care experience that women have. And as a result, men are in the dark. They become silent. They don't know what to ask. And as a result, I think their health lingers on. Their problems linger on. They don't get diagnosed with hypertension. A guy could be never see a doctor, and hypertension is silent. You don't feel that your blood pressure is up. The men are silent, and they don't seek out health care till they're about 50 when things start to break down. And so, really, this kind of a book, answering these questions and preparing the patient for a visit to the doctor is very helpful. I never resented patients who come in with a briefcase full of articles from the Internet, and I just say, I don't think that's the place to go for your healthcare.

[00:53:30.540] – Dr. Baum

Oftentimes those aren't credible sites. Let me give you a list of credible sites that are available to you and let's go from there. But I never resent a patient wanting more information about their health. I think that's a good thing.

[00:53:49.270] – Allan

I do too. I do, too.

[00:53:51.930] – Dr. Baum

Not to discourage, but to promote.

[00:53:54.890] – Allan

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

[00:54:03.390] – Dr. Baum

Diet and exercise. I got it down to two. We are an unhealthy nation. Obesity is not a problem of willpower. It's a disease, and it needs to be treated, and it needs to be treated early on. And proper nutrition is so very important. And I think if you have a good diet, fresh fruit, vegetables, lean meat, chicken, fish, avoiding trans fat and polyunsaturated oils, having high fiber in the diet is very important. Absence of artificial sweeteners and diet drinks should be avoided. Smoking cessation, moderate alcohol. Alcohol is good. The books say one drink a day. I think for a man, one to two glasses of wine a day is probably medicinal and healthy. And so I don't tell men, you have to be a tea toller. Limiting the caffeine consumption, especially late in the day, because it can affect your ability to sleep. And insomnia is a problem of middle aged and older men. And then exercise. We are a sedentary nation. We sit still far, far too long, and there are so many things that we can do, so many ways that we can exercise. Like that rebounder I talked about. I could have a rebounder right here, and I could be jumping on the rebounder and talking to you and not feel that I'm not giving you my undivided attention.

[00:56:14.150] – Dr. Baum

Walking the stairs. Walking up the stairs, not down. And having 10,000 steps a day, that's 5 miles. And you have to wear a tracker. Did you have a watch? Fitness watch?

[00:56:30.030] – Allan

I have a phone, and I carry the phone in my pocket that tracks my steps. When I'm out, I make sure I have my phone in my pocket.

[00:56:38.920] – Dr. Baum

Okay? So 10,000 steps a day and 150 minutes a week of aerobic activity, and that is some for brisk walking, jogging, tennis, swimming, 150 minutes a week. There are four conditions that are impacting this nation and the American health care budget. American health care budget over $4 trillion a year, 18% of GDP. More than we spend on military, we spend on health care. And yet, in America, we don't have the outcomes that compare to a nation like Sweden, Denmark, Germany, France, who spend about half that amount on health care per capita on their population. And we don't have the outcomes to support all that spending. And there are four diseases, four conditions that are bloating the healthcare budget, that is, cardiovascular disease, hypertension, heart disease, diabetes, cancer and neurodegenerative disease, alzheimer's disease. All of those are reasonably preventable and with proper diet and exercise and a few other things. Healthy lifestyle. Use the seatbelt every time. Go around the block. Put the seatbelt on. Smoking cessation. Don't engage in foolhardy activities. Don't go bungee jumping at age 60. That's probably not healthy to do. But practice good lifestyle habits. Get 7 hours of sleep a night. Good dental hygiene, which means brushing and flossing your teeth. I see.

[00:59:03.310] – Allan

You can't help it. You can't help it.

[00:59:06.530] – Dr. Baum

Okay. All right. Flossing your teeth. So much of health, poor health, can occur with a bad mouth. If you have periodontitis and you brush your teeth and it gets into your bloodstream, that can make you real sick and cause chronic inflammation. And then screening tests. Screening tests for colon and rectal cancer with a stool test, which we could go into, but you know what I'm talking about. Colonoscopy. Depending on your risk factors, the PSA test, cardiogram, chest X ray, these are preventive health that can take those four conditions and move them off the plate.

[00:59:58.930] – Allan

So, Dr. Someone wanted to learn more about you. Learn more about your books, including the Men's Complete Health Guide expert Answers to Questions You Don't Always Ask. Where would you like for me to send them?

[01:00:11.510] – Dr. Baum

Send them to Amazon.com.

[01:00:14.120] – Allan

Okay. Of the links in the Show notes, you can go to 40plusfitnesspodcast.com/609. And I'll be sure to have links to the books there.

[01:00:24.060] – Dr. Baum

And one other book that I highly recommend is Outlive by Peter Atia, and I'd like that to be in the Show Notes as well, because this is written for laypeople about trying to make our health span equal to our lifespan. We've done a really good job with lifespan from 100 years ago, we've added 20 years to our lifespan, but now we need to talk about the health span, and this book goes through a lot of practical ideas that we have discussed today that I highly recommend this book as well as my own.

[01:01:14.920] – Allan

Yes. All right, well, thank you so much for being a part of 40+ Fitness.

[01:01:19.370] – Dr. Baum

I look forward to getting together with you again, Allan. Last time it was five years. Let's not make it that long.

[01:01:25.870] – Allan

Let's not.

[01:01:27.000] – Dr. Baum

Okay. Thank you, Allan.

Post Show/Recap

[01:01:29.930] – Allan

Hey, Ras.

[01:01:31.470] – Rachel

Hey, Allan. It was nice that you had Dr. Baum back. That's pretty cool to have a repeat author on your show. Must be very prolific with his books.

[01:01:39.590] – Allan

Yeah, I barely remembered the interview I'd had with him back then, other than it was an interesting title, like how's it Hanging? The title of his book. I would say this was a little bit more formalized, and he was doing another doctor. So the Men's Complete Health Guide obviously doesn't have as much swagger as how's it hanging? And five years. A lot's happened in the field of surgery and around prostate cancer and some of the issues there. So I was glad to have that conversation withhim. Dr. Baum's written a lot of books on this topic, and particularly he has one that's on prostate cancer, which is awesome as well. And then How's It Hanging is a very similar book, but maybe a little bit more casual than this one. It's really just to get men aware that we have these health issues, whether we want to admit it or not. And if we wait till we're broken if we wait till we're broken, sometimes that's too late to really fix the core problem. And so that's why I wanted to have him on, to have this conversation. And things like telemedicine is a game changer, because when you can sit down and just call your doctor, it's 15 minutes phone call, and then you're back to work.

[01:02:55.830] – Allan

You literally close your office door or you go somewhere where, like, a conference room, and you sit down and have a 15 minutes conversation with your doctor, and you're back in the work. You didn't have to drive across town. You didn't have to sit in a waiting room. You didn't have to do all that kind of stuff. And the doctor can basically help you meet your health outcome goals right there on the phone. I think that's huge. And, ladies, you can schedule the call and don't tell your husband. Just hand him the phone. He's like, this is for you. Who is this? Your doctor. Have a conversation and then gosh. You have a list of questions. Have a list of questions for him right there. Hand him the paper. Hand him the phone, and then just say, go. And again, it's high time that it happened. I'm glad that it's happening the way it had to happen. With COVID and everything is kind of sad. But the shiny silver lining of this whole thing is that telemedicine is now a commonplace. Before I had a doctor, my health doctor, we were telemedicine because I didn't live where he is, I would go in there about once a year and see him in person.

[01:04:00.540] – Allan

But other than that, no, I was anywhere else in the world. Malaysia, Africa. I even called him one time from Iran, like that's when my call was, and I was like, okay, so it's evening, I'm sitting in my hotel room in Iraq, and I have a phone call with my doctor. We were able to do know, but he was kind of cutting edge. He was doing things that other doctors weren't doing at that point in time, which was why he was my doctor. And I didn't have to be in the hometown with him because I didn't have to go see him every time I wanted to see him or talk to him. I had a doctor that I could call when I needed to call. So I'm really glad that telemedicine is out there. This is a really good book, though. This is just a good book for you to kind of just go through. And it's not even something where you'd have to read it from cover to cover like I did it's where you can sit down and say, okay, I'm curious about this, and you can flip to that section of the book.

[01:04:57.280] – Allan

There are parts that I say, read the whole thing because he has an anatomy lesson on the front. And you may think you know your junk, but there's a lot more down there than you think. And so this is just a good idea. Why is this happening? Why am I experiencing this? Is this normal? Is this bad? What does this mean? And so this is just a really good primer for you to understand the anatomy and understand what's going on there and then just recognize some of these things just don't come to mind. Like osteoporosis.

[01:05:27.090] – Rachel


[01:05:27.940] – Allan

And the fact that, yeah, if you fall and break your hip, you could be in big, big trouble. So making sure you're getting adequate nutrition, resistance, exercise, all those things we talk about every week, they're important, and they're important for women, and they're important for men. And so don't poo poo something you learn about women, because men, we might have some of the similar issues, because guess what? We got bones, too.

[01:05:48.800] – Rachel

Yes, for sure. Yeah, these are all good things. And it's good to have, like you said, this type of primer, because sometimes you don't realize what's happening until it's maybe a little bit too late or hard to bring that back with treatment or whatever. Especially like the PSA screeening, you know, I talk about cancer screenings all the time with you, Alan. And PSA is a simple one. You get your PSA score and you keep an eye on it until it needs further attention. It's a simple screening and could save you a lot of trouble in the long run.

[01:06:21.720] – Allan

Right. And so this is something that's changed considerably since the last time I talked to Dr. Baum was before it was you got your PSA and then you got your digital check, which was not digital, very analog, and then you get that check, and then the doctor said, I think there's something we need to do here. Most of the time, the next solution was the biopsy. So now they're doing a biopsy. Now that's okay. But one of the problems with a biopsy is whenever you cut into a cancer, it has the potential to spread faster so it can metastasize because you cut it. And so the biopsy is not necessarily a thing you want to do. You don't have to. So a lot of doctors wanted to push for the MRI before the biopsy, which tells them a lot more about where the lump is, how it's lumped, so they know where also now they can do a better biopsy because they know more. But MRIs were very expensive, particularly five years ago, so most insurances didn't want to pay for that. They wanted the biopsy first, find that there's cancer, prove there's cancer, and then you can do your MRI so that you know what kind of surgery or what kind of interventions you want to do.

[01:07:33.380] – Allan

Things have changed a good bit now. Now there are other additional tests, the PSA plus and all other stuff, and there's some 4K tests and other things that can be done before. So your PSA might be high, but that doesn't mean there's a cancer. And so they can do these other tests that are non invasive before they start worrying about MRIs and biopsies and all that kind of stuff. And then they may find, well, no, your risk is very low. This is not an aggressive form. This is not a problem. We're just going to actively watch this. I don't think you called it actively watch back. Kind of my way of thinking about it was just not doing anything, which kind of sounds weird. Well, there's a cancer growing in me. How do I just not do that? But the reality is you don't want that biopsy if you don't need to, and then if it isn't spreading, you don't necessarily want to mess with the prostate because there's some downsides to the surgery. And putting it off for even a few years might mean that they come up with some technologies that make that surgery a lot safer.

[01:08:38.670] – Allan

So you may not have the side effects, but yes, jumping on it right now and saying, I got to get that out of my body, you're taking a risk, and you're taking a higher risk than you might by waiting and doing it later if you have to.

[01:08:52.200] – Rachel

Yeah, that's really great. It's awesome to see how technology and the study of different cancers like the prostate cancer has advanced over the years. It just makes things a lot easier. And, yeah, he called it active surveillance. There are cancers that could be present, but inert and are fine, just hanging out, not causing problems.

[01:09:12.900] – Allan

And some of us, whether we want to admit it or not, we're older and we're sicker, we got a lot of other things going on in our body that are going to kill us long before a prostate cancer would. And so that's the other side of it, is, do you want to take that risk and maybe mess up the quality of life that you have for the foreseeable future when that's not going to be what takes? You know?

[01:09:36.700] – Rachel

But I love this book by Dr. Baum. I hope that all the men, and maybe even the wives in our men's lives or loved ones share that with our husbands, who we know don't often choose to go to the doctor. It's a good thing just to have.

[01:09:53.220] – Allan

And I know it's a few months before Christmas, but, hey, if you're looking for a gift idea for a man in your life, this might be a pretty good one.

[01:10:02.510] – Rachel

Sounds great, Allan.

[01:10:03.960] – Allan

All right, well, I'll talk to you next week.

[01:10:05.970] – Rachel

Take care.

[01:10:06.850] – Allan

You, too. Bye.

[01:10:07.960] – Rachel

Thanks. Bye bye.

Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
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Thank you!

Another episode you may enjoy


September 19, 2023

Meditation made simple with Ariel Garten

Apple Google Spotify Overcast Youtube

If you've struggled with starting and maintaining a meditation practice, you'll enjoy this discussion with Ariel Garten of Muse.


Let's Say Hello

Due to Coach Allan's vacation, there is no Hello Section on this episode.


[00:03:12.350] – Allan

Ariel, welcome to 40 plus fitness.

[00:03:15.790] – Ariel

Thank you, Allan. It's a joy and pleasure to be here.

[00:03:20.210] – Allan

I've been really looking forward to this conversation for a lot of different reasons, but I would say the biggest one was I am a terrible meditator. I've tried and tried and tried, and it's something that I know benefits me when I do it consistently. But I've really struggled with this until I ran into you guys. And we're going to get to have a conversation about why we should meditate, the benefits of it, the different types, and then like me, why do I have such a hard time with this whole thing called meditation? And then we're going to talk about a tool that has really changed the whole game for me. That's why I'm really excited to have this conversation, because I get to pick the brain of a neuroscientist.

[00:04:14.050] – Ariel

That's awesome, by the way, a neuroscientist who also sucked at meditation when I started. So I hear you and I feel you.

[00:04:22.390] – Allan

Good, because this definitely helps. I know if we would just slow down a little bit and take the time to do this, that everybody's going to benefit from it. And so can we talk about what meditation does to us and what some of those benefits are?

[00:04:42.970] – Ariel

Sure. So meditation has more benefits than we could talk about in an hours long podcast. It's quite remarkable how this one little activity can have so much impact both in your mind and your body and your brain and your relationships and your work productivity and on and on and on. At its basic core, what meditation is teaching you to do is to change your relationship to your mind and your body. So we all spend time with thoughts that are floating around in our head and we assume we're supposed to be thinking those thoughts because that's just what's in our brain. We're thinking about the grocery list and the people who made us grumpy in the fight we had and, and with meditation, what you learn to do is shift that relationship so you're not thinking these thoughts over and over and over again. When the thought about the fight with your partner comes up, you can move your mind elsewhere onto something that's productive. When you desire to check facebook for the 39th time and you know that thought comes up, you have a tool to say, no, I can just move my attention elsewhere, let that go, forget about it and do something else.

[00:05:49.060] – Ariel

So fundamentally, meditation is a tool to help us calm our mind and body, shift our mind out of difficult thoughts that annoy us and that cause physiological distress, and to be able to shift our physiological sense, our anxieties, our stresses, and move those into a happier place. So when you do that, kind of the whole world becomes easier.

[00:06:11.750] – Allan

Particularly when I was working in corporate, I really saw meditation as a great thing. Like I said, I still wasn't very good at it and for a lot of different reasons. But I made a point every afternoon to at least try to meditate and I used different services that would talk me through it. Or I'd find a YouTube video and say, okay, well that's kind of interesting, I'll try that one today. And I could do 5, 10 minutes, but it just seemed like I wasn't getting anywhere, but I felt less stressed. I will say that just even that five minutes of just slowing down and saying, okay, I'm sitting here, I'm breathing I'm listening to the man or the woman guide me through this. But besides that lower stress and probably bringing my blood pressure down a little bit, what other benefits would someone get from meditation?

[00:07:11.530] – Ariel

So as I said, the benefits are too much to list. But if we want to get started, one of the main things that you'll realize is that the conversation in your head is all of a sudden less stressful. So instead of having all these thoughts in your head that are frustrating and annoying, you can gain control over the contents of your own mind and calm them down. And so that then rolls into all sorts of different aspects of our life. So in a workplace setting, you've got emails flying back and forth, you've got colleagues that may have triggered you, you have feelings that you may not be good enough. With a meditation practice, you learn to shift all of those things that would have caused you anxiety, all of those emails, all of those thoughts and feelings, you learn to shift them into a calm and neutral place. And so the workday becomes easier, your relationships with your colleagues improve. The same thing happens in the home front. So one of the things we commonly hear from people in their first few weeks of a meditation practice when you really sit down and do it, is that their relationship to their partner is getting better.

[00:08:16.880] – Ariel

That they're not. Yelling at their kid so much because in the past their kid would do something and the automatic reply would be to yell because you just feel stressed and ramped. And once you do a meditation practice for a few weeks, you've now practiced having thoughts and feelings and not reacting to them, having a thought and feeling and just saying like, okay, I can let that pass, that's okay. And when your kid does something really annoying that they maybe don't mean to or do mean to, the first sensation that comes up is usually one of the anger rising or the frustration rising. And in the past it would just come out of your mouth and you would be yelling at your kid. And with a meditation practice, you might notice that the anger begins and then you can take a moment and say, oh okay, that can fall away now I can stand back, look properly at what's happening, and then have the right response to it. Because we all know when we yell, then our kid just gets upset and yells and we start a whole cycle. And even if something's frustrating to us, if we can stand back and have a better response, oh my God, does life go better in all directions.

[00:09:23.130] – Ariel

So we have improved relationships, whether at work or at home, with your friends, with your partners. We also have improved physical function. So meditation has been shown to decrease anxiety, decrease stress, improve your general physical health, decrease the chances of heart attacks, and cardiovascular disease. The physiological benefits are huge. And then you also have benefits on things like sleep. So when you're not as anxious during the day, when you don't have as many racing thoughts, sleep becomes much easier. And then you have tremendous benefits, actually, in the physical function of your brain. The parts of your brain get bigger and stronger through an active meditation. Just like when you go to the gym, your muscles get bigger and stronger. We can dive more deeply into that one, too.

[00:10:13.730] – Allan

Yeah, let's do that. Because as I was doing research on meditation, for us to have this conversation, most of the benefits I was finding were kind of in that emotional area, so you have less anxiety, less stress, and then, obviously, there were physiological things that are benefits from that. So if you're not as stressed, your blood pressure is probably not as high, and you're not as stressed, you're probably sleeping better. But as we were getting into this conversation, you were mentioning to me before we got on the call, before we got on the recording, was that there's actual physical changes to your brain.

[00:10:51.730] – Ariel

Yes. It's quite astonishing. So, neuroscientists have been studying meditation and its impact not just on your behaviors and your general lifestyle, but actually on the organ of your brain. And what they've discovered is that meditation can actually increase the thickness and the function of parts of your brain. So, bad news, as you age, an area of your brain in the front called the prefrontal cortex begins to thin, just like as you age, all of your cells don't function quite as well as they did when you were younger. Well, it turns out, with the meditation practice, you're able to maintain the thickness of your prefrontal cortex even as you age. So our prefrontal cortex is responsible for our attention, our inhibition, our planning, our higher order processes. And as you really do a meditation practice regularly, you are working out your prefrontal cortex that part of your brain and strengthening your attention, improving your ability to inhibit your ability to not just yell at somebody, but hold yourself back and do the right thing. You're improving your ability to see a situation from multiple angles, and that actually has real impact on your brain itself, improving your brain health and longevity.

[00:12:09.050] – Ariel

Meditation has also been demonstrated to maintain the volume of your hippocampus. So the hippocampus is the part of your brain associated with learning and memory. And unfortunately, as we age, that part of our brain tends to shrink as well. Well, meditation has been demonstrated to maintain the volume of your hippocampus as you age. So it starts to stave off some of the effects of aging on your learning in memory, potentially. Meditation has been also shown to increase the density of your gray matter. So the gray matter is the number of neural connections you have. As an example, Einstein had more gray matter than the average individual. And in a study by Dr. Sarah Lazar at Harvard, she was able to demonstrate that just eight weeks of meditation, so, like not a lifetime, just a few weeks, was able to increase the density of participants' gray matter. So you're getting more neural connections, more information being packed and held in your brain. So meditation really strengthens your brain and helps to stave off the aging of the brain.

[00:13:13.310] – Allan

And then you mentioned earlier when we were talking that it also kind of helps us get rid of that lizard brain a little bit.

[00:13:21.170] – Ariel

Oh, yeah. So the quote unquote lizard brain is associated with the amygdala. So the amygdala is a part of our brain that's responsible for your fight or flight response. So when you're scanning the environment, your amygdala is always looking out for danger and going, oh no. So when we have anxiety, for example, you could have very heightened amygdala function. And the functioning of that amygdala then triggers the feelings in your body of fear, the rushing of your heart, the flush of glucose through your body, that sort of shakiness, that feeling of fear, and it also triggers thoughts about fear, oh no, this thing's going to be awful. Which then gives you the feeling in your body, which gives you more thoughts and the feeling, and it ramps, and it ramps, and then you're in an anxiety attack. Or if you're not somebody with anxiety attacks, you're just in a state of chronic stress. With meditation, you're actually able to calm the activity of the amygdala. And MRI studies show that short term meditators, people who haven't necessarily been doing it for years, but have had a little bit of a meditation practice, tend to have less reactive amygdalas, so you're not as stressed and reactive about things in the world.

[00:14:31.430] – Ariel

And long term meditators have even been shown to have a decreased size in their amygdala. So you're actually really just calming and not activating that part of your body repeatedly and regularly. And over time, not only are you feeling calmer in life, but actually your brain has changed in such a way that allows you to be calmer. It's quite extraordinary.

[00:14:54.510] – Allan

And even beyond all that, a lot of people that have difficulties with impulse control around food and things like that. I had another neuroscientist on not long ago, a neuroscientist who was also a comedian. And in his book he was talking about how his amygdala would almost be autopilot on his car to drive him over to Krispy Kreme. And while his logical brain was saying, no, there's no way we don't need this. There's no way we can eat just one, his control center wanted something, but his amygdala wanted something entirely different and he ended up in the parking lot of that Krispy Kreme. And so this is actually also going to help you if you struggle with certain impulse controls or certain things where you find yourself doing things that you told yourself you weren't going to do. Because I guess the adult in your brain is going to be having the conversation and you're going to be more in control of that and the amygdala that would talk you into doing all kinds of terrible things. It's going to be quieter and you're going to be more in control of that. So it's a win win where if you're trying to make changes in your life and you're trying to be productive and get things done for your health, for your fitness, for your career, for any of it, this can make your brain better at doing those things.

[00:16:17.690] – Ariel

Absolutely. And that's interesting. Meditation helps in two different ways. So meditation is very good for helping you deal with urges or cravings. Because in a meditation practice, what you do is you sit there for five minutes, ten minutes, whatever it is, and you just observe what's going on and you don't act on it. So as you sit there in your meditation practice, you might have the urge to go eat a cookie. And in normal life, you would just follow that urge without thinking about it. In meditation, while your timer says you're still only at three minutes, you have to sit there for two more minutes and you watch your body like, oh my God, I need that cookie. I need it now. And you're carved the time and space to sit there and say, hold on, there's just two more minutes. I can just sit here and watch. And so you're watching this urge, this urge that previously you would have followed, but you're not following it. You just sit there and observe. And what you feel is this urge rising and building and growing. And then at a certain point, if you don't follow that urge, it falls away.

[00:17:16.330] – Ariel

It rises and it falls, and then you can sit there and say, oh my God, I had an urge for a cookie. And instead of following that for the first time, I just sat there. And if I sit there long enough, it just leaves. And then all of a sudden, in that moment, the power of the urge goes away. You realize you don't need to follow your urges. You can just watch them rise and fall and you're still there, everything's fine, and you didn't have a cookie. And so you're experiencing it both sort of cognitively in the moment, you're watching your body and your brain is actually changing. Because in a meditation practice, just as you alluded to the prefrontal cortex, the parent part of your brain is strengthening. And studies show that there can actually be an increased projection between the prefrontal cortex and the amygdala at the child. So the prefrontal cortex is actually getting better and better at being able to control the amygdala and say, calm down, it's okay, we don't need to follow that urge. We don't need that cookie. The thing's not that scary, we'll be fine in the meeting, whatever it is in that situation.

[00:18:19.630] – Ariel

And so we are shifting ourselves out of the amygdala urge space, the kitty space, into the prefrontal cortex, adult y space. And that's part of the reason why you see people with a meditation practice. And we say things like, oh, that's a wisdom practice. This person is getting wiser, more evolved. They're able to rise above their previous urges and learn how to gracefully move through them and manage them on a moment by moment basis and actually have their brain change so that it becomes easier to manage in the future. It's incredibly cool.

[00:18:53.770] – Allan

Now, there are a lot of different ways to meditate, and I've really only scratched the surface. I had an app that I had on my phone back when I was in corporate trying to take care of myself because I realized, okay, I've got to get my food right, I got to get my movement right. And I did those two things and like, okay, now sleep. And I got that pretty good. And then stress was kind of like my last domino. The thing I'm like, okay, if I can conquer this baby, I'm golden. But that was the hardest one. And I tried to use meditation for that. So I tried various different things. I tried different apps, I tried walking meditation, which was actually, for me, one of the most effective. But there's a lot of different types. Can you kind of talk about the different types and kind of maybe use cases for a few of them?

[00:19:43.130] – Ariel

Sure. So the most basic form of meditation that most people learn first is a focused attention meditation. And you can focus your attention on almost anything. The most common thing is to focus your attention on your breath. So that's called a breath focused meditation. And what you're doing there is you're focusing on your breath. You're feeling it wherever you feel like in your chest, in your nose, you're feeling your breath. And eventually your mind is going to wander off onto a thought. And then when your mind wanders to the thought, you then say, oh, my tension is off my breath. Okay, that's okay, bring my attention back to my breath. And then you put your tension back on your breath. A thought will eventually come. You'll wander away, you'll say, oh, come on back, and you bring it back to your breath. And so it's a very simple practice. But from there, the transformations that we've been discussing start to evolve. So if you don't want to focus on your breath, you can focus on other things. So in a mantra based meditation, you're focusing on a word or a phrase. In a more religious context, it might be phrase like omade padna om.

[00:20:47.690] – Ariel

In a totally secular context, it might be a phrase like I'm happy today, or just a color or just a word. One. One. And so you're focusing on that over and over. And as your mind wanders away from that, you let it go and you come on back. Now, part of why this is so effective is let's go back to the Krispy Kreme example. So if your mind wanders onto Krispy Kreme and you're thinking, donut, donut, donut. Well, in your meditation practice, what you're learning to do is to take your mind off that donut and bring it back onto your breath, which has nothing to do with donuts. And you'll just be focusing on your breath, focusing on your breath. Eventually your mind will go, oh, donuts. And then you'll say, thanks, donut, come on back to my breath. And so instead of following these urges or following these thoughts, you're learning to redirect your mind back to something neutral and productive to you. So we talked about breath focus. You've got mantra meditation. A walking meditation is very similar, but what you're doing is you're putting the attention in the part of your body that's moving, so it's usually your feet.

[00:21:51.550] – Ariel

And so instead of following your breath while you sit here, you'll be walking very slowly, very mindfully, and putting your attention into the sensations of the steps. So you're just feeling the step underneath you. Eventually your mind is going to wander away to the donuts or Facebook or the grocery list or whatever it is, and you're just going to bring your attention back to your step. So in each of these, we're really just bringing our attention back to something neutral in our body and being able to practice shifting our attention away from things that don't necessarily serve us. And so you can do whichever form works for you, whatever way you find to best meditate. And it's all serving the same end.

[00:22:33.410] – Allan

Yeah, most of the ones that I would do if there wasn't a walking meditation, I would do a guided meditation. They're telling you, okay, feel your feet, think about the sensations of your feet on the floor, the temperature, all that. Then you work your way up your legs to your torso, and then your hands and arms, and then up through to your head. And as you kind of go through that, your attention is like 100% on you. Another one that I did, if I recall, was a stress one. And they wanted you to imagine that hot lava was being poured in the top of your head and then starting to fill up your feet all the way up through your body. So you try to imagine that warmth as this ray of sunshine or whatever is basically doing this and filling you up. So there's been quite a few that I've tried, but I think my challenges were always the fact that if I took the time to slow down for even a minute, my brain filled up with those thoughts. And almost every one of those thoughts was a to do item. They were not just random thoughts of oh, I'm hungry, or this or that.

[00:23:45.590] – Allan

It was literally, oh, I forgot to make that phone call this morning. I really need to make sure I make that phone call this afternoon. And then I found myself hitting pause on the meditation if it was guided to literally have a piece of note paper and write down that to do item before I could let it go. Because it terrified me to let a to do item that was important go, particularly if I had already forgotten about it that morning. But there are a lot of challenges. Wandering mind for me was a big one. But there are other challenges that people do have with meditation. Can we talk about a few of those?

[00:24:21.890] – Ariel

Sure. So the greatest challenge that people have with meditation, I find, is that they think meditation is supposed to be about letting your mind go blank. And it's not. So nobody's going to sit there and just magically their mind goes blank and all of a sudden they're meditating and maybe they're levitating. I think actually levitation is about as easy as letting your mind go blank for a few minutes. It's impossible. And so in meditation, what you're really doing is you're having thoughts which are okay, it's normal, our brains have thoughts. And when you have the thought, you're moving your mind away from it and back onto something that's neutral. In your case, when you were paying attention to different parts of your body, like your feet, your legs, your knees, that's called a body scan. So when you had a thought, you would bring your attention back to the next part of your body and just pour all your attention into it. So first problem, people have a misconception that your mind is supposed to go blank. It's not, if your mind doesn't go blank, don't worry about it. If you have a ton of thoughts, totally fine.

[00:25:20.630] – Ariel

The question is what you do when you have those thoughts. Do you follow the thought and think about it? Or do you let the thought go either by just bringing your attention back or writing it down? If you feel like you really need to, if that's your way to let it go, that's okay. Especially at the beginning and then returning to your meditation practice. Another common problem people have is the misconception that you have to be sitting in a particular posture. So there's no magic to sitting on the floor with your knees crossed in an uncomfortable lotus. It doesn't really matter how you sit. The standard meditation posture is meant to be one that creates a sensation of uprightness. So you're sitting with a straight back, you're feeling upright, you're feeling strong and grounded. For most people, that is not sitting in a lotus position on the floor, so forget about that. You can sit in a chair, in a comfy chair, however, makes you feel good so long as you don't fall asleep. Which brings us to the next challenge. Some people fall asleep when they meditate. That's also okay, and that's incredibly normal.

[00:26:25.860] – Ariel

At the beginning, I would fall asleep meditating at the beginning. Now when I do a focused attention meditation, it makes me more alert, because meditation ultimately does make you far more alert and more engaged in the world. But at the beginning, it can make you feel sleepy, and that's okay. It's probably a sign that you're not sleeping well, and that when you've given your body a few minutes rest, it just wants to fall asleep, which is a great sign to actually prioritize getting more sleep at night. And if you find that you're falling asleep in a practice, that's okay. Choose a shorter practice. Choose something guided. Do a walking meditation, for example, so that you're standing and you're moving, or use something that's going to give you a little bit of stimulation during the practice. You stay awake, stand up while you're doing it, take deep breaths. And then another challenge that people have is feeling like, are they doing it right? And so that's possibly the biggest challenge. Exactly. That's possibly the biggest challenge in a meditation practice. And for that one, know that as you're letting your mind go from a thought and coming back to the breath know, that is the act of meditation.

[00:27:39.070] – Ariel

It may feel weird or strange, but just keep doing it. And as you do it, bit by bit, you're going to see improvement.

[00:27:45.980] – Allan

Yeah, I think that was one of the hardest things for me, was there was no real feedback. There was no one there to really tell me, okay, Allan, you did that one well. That wasn't until you guys sent me one of your muse devices. And that was a game changer. One, because you have complete control over the meditation that you do, how long you do it. I mean, literally, you get on the app, and you're like, okay, I want to do five minutes. I want to do ten minutes. And then you sit down and you start and I'm listening to the waves, and they're going and then the feedback that I'm getting okay, I hear the little birds, then I know I'm on track. I hear a little bit more of the tougher waves. I know, okay, I got to get myself really back. I've let myself, my brain wander whether I knew I was doing it or not. The feedback that you're getting from the device that wraps around your head, it's literally reading your brainwaves to say, okay, are you where you're supposed to be with this meditation? And so it catches you leaving before you've even really left, which is really cool because it kind of okay.

[00:28:59.160] – Allan

Yeah, I guess I was sort of zoning out. I wasn't paying attention to my breath. I wasn't paying attention to the sound of the waves. And now here I am, I'm back, and then I get rewarded with little bird sounds. And so it's a really cool device. The Muse device I have I think that it's the S. I think they sent me the S one. Yeah, the muse S and it's great. I mean, it's so user friendly, and the app is just you get on your phone, they sync, and then you start literally sitting down, going through a meditation. And I don't want to say it's gamification, but it kind of feels like, okay, I want to do well, and I want the feedback and the five minutes. I can tell you it goes really quickly when you're really in it. It's not like you feel like because before I know I'd go through a guided meditation, five minutes felt like an hour of real time versus sometimes I'm sitting with amuse and five minutes is poof, it's gone. I'm like, wow, I'm just sitting here, quiet, breathing, listening for the waves and the birds, and I'm in it.

[00:30:17.910] – Allan

I love that. And then you get done, and you get done and you've got a scorecard. It's going to literally tell you what your heart rate was doing, what your brainwaves were doing, and kind of say, okay, I know I'm getting better because I get that feedback.

[00:30:34.570] – Ariel

I'm so glad it's been helpful for you and it's been meaningful. When we started the journey of creating Muse, it was really to solve that problem of, am I doing it right? Because it was so hard to really figure it out. I, as a scientist, knew the impact of meditation on the brain. I would be teaching people to meditate, and I, too, was a sucky meditator. My brain would bounce all over the place, and I'd get frustrated and be like, oh, what am I doing here? Am I doing this right? And of course, as an A type, you want to do things as best as you can. And so it was really in the process of building Muse that I, too, was able to say, right, this is a meditation practice. I'm focused on my breath now. This is when it's working. Oh, my mind has wandered away, and I'd be signaled instantly, and then I'd bring my brain back. And then that's how I established my practice. And it was a game changer.

[00:31:26.560] – Allan

Yeah, I think so, too. It was just what do they say? I think I've read somewhere is if you don't have time to meditate for five minutes, you should meditate for an hour. I haven't made it to an hour yet, but it actually does just make it easier to meditate longer because you feel like you're accomplishing something each and every time you do it. Which, again, I'm kind of like that to a type A, I like to know that I've accomplished something and didn't just spend five minutes. And I'm guessing maybe I did, maybe I didn't. This is definitely a game changer.

[00:32:03.830] – Ariel

We should probably explain exactly what we're talking about. People are like, what is this what they're talking about here?

[00:32:09.930] – Allan

Okay, so what the Muse is, is it's basically like a headband that has little readers on it. It can read your brainwaves, so it knows if it's a delta alpha brainwave. When you're in meditation and you're in the right headspace, your brainwaves are going to be in a certain pattern. I think it's delta dominant. I may be getting that wrong because I'm not the neuroscientist, but

[00:32:39.090] – Ariel

you see an increase in alpha, you see an increase in theta, you see some coherence. There's a whole constellation of things that happen in your brain when you meditate. And so it's a sweet sauce that we've been able to identify.

[00:32:53.110] – Allan

And it's measuring heart rate too, right?

[00:32:55.290] – Ariel


[00:32:57.930] – Allan

Go ahead. Well, no, it's basically collecting data from your body, the physical reactions that are going on in your brain and with your heart, your parasympathetic system. And basically that feedback is going into the app real time.

[00:33:16.510] – Ariel

Yes. And then changing your experience so that you're getting feedback. It's neurofeedback. So basically, Muse is a clinical grade EEG. So they're the same sensors that you'd use in a hospital if you went in to get an EEG. And the Muse is able to track your brain activity and know when you're meditating and when your mind is wandering. And then they're guiding sounds that give you feedback about your meditation. So when you're focused, you heard Allan talk about the waves. When you're focused, the waves are quiet and then little birds start to chirp, saying, Yep, you're doing it right. And then as your mind wanders away onto a thought, you hear the sound of the waves pick up and that becomes your cue, like, oh, that's a thought. Let it go. Come on back to my breath. And then you hear the birds chirping. And so it becomes this very simple way to know if you're meditating, because it's tracking your brain and body while you do it and giving you feedback and telling you where you're at. And then after the fact, you get your data charts and graphs and scores, things that show you moment by moment what your brain was doing so that you can track your progress and improve your practice day after day.

[00:34:23.090] – Allan

And what I liked about it was there were different themes. I guess the best way for me to say it is there are different themes. Like, I happen to like the ocean, so the ocean waves were one that really appealed to me, but there's a lot of other themes in there as well. So you can really kind of ratchet into making this yours. This is the device that fits on your head, and it's the app, the service that you then can go in and find all the different ways that you could do sound sets and all the different skype, I think you call it soundscapes or something. I forget exactly what it was called, but basically you can customize your approach to this. And I sit down with it, and I just say, okay, I want to do five minutes, and I set it for five minutes. And then it gets going. I hear the waves, and I kind of concentrate on that sound on my breath, and I watch them calm. And then I hear the birds, and I'm like, okay, I'm in my space. And then all of a sudden, I'm out of my space for one reason or another.

[00:35:22.330] – Allan

The guy outside my office is yelling for the boat. Anyone wants to go to Amarante? He's yelling, Amarante. Amarante. And I might hear that voice, and that might pull me away, and I'm like, okay, I know why I got it pulled away, but this is where I belong, and I'm back in it, and I'm hearing the birds. The birds are nicer to listen to than the guy yelling, Amarante. You've got a loud voice. But it's really been a cool tool. With the device and the app, you basically have the coach, the meditation coach right there to walk you through this to keep you engaged. And then at the end, you've got the feedback to say, okay, how did this overall meditation session go? What was your resting heart rate throughout this? Because you're sitting there and you see what your heart rate was the entire five minutes. So you can see if this is destressing you, calming you down. You see that happen real time. So it's just a really cool thing.

[00:36:22.410] – Ariel

Thank you. Yeah, it's been amazing. And one of the most amazing things is seeing the way that it's been applied, both in meditators, so people who've never meditated before and people who have expert practices both get value from it and then also in healthcare. So the Mayo Clinic started doing studies with Muse back in 2014. They gave Muse to women awaiting breast cancer surgery, hoping that it would help them in the cancer care process. And they published a paper demonstrating that using Muse decreased the stress and fatigue during their cancer care process and improved their quality of life. So that was like, oh, my God, I can't believe we've had yeah.

[00:37:02.470] – Allan

That's awesome. That's incredible.

[00:37:04.870] – Ariel

Yeah. And Mayo thought so, too. So then the clinicians at the Mayo Clinic started five other studies with Muse using Muse for fibromyalgia for long COVID that study is about to be published. They then gave it to their own doctors who were feeling stressed and having burnout in the emergency room during the pandemic. So doctors in the E.R. Use Muse, and they were able to decrease their burnout by 54%, improve their sleep, and even improve their cognitive function by using Muse every day. And they were able to find a.

[00:37:35.200] – Allan

Good thing for a doctor that's a really good thing for an emergency room doctor. Improved cognitive function. Yeah. There you go.

[00:37:42.500] – Ariel

Very essential. More so than for you and I. Yeah.

[00:37:45.160] – Allan


[00:37:46.210] – Ariel

And so it's been unbelievable. Now they have a new study in menopause that's going to be kicking off. So it's been amazing to see how this is rolled out, both with people moms that bring it home for their kids, and then everybody starts meditating in the family. And our real goal, which is to make a real impact in people's health and happiness and seeing that happen within healthcare systems now, Hope Hospital, about 100 of their doctors have been using Muse, and it's just been expanding. It's unbelievable.

[00:38:15.590] – Allan

That's awesome. So now you can get your own Muse and one year of the service. You guys are so cool to offer a 20% discount for the device and one year of the service if you just go to choosemuse.com/40plus, or as we always do here, 40plusfitnesspodcast.com/muse. And that'll take you to that page where you can get that discount code already in there, ready to go. I've loved the muse. I'm going to keep using it. I'm going to enjoy it. It's making me feel better. I get done, and I don't have any doubts that I had a good session. Or maybe I know why it wasn't because Mr. Amarante guy is out there yelling, but at least at that point, I know when I'm on and I know what it feels like, and that makes it that much easier to get there.

[00:39:10.590] – Ariel

Oh, amazing. It's always so incredible to hear people whose lives it's impacted, and it's just an honor and a pleasure to do so. And it's my greatest wish that everybody in the world is able to taste the relief of having meditation practice and get those spaces of just calm and ease throughout the day when the things that used to bother you just don't. If we could all just realize that the voices inside our heads that are shouting at us, the Amarantes in our own mind, that we have the power to turn them off, to turn our attention away from it, to move away, that we would all just live easier, happier lives. And that possibility is there for all of us. You can really learn to turn off those annoying voices in your own head and be able to just focus on what matters to you.

[00:40:02.120] – Allan

Okay, so again, you can go to choosemuse.com/40plus or 40plusfitnesspodcast.com/muse, and that'll take you to the page with the 20% discount and a free year service for it. So give it a shot, try it out. It's really helped me, and I believe it's going to help you, too.

Post Show/Recap

[00:40:26.790] – Allan

Hey, Ras.

[00:40:28.390] – Rachel

Hey, Allan. How are you today?

[00:40:30.630] – Allan

We're doing all right. Again. We're recording all of these, so there's not really a hello section in the episode as we go, uh so there's several of these are all being recorded together. But that said, yeah, I'm just as good as I was last time we talked.

[00:40:48.110] – Rachel

Well, that's good. Getting ready for your trip?

[00:40:51.690] – Allan

Yeah, it's all good. It's all good. This was really interesting because I really tried to work on meditation as a practice on a regular basis. And it was just one of those things where alarm goes off and I get distracted by something else or I'm working on something else and I'm like, okay. Because I was trying to do it in the afternoons because I knew that was my most stressful moments and it just wasn't there. And the problem was when I slowed down, like, just nothing in my head, then everything's in my head, it's like, oh, I forgot to call. Oh, I forgot to call such and such, and I need to send that email, and I got to get that little bit done. And so I end up having to stop in the middle. And so when I'd use the other apps, I'd push pause, and I'd go over there and say, okay, I just pushed pause so I could come over here and write my to do list. But when I was using this thing, it was like, no. All I'm really focused on are the sounds, the ocean sounds. I had the headphones in, so literally didn't hear a whole lot of outside sounds except for Amarante guy yelling because the boats, they're leaving right out from under me.

[00:42:07.270] – Allan

So the guy's out on the street trying to get just a couple more people on the boat for that trip. There were things that would pull me away from it, but it wasn't like my thoughts were doing it. It was just like, okay, I'm aware of something else going on around me. So there wasn't the wandering mind that I had before. And yes, there's an interruption, but then I immediately get the feedback that I'm out. I'm not paying attention or not present. And it tells you that literally, that's neat. The app tells you it's like, you're not here. Come on back. And then the waves calm down, and then the birds start chirping, and it's kind of an interesting little thing.

[00:42:51.100] – Rachel

That sounds really neat. I've never been one just to sit still. I'm kind of a fidgeter myself. But since I've started practicing yoga, which I would imagine is somewhat similar to Pilates, in that you need to focus on where your body is in space and holding moves or gliding into a new move. And when I've been practicing this, I listen to the person who's saying, okay, do this. Breathe three times. And so basically, as I'm doing yoga, I'm only practice or only thinking about breathing and moving. And 20 minutes goes by and I've not thought of, like, you were just saying all the things I need to accomplish on the rest of the day and my to do list, and I feel like Pilates or yoga or something is kind of probably a good transition to be able to sit still and focus on your meditation. And the other thing I just want to share, too, is that when I do things, whether I'm going to the gym or on a run or doing my yoga, I have decided that this 15 or 30 minutes of time, or whatever it is, this time period is mine. And I don't want to think about what else I need to accomplish.

[00:44:03.270] – Rachel

Like, in these 30 minutes, this is what I'm doing, and the rest of my day will wait, and it'll get done when it gets done. And I think having that time helps you process your thoughts a little bit better later on. Like she was talking about, you're not thinking of things repeatedly. You're not thinking the same thing twice. So when you're in a calm space and you can just think about one thing, then you're shifting your thoughts, and your anxiety levels kind of go down. I think all of this is a wonderful practice for people that might be suffering with a little bit of anxiety these days.

[00:44:39.260] – Allan

Yeah. If you're having difficulty sleeping, if your blood pressure is a little high, you know, it's all stress induced. You're trying to do the other things. Because when I started my journey, I started with nutrition and movement. I said, okay, these are two things I can control. I got to a point, and I'm like, okay, now if I'm looking at my health, what's missing? And I'm like, Well, I know I need more sleep, and I know I need to reduce stress. I reduced some of my stress by just getting out of toxic relationships. That was a big part of it. But I still had a very stressful job, and I still had some sleep issues. So I really focused on my sleep. And once I got my sleep down, which was really more of just go to bed at the same time and don't just think, I have to fall asleep right then. If I don't, that's okay. Just lay there. Just lay there and breathe. So in a sense, it was a form of meditation for me. Interestingly enough, that's exactly where I would go in my head. I'd be like, okay, I'm walking down the beach, and I feel the sun, and I'm just thinking about, if I were on the beach, what that would feel like and what that be like.

[00:45:56.080] – Allan

The sand under my feet, the sun, the waves, the smells, the birds, all of that. And so that's why I think I gravitated towards the ocean one on their app, they've got several. So it's not all ocean. There are different ones. But I think that's why I gravitated to it, because that was a way to really kind of bring myself down and fall asleep faster. And so I would go to sleep at the same time every night. That was kind of rule number one. Number two was I would lay there even if I wasn't going to go to sleep straight away. If I lay there for more than an hour I'd get up. But I think most people will find if you just lay in a dark room with your eyes closed for an hour, you're going to fall asleep. I'm sorry. You're tired. You are tired, probably.

[00:46:43.730] – Allan

And so that's what I would do. And then I wouldn't send alarm because the time I set to go to bed, there was, like, almost zero chance I would oversleep in the morning because that would require, like, 12 hours of sleep. I mean, literally, I didn't have to be at work until 09:00, which meant I had to leave by 08:00. So if I went to bed about 8:30, there's high likelihood I'm going to wake up sometime between five and seven. And when I do, because the sun's coming up and it's brighter in my bedroom because I didn't have the blackout, I didn't need the blackout shades there. Then I'd sleep, and then the sun would be coming up, the room would start lightning, and I knew if I woke up and the room was light, I needed to get up because I had slept enough. I got to work, so there was sleep. The stress part was where I was really trying to do the meditation and this and that, and I struggled with it because I got quiet. I'd think about the 100 things I need to get done before the day is over.

[00:47:43.190] – Allan

The only time I ever could just turn my brain off like that was lifting. When I'm focused on a lift, I don't even hear anything. So everybody's like, what's your favorite playlist? I'm like, I don't even try to listen to music anymore, or even books because I would start lifting and maybe four or five chapters later, and I'd like, what did I just listen to? Because I don't remember any of it. And so I was like, yeah, I don't listen to music. I don't listen to books. When I'm lifting, when I'm lifting, all I hear is the lift. All I hear is, okay, Allan, this is the form. I'm coaching myself through the lift. I'm feeling every bit of it, and I'm focused on that, and so I don't hear anything. And so that's a form of meditation for me is that. But with this, this is a very similar experience. When I'm sitting there with the muse on and it's going through it, it's telling me I'm present. It's helping me know that I'm present. And I'm listening to the waves, and that five minutes goes like, snap. Whereas before I try to meditate in five minutes, I'd stop three times, a hit pause to write something on a to do list because I didn't want to forget it.

[00:48:57.880] – Allan

I didn't want to let that thought go. Just let the thought, no, if I let the thought go, I'm not going to send the email. And then, yeah, tomorrow is going to suck. So, no, I've got to send that email. So I write down the email and then I go back in or try to do it again. And I never really get into a meditation that way. But this was different, this was definitely different.

[00:49:18.370] – Rachel

Well, it takes practice to be able to set those thoughts aside for later. It's hard, it's really hard. And that's really what we're trying to do is take that five minutes of the meditation and set all of those other thoughts that could be disruptive, set them aside for later and stay focused on what you're doing. But what was also fascinating to me is that this device is being studied at the Mayo Clinic and you had discussed for breast cancer patients where I would imagine and fibro both have high levels of pain. And so maybe doing this meditation has this really amazing physical adaptation that it changes your brain context, but also brings anxiety down. So maybe it has a lot to do with managing the pain and maybe focusing more on the healing process when people have this chronic type of pain. That's really interesting.

[00:50:12.550] – Allan

And as I went through and did some research before I had the conversation with Ariel because there was no book to read, this like usually I'll read a book and I'm like, okay, I don't want to go into this interview just asking a bunch of questions I don't know the answer to. They're still asked her things I didn't know the answer to, obviously. But as I got into doing my research, that was really a big part of it was if people think about meditation as a way to lower stress or to basically improve your focus, reduce blood pressure as related, sleep better, those types of things. But yes, meditation is a pain management therapy and it can be used that way. And given how many people are in some level of pain every day, taking opioids or other medications, INSEADs and stuff for pain which are not doing you the favors that you think they are, they're giving you a reprieve from the pain. But if you could sit down and meditate for five minutes and that pain dissipate for a few hours, that's a lot better than popping a pill if you can just do it through meditation.

[00:51:24.820] – Allan

So it's at least worth an exploration if you are in pain, to see if a little bit of meditation and it doesn't have to be sitting there closing your eyes, going ohm, and all that kind of stuff. Sure, it can be a walking meditation, just being present in nature and see if that helps because movement does help with pain sometimes. But this Muse device is fabulous and I'm really glad I have it about to take a vacation. And this is all going to be about stress reduction and just relaxation and it will be really nice to be able to get a practice and get consistent and really try to make that a habit of something that I do each day. And I think the Muse device is something that's going to keep me engaged. And I'll have the feedback and I'll have the reports, and I think all of that's just going to be something that's going to motivate me. Because part of my motivation, in addition to being someone who's driven and an Atlas, as I say, who wants a big challenge and meditating every day will be a big challenge. But the other side of it is, I also am somewhat of a tires person, so I need that consistency, I need that traction to feel like I'm making progress.

[00:52:43.310] – Allan

And so the Muse is something that's going to help me do that and help me see it.

[00:52:48.090] – Rachel

That sounds awesome. That sounds like a great thing to practice, for sure.

[00:52:52.070] – Allan

So if you're interested in this, they are given one year service for free and a 20% discount. You can go to 40plusfitnesspodcast.com/muse or 40plusfitnesspodcast.com/muse, and that'll take you to their sales page that they've given that special discount to us.

[00:53:11.550] – Rachel

So cool.

[00:53:12.100] – Allan

Go check it out. See if it's something you think you'll enjoy. I'm going to be using it regularly, and it's going to be a part of my daily practice, particularly once I make it that habit that I need to work on, because behavior change is not any easier for coaches than it is for clients. It's just something we are always working on. So I'm going to try to do that, and I'm going to use the Muse as a tool to make it happen.

[00:53:36.520] – Rachel

That sounds great, Allan. All the best for that. That's great.

[00:53:39.670] – Allan

All right, well, I'll talk to you next week.

[00:53:41.660] – Rachel

Take care.

Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
– Eliza Lamb– John Dachauer– Tim Alexander

Thank you!

Another episode you may enjoy


September 12, 2023

11 Vital Medical and Lab Tests After 40

Apple Google Spotify Overcast Youtube

On episode 607 of the 40+ Fitness Podcast, we discuss 11 medical and lab tests you should consider when you're over 40.


Let's Say Hello

Coach Allan is on vacation. We will return to our hello segments in mid-October.


Today we're going to discuss the eleven vital medical and lab tests that you should do after 40. Or at least have the conversation with your doctor about having, you know, these measurements I'm going to talk about today are really about your health.

This is more than weight. This is going to tell you a lot more. Now, I have to start this out with saying I'm not a doctor. I cannot diagnose or give medical advice. I'm just giving you some basic information to allow you to be ready to go have the conversation with your doctor. All of these are things that will help you identify chronic diseases. And if you know about them early, it's great. Obviously prevention is better, but early detection is very important for most of these issues.

Blood Pressure

Okay, so number one, blood pressure. High blood pressure, also called hypertension, is a huge health issue in this world. And in this country. There's over a billion people in the world that have high blood pressure. So that's like one in eight. So it's a big deal and it's something that's pretty easy to test. You can buy a monitor at a pharmacy or you can get it on Amazon. I'll put a link in the show notes for the one that I use. Your resting blood pressure should be around 120 over 80. You don't want that dropping too low and you don't want it too high. So knowing that and monitoring it can be very important for you.

Lifestyle is really the best way to manage your high blood pressure. There are medications they can give you and most doctors will prescribe the medication and tell you to do the lifestyle changes. If you've been on medication and you decide you want to make some lifestyle changes, it's worth having the conversation with your doctor and monitoring your blood pressure as you go just to make sure that you're not over medicated as you make these lifestyle changes and your blood pressure returns to more to normal. Typically this is one of those things where they stack medications to get you where you need to be until you get your body where it needs to be.

So blood pressure is a killer. You want to make sure that you're monitoring it. Easy test to do. You can buy the monitor and have it available. They're not that expensive. Again, go to the show notes, and I'll have a link to the one that I use.

Blood Glucose

Number two fasting glucose, or A1C. So fasting glucose is your blood sugar level when you haven't eaten anything for about 12 hours, usually you go in the morning, you get the test. They want you fasted, they're going to do a blood glucose test. This is a pretty standard thing. They'll often also do the A1C. The A1C is basically kind of a snapshot of what the last three months of your blood sugar was. So this gives them an idea if it's stayed elevated, and it's not just a one off, but this is something that's going on. If your blood sugar, your fasting blood sugar is above 100 or your A1C is above, say, six, you're pretty much diabetic at that point. The doctor is going to probably diagnose you as pre diabetic or diabetic at that point and want to start getting you on medications and recommending lifestyle changes. I would definitely go with the lifestyle changes. You want to get that blood sugar down. You want to keep it in a constant range. My blood sugar typically goes anywhere from 85 to 65. I like to keep it below 85. Occasionally, if I eat something that's high in sugar, it will pop up above that, but it doesn't stay there very long. My A1 C is typically below five. And that's, again, because I don't eat a lot of sugar, I don't eat a lot of processed foods. So my blood sugar remains fairly constant throughout the day, and I don't have a lot of problems.

Again, something you don't want to get too low, and it's something you don't want to get too high. And if you have some metabolic issues processing the sugar because you're insulin resistance or insulin resistant or something, it is something you just want to make sure that you're monitoring and taking care of. And this is not as easy as just saying, okay, well, I'm going to shoot myself up with insulin, or I'm going to drink some orange juice if I start feeling a little faint. You really do need to watch this. And if you start seeing it slide as you're younger, you're on a bad path, and you need to resolve that.

Calcium Score

Number three calcium score. There's a documentary called The Widowmaker. You can go to 40plusfitnesspodcast.com/widowmaker. This documentary is on YouTube. It gives a lot of information about what The Widowmaker is, which is basically calcium deposited in the aorta, and it can cause an instant death by heart attack.

It's not one where you have a mild heart attack and they do a little bit of work and you're out and you're working on it. This one will knock you down, and you're done. And it's killed a lot of people, and it kills them without any warning at all. Otherwise, they think they're healthy people. When they get a calcium score, some people realize that they are not in as good a shape as they thought they were. You want a low number, as close to zero as you can get. If you're in the tens of thousands over around 12,000, they're probably going to send you to the emergency room because you're effectively dying on the table right there. So you want to make sure that you're getting this calcium score. Talk to your doctor about it. It's not expensive. I looked it up. It costs about $200. It doesn't take long. It's not invasive. It's just an X ray. It's a pretty intense X ray. So it's not something you do every year unless you know you have a problem. But it is something that you would want to talk to your doctor about and get your calcium score.

Blood Count

Number four is a complete blood count. So a complete blood count is going to talk to you, tell you some things about your red blood cells and white blood cells. Okay? If either of these are high, that could be a problem.

High red blood cells can create some clotting and other issues. High white blood cells typically mean something else is going on in your body, perhaps cancer. And they'll want to know why your white blood cell count is so elevated. This is your immune system. This is your life. It's there.

And these are two tests that you can have done to get a good idea of some things that might be going on in your body that you. Didn't otherwise know about. Okay?

C-Reactive Protein

Number five on the list is C-reactive protein. Now, this is an interesting one, but. This protein helps show how much inflammation you have in your body. So things like heart disease, diabetes, cancer, most of the time, this can be detected, that there's problems because they're stressed out and their immune system is going haywire.

So C-reactive protein is going to tell you if there's some inflammation in your body, you probably already know it because your joints are probably already hurting, and some other things that are going on in your life around inflammation is a problem. But if you stay inflamed all the time, chronic inflammation, you're headed down a bad path. So knowing your C-reactive protein, managing your lifestyle to help manage that down really, really important.


Number six thyroid. Okay, thyroid is basically how our body manages energy. It is our metabolism. And there's about 200 million people globally who have thyroid issues. Some people will have thyroid that's overactive. Some have thyroid that's underactive. And so if you feel fatigued. If you're not recovering very well, you're. Not sleeping very well, it might be worth having your thyroid test. Now, most of the time when they're going to test, they really only just test one of the elements, but there's multiple elements they can test, which is the thyroid stimulating hormone T3 and T4, and there's a few others. If you know you're having a thyroid issue, you might want to go a little deeper into this. But thyroid is something that you can easily manage with medication, and often lifestyle changes will help. But this is a tough one because if it's impacting your causing you fatigue and it's keeping your metabolism from working the way it's supposed to, it becomes very difficult to lose weight or gain weight, and it makes it very difficult to have the energy to do what's necessary to stay healthy. So if you're noticing some fatigue problems, it might be worth just taking a look at your thyroid.


Number seven is triglycerides. Now, I know a lot of people out there, and your doctor too, will probably say that you should focus on your cholesterol, and I'm not going to go against that. If you want to know your cholesterol numbers, that's important too. But I think triglycerides, in my opinion, again, not a doctor, but this is the one I care about the most. I want my triglycerides to be low, and in fact, if I can get my triglycerides close to what my HDL is, HDL is the good cholesterol, if you will, then you're doing good. Now, most doctors are going to say you should be trying to get your triglycerides should not be more than a ratio of maybe three or four times your HDL.

I like to get mine below two. And often I can have it at one. If I'm eating really clean, doing the right things, I can keep my triglycerides level with or around what my HDL is. And that ratio tells me that I'm doing the right things for my body, I'm eating the right food. So having your triglycerides checked, that's usually a function of the whole lipid panel when they do the cholesterol. But don't just stop with, oh, the HDL is low or the LDL is high, the total is high. Too many times, people get stuck focused there. Triglycerides let you pull back the layer a little bit more and see what's going on.

Kidney Function

Number eight is kidney function tests, and there's a few of them out there, but basically you want to make sure that your kidney functions well, because your kidneys are basically doing a lot of the filtering and the cleaning and removing toxins from your body. And if that isn't working right, you could end up with what they call end stage renal disease. Okay?

And that could mean you're now getting dialysis or you have to have a kidney transplant, both of which are not something you want to do. So there are a few different things they can look for, like crenitine and GFR. A lot of little technical stuff in there that they can look at to get an idea of how well your kidney is functioning. And if you're on certain medications that can impact your kidneys, it's worth occasionally getting that test just to make sure your kidneys are still functioning the way you need them to function.

Liver Function

Number nine on my list is liver function. Now, similar to the kidneys, the kidneys filter blood. Your liver also does a lot of things it filters, but it also manages a lot of different things in our body from how we absorb medications and alcohol and food. Fructose in particular. The liver can help store fat. It's really probably one of the most important organs behind the heart and lungs to keep you alive.

So you want to make sure that your liver is functioning well. Because of our diet and lifestyle, many folks are dealing with fatty liver disease, even when it doesn't relate to alcohol. And hepatitis, which you can get in a lot of different ways, can adversely affect the liver. And when the liver is not working, you're not living. You're not going to be alive long if your liver is not functioning. So it is worth taking a look at how well your liver is functioning, particularly if you've been on different medications. If at any point in your time you took steroids or something like that, you may have damaged your liver, or if you eat a lot of sugar, particularly fructose, or drink a lot of alcohol, you've probably damaged your liver a bit and it's not going to function as well. And these tests will help you see how well your liver is functioning.

Vitamin D and B12

Number ten on my list is vitamin D and B12. A lot of people, like about a billion people in the United States, have vitamin D deficiency, and millions have vitamin B12. Now, vitamin D is really important for nerve health, for bone health, your immune system, all of it. If you live in a northern climate. You don't get sun on your skin regularly, or you wear a lot of sunscreen when you do, your body might not be absorbing and creating vitamin D the way it needs to, and you might be deficient. So you may need to supplement if you're low, but you don't know you're low unless you test.

So I don't recommend just taking a supplement for the sake of taking a supplement. But it is one of those things where so many people are deficient in vitamin D, there's not a ton of downside.

Now, vitamin B12 is important because our body uses it for metabolism, for the formation of red blood cells, nerve function and DNA synthesis. That's where our bodies are able to repair our genetic material. That's kind of important. If you are vegan or vegetarian, you might not be getting enough B12. And so you want to make sure that if you are not eating a lot of animal products, you should probably have your B12 tested occasionally just to see where you stand with that and whether you need to supplement.

So again, vitamin D and vitamin B12 are two of the most important vitamins that you need to be eating regularly or getting regularly through sunshine for vitamin D. And if you're not, you should test yourself occasionally just to see if there might be a deficiency there.


Number eleven is a colonoscopy. Everybody's favorite. Colorectal cancer affects over 1.8 million people worldwide every single year. So you start thinking about that. It's not maybe the most common cancer. It's one that we can find pretty easily with a colonoscopy.

Now, this is not a pleasant experience. You've got to go through a process of cleansing yourself. Hey, you're going to weigh five pounds less after you get done with this because you cleared out your colon and your intestines. But you want to be able to detect colon cancer early, and this is a test that will help you do that.

Honorable Mentions – Mammograms and PSA Test

Now, I do have two honorable mentions on here, and that's if you're a woman, I strongly recommend that you get your mammograms done regularly. You can talk to your doctor about your risk for breast cancer. You can look at your genome if you went and got the test, the DNA test, to see if you have the types of SNPs and whatnot, that make you more susceptible to breast cancer. If you took birth control pills for a long period of time, again, that's a risk factor. And there's some others around age. And so if you know you're in a higher risk group, make sure you're talking to your doctor about getting mammograms on a regular basis when they believe that that's the best cycle for you to do.

And then for men on our side, we can get breast cancer too. So checking yourself is obviously a good idea, but it's worth getting a PSA test every once in a while just to make sure, because PSA is basically going to tell you if there's some issues with prostate. Just because it's an elevated test doesn't mean you have prostate cancer. But it's the first indicator that they usually look for when they suspect that someone might have prostate cancer. Elevated PSA test is going to be like the first thing that they're looking for.

And it's real easy. It's blood test. You just go and get a regular blood test, but ask it's going to be for a PSA, talk to your doctor about it. Similar to the way I just discussed with the mammograms, the frequency that you would do this test really depends on the conversation you have with your doctor based on your risk factors and things. If men in your life have had prostate cancer before, your risk is higher.

Certain race things like black men, African American men are more likely to have prostate cancer than Caucasian men. So just know your risk factors. Have a conversation with your doctor. There's not expensive tests. I think I got one not long ago. It cost like $75. But hey, that included the blood drawn, the whole bit. And that's all I went in for, was that PSA test.

I could have stacked it with some other tests, probably, and it would have even been cheaper. But these tests are readily available, easy to get, and some of them you can even do at home.


So I want to go over these one more time in summary, just these are things to just think about. So you can scratch this down on paper and you got to talk to your doctor or you're thinking about how you're going to manage your health better. These are much better measurements than weight. I can tell you right now, if you got these things in line, your weight is not going to be a problem.

So we've got blood pressure, fasting glucose, or A1C, calcium score, complete blood count, c reactive, protein, thyroid, triglycerides, kidney function, liver function, vitamin D and B12, colonoscopy, and then, of course the honorable mentions of mammograms or PSA tests as appropriate.

So what this is, is if you were to go through this and talk to your doctor about it, understanding your risks, these are the ones that I think will give you kind of really good overall big picture of where you stand from a health perspective as someone over the age of 40.

So think about these tests the next time you go in. Talk to your doctor about what's on the test, what he's looking for, why he's looking for that. This is a good opportunity for you to be very proactive, to be an advocate for yourself, to ask the right questions.

Post Show/Recap

[00:18:33.170] – Allan

Welcome back, Ras.

[00:18:34.780] – Rachel

Hey, Allan.

[00:18:36.040] – Rachel

This is the best. This is a really good list of lab tests to have done. And the reason why this makes me really happy to talk about this is that there's still a lot of people in my age bracket that don't go and get their annual physical every year. To me, this is just something that I do automatically. It's my time to even though it might not be the longest appointment of the year with my doctor, I get the few minutes to talk about what I'm feeling, my family history. We get to do all this blood work and compare them from years past. I mean, having trending data is so important, but still, people don't go, and this is why they should. These eleven tests are why you should go at least once a year to your doctor.

[00:19:22.440] – Allan

Yeah, your doctor probably won't initially want you to do all of these tests, and that can be okay. That can be okay. But I would say, yeah, if you're over 40, particularly if you're over 50.

[00:19:35.260] – Allan

These tests are going to tell you a lot about yourself and about what your status is. And so if you have family members that have diabetes or high blood sugar or hypertension or they've had cancers, or you just know that you're at higher risk because of who you are, then you should be probably testing this more often than once per year, at least some of them. When I was working with a health doctor, and that was quite literally it, he was not a healthcare doctor where I go in for sick care. He was a doctor that I went into for health. And so we were talking about how I could be as healthy as I can possibly be. We got these tests, all of these tests done every quarter.

[00:20:17.750] – Allan

That's really expensive. So I don't encourage everybody to run that out there, because I think if you got a full scan, if you got a full blood test, they can run you over $1,400. I think mine were running me around 1400 when I was doing them, but it was really cool because the phlebotomist would come to me, they would come to my office, or they'd come to my house and take the blood so I didn't have to worry about it. They just came in, they took the blood, put it in a little box, and shipped it off FedEx to whomever.

[00:20:46.150] – Allan

And I would get all these answers. Except for the calcium score, that one's separate because that's actually done somewhere else. But all these others that are blood tests, I literally got a comprehensive report back so I could see if my kidney numbers, my liver numbers were all in sync, where they're supposed to be, what my vitamins were.

[00:21:05.600] – Allan

And it went a lot deeper than just vitamin D and vitamin B12. But those are two of the most important ones, I think. Again, not a doctor. So beyond the calcium score and the colonoscopy, of course, the mammogram, those are tests you have to actually go in for physical. All the others are basically blood tests. Well, I guess blood pressure isn't, but you can easily test that at home or anywhere. These blood tests here, those are the ones that yeah, you're going to see them.

[00:21:33.230] – Allan

So if you're not feeling well, your doctor might not even think to test. Your thyroid initially, not even be on the list, because that could be a wasted test. But if you tell them you're just feeling out of sorts and fatigued, they might throw the thyroid test in there just to make sure that you're aware of what your status is. And the hard part with fatigue, I just want to put this out there, is fatigue is not something that just sort of happens one day. It's like one day you wake up and your body and you're fatigued. For the most part, it comes in really slow.

[00:22:06.970] – Rachel

It does.

[00:22:07.860] – Allan

And so if you're comparing today to how you feel yesterday or felt yesterday, there might not be a big difference. And you might not even feel it or see it. It's sort of the deal where you don't necessarily see yourself losing weight even though you are. It's just coming off slow and steady, but you're just not seeing it because, okay, I'm losing a pound a week. But there's no visual.

[00:22:29.880] – Allan

What does a pound of fat look like coming off of my body? Kind of thing. This is kind of the same thing. It can kind of come in and then there's just a point where you're just not capable of doing things. You get winded walking up the stairs. Well, that might not be because you're not cardiovascular fit. That could be a symptom of thyroid.

[00:22:51.180] – Rachel

Actually I'm on thyroid medicine now. I just went hypo earlier this year and as a runner, I'm fatigued a lot, Allan. And then there's times in your life where maybe you've got stresses with work or your kids are sick and you're up late at night, and there's a lot of reasons why you could be fatigued. But you're right, it is kind of one of those, again, insidious things that you just don't pick up right away. And doctors don't I don't know why, but they don't always do the thorough panel like you had suggested. They just do the basic thyroid, not necessarily to the T3 and T4, which is unfortunate because that's where the good data is usually.

[00:23:32.770] – Allan

Well, if they see a drop or they see an increase, then they know there's something going on, and then they'll probably ask for a second test to go in and look for those things.

[00:23:41.580] – Allan

But if you think you're feeling fatigued. Bring it up to your doctor before you go to get your panel done. And they may even say, okay, well, I'm going to throw B12 in there in thyroid just to see what your status is. And most of the time there's not going to be a problem. But thyroid does affect a lot of people, and if you don't eat animal products so you're like, your cholesterol is high, so you've cut out all animal products and you're like, okay, I'm losing weight, but my blood pressure is still kind of high and my cholesterol is coming down, but I feel like crap.

[00:24:19.710] – Allan

Yeah, well, maybe your B12 is getting low and you need a supplement. But don't just do something because you think, yes, this is not a great chemistry experiment for you to just say, I'm going to start throwing supplements at this and see what happens. You want to know? Because some vitamins, kind of the oil soluble ones, so this is going to be like A-E-D. They're going to stay in your body when you take them. They're not going to wash out like b and C vitamins do. And so you can actually overdose on those things.

[00:24:52.320] – Rachel

Yeah, definitely be tested first.

[00:24:54.860] – Allan

You don't want to just start taking a bunch of vitamin D. You might make it a cyclical thing where you say, okay, because I know it's getting cooler months and I'm not getting the sunshine. I was I might go ahead and just add a little bit of vitamin D. You might do that, but then cycle back off once the summer rolls around and you're outdoors a lot, doing yard work or fishing or hiking or whatever, getting sun on your skin, say, okay, I probably don't need the vitamin D right now. I live in a climate that's basically summer all year round.

[00:25:26.570] – Allan

So I get out and my skin gets exposed to sun almost every single day. And so I wouldn't even think that I had a vitamin D problem, but if I went and got a panel and it said I was deficient, that would surprise me. But I'd go take some because I got to get it in there. It's important for bone health and nerve health, and it's a pro hormone, so it literally helps with just about everything else in your body. Very important. So I put this list together. As you can imagine, it took a lot of research to put this list together, but this is what as I was thinking through, how would I know I was sick?

[00:26:09.350] – Allan

I want to put together the test and say, how would I know I was sick?

[00:26:13.750] – Allan

These are the tests that I would want. I'm not a doctor, but I would talk to my doctor and I'd say okay, I'm 57 year old man who's spent a good part of his adult life overweight. I can tell you right now, when you see my cholesterol numbers, you're going to freak out because according to some of my doctors, I was dead years ago. But I'm just someone who has very high cholesterol and I could stop eating everything. I could just start eating lettuce or I guess broccoli. How about broccoli?

[00:26:50.370] – Allan

I could just eat broccoli and my cholesterol would still be high. I've taken statins and my cholesterol wouldn't go down. My HDL went down. It went down, but my LDL didn't. It was still exceptionally high. And so I can't get my cholesterol down no matter what I do food or medications. But what I can tell you is my HDL when I'm eating the way my body feels good serving my body, my HDL is off the charts. They want yours around 50. Mine's usually floating somewhere around 90.

[00:27:26.940] – Rachel

Oh, gosh.

[00:27:27.690] – Allan

And I can get my triglycerides down to about 90. The number they want there is 150. You want you below 150. They want your HDL above 50 and your triglycerides below 150. So that's a three to one ratio. If you're doing that, you're at a three to one ratio. The doctors are going to say you're. Doing golden again as long as your HDL is not.

[00:27:48.330] – Allan

Above 200, your total cholesterol is not above total 200, never going to get there. If my HDL is 90, I'm not going to get my total down below 200. Just mathematically impossible.

[00:28:02.510] – Allan

Because LDL is a calculated number. It's not an actual count. They count the HDL and they count the total. They don't count the LDL. It's a calculated number. If my HDL is over 90, I can't get my LDL. I mean, I can't get my total below 200,

[00:28:19.470] – Rachel

but if it's not impacting you, otherwise, if you don't have any other risk factors, your calcium score and your blood

[00:28:26.200] – Allan

and that's all fine. Yeah, look at my blood pressure, look at my calcium score, things like that. And my ratio almost one to one. Versus the three to one being standard. So I got stuff in there cleaning me up.

[00:28:43.610] – Rachel

That's good.

[00:28:47.110] – Allan

I'm not saying that everybody's going to we're all different. And all these reference numbers that are out there, you may hit some of those reference numbers perfect. There are people out there just perfect. All the reference numbers, they're right in there. Other people are one or two of them is going to be just completely out of whack. And it doesn't mean you're broken.

[00:29:04.890] – Allan

It just means, guess what? You're a little different.

[00:29:08.750] – Rachel

But this is why you go every year to get your physical, at least, because then you have trending data. So when these numbers get all out of whack, they're not trending in the same direction or they're not staying the same, then there's an indication there that something could be maybe reevaluated. But it's good to have that data. And I don't want to end our discussion until I really highlight the cancer screenings. You mentioned colonoscopy. I believe the age for colonoscopy is 45 now. There might be some changes to that, but it's gone down in age because the incidence of colon rectal cancer has increased so greatly lately. And for the ladies, the mammograms, the guys, the prostate checks, super important. And the only test I wanted to mention, Allan, that is the annual visit to your dermatologist for a skin cancer screening. Melanoma rates are increasing, and it's not only because of exposure to the sun. Melanoma is also a genetic trait that people don't usually know that they have. So all of these cancer screenings, as soon as you are of age and or your doctor approves it, because I've been having mammograms since I was 29, it's important to have the screenings done because you don't feel cancer, you don't feel well.

[00:30:24.650] – Allan

By the time you feel cancer,

[00:30:26.610] – Rachel

it could be a problem.

[00:30:28.410] – Allan

it's too late. Most of them, they're not symptomatic until they start spreading. Exactly. Talking to Dr. Baum and I think that episode is going to come up in a week or so, a couple of weeks maybe.

[00:30:41.340] – Allan

But we're talking about prostate cancer and he'S like, you'll never know. You have prostate cancer. What you're going to know is that you have bone cancer, and it's because it'S already spread to the bones. And so by the time it spreads to the bones, now you got a problem. And that's the cancer that kills you. It's not the prostate cancer that kills you, but you started with prostate cancer. And it spread to your bones, and you didn't do anything because you didn't know it. You had no symptoms and then till it was in the bones.

[00:31:08.800] – Allan

And now you got symptoms, but it's way past what they can probably cure. And so that's just the concept of be proactive here. Work with your doctor. He's on your team. We're going to talk about that a good bit with Dr. Baum, how you do that, and some of the cool things that have happened in the last few years with the way medicine works, that it didn't necessarily work that way before. And so this is really good opportunities here for you to have conversations with doctors, get these tests when they're appropriate.

[00:31:41.720] – Allan

Have data, make the right decisions, and understand, okay, if this, then that the information is there, you have to go get it for yourself, because you don't know what your numbers are until you go get your numbers. And the doctor is going to want to know a lot about you to know if it makes sense for you to get a thyroid test or to go out and get some of these other screenings because they're not appropriate for everybody. But there are times when you just get your doctors and say, hey, I want to know this number. Most of them are not just going to flat out say no.

[00:32:18.280] – Allan

If you say you want to basically have your hormones checked, the doctor is not necessarily just going to say no. They may say there's reasons to not test and tell you those reasons, but you're the coach, you're the CEO, you make the final decision. If you get a doctor, it's like, well, we're not going to do anything. Even if your testosterone is low, you might want to talk to a different doctor.

[00:32:43.020] – Rachel

Yeah, time for a new doctor.

[00:32:44.830] – Allan

But again, that's the conversation. He's an advisor. You're paying him. Whether it's your insurance company making the payment or not.

[00:32:52.500] – Allan

You're the customer. You're the one making this happen. So talk to your doctor, find out about these tests and get the ones that make the most sense for you and get them regularly so you do have trending data to know, okay, this is good. And over here, I might need to do some work on lifestyle to fix this. I might need to be on medication for blood pressure for a short period of time until I can get my body weight down and then maybe I can get off of it. I may need to do that to get my blood sugar down, metformin or something like that. Until my diet stabilizes my blood sugar below these reference numbers. And so you got to have the data to know what you don't know.

[00:33:31.680] – Rachel

That's absolutely right. So, yeah, do that physical. Get that scheduled ASAP.

[00:33:36.320] – Allan


[00:33:37.910] – Allan

All right, I'll talk to you next week.

[00:33:39.900] – Rachel

Take care, Allan.

[00:33:40.990] – Allan

You too.

[00:33:41.960] – Rachel

Bye. Bye.

[00:33:42.810] – Allan


Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
– Debbie Ralston– John Dachauer– Tim Alexander
– Eliza Lamb

Thank you!

Another episode you may enjoy


How to fix your relationship with food, your body, and yourself with Deanna Schober

Apple Google Spotify Overcast Youtube

On episode 606 of the 40+ Fitness Podcast, we meet Deanna Schober of Built Daily and the Fitness and Sushi Podcast and we discuss how to fix your relationship with food, your body, and yourself.


Let's Say Hello

With Coach Allan being off this month, there won't be a hello session for a few weeks. We'll see you after mid-October.


[00:01:47.090] – Allan

Deanna, welcome to 40+ Fitness.

[00:01:50.210] – Deanna

Thank you so much for having me. I'm so excited.

[00:01:52.850] – Allan

Yeah, we found each other because you have a podcast, Fitness and Sushi. And so I reached out to be a potential guest I think you probably had listed on one of the sites where you're looking for guests, and that's kind of how I came across you. You and Tony, your husband is your co host on Fitness and Sushi. And then as I started kind of diving into, okay, who are these people and what are they doing out there? I really resonate with your message. I think that so many times people think, well, I just got to find the right diet.

[00:02:24.990] – Allan

I've tried them all, but I just haven't found the right one. And so they're always out there looking for the diet. They're looking for ways to burn more calories than they consume. And so they go into the gym and they find one elliptical. When they get on it, it says, okay, in an hour, they did 500 calories. And then the other elliptical, which is a little different, it says they burned 600. So they now have a favorite elliptical. It's just this whole idea of, okay, I have to do all this stuff.

[00:02:54.540] – Allan

Add all this stuff to my life to lose weight. And your message is quite different than that.

[00:03:01.710] – Deanna

Yeah, what you just described is like, I'm going to math myself to a better body or better health. I'm going to math myself. I always say that we are not math. Of course math is a consideration, but we're all about the whole person, which includes behavior, psychology, emotions and preferences. And also we have these brains that we have to deal with that work a certain way, they're hardwired a certain way, we have to understand them. Because if you're just mathing your way through health and fitness, your brain is not going to like that. It's not going to let you be consistent with that.

[00:03:41.740] – Allan

Yeah, and even beyond that, I mean, yeah, we are hardwired at some level. But our past, our traumas, our history. Everything creates these grooves that's valuable if you were a hunter gatherer and you know, okay, yeah, if I go that way, that's poison ivy and I'm going to be suffering for three days. If I go that way, there's a bear and I'm going to be dead going that way. And so your brain starts hardwiring and soft wiring to kind of remember and know.

[00:04:12.580] – Allan

And as a result, our behavior is not fixed, but it's pretty hard to change. And unfortunately, diet culture doesn't really help us do that.

[00:04:23.730] – Deanna

No, it goes directly against a lot of it. It puts us into famine mode, survival mode. It puts you into a state where you are literally now working against your brain's strongest desire, which is for you to survive. And if you are not eating enough, if you are putting yourself into a state of scarcity, then those are going against your brain's hardwiring desire to survive. And yes, you can overcome it. People do for bursts of time or long periods of time, but they do it and it's extremely uncomfortable. It's not pleasant, it's very difficult. It requires a lot of energy. And it's the hardest way to be consistent when you're working against your primitive. Survival skills or primitive survival mechanisms.

[00:05:16.950] – Allan

Yeah, of course. I'll go on various forums like MyFitness pal and Facebook and things like that. And I think what's so disheartening to me is that there'll be someone and they'll say, I'm eating at a calorie deficit and not losing weight. They're doing the math thing and they're on a diet and they're doing it and they're like, okay, I know everything I'm eating. I know all my movement. I put it all into the formula. I should be losing weight and I'm not losing weight. And they get just so disgusted with that whole thing that when I read it, I just know they're going to quit because no one is reaching out and telling them that they have to do some of this other work first and then the other parts kind of fall in place. So it's not a diet, it's just changing behaviors, changing thoughts.

[00:06:06.460] – Allan

Now, you call that healing. Can you kind of get into how that works and how you guys see that as the basic paradigm of how we can fix ourselves so that we get healthy without having to do all the diet stuff and being frustrated by it?

[00:06:26.360] – Deanna

Yeah, I think the idea is that with healing is actually not that you need to fix yourself. It's that you came into this world intuitively, like having a good relationship with food, having a good relationship with your body and society and all its ideals and the weird things that humans do. Comes in with diet culture and really has kind of destroyed those relationships. So healing is getting us back to that foundational place where we are waking up every day and we're taking care of ourselves. And food isn't like an obsessive thought throughout the day and controlling our bodies is not an obsessive thought throughout the day. And what that does is allow you to return to a state of thriving instead of surviving, which is what dieting puts you in.

[00:07:15.420] – Deanna

And when that is your state of mind, then you're much more consistent with any kind of changes that you make. And yes, there's work to do and habits to form through that process. But if you're dieting, you're forming those habits and also working against your brain. You're also working against the way that you are wired. And so healing is really just getting you back to that place of having a good relationship with food and reminding you that you can trust yourself with food. So many people don't trust themselves with food and because a calorie deficit has frustrated them and they've gotten to this place of binging and restricting and binging and restricting over and over again because of that whole math equation thing and following meal plans and feeling frustrated. And when you follow a lot of diets too, no diet ever tells you. Like, this is an us problem.

[00:08:14.190] – Deanna

They say, this is your problem. You're not trying hard enough. You shouldn't have any excuses. There's something wrong with you. And the reality of that is that if 97% of people can't follow a diet for more than two years, then something's going on there. It's working against human being psychology and human beings behavior to our survival instincts. So we want to try to get them back to that healed place where we take away the damage that diet culture has done to those relationships and then start them fresh from that place.

[00:08:52.430] – Allan

Yeah. One of the things I like that Tony had in his book, which I wrote down, is called The Ideal Body Formula. And you guys have talked about this a few times, I've heard Is where you talk about how weight loss is not the objective. I don't think you said side effect.

[00:09:11.540] – Allan

I don't think Tony said side effect. Was that because I've always said, if you're doing the things that your body needs to be healthy and feel safe, then you're going to lose weight if you need to lose weight. If your body needs to lose weight, it will do the natural thing once you start getting it healthy. And weight loss is just a side effect.

[00:09:34.230] – Deanna

Exactly. I think your example of going on to the reddit Forum or the MyFitness Health forum and someone's trying so hard to lose weight and they're getting so frustrated. And the reality is that what we have seen and what we know is that the harder you try to lose weight, the harder it is to lose weight. And the more you try to force this thing to happen, the more resistance you're coming up against, the more frustration you're coming up against, you're more likely to give up. Your behavior really changes. And so what we propose is that you stop trying to lose weight and you start trying to really just wake up every day and take care of yourself in the best way that you can without all the dieting stuff, all the dieting attitudes and mindset and take care of yourself and kind of relax into that. And what we have seen is that that has been the way that people who couldn't lose weight finally can because they're forgetting about it.

[00:10:32.650] – Deanna

They're just trying to let it go and trust their body, that their body will do the right thing and just make changes because they want to feel good, because they deserve it, because they're finding joy in their new routine. That's a big piece of what we do. And when you are finding joy in these things and you're enjoying what you're eating, you're enjoying your exercise, it does become a natural side effect. You're not trying to do anything. And because of that, it's very sustainable.

[00:11:00.780] – Allan

Yeah, it's funny because I will, I'll be out there and I'll be looking at this and that 1% or 3%, whatever it is, the people who successfully lost the weight, doing the calorie counts and things like that, you can look at them on MyFitness pal and it shows you how many days in a row they logged in. Not that they logged their food, but they logged in and they're usually hundreds or thousands of days. And so this is someone who doesn't trust themselves.

[00:11:29.360] – Allan

And so they are probably logging their food every single day and probably will for the rest of their lives. I'm accountant, so I don't mind doing number crunching data and all that kind of stuff, but that just seems so exhausting.

[00:11:45.010] – Deanna

That's not the life I want for myself. I say that to my clients all the time. I don't want to be like 80, 90 years old and still be having to log everything that I eat and weighing myself every day. My grandmother is 93 years old and every time I see her, she still tells me how much she weighs and that's a major thing on her mind still. And I just think, God, I don't want that for myself. And I mean it's the best thing I've ever done, is letting go of that obsession and just enjoying my fit lifestyle, but enjoying it.

[00:12:17.680] – Allan

Right. And it's one of the things I'll talk to my clients about this. They get weirded out by the fact they're like, okay, what's my meal plan? And I said, I don't know. What's your schedule next Thursday? And let me pull up my calendars. So you see, I couldn't write you a meal plan because I'm not living your life. I don't know the food you like. I don't know how they make you feel. And so I said, well, here's what I want you to do. I want you to go eat, and I want you to write down in your journal how you felt before you ate and then write down in your journal how you feel after. And then the next day and what that will be is over time. You're basically telling yourself you're teaching yourself. Okay, these are the foods that serve me, and these are the foods that don't. Okay, does that mean we're going to not eat the foods that don't serve us? Of course we are.

[00:13:08.910] – Allan

Aunt Martha has a birthday, and we're all going there because she's turning 90, and there's birthday cake. We're going to eat a little bit of cake. That's okay. So many people get so frustrated with. Oh, well, I broke the rule. Yeah, I ate some bread. Oh, my God.

[00:13:26.930] – Deanna

And the irony of that attitude is that it makes you eat more bread and more cake. That's the irony of that. The more you tell yourself, I can't have this and put something on this pedestal of this is bad, or this is forbidden, then every time you eat it, your willpower will break down and you eat it.

[00:13:48.490] – Deanna

But you're telling yourself, this is the last time this is bad, so I won't do this again. And so that intensifies when you eat it and you eat more of it. Yeah, and then that happens all the time.

[00:13:59.230] – Allan

Don't see a purple elephant. Don't think about a purple elephant.

[00:14:02.660] – Deanna

Yes, exactly. Or my favorite one is like, telling my kids going into their room and out and they see a toy that they haven't played with forever, and suddenly it's going away. They're like, that's my favorite toy.

[00:14:18.130] – Deanna

with food, when you threaten to take it away. It's going to suddenly look shiny and exciting, because now it's scarce.

[00:14:27.110] – Allan

You do see this. If you get into the forums where there's a particular way of eating, be it vegan or carnivore or keto or whatever, if there's a certain way of eating, there are purists out there that are going to tell you, they'll even ask. It's so funny. Someone will plug in, and they'll say, well, can I have some tomatoes with my hamburger meat or ketchup? And it's like, well, of course you can. You're a grown person. If you want a little bit of ketchup on your burger, have a little bit of ketchup. You know, the bun probably isn't serving you very well, but the burger, it's fine. If you tolerate meat, then it's fine. But it's just interesting to me that we do get into this thing and then we see the people who are so strict as leadership for almost like a cult and so we go, okay well the diet god just told me, I can't have ketchup on my hamburger meat.

[00:15:29.690] – Deanna

Well and that honestly is really tempting when you are so anxious about your weight and your body you don't want somebody to be like yeah, you can have cake sometimes and you could be.

[00:15:43.600] – Deanna

Lackadaisical about that's not what you want to hear. You want to hear what's going to work fast, what's really exciting, what's really going to fix this because it closes a loop in your brain. It's like I've got this problem and if I here is the answer and it's very extreme and because of that it's going to work and it's going to work fast. And I've got all these proof and before and after pictures without any regard to whether it's sustainable or anything. Sometimes it's a trauma response. I think dieting can be like a trauma response to the anxiety of I'm not good enough, my body's not good enough. I feel bad about myself. I feel this anxiety about who I am and what my body looks like. And so we're much more vulnerable in that position to the diet guru who's going to tell us, like, don't ever eat a hamburger bun again, or whatever extreme thing is that it does feel very exciting to somebody who is desperate. And so that's one of the major things that we work on is to help people to get rid of that body anxiety because the body anxiety will begat the food anxiety and you're more vulnerable to those strict rules and that strict lifestyle that doesn't work, that makes everything worse.

[00:17:00.670] – Allan

Fast is not sustainable and usually strict is not sustainable. You have to feed your body and you have to heal your body as you said.

[00:17:08.480] – Allan

Now another area where because again, as you said, there's anxiety and there's trauma. And there's things that are going on and so as a result our relationship with food is almost like an abusive marriage.

[00:17:23.070] – Deanna


[00:17:23.790] – Allan

And so something goes on in our life and now we have to eat it away because this is our companion. This is our friend until it's not because we're going to feel guilty as crap about doing it later. So there's this concept, it's aptly called emotional eating. How can someone recognize when they're emotionally eating?

[00:17:45.610] – Deanna

Well a lot of people first of all I think, think they're emotionally eating. When they're actually just deprived and restricted. So deprivation meaning they have a scarcity relationship with certain foods and restricted meaning they're not getting enough to eat at their meals. You have a lot of women, especially who are skipping meals because of career pressure, because kids or just they don't have time, they haven't prioritized it. And so they're showing up to the end of the day after a long day with their stress built up.

[00:18:21.820] – Deanna

And they're sitting down and they're eating nonstop and calling it emotional eating because they're stressed and emotional. But in reality, what we've seen is that when we help people to come out of those two states of deprivation and restriction and they're eating enough throughout the day and they're regulating themselves physically and mentally with making sure they're satisfied with their food and what they're eating, that emotional eating is reduced by quite a bit. So we work on that first. Before we ever even get to emotional eating, things need to be eliminated first and then you can start to take a look at emotional resiliency. That is such a big deal.

[00:19:04.910] – Deanna

I think that so many of us are so afraid to feel our feelings. I think that anyone who's 40 plus never had any sort of emotional as a kid or growing up, feelings were not talked about. Like, I was allowed to feel happy, but nothing else, like everything else was very uncomfortable for my boomer parents and very shoved under the rug and they just didn't know what to do with it. And so a lot of what we do is teach people how just teach women how to just feel their feelings, which is to not sit and ruminate in the thoughts that are coming along with the emotions, but to actually sit down, turn off the thoughts that are running, and stop the story and just feel the physical sensations. Because emotions are very physical and the sensory experience of it and tuning into that helps you to process it and get it out. And when you learn how to do that and you also learn adaptive coping skills for those emotions, which is you're feeling the feelings, and then maybe you still need to soothe yourself in some way. There's other things that you can try that are so freaking simple that nobody ever believes that it's going to work. It's just sitting and taking deep breaths, doing tapping, if you've ever heard of tapping, just going for a quick walk. Standing outside and looking at birds.

[00:20:26.330] – Deanna

These things sound so simple, but it really works. It helps you to soothe yourself and to release certain hormones and chemicals in your brain that will calm your nervous system down. And you also need to learn how.

[00:20:40.990] – Deanna

To complete the stress cycle. Because the stress cycle is you go into fight or flight, your body needs some kind of signal that you're safe. What we've been doing is coming home and using food to tell our body that it's safe. Which is like, there's no shame in emotional eating. That's number one. If you emotionally eat, that's nothing to be ashamed of. And it's not even always a problem. We always say it's only a problem if it's a problem.

[00:21:02.370] – Deanna

But completing the stress cycle can look like just shaking your like coming home and just shaking your body, shaking your arms and legs. It's a way that animals do this to shake the stress and move the energy out of their body. We can do the exact same thing. And it's very simple, but it works. It definitely works.

[00:21:20.970] – Allan

Yeah. That's kind of a concept that in my coaching training, they called it breaking the chain. So basically what you're doing is you realize, okay, I shouldn't be hungry, but I want something, and I just need to know if this is emotion or is this actual hunger. And I thought it was funny, you have an email list, and I'm on it. So I'm reading your emails,

[00:21:42.770] – Deanna

I know what you're about to say.

[00:21:43.940] – Allan

You wrote the other day about the statement. I guess the advice was, okay, would you eat broccoli? You kind of tore that one a hole. But even with that, there is a need to somewhat figure out the right way for you to break that chain.

[00:22:02.570] – Deanna


[00:22:03.380] – Allan

Can you talk a little bit why not broccoli versus something else?

[00:22:07.270] – Deanna

Well, first of all, I think that that's just misleading because never in my life when I have been super hungry have I ever craved broccoli. That's just not I don't crave broccoli. I eat broccoli because I know it's good for me, but I don't crave it. I've had clients told me before that they crave it, but I never have, the whole idea is, like, if you're not craving broccoli, then you're not hungry. And so that's not totally true. I've seen clients who, when you get so hungry that your blood sugar is low, you don't crave broccoli.

[00:22:39.480] – Deanna

You don't crave vegetables or anything with any kind of fiber in it because that takes too long to digest. You crave chips and sugar and high calorie foods because your body wants to get energy to your brain really fast. So just because you're having those cravings doesn't mean that you're emotionally eating. You might just be over hungry and let yourself get too hungry. We see that quite a bit.

[00:23:02.480] – Deanna

But also it doesn't solve the problem, which is like just telling yourself, well, I'm not hungry, I'm not hungry. I just want to eat, doesn't give you a solution to that problem. And the solution is to emotional eating tonight way past, or it'll be weeks in the future at this point, but when this comes out but I'm teaching an emotional eating Master class tonight because there's a lot to know about emotional eating. It's a multipronged approach. It's definitely not as simple as am I hungry or am I just bored? Am I hungry or am I emotional? You have to know what to do with the emotions. If you are just emotional, you've got to have proactive things put in place. Like daily I journal my feelings and just get it out onto paper. That helps me process it. So there's the proactive side, and then there's the reactive side. What do you do when you're having the emotions? You don't run from them. You feel them. And then you soothe yourself in a way that works and turns off the stress cycle. I'm sorry about that email. You have to be kind of opinionated. About these things sometimes.

[00:24:10.990] – Allan

No, it was great because it really made me think about, okay, I understand. We have to break the chain or at least have to understand why we're doing what we're doing.

[00:24:18.720] – Deanna


[00:24:19.400] – Allan

Slowing yourself down, whatever that can be. I love the idea of journaling. So sit down, or you eat and just sit down in your journal for about five minutes. And I'll tell my clients this. I'm like, you're a grown ass man or you're a grown ass woman.

[00:24:34.220] – Allan

If you want to go have a slice of pizza and drink some beer with your friends, you do it. You do it. And sometimes you do it not just because it's taking care of you, but sometimes you're taking care of them. A friend calls me up and says, Look, I'm going through something. Can we go have a couple of beers? My neighbor, I think tonight yeah, he's going to be building something across the street, and we watch over his property because he doesn't live on this island.

[00:24:58.640] – Allan

And he just said, hey, let's have a cookout together. It's my birthday. I want to celebrate my birthday. So what am I going to do? I'm going to go over there. I might have a couple of beers. I'm going to have some cooked food that wouldn't be food I'd necessarily eat. I know tomorrow I'll wake up and. I won't feel 100% because I found out what 100% feels like.

[00:25:17.110] – Deanna


[00:25:18.790] – Allan

Okay. And so when you find out what feeling good feels like, then you know when you're not feeling good. So far, we've probably spent most of our lives feeling terrible and thinking that's normal.

[00:25:29.790] – Deanna

Yeah. And I love everything you're saying. That's the whole picture of life. Right. It's like I could get to the end of my life and be like, man, I was perfect with my eating, and I was perfect with my exercise, but I missed out on beers with my friends or I missed out on wine night or margarita night. That's not balance to me. It sounds so cliche and so simple, but it really is all about balance and being able to live this lifestyle that allows you both, and that's going to look different for everyone. So. Yeah, I love that.

[00:26:01.840] – Allan

Right. And that's why I'm going to ask you this next question. But I define wellness as being the healthiest, fittest, and happiest you can be. And one of the reasons I asked that question that way is because I think when someone goes down the diet rabbit hole, they're rejecting happiest.

[00:26:21.050] – Deanna


[00:26:21.710] – Allan

When they think they have to burn off calories so they can eat what they want to eat, they're not paying attention to what fitness really is. It's not about how long or how fast you can go on that elliptical. It's about what your body's capable of doing. And sometimes it's not just being an endurance athlete on the elliptical machine. You got to be able to lift stuff, push stuff, move stuff, move your body so there's a lot more to fitness. So when someone's on that diet culture thing, they're often not paying attention to their fitness and they're not paying attention to their happiness. And nine times out of ten, because of the way they're approaching this with this restrictive approach and everything else is going on, they're not actually even taking care of their health

[00:27:03.640] – Allan

So the things that matter most in life, health, fitness and happiness are completely avoided as a topic in their lives. When they're on this diet. And so I'm going to ask you so folks can get off the diet roller coaster.

[00:27:20.690] – Allan

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

[00:27:30.270] – Deanna

Okay, first of all, we have something that we call the ideal body. And the ideal body is not your perfect body. It's not societal's ideal, but it's kind of like what you're saying. It's those kind of three things put together. It's your healthiest body that's in perfect harmony with your healthiest mind. It's your physical health, but not at the expense of your mental and emotional health.

[00:27:54.730] – Deanna

So that is kind of our definition of that. And those relationships are good food, body, exercise, and mind. So what was your question again?

[00:28:04.010] – Deanna

Three tactics?

[00:28:04.960] – Allan

Just three strategies or tactics that we can take away that could help us be healthier, more fit, and have more happiness and joy in our lives.

[00:28:14.750] – Deanna

Okay, well, I would say think in terms of addition, not subtraction when it comes to food. Abundance, not scarcity.

[00:28:23.530] – Deanna

Like I mentioned at the beginning, that we have to work with our brain and not put ourselves into that state of scarcity. Because your brain, when you're in scarcity and it can't have sugar, it can't have cake, can't have pizza, there's a process that happens in our brain automatically that starts scanning its environment for pizza and sugar. And that is just how it works. We cannot get away from that as human beings. So don't think about what you can't have. Even I tell this to my diabetic clients, to clients who really need to eat less sugar and really need to eat less cake. Don't look at what you can't have. Start looking and finding the things that you can and stay focused on addition, not subtraction. You're not trying to get rid of anything. You're just looking for nutrient dense foods and trying to get those in and enjoy those.

[00:29:13.090] – Deanna

So addition, not subtraction.

[00:29:15.270] – Deanna

This is going to be more towards happiness, and that's stop thinking of your body as this prize or an outcome. I think that when it comes to happiness, we think that happiness lies at the other end of that weight loss. And so that's why we're like, we'll do whatever it takes, we'll work really hard and then we'll be happy when we get that body. And I've been there, I did that.

[00:29:42.840] – Deanna

I dieted down to what I thought was going to be I had ABS, I had like a six pack. And the body I thought was my dream body, it did not make me happy. It was really shocking. And some people don't believe me when I tell them that. They're like, I'd like to try. But I was actually more insecure than ever. I felt like I was on display. I felt like everyone was watching everything I did.

[00:30:07.250] – Deanna

And it was like a temporary hit of happiness. And then I had to work harder to keep it.

[00:30:16.020] – Deanna

There was so much pressure on me. So get rid of that idea. Just get rid of the idea of achieving something with your body and start thinking in terms of today. How can I take care of my body? Just stop objectifying your body at all. It's not that you don't like it or like it. It's just that this is your body, period. It's your home, you live in it. It's not an object, it's you. And to just practice self care every single day and start thinking, being more present about that.

[00:30:47.970] – Deanna

Third, I think, let's see, all or nothing thinking, I think is probably one of the best things that you can do for yourself is to get out of that all or nothing state of mind where I'm either all in and doing it perfectly or I don't try at all. And just find the messy middle where you're taking messy action. We call it half ass action sometimes, like, something just take action, get out of your head, stop overthinking everything and really just find something.

[00:31:17.480] – Deanna

Something that you can do is better than nothing at all. Like doing one workout a week is better than doing no workouts all year. And doing eating a few fruits and vegetables throughout the week is better than eating none at all.

[00:31:30.350] – Allan


[00:31:31.180] – Allan

So Deanna, if someone wanted to get in touch with you and Tony, where would you like for me to send them?

[00:31:36.750] – Deanna

Well, I since you're listening to a podcast, I'm assuming you like podcasts. So the Fitness Position podcast is where Tony and I, we banter, we talk about the healing process and we talk about how we've overcome it ourselves and how we've gone through these very things ourselves. We have a long history with this stuff, but the Ideal Body Formula book my husband Tony wrote and he went into depth. It's our strategy. It's how to heal your relationships. There's an assessment in the book that you can take and find even what your relationship with food, body, exercise and mind is like, and that is at idealbodyformula.com.

[00:32:16.250] – Allan

Okay, you can go to 40plusfitnesspodcast.com/606 and I'll be sure to have links there. Deanna, thank you for being a part of 40+ Fitness.

[00:32:27.150] – Deanna

Thank you so much for having me. I had a blast.

Post Show/Recap

[00:32:30.130] – Allan

Hey, Ras.

[00:32:31.240] – Rachel

Hey, Fitness and Sushi sounds like a really fun podcast.

[00:32:35.870] – Allan

Yeah, if you go back, I was on, I think, September. Her August 30 episode. So the episode that came out last Wednesday, I was on her podcast.

[00:32:46.410] – Rachel


[00:32:47.030] – Allan

She's on mine. So we kind of just swapped back and forth because we have similar messages. In the way that we look at food and movement and things like that, is that the things you do should serve your body, and it shouldn't be strategies and tactics or diets and exercise before you actually start working on the mindset stuff. That's where their whole ideal body concept comes in is this, okay, you're not on a diet. You're eating. You're feeding yourself. And you've got to work on your relationship with food. You got to work on the relationship you have with your body, and you got to work on the relationship that you have with yourself.

[00:33:25.250] – Rachel

Well, I love that she had said you need to find joy in both eating and exercise. And she had mentioned, too, you need to consider what foods serve you. Just like you mentioned. I mean, we're not just eating calories. We're eating foods that we want to enjoy tasting and that do good in our bodies. And it's not that always foods are good and bad. You guys talked about craving broccoli. I don't crave broccoli either on a regular basis.

[00:33:55.130] – Allan

Well, I crave Brussels sprouts, but that's only because I can't get them.

[00:33:59.630] – Allan

Yeah, but I think the thing is if you start understanding what food does for you, it's energy, which is the calories, and you need energy. No one sits there and says, I want less energy.

[00:34:12.610] – Allan

I want less energy. And then no one says that because. They want more energy. But energy comes from food. So if you're eating good quality food. And you're eating the right varieties of it, you're giving your body the nutrition it needs and the energy it needs. And your body turns on. And so there's just opportunity there. I mean, we're going to talk about vitamins next week, but vitamin B12, if you're not eating meat or animal products, you may not be getting enough B12. B12 is a key component to your body producing energy. And where is it going to come from? Mostly animal products.

[00:34:54.020] – Allan

Okay, so when people start looking at foods and label them as good or bad based on what they've read or what they've heard, it just creates this syndrome, this cycle that just self inflicts over and over and over. It's like, oh, I ate a bad thing. Well, I guess I'll start back on Monday. Yeah, well, dude, it's Tuesday. You're going to wait till Monday because you had a cookie today. You're going to destroy the cookies for the rest of the week and start back on Monday. That makes no sense whatsoever.

[00:35:24.230] – Allan

So you got to fix that relationship stuff, because if you don't do that, you end up in these cycles where, oh, I screwed up. I did something bad. I'm a terrible person. And you're just beating yourself up over that.

[00:35:37.930] – Rachel

Right. Well, it's important to find foods that agree with you. There are certain foods I eat that just don't agree with me, but also find foods that are palatable besides the ones that are manufactured to be palatable.

[00:35:51.720] – Allan

Yeah, well, I was at a party. And I should have eaten before I went. I didn't. There was vegetable platter, just the basic broccoli, carrots, and forget what the other one was, but little tomatoes, I guess, and it had the ranch dressing. And so I go over there with a plate, and it's like, okay, there's chicken nuggets. There's all kinds of sweet stuff. And I'm like, okay, well, I guess. I'll go grab some broccoli, and I put it on my plate. No one else was anywhere near this vegetable tray. And so I grabbed some of the broccoli, and I grabbed some of the ranch dressing, and I went over. I'm just eating this, and then I'm still kind of hungry. So I go back to the table, and no one else has touched the broccoli or the carrots. But the broccoli looked good, and I liked what I just ate, so I grabbed more of it.

[00:36:39.950] – Allan

By the end of the night, I had eaten all the broccoli, every last bit of it. No one else had any. There were still a lot of carrots there. I don't know that anyone else ate carrots. I don't know anyone ate people were eating some of the tomatoes. But just at that moment, that wasn't what my body wanted or what I wanted. I just ate broccoli, and I enjoyed it.

[00:36:57.930] – Allan

So it's not that you would crave a vegetable over it. The basic principle was this, if you're going to label broccoli as good and you're going to label a cookie as bad, and that's in your head, then you're going to label yourself based on what you just chose to eat

[00:37:18.720] – Rachel

success or failure.

[00:37:20.320] – Allan


[00:37:21.060] – Allan

And who are you? Who are you? Yeah, I wanted to lose weight, but I ate the cookie bad. okay.

[00:37:29.380] – Allan

And that's what they want to try to get away from, because that's what gets toxic, because someone says, hey, I just baked these cookies I brought into work today. You should have a cookie. Are you literally going to look them in the face and say, no, I'm not eating any of your cookies?

[00:37:48.690] – Allan

have some of the cookie. You don't have to eat the whole one. Just say okay, yeah, I'll try it. And you take a little pinch off and you eat it. And there should be no remorse to that. You're basically doing something kind. You're doing something nice. And if you think, well, I'm being bad, this is bad, then you can't come from a genuine place of love and caring and kindness because you've labeled this whole event as bad.

[00:38:14.020] – Rachel


[00:38:16.510] – Allan

And it shouldn't be.

[00:38:18.140] – Allan

A little bit of this or a little bit of that is not going to derail you. It's not going to kill you. And unfortunately for a lot of people, mentally it does. They let it derail them rather than sit there and say, oh, I don't know how many times when I was in ketosis, I would know. I'd almost know as soon as I got home.

[00:38:35.850] – Allan

I'm like, crap, something's not right. And then I'd check my ketones either then or in the morning, and I'd be out of ketosis and I'll be like, dang, something was in the food.

[00:38:50.170] – Allan

 I didn't know was in the food. And now I'm not in ketosis. Now I could have lost my stuff and said, well, since I'm out of ketosis, I may as well go eat everything in the kitchen that I wouldn't eat otherwise. And I didn't approach it that way. It was like, okay, well, that happened, right? I know next time I'm not getting that. I know it's on their menu. It was delicious.

[00:39:09.700] – Allan

But if I want to stay in ketosis, that's not going to serve that purpose. So I'm not going to have that. I'm choosing not to have that when I go back because I know it will take me out of ketosis.

[00:39:23.270] – Rachel


[00:39:24.160] – Rachel

Well, that's just the point, is that it's just this one meal, this one snack, this one thing. We're on a health journey, hopefully for decades, years. Just one day out of that snapshot of time. It's not that big a deal. And we need to learn how to give ourselves a little grace when these things happen. I mean, I always talk about the holidays when my mom breaks out the delicious Greek cooking, particularly the baklava. You can imagine there's a lot of sugar in the baklava. But it's a celebration. It's a time to enjoy the family traditions. And it's just a moment. I will probably pay for it later, personally, but it's worth it you know, and you just move on. The next day can be a better day.

[00:40:14.130] – Allan

Yeah. And that's really what Deanna and Tony are all about, is just this idea of let's work on our relationship. Let's think about why we feel the way we feel. Why do we put value on a dress size?

[00:40:27.910] – Allan

Why do we change clothes five times in the morning? Because we don't like the way this dress or this thing looks on us, so we're going to change into something else. Why do we do that?

[00:40:37.370] – Allan

Why do we put so much worth in size and weight? And that's kind of the whole point of where they're going with this, is let's just work on being healthy and actually being kind to ourselves. And if we'll do that, if we'll fix the relationship we have with ourselves, the relationship we have with our body, the relationship we have with food, the relationship we have with exercise, if we work on those relationships and we truly think of them as relationships, and every relationship takes investment. And so if you invest the time and effort to build that relationship up, to build yourself up, to understand that your body is what it is, but you can help make it better with some basic work, realize, okay, I'm not going to approach food like there's good food and bad food. I'm just going to ask myself, is this something that's going to serve me and give me the nutrition or not?

[00:41:32.980] – Allan

Is this something I want to build my brain out of? Is this something I want to build bones out of? And occasional cookie is not going to matter.

[00:41:43.750] – Allan

But if I'm eating cookies every day.

[00:41:45.890] – Rachel


[00:41:46.660] – Allan

then it does. So that's a different thing. Basically, I'm okay to put in a little of substandard stuff here and there, but I can't make that the staple. I can't make that the norm. And that's really where they're coming at.

[00:42:00.890] – Rachel

I love it. That was really fun. I imagine their podcast is a lot of fun.

[00:42:04.790] – Allan

Yeah. So I'm going to be a guest on there. If you go over to Fitness and Sushi podcast, well, wherever you listen to this podcast, it's there in the show notes for this episode. I'll probably have a link to their podcast. So you can just go on over to their website. But it's everywhere. You listen to podcasts. And so I'm on their August 30 episode, which was last Wednesday.

[00:42:26.330] – Rachel

Sweet. Can't wait to listen.

[00:42:28.460] – Allan

All right, well, I will talk to you next week.

[00:42:31.040] – Rachel

Thanks, Allan. Take care.

[00:42:32.820] – Allan

You too.

Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
– Debbie Ralston– John Dachauer– Tim Alexander
– Eliza Lamb

Thank you!

Another episode you may enjoy


August 29, 2023

9 things to drop from your life today

Apple Google Spotify Overcast Youtube

I'm usually a fan of adding good things into your life to crowd out the bad. But I thought I'd go through my top 9 things you should remove as you work on improving your health and fitness. 


Let's Say Hello

[00:01:19.270] – Allan

Hey, Ras. How are things?

[00:01:21.390] – Rachel

Good, Allan. How are you today?

[00:01:23.420] – Allan

Well, just moving.

[00:01:26.170] – Rachel


[00:01:26.960] – Rachel

Yeah, well, moving. We're going to take a month off.

[00:01:29.420] – Allan

So trying to get a lot done. In fact, we're actually going to do our portion of three different episodes this week, and then we're going to do. Four episodes next week. And so I only have one of those four recorded right now, so it kind of gives you an idea of what it's like to try to get ahead. So we'll have what they call in the can, like seven or eight episodes.

[00:01:51.530] – Allan

Once I leave, I guess seven, and then I'm out. And so the whole month of September, this one is going live on the 29th, so, yeah, I guess it's going live next week. Okay. Yeah, that's how confusing it gets when. You try to get way ahead.

[00:02:08.320] – Allan

But we're still doing the bingo on Facebook. So if you go to the Facebook group, 40plusfitnesspodcast.com/group, or you can just go directly to the bingo sign up page at 40plusfitness.com/bingo, then. You can go and sign up for the bingo. But you are going to need to be in the Facebook group to play bingo because that's where you're going to post your card. And so on your card each day you can do one square, and you want to do a line, an X and a blackout. So get as many of those done in a month as you can at the end of September. Then there's the cut-off, and you have until October 1 to post your card completed card.

[00:02:47.140] – Allan

What you did during September, it is on an honor system, but at the same time, this is an opportunity for you to maybe do some things for your health and fitness that you hadn't considered doing before. So there's some fun tasks and some.

[00:02:59.620] – Allan

That are going to be a little. Bit more challenging around nutrition and fitness but there's 24 squares you got to fill out there's one free in the middle, and so that's 30 days to get 24 squares filled out to get us a blackout. And there are prizes, so if you get a line, there's an opportunity for prizes. If you get an X, there's an opportunity for more prizes. You get a blackout, then you get the best prize pack of all. So there's a reason for you to keep with it and stay consistent. And hopefully this will help you stay a little bit more motivated during the month of September while I'm on vacation.

[00:03:31.890] – Rachel

That sounds awesome. Sounds like a lot of fun.

[00:03:34.240] – Allan

How are things up there?

[00:03:35.780] – Rachel

Good. A while back, I mentioned I was tapering for an upcoming race, which was the other weekend, and we had such a fun time. We did a marathon relay. So I had a team of five. I was one of the five. I did my five mile leg, and it was just a super fun weekend. There was a ton of kids out there for cross country teams were doing the relay as well, so it was just a riot, and it was a super fun experience. So I totally recommend if nobody wants to run a full marathon, see if they have a relay, grab a couple of friends, and maybe do some miles together. But it was just a riot.

[00:04:13.810] – Allan

Well, 5 miles for you. That's like a sprint, right?

[00:04:16.160] – Rachel

It is, yeah. It's a good day for me.

[00:04:19.810] – Allan

You get through, and you're like, I should still be running.

[00:04:22.080] – Rachel

Yeah. And it was really for fun. We were not super competitive. Not super competitive about it. But I'm going to just say that my face hurt so much worse than my legs. I was laughing so hard the entire weekend. And although I did race well, I did hit a pretty good time for myself, and my legs were a little sore from racing. My face hurt far worse from laughing so hard. It was just a riot. Fully recommend it.

[00:04:47.310] – Allan

Glad you had a good time.

[00:04:48.410] – Rachel

Yeah. Gosh yeah. Good people. Good times.

[00:04:51.250] – Allan

All right, are you ready to get into today's episode?

[00:04:54.180] – Rachel



Today we're going to discuss nine things that you should drop from your life today. Now, I've never been a huge proponent of trying to eliminate certain things that you do. I'm always a bigger fan of adding things in. I found if you eat real good food and you feel good, you don't want the sugar, you don't want the processed stuff. And so it's kind of one of those things where I'm telling you that these are the things that you want to exclude from your life, but if you can replace them with something healthy.

It's a double win.

So the first one on my list.

And I don't think this should be.

Any surprise to anybody, is smoking and tobacco products. One of the reasons I listed this one first is it is probably the hardest thing for you to stop doing. But beyond that, I've seen firsthand what the cancers associated with smoking and tobacco products do to the human body. I watched my grandfather have bits of his throat and tongue cut out. And I watched my father in law basically drowned in his own blood because he had lung cancer. So this is no joke. Smoking has so many bad things that it does to you. It's something you need to get off of as soon as you possibly can. Try some of the stuff that's out there. The gums, the patches, the I don't know, hypnosis products, anything. Just do what you got to do to get off of that stuff.

The second one on my list is sugar.

And when I'm talking about sugar, I'm not necessarily talking about the sugars that come from natural foods like carrots have.

Some sugar in them. Fruit obviously has sugar in it.

That's typically not the problem. It's the added sugars and they get snuck into just about everything on the shelf. It's really kind of crazy if you start looking at the foods that we eat and you start logging this stuff.

To realize how much sugar is in.

Things just to make them more palatable. So the more you can cut sugar, you're probably going to lose some weight. And if you'll go to fortyplusfitness.com, scroll down a bit, you'll see where I have some challenges. One of those is a sugar challenge. It doesn't cost much, but it's a.

Really good 28 day challenge to help.

You cut down your sugar.

And that's going to have all kinds.

Of health benefits for you.

The next one is related.

It's processed foods.

Most processed foods are engineered to taste.

Good, to make you want more of them, to make you eat more. They're not processed in a way to make them more healthy.

Quite literally, it's the opposite. They want you eating more.

They don't really care about your health.

They may use terms like healthy or whole. All kinds of things, green labels, things like that to make you think that.

A food is healthy for you.

But if it's processed, it's not. And that's just a marketing gimmick. So cut out the processed foods and your health is going to improve considerably.

Sitting for long periods of time is another one.

And most of us are in jobs where we do have to sit for.

Most of the day, but we're still.

Sitting a lot more than we need to. So I'd strongly encourage you to have walk breaks. There's a process of work called the Pomodoro method where you work steady and focused for 25 minutes and then you take a five minute break. My recommendation would be for that five.

Minutes to actually be movement of some sort, get your body moving.

It's going to re energize your brain. It's going to make you more effective. It's going to make things a lot better. You're going to be more productive. But just sitting there for hours and hours and hours is not doing your body any favors. So if you can get up, if you can take a phone call while you're standing, get an adjustable desk. If you can just find ways to be moving a little bit more each day and sitting a little bit less.

The fifth one on my list is negative self taught. Now, I've talked about this topic a.

Good bit over the past five or six months for sure.

And what's happening here is our bodies.

Basically receive food, they receive water and.

Liquids, they receive movement.

What that does for the body and negative thoughts and our environment. And so if you've got negative self.

Talk, you're telling your body you're in.

Trouble, you're telling your body to be unhealthy. It may not seem that way, but negative self talk beats you down and keeps your body from recovering. It keeps your body from doing the things, raises your cortisol, which causes you.

To cut out muscle and to store fat.

And so the negative self talk is something that's very, very damaging to you.

So I'd strongly encourage you to get a journal.

I've said this so many times on the show. Get a journal.

And when you catch yourself doing negative self talk, write about it.

Write about what's going on in your life, why you wrote that statement.

And then as soon as you write.

That statement out, as soon as you think that statement, you write that statement out.

It's your job to refute that.

You're not a bad person. You don't always mess up. You find yourself using those words. You're probably using negative self talk and.

It'S not helping you on your health and fitness journey.

The 6th one is toxic relationships. And I get this is a little.

Touchy, but if you've got people in.

Your life that are making it harder for you to be healthy, they're making.

Your life harder, you don't need that.

That's not helping you. And so if you can end a toxic relationship, it's going to free up space for you to invite somebody else that's much more valuable to you, that's going to be better for you into your life. So try to cut out toxic relationships.

Which leads me to number seven, which is social media.

Social media is the current birthplace of almost all toxic relationships.

Now you get on one of these.

Social media platforms and you write something, someone's going to say something negative, they just are. And then that can escalate into a.

Whole myriad of other things.

So the less time you spend on social media, the better off you're going to be. And the social media that you do consume should be valuable to you. It shouldn't just be out there looking for problems, listening to what other people are having to say about you in your life. Yes, it's cool to share how you're doing, but share it with people that care, you can come to 40 Plusfitnesspodcast.com.

Group and join the 40 plus fitness group. And that's a group of people that.

Are going to treat you right. That's a group of people that care about health and fitness. We're all over 40, so this is not kids running around yelling at each other and causing all kinds of grief. There are no anonymous accounts in the group. I approve each and every one that comes in and I will kick them out if they are abusing what we do there.

So avoid social media where you can.

And if you are going to do it, find good places where you can consume things that are valuable to you.


Number eight is alcohol. And I know we've all read it, oh, well, two drinks is actually probably healthy for you. No, that's a doctor doing a study that already has a predefined idea of what they want the outcome to be because they actually just want to go.

Have a drink and feel good about it.

Alcohol does not serve you. It dehydrates you. It does no value when they show you the studies about resveratrol and all.

That stuff, the amount you would have.

To drink to get the dose necessary to get those improvements, if they even happen for humans, because it's really rat studies, it's enormous. You would never be able to drink that much alcohol. And even taking the supplements probably isn't.

Getting you where you want to be. So again, if you're going to drink.

Obviously in moderation, but it's not helping you. And if you're interested in improving your.

Health and fitness, that is one of the things that you should drop. And then number nine is unnecessary medications. Now, if you listened to the show.

Last week, episode 60 Four with Dr. Levy, she wrote the book on that. She's a doctor of pharmacy, and basically she does audits of people who are on various different medications. And as we get older, how we react to different medications changes. So having an audit done or just a review done of what you're taking and trying to figure out if any of those might be unnecessary would be.

A good way for you to cut those back. Every medication has drawbacks. It has side effects. It just does. There's no safe, 100% safe drug out there. So if you're taking them, you're probably.

Then going to have to take other.

Drugs to deal with the side effects of the drugs that you're taking. So if that's the case, try to find another plan. Try to get off of some of them. If you're improving your health, a lot of the medications you're taking might become unnecessary. So if there are unnecessary medications, talk to your doctor, get a professional, get a doctor or a pharmacist to go through the list and see if there's any redundancies things that could probably cut out. There are some reasons for there to be redundancies at time. But for the most part, if you're taking one drug and it's not working for you, you should stop taking it and consider something else if that's what you need. But you got to talk to your doctor and you got to know what you're taking, and you got to have that conversation.

To recap, my list of nine things to drop from your life today,

  1. smoking or tobacco products.
  2. sugar.
  3. processed foods.
  4. sitting for long periods of time.
  5. negative self-talk.
  6. toxic relationships.
  7. social media.
  8. alcohol.
  9. unnecessary medications.

The more of these things you get out of your life, the better you're going to feel, the healthier you're going to be, and you're going to be much more likely to thrive without these things in your life. So if any of these are in your life today, it's worth putting in the work necessary to get them out so you can live a healthy and long.

Post Show/Recap

[00:14:18.850] – Allan

Welcome back, Ras.

[00:14:19.900] – Rachel

Hey, Allan, you know, like you, I prefer to add things versus drop things. But as I'm listening to you talk about all these things that we should really eliminate from our life, I'm like, yeah, it's a good thing to cut out things like smoking, sugar, sitting. These are all pretty big things that we could maybe stand to reevaluate in our lives. See where we stand.

[00:14:41.040] – Allan

Yeah. And sometimes it is easier to add something, and that makes it that you're going to do less of these other things. Just something to think about. If these things are in your life, they're holding your health back. They just are.

[00:14:53.550] – Rachel

Well, I want to start with sugar right off the bat, and I just mentioned this because a couple years ago, when I was reevaluating my diet, I went towards the keto style of eating, and I was eliminating sugar, and my mind was blown, Alan. I was just shocked at where sugar is in all the foods. It's just hidden. When you think of sugar, at least when I was thinking of sugar, I'm thinking candy bars, pop. That's the easy ones. But there's a lot of sugar in the yogurt we might eat or the creamer I might put in my coffee, or it's even in ketchup. And some other weird things that you wouldn't think about. So taking the minute to look at the labels was super eye-opening.

[00:15:36.590] – Allan

Yeah, I'm preparing. We're going to do it when we get back in October. There's a chili cook-off. And so I'm preparing the chili for 0ur team this year. And so I've been experimenting with the different spices and how to put it together. And one of our teammates, being helpful, wanted to send me a recipe, sort of like, this is the one that'll win. So, yeah, I'm going to do someone else's recipe for my chili cook-off. No, but they all use the canned stuff. This recipe, it called for brown sugar.

[00:16:07.880] – Rachel

Of course.

[00:16:08.650] – Allan

Just throw half a cup of brown sugar in there and everybody's going to love it. And others are throwing in chocolate bars. It was a couple others that threw in sugar. And everything's coming out of a can. Everything that they're putting in there is coming out of a can. I'm like, soak your beans. Yeah, this is not Texas chili, by the way, but soak your beans and then just do mean it.

Yes, it takes a little bit longer to make your own tomato know, it just does. But when you do it, you know what's in it. I'll be able to tell you there's nothing in this. When I get done and I make this thing, there won't be anything out of a can in my chili.

Everything is going to be the raw spices. Everything's going to be the raw vegetables and the meat. And so there's not going to be a bunch of processed stuff or chemicals or sugar in my chili. It'll be something that even if you're keto, you can get past the beans. You can eat it. But it has to be made with hamburger or should be made with hamburger.

What their intent is to make it all fair, and they need beans to kind of bulk that up a little bit. Because just hamburger meat, chili is just okay, but just a little bit of beans to get some fiber and a little bit of bulk in there. But no, it's like you're right if it's in a box bag, jar or can, you need to read the label.

[00:17:29.570] – Rachel

Oh, gosh, yeah.

[00:17:39.970] – Allan

Probably avoid it anyway, but read the. Label first while you're still standing in the store. And then ask yourself, is this something that if I really cared about myself. That I would feed to someone that I care about?

[00:17:39.970] – Rachel

Or is there a better option?

[00:17:41.590] – Allan

Yeah, or is there a better option? There are a lot more of them now. You walk down the aisle and no sugar added peanut butter. Peanut butter should just be peanuts. It really should grind up some peanuts. That's all peanut butter is, is just ground up peanuts. When they start putting sugar and they start pulling out the actual oil from the peanut and putting vegetable oil in. There, you've got to ask the question why.

[00:18:05.240] – Allan

And that's to make it cheaper and to make it more palatable so you'll eat more of it and buy more of it. And again, there's no reason for there to be sugar in peanut butter. But they put it in there.

[00:18:16.270] – Rachel


[00:18:18.600] – Allan

There shouldn't be a no sugar peanut butter. There just shouldn't be sugar in your peanut butter. But we got to read the label. Sugar comes in a lot of different names. If it has an -ose ending, it's probably sugar. And so they'll put different ways to put it in there so they can put it further down the label.

[00:18:36.990] – Allan

High fructose corn syrup is one of the big ones that you'll see, but tt's glucose, it's cane sugar, it's agave nectar. It's all these different things. They're all sugar. And what you want to do then you see all these on the label. They're way down in there. But if there's more than one or two of them now you got to go up there and look at the numbers. Sorry if you don't like numbers, but look up at the numbers and see how many grams of sugar is in this thing. And if it's not fiber, it's mostly sugar.

[00:19:09.230] – Allan

Even if it doesn't say the sugar directly, that's added sugar, it could still be a simple carb that's going to act just like sugar in your body. So you take the total carbs and then you look at the fiber, and that different number is net carbs. And so if you're trying to manage your carbs and manage your sugar, that's where you're going to see it. And then you start looking through the ingredients list. Hint, if there's more than five, put it back. But if they're going to have two or three different types of sugar in it. That's exactly what they're trying to do, is to hide the sugar in this product.

[00:19:42.860] – Allan

So you just don't know how much is in there because they're obligated to put it in order of volume. So ketchup? Yeah, the top ingredient might be water. And then tomatoes and then sugar. And you're like, okay, so the third ingredient in this is sugar.

[00:20:06.000] – Allan

Again, some of the things I see online, I just have to turn it off. I literally just have to say, okay, I'm out. And so that's why I put social media on there, because

[00:20:14.930] – Rachel

That's a good point.

[00:20:14.530] – Allan

There was a woman adding sugar to her Pepsi.

[00:20:15.230] – Rachel


[00:20:15.840] – Allan

Yeah. Her question was, how many spoons or tablespoons of sugar do you put in your Pepsi? There's an individual adding sugar to sugar,water, to make, I guess, more sugary. And I was like, I can't. I just can't. But that's out there. And so people are doing these things. They're filming themselves do it and stop. Just please don't. I went past that post.

[00:20:52.450] – Rachel


[00:20:53.170] – Allan

And I shut my laptop. I was done because I couldn't. But I held my tongue, I held my snap back of how completely unsmart that was.

[00:21:05.960] – Rachel


[00:21:07.030] – Allan

Yeah, but it's out there. It's out there. People are so addicted to sugar. They will put sugar on sugar and it's just stop, please.

[00:21:18.300] – Rachel

That's got to be the worst I think that's probably the worst thing. That's why I wanted to chat about it for a second. I think all the different varieties of sugar and all the myriad of products that we eat every day, it's insidious and it adds up so fast and we just don't realize it until we begin to look. So, yeah, it's important to start paying attention to that.

[00:21:40.510] – Allan

I agree. Sure.

[00:21:41.790] – Rachel

And then the other thing you had mentioned was sitting can't sit for too long. I've heard people say sitting is the new smoking. We've heard that for a few years now, too. And in the running community, I don't think sometimes runners may not realize we go out for our three, four, five mile run in the morning, and then we spend the day at work. We come home and we're tired because we got up early to run, and we spend the evening on the couch watching TV. And like, well, you kind of are undoing all the great work that you just did that morning. And so if you pay attention to your lifestyle, if you spend too much time sitting, it might be time to, again, reevaluate what you're doing in the evenings.

[00:22:22.690] – Allan

And it's really about movement, because this is not you should stand up all day long either, because that has health ramifications. Too I remember because there were a lot of women standing in the pharmacy business. I was in the pharmacy business when I was in college, and they would gave problems with their varicose veins and other issues because they were standing in one place for a long period of time.

[00:22:44.930] – Allan

It's really about movement. So the opposite of sitting is not standing. The opposite of sitting is moving. Okay? Your glutes need to be engaged, which. They are not when you're sitting. And so the opposite is moving. So getting up and walking around, getting up and maybe doing a couple of jumping jacks or some body squats or just something, the opposite is not standing. So if you get one of those adjustable desks, adjust it.

[00:23:10.210] – Allan

I would basically set the timer on. My phone for 30 minutes, and every. 30 minutes, I would adjust my desk. Up or adjust my desk down. Sometimes I would sit on one of the balance balls if what I was working on didn't require me to be worried about this. And I had a wobble board and. All these other things, and people walk in my office, it's like, what in the heck are you doing in here? Looks more like a gym than it does an office. And that was by design.

[00:23:36.100] – Allan

I wanted to be able to move. I had a yoga mat. I have a yoga mat in my office.

[00:23:40.790] – Rachel

So if I feel like I need to move around, I've been sitting for a little while. I can get down on the floor on the yoga mat and do some bird dogs, do some crunches, do some hollow holds, just different things to basically get my body moving and engaged and not just sitting still.

[00:24:00.090] – Rachel

Oh, I think that's important, to find different ways to move throughout the day, and then especially in the evening when we're sitting there watching TV. We always talk about this, too, Allan. When the commercial comes on, get up and go do something for me. I'm doing laundry in the evenings, so when the show ends or something. I can go downstairs, maybe walk up, go back downstairs. I kind of do some chores in the evening just to get stuff done and kill two birds with 1 st, basically.

[00:24:27.750] – Allan

Or try like the Starrettes do: just sit on the floor.

[00:24:32.910] – Rachel

Oh, yeah.

[00:24:42.910] – Allan

You're going to squirm you're going to move around. If you try to sit on the floor and watch TV, you're going to squirm around a little bit. You're going to be moving the whole time because it's kind of uncomfortable to sit on the floor for a long period of time without moving around. When we sit in a chair, we're just in this comfortable, supported place that, there's not a lot of reason, especially on a couch, not a lot of reason for us to do much moving except to reach out and grab your beer, I guess.

[00:25:02.190] – Allan

But it's just getting down on the floor that's going to open up your hips. It's going to make you move around a bit, and then yeah.

Then pop up onto the couch for a little while and then get up. Yeah, walk into the bathroom or walk over to grab your laundry. And you can stand there and fold it while you're watching the television program. And then sit back down if you're still watching. But there's lots of things you can.

[00:25:24.790] – Allan

Do to watch your show wind down. And still get some general movement in it. We're not talking about getting on a treadmill and running for a half hour while you're watching TV. This is just casual, gentle movement, and your body's going to appreciate that.

[00:25:39.920] – Rachel

Oh, absolutely. These are all great things to consider or try and figure out how to eliminate them out of your day to day.

[00:25:47.150] – Allan

All right, well, I'll talk to you next week.

[00:25:49.680] – Rachel

Sounds great, Allan. Take care.

[00:25:51.280] – Allan

You too. Bye.

[00:25:52.350] – Rachel

Thanks. Bye bye.

Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
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Thank you!

Another episode you may enjoy


August 22, 2023

How to properly manage your medications with Dr. Hedva Barenholtz Levy

Apple Google Spotify Overcast Youtube

With many of us taking several medications each day it is hard to know that we aren't taking unnecessary drugs or dealing with adverse reactions when we don't have to. In her book, Maybe It's Your Medications, Dr. Hedva Barenholtz Levy shows us how to best manage our medications as we age.


Let's Say Hello

[00:01:26.690] – Allan

Hey, Ras, how are things?

[00:01:28.300] – Rachel

Good, Allan. How are you today?

[00:01:30.320] – Allan

I'm doing all right. I'm doing all right. We're getting closer to my vacation.

[00:01:34.570] – Rachel


[00:01:36.830] – Allan

And so a couple of big things. One is I won't be taking new clients during September. So today's the 22nd. You got about a week. If you go to 40plusfitness.com/discovery, you can book a call with me and we can go ahead and get you going. If you don't hit me this week, then I'm going to be closed for September. I'll still service my existing clients, I'll still do the podcast, and I got a special little surprise I'm going to talk about in a minute that I am going to do, but I'm not going to take on new clients during that period of time. So if you're not in the door before I get on the ferry to leave this island on September 1, I can't talk to you. I won't bring you on until October, probably October 2. Based on what my wife has shown me, my itinerary is because she's doing all that, I'm just tagging along.

[00:02:26.510] – Rachel

Nice, that sounds awesome.

[00:02:28.400] – Allan

So if you want to work with me, this is the time you could email me or you can go into 40plusfitness.com/discovery. That's a direct link to my calendar. Literally. You see days on there that are available to book. That's the days I'm available to book. So go check it out. Also, I want to do something a little fun in September. I want to play health and fitness bingo.

[00:02:52.510] – Rachel

Oh, boy.

[00:02:53.990] – Allan

Okay, so I'm going to roll out the first of hopefully many 40+ Fitness Bingo games. Okay. And the way we're going to play this is it's going to be in the Facebook group, but you can go to 40plusfitness.com/bingo to get the details, but you basically will get a bingo card with some health and fitness activities, that you can do during the month of September. So it's going to run for 30 days. There's three levels of game and prizes at each level, it'll be drawn off of people who complete that level. So there's going to be, of course, the straight line, the way you normally play bingo. There's going to be the x, the middle space is a free space, and then there's also going to be a blackout. And so the prizes will be relative to how far you make it through your bingo card of whether you get a line, an x, or a blackout. And I'll have some prizes available for that and we'll finish that up in September. So just a little heads up, there are 25 squares in a bingo card and there are 30 days in September.

[00:04:05.000] – Rachel

Oh, cool. This sounds so fun.

[00:04:08.270] – Allan

This isn't like you're going to have to do this all the time, but the rule is it's one per day, so you can't fill multiple squares in the same day. This isn't like I go out there one week and just bust all this stuff out and say, well, yeah, of course I got my protein and I had 30 grams of protein on this day. I'll check both. That's not how it works. Each day you score something on the card. And this is based on an honor system, but it still can be fun because there'll be things that you wouldn't maybe necessarily have really focused on. So it's going to maybe take you outside your space a little bit. If you're not doing resistance training, you know there's going to be a square for resistance training. You absolutely know it's going to be in there if you're not moving much, if you're sedentary. Yeah. There's going to be park your car at the back end of the parking lot instead of at the front, and it's going to be the little things like that, but I think it's doable by just about everybody. But you can find your line.

[00:05:02.960] – Allan

You can find your line. If you just can do a line, then that's great. It's better, maybe better than what we've done or an x or a blackout. But there'll be prizes involved, so I'm hoping to get some folks involved. You can go to 40plusfitness.com/bingo.

[00:05:17.270] – Rachel

Sounds awesome. What a great challenge.

[00:05:20.880] – Allan


[00:05:21.830] – Allan

All right. Well, how are things up there, Rachel?

[00:05:24.210] – Rachel

Oh, wonderful. Getting ready for a camp out this weekend. We're taking the camper out to a park up here in Michigan and just looking for weekend of peace and quiet.

[00:05:33.760] – Rachel

Getting away.

[00:05:34.760] – Allan

Yeah. You got about another month and a half.

[00:05:37.850] – Rachel

I know, I know I'm losing to be. I gotta enjoy as much as I can outside before it starts snowing.

[00:05:48.040] – Allan


[00:05:48.610] – Rachel

Not that I'll not go outside because, you know I do.

[00:05:51.390] – Allan

But you will. But you won't be camping.

[00:05:53.430] – Rachel

No. Yep.

[00:05:55.770] – Allan

Mike will be ice fishing in a few months.

[00:05:57.510] – Rachel

Oh, for sure but let's let's just wait. I'm not ready for summer to go away.

[00:06:02.130] – Allan

Yeah, I'm not either. All right, well, are you ready to have a conversation with Dr. Levy?

[00:06:08.600] – Rachel

Sure. Sounds great.


[00:06:34.510] – Allan

Dr. Levy. Welcome to 40+ Fitness.

[00:06:37.630] – Dr. Levy

Thanks so much, Allan. Glad to be here.

[00:06:39.780] – Allan

Now, the name of your book is Maybe It's Your Medications: How to Avoid Unnecessary Drug Therapy and Adverse Reactions. And I think everybody wants to avoid adverse reactions, but I like the word you used therapy.

[00:06:54.230] – Dr. Levy


[00:06:55.430] – Allan

Because we don't have a drug deficiency. This is meant to get us over a period of time when we can actually fix ourselves versus just deal with the symptoms. So I love that you use the word therapy, and I love that you use the concept of that health is a team sport, because I think too many times we just think, well, there's the doctor, he's the coach and the quarterback, and I'm just doing my part. I'm an offensive lineman. It's thankless I just take my pills, and I go on with my life. Right.

[00:07:27.360] – Dr. Levy

And it's a little bit more than that, right?

[00:07:29.060] – Allan


[00:07:29.760] – Dr. Levy

So I definitely talk about the concept of your healthcare team, and I think that's maybe an important thing. We could start off with that understanding. Of course, we think about the main players the physicians, the pharmacists, the nurse. But there's occupational therapists, physical therapists. When I was talking to a group of older adults, someone mentioned the dentist. Right. These are all part of our healthcare team, but the most important person on that team is you, the patient, the consumer, the one who's taking those medications. And I think all too often, people don't recognize that they are an important part of their team. They have a voice, and they're actually in the game, as you said. Right. Using that analogy. So that's an important thing. And then if you start with that premise that I have a voice, my opinions matter, my preferences matter, what I'm experiencing when I take medications matter, then you're at a different starting place, I think, with the drug therapy and that's talk about that phrase again, too. Medication we can talk about medications we can talk about pharmacotherapy is another term for drug therapy, and I never really thought twice about it, so I appreciate you bringing that up.

[00:08:28.740] – Dr. Levy

But it's drug therapy. It's another approach to managing our health, and it's one aspect of managing our overall health. And the link with healthy aging, I think, is so important, which is where this book came about. Too often, we continue taking medicines as we get older, and they may not be helping us age in the most healthy manner if they're unnecessary or causing problems.

[00:08:52.170] – Allan

Now, I came from an accounting background, so when you give me a number and a list someone called it a listicle once, but when you give me a list of things, it's like I'm kind of drawn to that. I kind of like that idea of a list. And so you identified five characteristics that increase the risk of adverse drug events. Like I said, I think most of us want to avoid that. Can you talk about each of those briefly and why they're important?

[00:09:15.730] – Dr. Levy

Yeah, sure. So I present these five characteristics as when you look at them together, it's kind of unique for the older adult population. And in medicine, we talk about age 65 and olders is the cut off of sorts. And so those five points, the first one is taking multiple medications puts you at increased risk of having an adverse drug event. And that kind of makes sense. The more medicines you're exposed to, the greater the chances are of having a problem from them. Why does this happen? Lots of reasons, but one is we have more chronic conditions as we get older, and that leads to the need often for at least one medicine, but sometimes two or three, depending on the condition. Right. We think about diabetes and even heart failure and other conditions where you need several medicines. The other characteristic is or the second characteristic is the involvement of multiple physicians on your care team. So think about how our healthcare today is a little bit divided. We have specialists all over the place. The number of older adults who are seeing specialists has almost doubled in the last 20 years. So that's something to think about.

[00:10:19.910] – Dr. Levy

When physicians are prescribing their own medicines for you, are they communicating with each other? Do those medicines interact? Does one physician know everything that you're taking? So that's where some of those other risk factors come in, when you have more prescribers involved.

[00:10:35.210] – Allan

I worked in a pharmacy when I was in college, and I can tell you the pharmacists back there, yeah, they've got the little computers, but they are so slammed to just keep turning pills out because the retail environment is just they will do a consult with you. But it's even hard for them if they're just seeing a script unless the computer tells them there's a definite deal. But this goes even further to say, okay, because two doctors talking to each other, pharmacists looking at you could get your stuff filled in the same place. And it doesn't necessarily mean it's being reviewed and covered off.

[00:11:11.880] – Dr. Levy

And there's some safeguards in place. I don't want to scare people, but definitely not all of the information is at the pharmacy system. And we can go into how to know what medication is the right choice, the right drug for a person. We have to have some of that medical information, the health background, which pharmacy systems don't have. So, yeah, that's another concern. Right. We can only do so much checking at that community retail dispensing setting. So clearly, the more doctors involved, studies have shown that there's an increased risk of having an adverse drug event occurring. The next two reasons kind of go together. And they're big words, but I do introduce them in the book. I think it's important for people to at least know these terms are there and then talk about them in more easy word with easier words, pharmacokinetics and pharmacodynamics. And this simply refers to pharmacokinetics, is how our body handles medications. And as we get older, our body handles medications differently. Our kidney function changes, our liver function changes, and that impacts how our bodies process and get those medications out of our system. Some medications can have a much longer duration in the body because of these pharmacokinetic changes, if you will.

[00:12:23.810] – Dr. Levy

So suddenly, as we get older, we might need lower doses or we might need to avoid certain medications because our bodies are handling medicines differently. So that piece is another that's a third characteristic that's really important. And then the fourth one I mentioned, pharmacodynamics, another big word, but that simply refers to how the drug affects our body. And the most simple way to address this for older adults to understand how our bodies change and deal with these medicines differently, is our bodies are more sensitive to the effects of medications as we get older. And that's the pharmacodynamic piece. But that really means maybe smaller doses will be just as good for older adults. It means that there's certain drug classes that we might want to avoid as we get older because we're more susceptible to having a serious, more significant side effect, like Drowsiness. Dizziness, that fall risk, things like that. And then the fifth characteristic I include is the fact that older adults are not enrolled in clinical trials as much as the younger population, those under 65 years old. And that's because it's hard to study a drug, its effectiveness, if a person is taking many other medications and has many other health conditions.

[00:13:33.550] – Dr. Levy

So it's not as clean, if you will. But we cannot know how a drug will affect an older person or an older person with different health conditions unless we study or have it exposed in someone with those conditions. So that means when a drug is newly available on the market after it's been approved by the FDA, we may or may not know exactly how the safety and effectiveness in an older individual. So those five characteristics, putting them together, kind of make that older adult a little more unique situation and at higher risk of having an adverse drug event.

[00:14:10.270] – Allan

Yeah, and I think that's easy to see. There's nothing inherently wrong with any one of these things. It's just a part of the way the system works. They want to get a market, a drug to market quickly. If they can't get enough older adults in there and one of the things I would say is it's probably chronological age, biological age, two different things. So you might not be 65, but you might be in a 65 year old body. And so drugs would affect you. If your liver or kidney is not functioning the way that it's supposed to, then you might have the wrong drug, you may have too much of the right drug and all that. So I think one of the keys to me is if you start a new drug, you need to have that conversation is to know, okay, what does this drug do? Why is this doing it? What are the potential risks? Because there are no wholly safe, fully effective drugs out there.

[00:15:04.740] – Dr. Levy


[00:15:05.400] – Allan

Okay. Something could go wrong, and in fact, it goes wrong a lot more often than we would hope. And you listed the stats in the book, which, again, it's scary stuff. If you're on multiple medications, it is something that you definitely want to pay attention to. And you identified that as medical related problems or MRPs. So we won't keep saying medical related, medication related. Now, poor Frances, in your book, she exhibited all eight of these.

[00:15:38.440] – Dr. Levy

Well, you had to make a good example, but it wasn't too far of a stretch.

[00:15:46.190] – Allan

Frances, frances had it rough. And as she went through her evaluation, and we're going to talk about this evaluation process later, but as Frances went through it, she hit on all eight of these things. Like I said, I love lists, but poor Frances, can you talk through the eight MRPs that you could deal with when you're dealing with medications?

[00:16:06.880] – Dr. Levy

Yeah. And so I introduced those MRPs, not to make it more convoluted or complicated, but to help individuals understand that there's a lot to look at when helping a person look at their full medication regimen and is everything appropriate in helping them. And the goal is to minimize the risk of harm, obviously. So the MRPs that I talk about, so this is like a standard way I would do a medication review. I think most pharmacists would take this general approach. The first type is the adverse drug reactions. Right? So very obviously linked to medications have side effects, adverse drug reactions, it's kind of the same name. And so we have to look for is a person experiencing any adverse drug reactions or side effects at the time? Drug interactions is another important medication related problem. And also with this, we have to remember to always looking for not just prescription drug interactions, but also the non prescription medicines a person might take. Don't forget the over the counter medications as well as the dietary supplements. And I also talked go into a little more detail in one of the chapters about interactions. How drugs can interact with disease states a person's health condition.

[00:17:16.560] – Dr. Levy

So we need to be careful of someone who's taking a non steroidal anti-inflammatory if they have heart failure or high blood pressure, it can worsen those conditions. We look at dosages doses that are too low or too high. As we talked about, doses can be too high. So we worry about that for our older adults, especially if there's kidney issues, liver problems, for example. But something that can be overlooked is a dose too low. So another important consideration we should have with the medications we're taking is is it effective? Is it doing what it's supposed to be doing? And if not, is it because there's a dosage issue? So if we're going to treat high blood pressure or treat high cholesterol, let's make sure we're at a correct and effective dose that the drug is going to work for the person. So those are the two kind of partner problems too high and too low. A fifth medication related problem is the selection of improper drug. And this is I spend more time in a couple of chapters in the book on this topic because as we get older, geriatric experts have identified a list of medications that are considered potentially inappropriate for older adults.

[00:18:20.130] – Dr. Levy

And I do emphasize the potentially part because everybody is different. But it just brings to mind that as we get older, again, because of those changes I mentioned earlier, the pharmacinetics and pharmacodynamics medicines may not be the best, certain medicines may not be the best choice as we get older. Another problem is an undertreated or untreated condition. So that's just as serious. If someone has a condition that really does need medical care and they're not getting it, that can lead to further problems. Anything from maybe it's an undiagnosed respiratory infection, someone's treating a cough, and it really becomes becoming something more serious. Or what feels like reflux of stomach issue. Maybe it's a heart issue. I know you talked about that on a recent episode. So we want to make sure that nothing is being missed. Osteoporosis, the weakened bones. Is a person getting enough calcium and vitamin D, for example, not getting a medication? That's another again, a whole chapter is devoted to someone not getting a medication for various reasons. Maybe they're not taking it the way they should be taking it at home. Maybe they can't afford it and they never fill the prescription or they stopped filling it.

[00:19:27.030] – Dr. Levy

Maybe they didn't fully understand when and how to take it, so they're just not taking it properly. And then the last one is the unnecessary medications. And that's a really big concern in healthcare today and working with older adults because we have these growing medication lists and is everything still needed? So that's a real big topic we can talk about too. Those are the eight problems.

[00:19:49.610] – Allan

And I think, again, one of the reasons I wanted to talk about this in particular is that this kind of shows you the complexity of the model. You got the number of medications, what they do, what the risks are, and then all of these little kind of caveats of, are you getting enough? Are you getting the right thing? Are you actually taking it the right way? Are you taking it regularly enough? Are you now kind of making decisions? You talked about a patient who said, okay, this is too much. So instead of going and having the dose brought down, she's like, I'll take it every other day. And her condition didn't improve, so the doctor gave her another medication, and then she decided, well, I don't want to take this the same day I'm taking that one again, not how it was prescribed. And every other day she's taking that one again. The condition doesn't improve. So the doctor is like, well, we got to put you on a third blood pressure medication. And now they're on three blood pressure medications, where perhaps if they had just asked the doctor to lower the dose of the first one to the appropriate dose, it wouldn't happen.

[00:20:47.870] – Allan

But that's hard and add to the complexity. You're listening to this podcast. So if you've made substantial lifestyle changes, some of the medications you may have been on, you may no longer need. A lot of people have high blood sugar, high blood pressure. They start eating better, they start moving better. Their blood pressure comes down naturally, their blood sugar comes down naturally, but they're still on the same dose of those medications. Your blood pressure might go too low, your blood sugar might go too low. And now you're going into the doctor, why is your blood sugar too low? And it's like, I don't know. Now they're putting on a third medication.

[00:21:25.930] – Dr. Levy

You're nailing a really important point, or I've fallen. I don't know. I've had these experiences of falling in the past month. Doctor, what's going on? And you find out the blood pressure has been dropping too low. So that densifying therapy and what you're bringing up the topic of communication, which I sprinkle throughout the book, because it's so important for us as consumers to communicate with our healthcare team, with our physicians. She may or may not have been on the right dose, but she wasn't feeling right, or she didn't like it. She needed to say something to her doctor rather than go on silently and tolerating whatever she thinks she's doing, making her own adjustments.

[00:22:07.590] – Allan

The other thing is, people will go to the doctor, they'll get a prescription, the condition will not improve, and they'll just continue to take what they were told to take, even though the stomach isn't better, this isn't better, they don't feel better

[00:22:22.040] – Dr. Levy

or pain not improving or something like that. Right. So is it the way the person is taking it? Is it the dosage too low, perhaps? Is it maybe just the wrong medicine for the person? But yeah, to continue and that's where we get into these unnecessary medicines and for people to think it's been approved by the FDA. My doctor's prescribing it. There's absolutely no risk, I think is just misleading for us. And we fall into that complacency. We just get comfortable with the medicines. I think we need to be a little bit more vigilant. Not to doubt all the medicines, but just to make sure, do I need it? Because ideally, we want that fine line of taking just what you need that's helping you and avoiding what is not helping you. But you make a great point about people who are making lifestyle changes and improving their blood pressure, blood sugar control, all that wonderful stuff. The medicines might be over too high of a dose at that point, right?

[00:23:19.340] – Allan

At least letting your doctor know that you're making these lifestyle changes and therefore they'll know, okay, well, you may have to lower this drug. Measure your blood sugar, measure your blood pressure. Let's see where it's trailing. If it starts to go low, call in and we'll lower the dosage on your medication.

[00:23:37.350] – Dr. Levy

So that's part of that monitoring. And there's so much we can do at home. And that's, again, being on the healthcare team. Help your doctor monitor, do what you need to at home. Check the blood pressure. If you have the blood sugar monitoring, do what you need to do and make sure you're talking with your doctor about those results.

[00:23:54.090] – Allan

Now, one of the things about that team is that this is I'm not going to call it rocket science, but the biology of medications, particularly when they're combined and as we age, is very confusing, can be really confusing and really maybe above our head. And it's okay. It's okay to admit that this is above my head. I don't have all the answers, but there is kind of a solution out there. I think if we search for it, we can find it. But getting a comprehensive medication review by a professional that does these things, particularly for older adults, can be a valuable thing. Because the other things you brought up in the book that we haven't even touched on are things like over the counter drugs, the supplements we might be taking, our dietary changes in the way we feel or look, if you've lost significant weight, if you're not moving as much as you were. So sometimes lifestyle is going in the opposite direction of what you were doing. I mean, sometimes it's just you're losing bone mass, you're losing muscle mass, and it might be one of the drugs you're taking that's causing some of that to happen.

[00:25:03.670] – Allan

Can you talk a little bit about the comprehensive medical review, what would be involved, and then how we would go about the process of deprescribing? Because I think a lot of people think, well, I'll just quit a medication, and sometimes that creates more problems than the medication did. So you can kind of talk about that, because I don't think this is something where you just make the decision, I'm going to take this every other day because I'm not feeling good on it. Can you talk about that review and how it would go?

[00:25:30.860] – Dr. Levy

Yeah, sure. So I think a most valuable tool is to have a medication review. And like you mentioned, it needs to be by somebody who knows the drug therapy, who knows the medications, and for the older population, which is where my focus is, it's going to be someone with that geriatric specialist, geriatric specialty. And pharmacists have that specialty, geriatricians, or the physicians who are specialized in geriatrics. But nurse practitioners and physicians assistants can also have that Geriatric specialty. So the medication review is a chance to look at everything a person is taking. And as you touched on thank you for mentioning it, the over the counter, the OTC products, things like antacids and even aspirin a lot of people don't think about aspirin being on their regimen because they get it without a prescription. Right. I've come across that all the time to other pain medicines, cough and cold preps anything you might be taking without a prescription is important to be included in that medicine list for the review, as well as the dietary supplements. And dietary supplements is a whole other ballgame because it's just important to mention that they're regulated as food by the Food and Drug Administration, not as medication.

[00:26:35.910] – Dr. Levy

So there's a whole other little ball of concern we have with the supplement. But a medication review is a chance for that medication expert to look at everything you're taking and look for all of those eight medication related problems that I mentioned earlier and identify not only actual problems. What I do a lot is looking for potential problems because if we can prevent something from happening, then we prevent the additional doctor visit, the added prescription, the emergency department visit, or even a hospitalization. Right. So all those statistics that we know go with having an adverse event with a medication, we want to prevent it. Right. So a lot of people might say, I'm doing fine right now. I'm taking what the doctor has told me to take. There still are things to find when you open up the lift, the hood and you look under the hood of the car, you can find some of those eight problems. And things like very hard it's very hard to identify without talking with a person and doing a review is finding out how they're taking their medicines at home and looking for the under treatment issue and are they even getting their drugs and taking them the way they should be taken.

[00:27:40.260] – Dr. Levy

So where you go about finding a review is a challenging part. And I touch on as best I can. I truly believe pharmacists have the therapy. So I always encourage people to find a pharmacist who can do this type of review. And if you're enrolled in Medicare Part D, there is a comprehensive review that is part of that program. I just cannot say universally these are the criteria of who's going to qualify. I encourage people to call their part D plan to find out if they qualify. And then there's senior care pharmacists out across the country who do this on a private basis kind of thing as well. So does that answer anything else you want to touch on with the medication review?

[00:28:20.450] – Allan

Because I think that the situation is the doctor, he gets maybe seven, eight minutes with you, and he's looking at your medicine list, so he knows what you're taking, but he's got to make some decisions, and he's not necessarily going to ask you or tell you how to take this medication. Now, you go to the pharmacy and you get your prescription filled. They may give you information or maybe a booklet or something that you didn't read. It's like, oh, everyone knows how to use an inhaler, or Everyone knows how to use eyedrops.

[00:28:48.330] – Dr. Levy

No sometimes. Right.

[00:28:50.330] – Allan

Right. So it's just those concepts of let's talk about it, let's set up a plan, find the right teammate to come in and help you complete this so that you're in it. And I think you recommended, if you can and it works for you, to try to get this done about once a year, because your medications may change in that time, your lifestyle might change and well, sorry, we're one year older.

[00:29:16.370] – Dr. Levy

Absolutely. It's like the regular tune up. You just want to make sure and with a little luck, maybe some medicines are no longer needed and those can be removed.

[00:29:25.440] – Allan

You save that copay and you can hire a coach.

[00:29:28.710] – Dr. Levy

There you go. I think that lifestyle just yeah, there's so much we can do to be looking at the full picture. Right. So it's not just the medications. That's one piece of this puzzle of how to age healthy and taking care of ourselves is such an important part, and you kind of touch on it. The physician doesn't have a lot of time. Pharmacists are the most accessible healthcare profession. We're there, unfortunately, yes. Pharmacies look very busy these days. But I also will continue to say that pharmacists are trained to communicate and educate about drug therapy. This is what we love to do.

[00:30:03.470] – Allan

They have that little kiosk over that little booth thing. You go over the other window away from everybody. You can have that private conversation

[00:30:09.370] – Dr. Levy

consultations over there. Right. And I'd like to see them use more. We have our healthcare system. We can stand to have some improvements, but pharmacists do have the skill and this interest. So I would always tell people, don't be so intimidated. Ask if the pharmacist has time. For sure when you pick up a prescription and you are asked, do you want to have any questions for the pharmacist? How many people ever say, yes, very

[00:30:30.010] – Allan

We're in a hurry to grab that bag, give them our credit card and walk out. People at this pharmacy there sick people at this pharmacy.

[00:30:36.990] – Dr. Levy

I don't want to stay, but I encourage people say yes. Try saying yes and talk with the pharmacist. You don't know what you don't know is another important theme, I think. But if the pharmacist is busy, then find another time when they can speak with you. He or she can talk to you about your medications to do a more thorough review. Probably they can't do that on the spot. You're going to have to set aside a separate time. And I'm hoping pharmacy will continue to evolve where we do have more time with the patient to do what we call primary care, to go through these medications to help people understand their drug therapy and identify problems. So when I do my work, any potential or actual problems, I find I'm communicating with the patient's physician because that's where the changes can get made. Pharmacists can't prescribe. It's the physicians that do that. And that brings us to maybe the deprescribing considerations. That's okay. So as you said, just stopping something on your own can be very scary. Of course, you hear a lot of people say they did it and everything's okay, and you're like, by the grace of God, if it was fine, things can happen.

[00:31:38.930] – Allan

Yeah, a lot of people jump out of airplanes and don't die.

[00:31:43.070] – Dr. Levy

Right? It depends on what risk you want to take. Right. But your health is additive. So with the deprescribing so this is a fairly new term that has taken hold in the medical world because and I have a love hate relationship with the term initially. I view deprescribing. By definition, deprescribing means reducing or eliminating drug therapy when appropriate. And I've been arguing for 25 years that's what I do. I review the medications, I identify ways to optimize drug therapy. What can we remove? Where is a dose too high? What is still necessary? Is the person taking it correctly? So I try to clean up the medication list for a person with their physician. The deprescribing movement, though, is relevant because we have to name it to be able to talk about it. We do need some research about deprescribing because when it comes down to is it safe to stop a certain medicine and how do we stop it? Can it be stopped cold turkey? Does it need to be tapered in the person with these conditions? Is it okay to stop it? What are the risks of the problem recurring if you stop it?

[00:32:43.990] – Dr. Levy

we don't have all of that science, right? So that's where deprescribing as a science, needs a name and needs that attention. So we do have a lot of research going on in this deprescribing area. When we bring it down to the individual, it means, like I said, as we talked about that medication review, finding what may might look like a medicine that may no longer be needed, then we have to have the conversation looking at all the health information, how stable is the disease or the health condition? What are the patient's preferences? That's a really important piece. What matters most to the individual taking fewer medicines? Or maybe they want to prevent something in the future from happening. And sometimes some of our medicines are prevention. Right. Are you willing to risk possible side effects now to prevent a heart disease or something later on? Or are you more concerned about how you're doing right today? There's some interesting studies that have looked at even, like with sleep, do you need immediate sleep relief that taking care of that symptom right now is most important? Or are you willing to you understand the risks of some of those medicines and you'd rather figure out the harder way to improve your sleep right.

[00:33:51.150] – Dr. Levy

The sleep hygiene and other factors that might help. So there is a lot that goes into deprescribing, and then we come down to, okay, if it is agreed upon that we will stop a medicine. Typically in general, it's safer to slowly lower that dose, but patients need to be educated. So if you're going to slowly reduce the dose, what symptoms might you be looking for in yourself or your mom or dad, whoever's involved? And what do you do should they return? Right. Those symptoms come back. So that part of that educational piece needs to be part of that deprescribing, if you will. I want to make sure I cover it.

[00:34:26.620] – Allan

Yeah, absolutely. No, that's why I think this book is so valuable is this is really a good primer for you if you're dealing with a lot of medications or if you know someone who is, because let's face it, with 10,000 people are turning 65 or older every month, I think you said. And so most of us, we're going to turn 65 and we're going to be in that age group. And so the medications we start taking today don't necessarily have to be the medications we're taking and probably shouldn't necessarily be the dosage and medications we're taking then. So getting ahead of the curve and understanding what we're on now and understanding what it's for and how we feel and is it helping us. I think there's just a lot of opportunities there for us to not nip this in the bud, but be on more solid footing as we age to make sure that we're doing the right things and our team is there supporting us and helping us do the right things too.

[00:35:21.290] – Dr. Levy

Yeah. And I want to say I think this statistic is even 10,000 per day.

[00:35:25.190] – Allan

Are turning per day. Okay. Yeah.

[00:35:26.790] – Dr. Levy

Turning 65. We have millions and millions of these baby boomers. We're all there or almost there are turning 65. So those numbers are upon us, and that puts more strain on the healthcare workforce right. To manage these older adults. And that Geriatric specialty. Unfortunately, there's not enough of us trained in Geriatrics to fully know these nuances about the drug therapy, which makes it even more important that you kind of stay on top of it. And the book, yes, it has a lot of information and it doesn't always have the fix. But the point is to ask the questions, to empower you, to feel confident that I do need to ask questions about the medications and I'm entitled to ask those questions. And these are the questions I can be asking. At least start the conversation right.

[00:36:12.150] – Allan

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

[00:36:22.010] – Dr. Levy

And one thing that's really important that I always focus on is what matters most to the patient. So that happiest and it's a very subjective thing of what of wellness and where you are, where are you on the realm of possibility? So I love the question and the three things I came up with would be one, adherence. So that's another term I bring up in my book. But it's taking the medications as instructed. If you're prescribed a medicine, your doctor has identified a condition that can be treated with this medication, make sure you're taking it correctly. So that means if you have side effects or cost issues or maybe you don't quite believe in the medication, so those health beliefs matter. You need to communicate with your physician about the medication. But if you had medications, take them as instructed. Don't take them here or there when you feel like it. So that's an important piece. The other piece, which is I talk about a lot in that book, is minimum in the book, is minimizing the unnecessary medications, right? So wellness is when you're trying to be your best and feel your best. You don't want the drowsiness or with the risk of a fall or other issues, that's common side effects or stomach issues or whatever it might be.

[00:37:38.360] – Dr. Levy

So minimize unnecessary medicines and take only what's really needed and helpful. The third strategy I think is really important is that self advocacy. Speak up for how you feel day to day concerns you have and when it's going great. I mean, that's something important to share too. This feels right. This medication, I think, is important to me. That's an important piece to share also, but how you feel day to day. I use the analogy of chain. The healthcare is a link chain, if you will, and you are the end of that chain. So you have the physician, the nurses, the pharmacist, but you ultimately are at the end of that chain knowing how you feel every day, how those medicines are affecting you, good or bad. If you notice something different, you need to say something about it. Maybe it's the medications which that title came after many years, a couple years of using another title. I came to that title very last minute. But maybe it's your medications, you need to talk about it

[00:38:34.820] – Allan

thank you. Dr. Levy, if I were to send someone to learn more about you and learn more about the book, Maybe It's Your Medications. Where would you like for me to send them?

[00:38:44.230] – Dr. Levy

My website for the book is maybeitsyourmeds.com, and there you have links to my blog as well as to more information about the book and myself.

[00:38:55.210] – Allan

Cool. You can go to 40plusfitnesspodcast.com/604, and I'll have the links there. Dr. Levy, thank you so much for being a part of 40+ Fitness.

[00:39:06.750] – Dr. Levy

My pleasure. Thank you so much, Allan.

Post Show/Recap

[00:39:09.550] – Allan

Welcome back, Ras.

[00:39:11.190] – Rachel

Allan, oh, my gosh, I loved it. Starting with the title, maybe it's your Medications. I love that title so much. I mean, there are time and a place there is a time and a place where we need something. We need some medications, but sometimes it's like opening Pandora's box. There's a lot that can go sideways whether you intend it to or not.

[00:39:31.740] – Allan

Yeah, it was on Twitter a couple of days ago, and there was a health and fitness influencer. She likes to be called an influencer. I just want to help people. But she's an influencer. And so she went on this little live rant because that's what you do now, is you find something to be just up in arms about, and you rant about it on social media. Well, her rant was that she had been using this birth control pill for years consistently, so she wouldn't have a period because her doctor said that's the way you can do it. So you don't get pregnant. Very low likelihood you get pregnant and you don't have periods. So she's been taking this stuff consistently for years, and then she's ranting because now she's finding out that there is a side effect to this medication that includes cancer.

[00:40:23.750] – Rachel

Oh, my goodness.

[00:40:24.770] – Allan

And so her rant was, well, my doctor never told me. My doctor never told me that there was a side effect of cancer.

[00:40:33.970] – Rachel

Oh, my gosh.

[00:40:34.910] – Allan

And I'm thinking there's a little piece of paper in the box. You fill that prescription if you're going to be taking it consistently and skipping the little sugar pills or whatever they use now for the little pills that are in there that you're supposed to take. I don't know. I haven't had a person that needed birth control in a couple of decades, but it used to be these little foil pack things, and you took one every day, and there was a couple of them that were basically they said sugar pills.

[00:41:00.060] – Allan

Yeah. Okay. I'm thinking now, maybe they'd moved away from the sugar pills, but she was upset with Was because no, she's probably getting three or four of these at one time just to keep her going for a few months. And then she'd go and get it filled again. And there'd be a little piece of paper in that box and that little piece of paper would never get unfolded, it would never get read, and it would never be understood. And so, yeah, every medication you take, even most supplements, have potential side effects. And so if you're taking something, you really need to know the core three things why am I taking this? What's the possible downside and the risks associated, particularly for someone in my condition or my age or whatever? And then three, how do I take it properly?

[00:41:52.510] – Rachel

Oh, my gosh. That's a big one right there. Taking it properly.

[00:41:57.230] – Allan

Well, it seems like a simple thing. but sometimes it's not take with food. So if you're taking four or five or 15 medications and eight of them are with food and three of them are not, and some are in the morning and some are in the evening, you need to math something. You need a box. I don't even Google. Maybe that's something Google would be really good at, is, okay, Google, I want these alarms each day at this time and remind me, I got to take these with food. And maybe AI can do that stuff where you're just sending you a message or text and saying, hey, it's time for you to take your glaucoma medicine, or whatever. But it's just one of those things where you have to understand what you're doing and why you're doing it, because you're the CEO, and if you've taken a medication and you didn't know the side effects, that's a problem. If you're taking a medication and don't know how to take it, and beyond knowing how to take it, the question comes up. Okay, so, yes, you know how to use your inhaler. You have asthma, and you know how to use your inhaler.

[00:43:03.270] – Allan

But can you do it when you're stressed? Can you do it when you're kind of freaking out because you're having an attack, and now you had to go back into the kitchen, you're having difficulties, and you grab it out of the counter and you're trying to take it? And can you do it properly when you're in that stressed situation? And we talked a little bit about this. Yes, you want to work with your doctor. Yes, they're part of your care team, but you've got to do those three core things, right?

[00:43:32.440] – Rachel

Well, it's important. Alan I just started taking thyroid medicine for hypothyroidism, part of my menopause journey, and this is the first time that I've had to take a medicine without having an illness. Like, I've taken antibiotics before, but this is a full time, probably for a very long time medicine that I got to take. And so my doctor gave me some information, but when I got home, I did read that little tiny piece of paper that comes in my pill box, and I actually learned some things that my doctor did not fill me in on. So if anyone's not taking a thyroid medicine, you actually have to take it on an empty stomach FYI you can't just take it willy nilly at any time of the day when you feel like you've just remembered to taking it. And then I've also learned, too, that there are certain foods that will make it less absorbable. So I take it on an empty stomach, you have to wait 30 minutes before you can even eat anything. And then there's some foods that you shouldn't be eating. You shouldn't be taking an iron supplement. At the same time, you should not be having walnuts and some other random food items.

[00:44:36.060] – Rachel

So I did all that research, I did all that little fine print reading to figure out I need this thyroid medicine to work. That's my a goal. So I want to do everything I can to not sabotage that by eating the wrong things at the wrong time. But I can only imagine with blood pressure medicine, heart medicine, diabetes medicine, there's got to be a ton of rules for all these other things.

[00:44:59.740] – Allan

Yeah. And then the other side of it is what happens if there's a change in you. So you're listening to this podcast, and so I'm going to go on the general assumption that you want to improve your lifestyle and live a long, healthy life. So let's say you lose 30 pounds. What does that change? Because some medication doses are based on how big a human you are.

[00:45:25.740] – Rachel

Weight. Yes.

[00:45:26.620] – Allan


[00:45:28.090] – Rachel


[00:45:28.680] – Allan

And so if you lose some weight and now do you need the same medications? And so it's worth going to even if just go to the pharmacist, go to the counter. They've got the little quiet little booth over there. It's kind of private. You can go there and say, hey, I'm just curious. I've done a little bit of reading, but I weigh 30 pounds less than I did when these medications were prescribed. Should I be taking the same amount if I weigh 30 pounds or 60 pounds less? That's a big difference. You tell your doctor, hey, I'm going to go low carb, or basically say, I'm going to cut out sugar. How should I manage my medication when I start reducing the sugar that I'm eating? Because what I don't want to do is have my blood sugar go too low. And now what am I doing? I'm drinking orange juice or soda just to make it all work right. And so it's one of those things you need to know why, you need to know what the risks are, and you need to know how. And that's most of what this book is. But she has a lot of great information in there.

[00:46:36.290] – Allan

How to approach your doctor, how to have these conversations, how to get one of those reviews done,

[00:46:43.740] – Rachel

one point I want to make really quick, Alan, is that we rely on our doctors to tell us all of this information about the medicines we should be taking and how to take them. But I want to remind people that all of the doctors that we go to may not always be on the same page. So, for example, if you're going to a cardiologist and he has you on a blood pressure reducing medicine, and then you go to your general practitioner and she sees that your blood pressure has dropped so low that she puts you on a different blood pressure medicine to get it back up to normal, obviously, it's a contradiction there. So just I want to point out that you need to make sure that all of the doctors that you see are fully aware of all of the medicines that you take so that they're not counteracting what each of them are trying to achieve with helping your health.

[00:47:31.140] – Allan

And that's one thing well, that's one of the things Dr. Levy got into, was she know if your kidney's not functioning very well, and then because your blood pressure, your doctor puts you on a diuretic, I think you can see there might be a problem there. Your doctor knows that you have some kidney issues. At this point, I'm not on any medications at all. I did take aspirin the other day because I had a headache, but the only thing I can remember taking in, I don't know, three or four years was maybe a little bit of aspirin here and there. But if I were on multiple medications, when I went into any doctor, any doctor I walked into, I would have that piece of paper and I would say, okay, here, you can put this in my record. If you need to, but I want them to be able to pull it out when we're having I'm going to get a copy here, maybe, but just here's. List of everything I'm taking. Here's when I'm taking it, here's how much I'm taking. So I want you to have a complete transparency, and then any issues that are going on.

[00:48:33.920] – Allan

I lost 30 pounds. I've gained 30 pounds. My hair is falling out. Other things are going on in my body. And if the doctor tells you, well, that's just getting old, I would probably go find another doctor.

[00:48:46.660] – Rachel

Yes, please.

[00:48:49.530] – Allan

But have conversations. Yes. They'll give you seven to eight minutes, but be ready. If you just sit there and listen to them for eight minutes, you're not going to learn everything that you need to know.

[00:49:01.720] – Rachel

Yeah. Neither are they. You need to tell your doctor what's going on. You need to keep them 100% informed with what's going on so that they can treat you properly.

[00:49:10.740] – Allan


[00:49:11.950] – Rachel

Yeah. Great. I love this book. It could be your medication.

[00:49:16.690] – Allan

Well, it is, and it's definitely the right conversation to know, because your pharmacist and even your pharmacist will take more time, but your doctor just isn't given enough time. I talked about that last week with the urologist, Dr. Boone. They're just not given enough time to really tell you everything they want to tell you or should tell you. And so you have to be an advocate. You have to ask the right questions.

[00:49:39.180] – Rachel


[00:49:39.980] – Allan

This book can be a good start to that.

[00:49:42.060] – Rachel

Super helpful. Yeah.

[00:49:44.110] – Allan

All right, well, I'll talk to you next week.

[00:49:46.730] – Rachel

Great take, Allan.

[00:49:48.050] – Allan

You too. Bye.

[00:49:49.060] – Rachel

Thank you. Bye bye.

Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
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Thank you!

Another episode you may enjoy


August 15, 2023

Unsaid things during your urologist appointment with Dr. Martha Boone

Apple Google Spotify Overcast Youtube

On episode 603 of the 40+ Fitness, we meet Dr. Martha Boone and discuss her book, The Unfettered Urologist: What I Never Had Time to Tell You in a Fifteen Minute Office Visit.


Let's Say Hello

[00:01:25.690] – Allan

Hey, Ras. How are things?

[00:01:27.230] – Rachel

Hey, Allan. Good. How are you today?

[00:01:29.890] – Allan

Doing all right. We had another incident this weekend.

[00:01:35.080] – Rachel

Oh, no.

[00:01:36.270] – Allan

But this is a happy ending.

[00:01:38.580] – Rachel

Okay, good.

[00:01:40.110] – Allan

Well, it's happy because here's the deal.

[00:01:43.190] – Allan

A friend of mine here, another friend. Here had actually listened to our podcast when I talked about losing my friend, Greg to a heart attack. Well, this weekend, he's short of breath, pressure in his chest, not feeling well. The night before, he felt kind of an odd thing in his shoulder. Now he sees these lineup of symptoms.

[00:02:10.170] – Allan

And you get nervous and so blood pressure goes up and a lot of the things going on. Anyway because there's not really an ambulance. There is an ambulance service on the island, but you do better to walk. Even if you're having a heart attack, you'll get there faster. But my wife went by, she has a car, so she picked him up and took him.

[00:02:30.000] – Allan

And I just stayed online with them and just kept him calm and said, okay, here's what you do when you go in to talk to the doctor. Here's what you tell them, and then you don't leave there. Even if they tell you it's nothing. You don't leave there until you get an EKG. They can do anything else they want to you, but you're not leaving there till they do an EKG and tell you it's normal.

[00:02:53.110] – Allan

And he did that, and he actually did have to advocate for himself to get the EKG because the doctor just wants to say, well, this is indigestion, and you've got bronchitis and you're old man, so this is normal and it's not normal.mAnd we're going to talk about that a little bit later. But the whole point being is, it was probably not a heart attack. At this point, we're not sure.

[00:03:14.220] – Allan

The doctor says it's not, but at this point, it's like you have to be an advocate, you have to be demanding. His wife had to go in there because he was sitting in the waiting room and she literally had to go in there and start raising hell to get them to come out there and start taking care of him. So if you find yourself in a waiting room and you were having chest pains, don't sit in that waiting room. You go up there and tell them, I'm a middle aged man or woman. And I'm having chest pains and I'm not going to die in your waiting room while you sit here and do whatever the hell you think is more important.

[00:03:49.610] – Allan

If nothing else, get me an aspirin, get me a nitroglycerin, get me something that you know is going to help someone if they're having a heart attack. But I'm not going to just sit here and not be cared.

[00:04:00.330] – Allan

You know, again, we're not in the United States, but you hear horror stories of emergency rooms in the United States too, so it happens everywhere, I'm sure, but it's just you got to advocate for yourself. And he did.

[00:04:11.040] – Allan

And fortunately, the outcome is not a bad outcome. And he was in the right place he needed to be. If he was having a heart attack because he didn't ignore the symptoms.

[00:04:22.160] – Allan

And it might have been indigestion and it might be bronchitis, it might be a lot of things, but at least at that point they confirmed to him that it was not a heart attack. They did the EKG, they did the blood work. And so he's reasonably confident that he was not having a heart attack, which, again, very good, but it's also convincing him he should probably quit smoking.

[00:04:41.330] – Allan

And I concur. okay.

[00:04:45.320] – Allan

But these are the health conversations we need to be having and we need to be aware and pay attention to ourselves. So again, if you don't know the symptoms for a heart attack, a little different from a woman and a man, but take some time, get yourself familiar with those things because it's not normal to fall apart over time. If we do the right things for our body, our body will be healthy for a long, long time. And so if you notice symptoms, pay attention.

[00:05:11.420] – Rachel

Yeah, for sure.

[00:05:12.420] – Allan

And then the second thing I want to talk about is I've been planning our trip.

[00:05:15.890] – Allan

We're going to take September off from Lula's for sure. We're shutting down Lula's and I'm going to not take any new clients in September. So today is August 15 and so after got two weeks. Now if you want to work with me, this is your time to sign up. I'll be servicing clients. Podcast will keep rolling on through September, but I won't be taking on new clients. So if you decide you want to message me in September, I'll take your details, you can fill out the form.

[00:05:45.600] – Allan

But you're not going to see anything on my calendar to book, so you could email me and send me your details, and I'll say, okay, I'll talk to you October, probably October 2, and that's it.

[00:05:54.790] – Allan

So if you want to work with me, you can go to 40plusfitness.com/discovery. It'll let you there's a calendar right there that actually ties to my calendar.

[00:06:03.980] – Allan

So if you see open dates, that's times that I'll take those calls, but I promise you right now, you will not see one of those dates in September. So, 40plusfitness.com/discovery if you're looking to make a health and fitness change.

[00:06:17.380] – Rachel

Awesome. Sounds great. Glad you get to take this time off, Allan. It'll be really nice for you and Tammy.

[00:06:23.120] – Allan

Yeah. I mean, I'll still service the clients that I have that are remote online because I can. But I'm not taking anymore. It's too much work to onboard a new client, and I don't want to be doing that while I should be on a beach somewhere

[00:06:38.200] – Rachel


[00:06:39.170] – Allan

Yeah. Or doing something fun.

[00:06:41.090] – Rachel


[00:06:42.050] – Allan

Tammy's planning 99% of it, and I'm just going along for the ride.

[00:06:47.400] – Rachel

Nice. That sounds awesome.

[00:06:49.280] – Allan

How are things up there?

[00:06:50.960] – Rachel

Wonderful. I'm having a very relaxing week. I'm in taper mode for a race that's coming up this weekend. So besides talking with you and run club later tonight, I literally have nothing on my calendar, and I'm just taking the time to relax and chill and get ready for the weekend.

[00:07:09.330] – Allan

That's awesome.

[00:07:10.520] – Rachel

It is. Feels good.

[00:07:12.700] – Allan

Well, good luck with your run.

[00:07:14.590] – Rachel

Thank you.

[00:07:15.260] – Allan

I want to hear next or over the next couple of weeks how that went.

[00:07:18.860] – Rachel

Sure, yeah. I'll keep you posted.

[00:07:20.570] – Allan

Let us know. All right.

[00:07:21.980] – Allan

So are you ready to talk to Dr. Boone?

[00:07:24.440] – Rachel



[00:07:58.810] – Allan

Dr. Boone, welcome to 40+ Fitness.

[00:08:01.940] – Dr. Boone

Thank you for having me. I'm excited to be here.

[00:08:04.540] – Allan

Now, your book is called The Unfettered Urologist: What I Never Had Time to Tell You in a Fifteen-Minute Office Visit. And as I went through the book, it's set up really well for you to if you just had an incident or issue and you wanted to flip to that part of the book, you could. But quite frankly, I would encourage anyone that wants this book or wants to learn more about this. Maybe you're having some issues or have had some issues and you just don't have the answers, read the whole book, because there's things in the book that, as I went through it I'm like, okay. And then it was like juxtapose backwards and forwards, and I was like, okay, this is actually kind of interesting because everybody wants simple rules, right?

[00:08:50.320] – Allan

They want, okay, vitamin C is good for you. Well, it can be for a UTI and maybe not so much for a kidney stone.

[00:09:01.170] – Dr. Boone


[00:09:02.410] – Allan

And so it was just kind of that thing of saying, everybody thinks, well I'm just going to have my orange juice every morning, and that could actually be a problem, even though we would personally call it healthy.

[00:09:14.450] – Dr. Boone

Exactly. Everything in moderation.

[00:09:17.660] – Allan

Yeah. And so that was just one of the interesting things as I went through the book, to sit there and say, I didn't know that. And so if I had kidney stones. I wouldn't have thought to avoid citrus. And then I didn't even know there were two different types of kidney stones. And so it's just as I went through the book, I'm like, there's a lot more to this than it sounds like. It seems like simple plumbing till you really start looking at what's down there.

[00:09:38.440] – Dr. Boone

Yeah, we've made a whole field out of good.

[00:09:42.250] – Allan

Actually visited a urologist not long ago because there was a little bit of blood involved. And so I did go see a urologist and my co-host Rachel, who'll be on the know, we talk about this episode in other sections. Her husband had some blood, and he got diagnosed with kidney cancer, and he's had one of his kidneys removed, and he's just 50 years old. And you actually had a girl in the book that was much I mean, she was young young, and she had kidney cancer. So there's a lot in this book to help us stay healthy and know when and how to work with our urologist. So I really appreciate the opportunity to profile this.

[00:10:23.510] – Dr. Boone

Thank you.

[00:10:25.110] – Allan

So let's jump into kidney stones, because I've actually had a little kidney stone before, and I say little because it wasn't nearly what a lot of people go through. And fortunately, technology, I was able to excrete it. So that was the cool part for me. But kidney stones are, I guess, the way you said in the book, they get rated up there as being worse than pregnancy or at least as bad. Can you tell us a bit about kidney stones? What they are, how they form, how we can prevent them? And then if we do find that we have kidney stones, we can't pass what we should consider for treatment.

[00:11:01.820] – Dr. Boone

So when I first was interested in becoming a urologist, we would make foot long incisions on people to get a kidney stone out. The technology has advanced so that we can get most kidney stones out with a quarter inch fiber optic tube. We can use laser energy to break up the stones, and we can take the pieces out with baskets so most people do not have to get cut on their bodies at all. But women who have had both childbirth and had a kidney stone would pick childbirth every day. So it is one of the most painful things that can ever happen to a person. So we want to prevent them as best we can. Now, even though the technology for getting rid of stones and surgically treating them has greatly advanced, the incidence of kidney stones or the number of people who have them in the population has skyrocketed. We're seeing so many more children with kidney stones. We're doing surgeries on children for kidney stones. And most of this is totally preventable because it's based on our bad dietary choices and our lifestyle choices. So the number one thing for preventing kidney stones is to make sure that you're adequately hydrated and adequately hydrated.

[00:12:17.040] – Dr. Boone

For a simple test, all you have to do is look in the toilet. If you're not taking a drug or a supplement that can make your urine dark, then your urine should look like pale lemonade. If it starts to get dark or psychedelic yellow, then you're very far behind with your hydration. So what causes the kidney stone to form? Our body gets rid of toxins in multiple ways. We breathe them out, we defecate, we sweat, and we get rid of liquid toxins through our urine. So anything that our body perceives that it doesn't need will show up in our urine if it's a liquid form. And what we have in that urine are crystals. And if we become dehydrated or we have the right environment, the crystals could stick together, almost like those crystal experiments we saw in middle school, where you would put all these things together and then the crystal farm would grow. That's exactly what happens in the kidney. So we want to make sure that what is presented to the kidney is either dilute enough through good hydration so that the crystals don't stick together, or that the components of the crystals are decreased.

[00:13:19.690] – Dr. Boone

So number one is hydration. Of course, your hydration will vary based on what you're doing. I mean, if you're outside a big athlete like you are, and you're sweating a lot, you're going to need a whole lot more fluid than a 90 pound elderly woman who's sitting at home all day. So you'll have to calculate your fluid intake based on your activity. And for the average person who's not doing anything extraordinary, it's basically your body weight in pounds divided by two. So if you weighed 140 pounds, most people would be hydrated. If you took 140, divided it by two, which gives you the number 70. If you stay somewhere in that range with your total fluid intake on a daily basis, you should be hydrated. The second thing that leads to kidney stones is a high salt diet. And this is ubiquitous in the world right now. If you went and had one fast food diet that would be more sodium than you should have for the entire day. And the problem with sodium is that the kidney level is exchanged for calcium. So anytime that you're eating high sodium, you're leaching calcium out of your bones, which can lead to osteopenia or loss of calcium in the bones, and it is delivered to your kidneys, which can lead to kidney stones.

[00:14:32.370] – Dr. Boone

So managing the sodium in your diet is very important. For the average person, you should have less than 2300 milligrams for 24 hours. Sounds like an awful lot. But if you start reading labels and particularly looking at anything that comes in a box or fast food, you'll quickly see that we are having way too much sodium in our diet.

[00:14:54.590] – Dr. Boone

One of the old wives tales out there is that you should limit calcium in your diet. There are actually types of stones that are more likely to occur if you limit your diet too much in calcium. And we need our calcium for bone health, so please do not be limiting the calcium in your diet. Now, if you were a chronic stone former, somebody who's made more than one stone, that would indicate that you would want to have either your urologist or your nephrologist do a panel of blood tests. It's about 30 blood tests and a 24 hours urine. And what the doctor would do is compare what's in your blood to what's in your urine, and then they could make very specific dietary changes. Sometimes medication is necessary. Sometimes it's something that you're taking. You had mentioned the vitamin C, so vitamin C is healthy for most people, but if you take too much, it's exchanged at the kidney for oxalate, and oxalates form stones. So if you take too much vitamin C, like the typical scenario we would see in the wintertime, people think if they take a whole bunch of vitamin C, it wards off colds or the flu.

[00:16:01.720] – Dr. Boone

And we would see people come in who'd never made a kidney stone before, and they had made one based on taking way too much vitamin C. So if you are making stones regularly, your doctor would check your blood and your urine to figure out exactly what needs to happen. Now, if you've made one or two stones and you just want to try to do what you can best do for yourself, I would encourage you to look at a product called therolif XR. I have no financial relationship with this company. It's a quality company. The company name is Theralogix Theralogix, and this product has some natural compounds in it that are actually stone blockers. And so if someone wanted to start themselves on something that definitely wouldn't harm them and could possibly decrease their stone incidence, then that would be a product to try. The other thing we want to be careful about is going on these really high protein diets. I had never made a kidney stone in my life, and I decided that I was going to lose weight going on a very high protein diet. Well, I had my first experience with kidney stones because high protein can lead to dumping of calcium in the urine, which can lead to kidney stones.

[00:17:12.020] – Dr. Boone

So we want to make sure that we're taking in the right amount of protein for our exercise level and for our age and for our body weight. Those are the prevention things.

[00:17:25.230] – Allan

Good. Because yeah, even though the surgery is a little less invasive now, waiting for that to happen and having them get in there and all that, that's not going to be a joyous moment. So being a kidney maker, I mean, a stone maker is not necessarily a good pastime.

[00:17:45.730] – Dr. Boone

No, not at all. I was very indignant when it happened to me. I was like, how could this happen to me? I'm a urologist. In fact, at first I didn't know what it was. I thought it was ovulating. And then I looked in the toilet and there was all this blood and I was like, oh, that might not be an ovulation.

[00:18:01.290] – Allan

All right, so now, another thing that is fairly common in women, a little less common in men, are urinary tract infections, UTIs. And I know as women get older, the incidence of UTIs tends to go up, right?

[00:18:16.130] – Dr. Boone


[00:18:17.020] – Allan

So let's talk a little bit about that, what that is, and then what we can do to prevent and if we need to treat it.

[00:18:24.290] – Dr. Boone

So as urologists, we all have kind of wacky sense of humors. And I think of urinary tract infections as very good evidence that God must be a man, because the anatomy of the female is a set up for having an infection. You have the rectal area which has the highest content of bacteria in the body, right next to the vagina, which is basically a warm, moist, culture medium which is right next to the urethra, which is connected to the bladder, which is supposed to be sterile. So you have an organ which is sterile in most people, very close to an organ that is the highest content of bacteria. So the real question is why don't all women have urinary tract infections? And we believe that it has to do with local immunity. The person's local immunity is able to fight off the bacteria. Now, again, what could prevent bladder infections? We go back to this being hydrated. It's simple flow dynamics. If the bacteria have tracked from your rectum up into your bladder, if you're drinking an adequate amount of fluid, you can flush them out. So it's kind of mechanical. The second thing is to be sure that your hygiene is good.

[00:19:35.460] – Dr. Boone

So the old thing that your mother teaches girls to wipe from front to back, it's a very valid thing. You don't want to pull the bacteria from the back to the front, so you want to use good hygiene. Another thing that works well is to be sure that you're managing your stress. There's no scientific study that shows this, but we know that stress can make all infectious diseases worse. And the way that it works is that you get stressed, your cortisol levels go up and that kind of suppresses your immune system. So even if you had the native immunity to fight them off during times of stress, you might not be as well able to do that. And we see this all the time and it can be even good stress. We see young ladies who are about to get married or who are about to graduate from college or something fabulous is about to happen to them, but they experience it as a stress will change and they'll get a bladder infection just in time for the wedding or the honeymoon or whatever they have planned to do. So the big problem with urinary tract infections is the overutilization of antibiotics.

[00:20:40.250] – Dr. Boone

When a woman goes to a doctor and has all those hideous symptoms of a bladder infection, the doctor feels motivated to do something right then. So they'll give them a full course of antibiotics. The problem with that is that the bacteria are brilliant and they will do something called become resistant to that bacteria, I mean, to that antibiotic. So they recognize that the antibiotic is present and they can actually change themselves so that that antibiotic no longer works on them. And they tend to become stronger and stronger and stronger each time that they're exposed to an antibiotic. And this is how we produce something that's called a superbug. And a superbug is something that's so strong it cannot be killed by any of the current antibiotics. If we keep going like we're going now, the way we're utilizing antibiotics, we're going to reach a point where we have all these superbugs that we cannot treat and they can cause death. So we'll go from having an aggravation to something that could actually cause mortality. So it behooves all of us, both patients and doctors, to work on this problem from a prevention standpoint. Now, the good news is, when we look at prevention, we have an excellent protocol for preventing them and it involves using a good quality Cranberry supplement.

[00:22:02.330] – Dr. Boone

Now, when we talk about Cranberry, we want to know why would this work? And what Cranberry does is it has something in it called PACs. The scientific word is a pro anthocyanidin. And this is a compound that can keep the bacteria from sticking to the lining of the bladder. So that when we're hydrated and we drink fluid, it will push the bacteria out more likely than it would be for them to grab onto the lining of the bladder and be able to set up a full blown infection. Now, the Cranberry products that have the best budgets for advertising are not necessarily the best product. So over many years of having my patients utilize these things, I learned that the following things work. And again, I don't have any financial relationship with any of these people, and there'll be information on my website. If people want to go and read the actual studies for themselves, they can do that. But pure cranberry juice works beautifully. The problem with that is most ladies would gain about 20 pounds in a year if they drank enough cranberry juice to be able to ward off infections. So the products that I've had the best results with are a product called Theracran, another product called Elura and a third product called Utiva.

[00:23:23.740] – Dr. Boone

And these are all made by small companies that don't have big advertising budgets, but what they have is quality control. So you want to make sure that each pill has the adequate amount of these PACs in it to be able to actually work. And I would have my patients, if they are not having a lot of UTIs, and if they're having three or four year, I just have them take one pill at night so that the product is sitting in their bladder and affecting the bacteria while they are asleep. If they're having more than four infections per year, then I would have them take it morning and night to be sure that they're getting maximum effect from this. And then I would make sure that the patient partners with whomever is managing their UTIs to try to use the lowest amount of antibiotic for each infections that they can possibly use, the fewest number of pills, the shortest course, and try to do everything that they can to not use the stronger antibiotics. Because we know that this is just going to get worse and worse and worse if we don't manage this on the front end.

[00:24:31.990] – Allan

Yeah. When I was reading your book, one of the things that kind of came across my mind when you were talking about the design of a woman, I was actually thinking that maybe there was a purpose to it in that. No, when you have something bad and you have something good so I have good bacteria and I have bad bacteria. And when they're forced to fight the good bacteria, the hormetic effect, they get stronger. And then now the child is born through the vaginal tract, and that becomes a part of their microbiome. So a thought to me was, this might be just a way to make sure that the vagina is properly populated with good bacteria that are strong and resilient so that they could take care of the baby. But that's just a theory.

[00:25:17.570] – Dr. Boone

I think that's a great idea. Found that anywhere in science, but I think it would be something that be worth studying.

[00:25:23.790] – Allan

Well, yeah, maybe, but that was just the whole point of, yeah, we're talking about design. And I would just say, okay, I don't believe there's an accident out there in design. I think there's a specific reason for it. And we might not like the outcome all the time, but there's probably a very good reason for it.

[00:25:43.950] – Dr. Boone

I did want to mention one other thing. So you had mentioned about how the incidence of infections becomes greater as you get older, and I wanted to address that. So when a woman is young and we have a lot of estrogen, the vagina tends to be acidic and the acid environment makes it very healthy for the local microbiome, which you were speaking of. And that makes it less likely that the pathogens can take root in there. As we get older, with less estrogen, naturally we become more alkalotic in our vagina and so the pathogens can have a much bigger party down there. Also, as we get older, our bladders don't empty as well. So clearing everything out with each emptying is not as good as it is when we're younger. So one thing that a lot of women have been able to benefit from is either topical estrogen right to the urethra and the vagina, or being estrogenized through hormone replacement therapy. So we have seen women who are appropriate for that and some women are not. Their doctor will decide, will help them decide whether they're appropriate for it or not. But that has been something that we've really seen to be able to break the cycle also good.

[00:26:48.630] – Allan

Now let's shift gears a little bit, if you will, and let's talk a little bit about erectile dysfunction.

[00:26:56.710] – Allan

It is also something that men tend to notice as they age, but it's not always related to testosterone. Could you tell us a little bit about what it is, how we can prevent it and if we do find ourselves with ED, what we can do to treat it?

[00:27:14.490] – Dr. Boone

As urologist, this is one of my favorite topics because the penis is actually an amazing organ. It has to have good nerve input, it has to have good arterial input and it has to have normal venous outflow to be able to function well. So it's actually a very complicated organ. The thing I'd like for the listeners to really remember is that it is normal for a man to occasionally have problems with erections. And the reason for that is the sympathetic nervous system. The design is such that you don't want to have an erection if you have to go out of the cave and fight the tiger. So the man is hardwired during times of increased sympathetic outflow of the sympathetic nervous system to not be able to have an erection. So the brain doesn't know the difference between it's time to fight the tiger and I had a fight with my boss or I've been on the road traveling for two weeks and I'm exhausted, or my wife and I have been squabbling because I've been on the road traveling for two weeks. So having the occasional difficulty is normal and it's not anything to get too freaked out about.

[00:28:22.450] – Dr. Boone

If you are a young man under 55 and you are having regular problems with erections, this is a wake up sign that you do not want to ignore, because what that implies is that there is something metabolically going on. Sometimes it can be pre-diabetes, sometimes it can be high blood pressure, sometimes it can be elevated cholesterol. But there's a 50% increased incidence of having a heart attack as a young man, if you are having regular erectile dysfunction. So if you are attempting to have intercourse and you can't because your penis won't become fully erect, you need to go to your internal medicine doctor and be worked up for all of these possible causes. And that is so important. I mean, this could actually save your life. So it's not anything to ignore. Now, what are the things that can cause it? Smoking will damage the blood supply to your penis, and interestingly enough, sometimes it never comes back. So if you're a young man out there and you're thinking, I'm going to smoke for a while and then I'll stop later, please don't think that smoking is very toxic to the blood flow. Unhealthy lifestyles, being sedentary, being overweight.

[00:29:38.630] – Dr. Boone

Fat cells are not just sitting there doing nothing. They're very metabolically active. And in the male, they can make estradiol which feminizes the man. And this estradiol can have a feedback mechanism that can decrease your natural testosterone. So decreasing your percentage body fat can be very helpful to improving erections. Alcohol use. Alcohol can very much affect erections, as can drug use. Diabetes, diabetes causes both damage to the nerves and to the blood supply to the penis. High blood pressure, elevated cholesterol damage the blood flow, psychological issues, anxiety issues. During the first ten years that I was urologist, I almost never saw young men with ED. In the last 20 years of practicing, I saw this all the time. People were overworked. They were trying to juggle home life and traveling and just the stresses of modern life. So I saw so many young men with really no metabolic problem who all of a sudden had erectile dysfunction. Then we have all the neurologic diseases, things like Parkinsonism, multiple sclerosis. I encourage men also to look at sleep disorders. If you have sleep apnea, that can cause you to have elevated cortisol, which can also affect your erection.

[00:31:04.510] – Dr. Boone

So if your partner tells you anything like, hey, you're snoring or you seem like you're stopping breathing sometimes at night, you definitely want to see your internal medicine doctor to consider getting a study to make sure you don't have sleep apnea. The relationship between low testosterone and erections is something that the urologic community argues about. The conventional urologic literature will tell us that the hormone testosterone causes desire or libido, but it's not necessarily connected to the actual functional aspects of being able to have intercourse. In my clinical practice, I did not find that to be the case. Over and over and over again, when men had very low testosterone and we would supplement it, they would report that the quality of their erections were much better. So I'm not sure that that case is really closed. But if you look at the literature, they're going to say testosterone does not cause you to have better quality erections. But I don't believe that.

[00:32:05.610] – Allan

I think it's on the social psychomatic side where when you are feeling better and more masculine and everything that testosterone does maybe have more muscle mass, lose some body fat percentage, those things are just going to happen as a side effect, if you will. Maybe not a direct correlation, but definitely I think when your testosterone is higher, you feel more like a man, and I think that's going to help.

[00:32:33.730] – Dr. Boone

Yes, it's very complex. I think it's fascinating. I mean, I loved seeing these patients because it was never just one thing. It was always lack of exercise, too high body fat, stress, not enough sleep, relationship issues. I mean, it's always complicated. And so I loved helping people work through those kinds of issues.

[00:32:53.370] – Allan


[00:32:53.880] – Allan

And I think one of my core takeaways from this conversation in the book was, okay, don't just go in there and ask your urologist for that blue pill and go on. Spend some time actually figuring out why this might be happening, because it could be a sign of a bigger problem for you. And if you just go straight to the blue pill, you might miss something important.

[00:33:15.390] – Dr. Boone

Yes, I think that is an excellent point.

[00:33:21.150] – Allan

Now, I love having doctors on here that are sort of not doctors as much now as they were before. And the concept of your book was, if I could have told you in the 15 minutes everything I needed to tell you, this is it. And you called it a love letter to your patients. If I go to a doctor, I'm the kind of person who wants the best health outcome possible.

[00:33:43.880] – Allan

I'm not worried about what it's going to cost me. I'm not worried about the rest of it. I'm like, okay, I want a good health outcome. And so if I go into a doctor, how do I get the best health outcome? Because it just seems to go against the way the system is designed right now. It's designed almost as a conveyor belt. And the sad part and I'll tell the story, I have a friend that had a heart attack, and so I thought, okay, well, I'm going to go get a calcium score just to see where I stand. And because I don't live in the united States, I don't have a US based GP. And so I go to call a clinic that does the calcium scores. It's $200. It's a simple little X ray thing, takes five minutes. $200. I'm like, okay, I just want one of these.

[00:34:36.070] – Allan

And they're like, well, your doctor has to call it in. I'm like, Why would I have to go to a doctor? I'm 57 years old, and I want to know my calcium score, and it's reasonable. It's not like I'm asking them for a test that doesn't make any sense. And so as I try to manage my health outcomes, working with doctors, it just seems like the system is built to make it very difficult for me to do that.

[00:35:00.770] – Allan

So what's some of the advice that you have for us to approach the medical system the right way?

[00:35:08.690] – Dr. Boone

So, the system is definitely not user friendly. It is not user friendly for the doctors, and it's not user friendly for the patients. So to say that in many ways it's broken, I think is absolutely correct. For your specific scenario that you just mentioned, the two main reasons to not have patients be able to walk in and get whatever test they want. A calcium score is a very high radiation test. So someone who is monitoring your overall health and paying attention to how much total radiation you're getting from various tests should be deciding the benefit versus the risk and presenting that to you and then having you make an informed decision. So I think patients being able to go in and just get any test, I kind of agree that that's not a good idea because you don't know what you don't know. The other thing is, if you go in to get that test, someone needs to be monitoring the follow up that knows what the test means. So if you were to go in there and see a large percentage blockage in your left anterior descending artery, you might need a calf and a stent that day.

[00:36:19.070] – Dr. Boone

You might be on the verge of having a major heart attack. So if a doctor hasn't ordered the test and there's not a doctor assigned to review the results, the radiologist is not really the person who can do that. Radiologists don't manage patients. They look at studies and tell you what's on there and then call the doctor or whatever. So the follow up part for a test needs to be there also. So those are kind of the two main reasons that they would not have the patient be able to get it for themselves. Now, as far as how to work the system, I think managing expectations is really important. What is an MD? An MD is a person with incredible science background. Now, what does science mean? Science means it has been demonstrated in a randomized, double blind placebo control study. What does that mean? It means that we have tried to eliminate bias from the study. So Dr. A, who thinks that his little pet procedure is the best thing in the world, goes around telling everybody, hey, we've got to treat everything this way. In a scientific study, you would have people who did not know

[00:37:32.940] – Dr. Boone

Dr. So and So did not know it was his Pet study, and they were studying it blindly to see if it worked or not. And so we would get information about whether something was really effective or not. And that's pretty much what science is. So when you go to an MD, we are licensed to tell you the things that have been proven by science. And so there may be things going on out there in the alternative community that we don't know anything about, or we may have some sideways information about it, but we don't have the randomized double bond control studies. And so it's not within the purview of our licensing to recommend things that have not been proven scientifically. Now, how would a person figure out how to have their best health? I read your book, The Wellness Roadmap, and I saw so many tools in there that I think would be helpful to a person. So I think recognizing that an MD is there for catastrophic things, the doctor is the one you go to when everything's failed and you've got a big mess and you've got a problem and somebody's got to fix it.

[00:38:39.580] – Dr. Boone

My appendix needs to come out. We're really good at that kind of stuff. We don't in the past have had a lot of training in prevention of diseases. So the average MD, unless they've gone to the trouble to educate themselves, is not going to be the one who's really going to know a lot about nutrition. Many doctors don't know anything about exercise. I mean, some of the Orthopedic guys can tell you a bit about that, but most of us really don't know a whole lot about exercise and how the body responds and exactly what we need. So I think for a person to realize that they could need a lot of people other than the doctor to have their best wellness, they might need a life coach like you, they might need a trainer, they might need a masseuse, they might need an acupuncturist, they might need a chiropractor, they might need a hypnotherapist. I mean, they may need a whole lot of other things. But the main job of the MD is to help guide the patient towards what tests they need to have. Like when is the best time to get a colonoscopy, how often should you have a mammogram, those types of things.

[00:39:43.020] – Dr. Boone

The MDS have the best scientific information about what your blood test actually means. So if you go somewhere and have 50 blood tests done, you're an intelligent person, you've done a lot of reading, so you'll be able to figure out on the surface what it all means. But an MD should be able to look at the details and help give you some ideas about what's coming down the road that you need to watch out for. So I think having the best expectations of what you can get at the doctor and what you can't get at the doctor I think would be very helpful. Then there are people who are opening up concierge practices where they're trying to offer more time to the patient more discussion, someone intelligent like yourself who's done so much reading and interviewed so many people, you would go to the doctor with a different level of information, and you would want to talk on a different level. And so a concierge doctor may be the kind of person who would work better for you because you could have an hour long visit and you could go through all the different things that you've read, and they could give you the pros and cons of why you might want to try this as opposed to that.

[00:40:49.150] – Dr. Boone

But when you're going just to a standard doctor for your routine visit, it's hard to get that in the current environment.

[00:40:55.610] – Allan

Yeah, 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?

[00:41:08.630] – Dr. Boone

So my personal prejudice is that it all starts in your mind. I think what you choose to think creates your personal environment. And I saw that over and over and over again. Two people can get diagnosed with the same cancer. One person sees it as a wake up call. They get rid of a toxic relationship. They change their job, they start to exercise, they change their diet, they start to take supplements. They start to look at all kinds of alternative therapies while they're having surgery and chemo and radiation. Another person will see this as a call to having a gigantic pity party, oh, my God, why did this happen to me? I'm such a good person. And they will become angry and miserable and regretful, and they'll die a terrible death and have a lot of misery until that death comes. And the difference between these two people is what they're choosing to think about the situation that they're in. And I think that speaks to all parts of our health and our wellness. I mean, you and I were talking before we started the podcast about trying to motivate people and trying to help people stay motivated and why one person will get on a program and stay on it and another person won't.

[00:42:31.480] – Dr. Boone

I think a lot of it has to do with what we tell ourselves. I mean, you talk in your book about having a vision. Well, you're a big accomplished athlete. Me, I'm a bit of an egghead. So my vision was to not be a little old lady with a bag full of pills going around to every doctor in town. So my motivation for going out there and exercising when I don't want to do it is to take the fewest number of pills, have the fewest number of doctors visits and test and surgeries and all that as I can possibly have. And to be able to enjoy my life, to get up and down off the floor without having to hold on to something. I have those visions. I mean, I want to be able to go sailing and jump off the boat and swim around and look at the fish. So I think having a vision and using your mind to be able to create a plan for wellness is, to me, the most important thing. Number two is also kind of something that you alluded to in your book, which is trusting your body.

[00:43:32.310] – Dr. Boone

I mean, we're all at different levels. You told a story about getting some CDs or DVDs and exercising, and the next day you couldn't get out of bed. And I think having patience, a person who is not healthy didn't get there overnight, and you're not going to get out of that overnight. I mean, I had a two year plan for my wellness, and I based it on watching so many people come in my office and getting gung ho with both the nutrition and the exercise and everything at one time. And then they just couldn't keep it up. It was just too much. So what I recommended to my patients and what I did for myself was the first thing I did was I tried to cut down on sugar, I tried to cut down portions, and I tried to just simply move more. I mean, in the beginning, I would park my car at the end of the doctor's parking lot, I would take the stairs up to the operating room. So I incrementally changed all these little things. And my endpoint was not weight reduction. It was to feel better, to not be short of breath, and then ultimately to get off some of my pills.

[00:44:38.260] – Dr. Boone

And that has happened, and I'm very grateful. The third thing is meditation. Oh, my Lord, this is so underutilized in our world. I mean, I think we should be teaching kids to do this when they're young. Our mind is like a gerbil in there jumping around. And through meditation, we can learn to calm down and to not trust all those thoughts. And that those thoughts are creating emotions, and those emotions are leading many of us to the refrigerator. And so if we can change those thoughts through calming them down, then we can stop it before we get to the negative emotions of anxiety and agitation that lead us to want to go to the food. And then the last thing I think is just to try to be patient with your body. The body is brilliant. It can heal most things if we just give it sleep and proper nutrition and move around and manage our stress. The body is just brilliant at taking care of itself.

[00:45:43.550] – Allan

Yes. Thank you for that. So, Dr. Boone, if someone wanted to learn more about you and learn more about the book, The Unfettered Urologist, where would you like for me to send them?

[00:45:53.810] – Dr. Boone

So my website is www.marthaboone.com. It has on there both my novels because I'm a fiction writer, too, and it will have the links on there for a lot of the things that we've talked about if people want to educate themselves further.

[00:46:16.730] – Allan

Awesome. Thank you so much and thank you for being a part of 40+ Fitness.

[00:46:21.250] – Dr. Boone

Thank you for having me. I appreciate it.

Post Show/Recap

[00:46:27.630] – Allan

Welcome back, Ras.

[00:46:29.390] – Rachel

Hey, Allan. That was a really great conversation with Dr. Boone. There's a lot to really talk about, but kidney stones, UTIs, erectile dysfunction, these are all really important things or situations that need to get reviewed and managed before things get out of control. And they can happen quite frequently, especially as we age.

[00:46:50.050] – Allan

Yeah, I mean, OOH, what's that?

[00:46:55.890] – Allan

We're talking about parts of the body that people don't really want to spend a lot of time talking about. But the whole point being is if things aren't normal yes, things aren't normal.

[00:47:05.690] – Rachel


[00:47:06.260] – Allan

So don't take a little thing and say, oh, it's just a little blood, or, oh, there's a little itch and it doesn't go away, or, oh, this keeps happening. It's not normal.

[00:47:19.110] – Rachel


[00:47:19.660] – Allan

They're not normal. Healthy responses. Yes. So it might seem like a little thing. You're not a hypochondriac. If there's blood in your urine and you go see a urologist, they're not going to call you a hypochondriac unless you're seeing them five times a month, you know, I recently went to urologist because there was blood where there wasn't supposed to be. What's going on? And I've had kidney stone before, so I kind of knew. But you can't help but Dr. Google search.

[00:47:57.190] – Rachel

Usually not good.

[00:47:58.090] – Allan

There's blood. What are the possible things? And again, some people will poo poo it and say, oh, well, maybe this happened or maybe that happened, and I can excuse it. I can say, oh, well, this is why this is this way. It might not be, and so it might not be what you think it is, so it's at least worth going and nothing else. They'll give you a couple of blood tests or they'll do a little bit of urinalysis or something to at least give you the appropriate treatment.

[00:48:26.710] – Allan

But recognizing that these things are happening, there are lifestyle changes for almost every one of them.

[00:48:35.480] – Rachel

Oh, for sure, yeah. There's a lot of preventative measures we can take to maybe stave off kidney stones and UTIs and anything else. Supplements we could take. Exercise, eating well, staying hydrated. Super important.

[00:48:53.290] – Allan

That sounds so much like the five pillars of health.

[00:48:56.220] – Rachel

As usual. Yeah, as usual.

[00:48:59.110] – Rachel

And even lowering stress. Like Dr. Boone had said, stress can begin the snowball effect for some of these illnesses.

[00:49:09.710] – Allan

You're not going to be able to go into a urologist office and have a 15 minutes conversation with them today. She said 15 minutes, but I don't know. I mean, I was because it's Panama, so it's a little different. But most of the time when you're in there, you're going to see their nurses and keepers, people that are hustling you around, moving you from place to place, and you're going to see the doctor for a few minutes, probably no more than seven or eight. And that's the way the medical system is set up right now.

[00:49:42.890] – Allan

So having your questions in order and having the right conversation when you're having it, and don't think Dr. Google's better than what the doctor has to say. But if there's a misalignment, if there's a misalignment over what you're reading and you know it's coming from a credible source. So credible source, cleveland Clinic sometimes WebMD anything that's coming from probably the government, the CDC or something like that, that's information that that doctor should know. And so their response should be generally in align with what you're you know, you can go to the Heart Association website and ask for the symptoms of heart attack.

[00:50:25.400] – Allan

It's right there on the page. You can print it out, tell the doctors, like, look, I got six of these.

[00:50:30.300] – Rachel

Yeah, check.

[00:50:32.570] – Allan

So something else is going on. Let's talk about it. But what they say should make sense to you because you're the lead advocate. You're the CEO, you're the team captain. And they're the players and the coaches. And so you've got to make this all work with them. So it's about working with them. And don't ignore the little things because little things become big things.

[00:50:53.970] – Rachel

Well, I always like to say, too, Allan, I know it's a terrible statement. A lot of people hate this, but you don't know what you don't know. And I'm not a doctor, so I can do Dr. Google and maybe get some things together. But like I've mentioned to you and our listeners in the past, when my husband had blood in his urine, we were in marathon training at the time, and blood and urine is not unusual. It's a condition called grabdo. And I know there's a longer word for that. I don't know what it is, but it's when your muscles kind of break down some proteins and nutrients and it pees it out, that's fine. That's not a dangerous condition. But there are other things it can't be. It can escalate, like, everything. Yes.

[00:51:39.230] – Rachel

And that would have made sense for us at the time. But what if it was a kidney stone that came out of the blue? And in Mike's case, as I've mentioned, the past ended up being kidney cancer, which is something that we would not have known at the time had we not gone to the doctor, had the pee test done, had some scans done where they could actually see it in his kidney. So something as innocuous as maybe blood and urine, it's not always you just don't know what it could be. And that's why you need to go to the doctor to have it more further evaluated.

[00:52:14.790] – Allan

Yeah. And, yes, there's a cost involved. There's always a cost involved. But the cost of prevention is a lot lower than the cost of what happens when this becomes a chronic problem.

[00:52:31.490] – Rachel


[00:52:32.150] – Allan

And so catching it early will cost less and give you a higher probability of living longer, better.

[00:52:43.060] – Allan

So just recognize that the earlier you have that conversation, the earlier you go get checked out. It's better all the way around, it costs less, and the health outcome is going to be a lot better.

[00:52:57.610] – Rachel

And we talked about earlier, too, not necessarily reaching for a pill. Right? I mean, of course, if you have a UTI, you might need an antibiotic or something to help with the infection, but what was it that caused the infection in the first place? Is it poor hygiene? Were you swimming in a pond or a lake somewhere? Do you have an allergic reaction to maybe the detergents you're using for your undergarments? I mean, there could be just a dozen different reasons, but same thing with erectile dysfunction. That could be a symptom of a larger issue.

[00:53:32.290] – Allan

I would dare say I'm almost going to go out of limb and say most of the time it is, yeah.

[00:53:37.300] – Allan

You'Re ignoring something else in your lifestyle, and as a result, this is the outcome. And if you dealt with the lifestyle problem, because healthy thing, healthy heart, that's all I'm going to tell you right now, is that if that's struggling, your heart is struggling, period. And that's about blood. It's about blood.

[00:54:01.390] – Allan

So if you are pre diabetic or diabetic and you're having this problem, it means your feet are not getting enough blood. Okay? And so you're probably at some point, you're, like, going to lose a foot.

[00:54:11.710] – Allan

So dealing with the lifestyle stuff, if you're diabetic and those types of things, if you're having difficulty with blood flow to your pelvis, you're having difficulty blood flow everywhere else in your body.

[00:54:23.140] – Allan

So just think about that for a minute. It's a symptom. It can be treated with a blue pill or there are other pills now.

[00:54:31.750] – Allan

And they give you the warnings. There's a downside to everything you put in your mouth, food or medicine or supplement. There's always some form of downside, some reaction you could have to it, and not knowing that could be a problem. So if you're having symptoms, it's not normal?

[00:54:49.850] – Rachel


[00:54:51.450] – Allan

No. I can tell you right now that's not what getting old does to you. It's about your healthy or unhealthy lifestyle.

[00:54:59.080] – Rachel

Yeah. There could be a lot more going on than what we can figure out by Dr. Google.

[00:55:04.290] – Allan


[00:55:05.270] – Rachel

It's worth going to the doctor.

[00:55:09.650] – Allan

Little tests, blood tests or something like that. It's worth going just to know.

[00:55:13.330] – Rachel

Oh, absolutely. If you can fix this in the short term, then you won't have long term consequences later. I just feel like some things can be reversed or fixed through lifestyle changes. Save that pill for later. But, yeah, better to go now than wait till later.

[00:55:32.600] – Allan

I agree.

[00:55:33.720] – Rachel


[00:55:34.220] – Allan

All right, well, I'll talk to you next week.

[00:55:36.250] – Rachel

Sounds great, Allan. Take care.

[00:55:38.050] – Allan

You too. Bye.

[00:55:39.060] – Rachel

Thank you. Bye bye.

Music by Dave Gerhart


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

– Anne Lynch– Ken McQuade– Leigh Tanner
– Debbie Ralston– John Dachauer– Tim Alexander
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Thank you!

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