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Scot: All right. Do you have any questions before we start, Neil? Anything that you want to know? Anything that'll help you feel more comfortable?

Neil: No. I mean, just thanks for having me. I didn't contact you guys for that. I just wanted to know how to treat sleep apnea, but it's great to be a part of the show, so thanks. Yeah.

Scot: Well, that's the danger of reaching out to us, is we might have you on the show. No, we really appreciate you being on the show. This is something we'd like to do more of, but it can be really challenging getting listeners to interact. There's not a lot of interaction. We like that because it's about men talking about health, and we like as many perspectives as we can get.

This is "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. I bring the BS. As always, the MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. Good to be here.

Scot: Mitch Sears, as always, in the mix. We always love having his perspective on the show.

Mitch: I'm happy to be here.

Scot: And we are so excited. Our guest of honor this episode, guys. We have an actual listener joining us.

Troy: Yeah, it's exciting.

Scot: His name is Neil. Neil, welcome to the show.

Neil: Hey, thanks for having me. I'm super excited to be here. Big fan.

Scot: We're super excited. Oh, did you hear that? He's a big fan.

Mitch: I know. What the heck?

Troy: Do we have competition for a number one fan now?

Scot: I don't know. I thought we just had one fan.

Neil: I'm it.

Scot: "Who Cares About Men's Health," changing one Neil's life at a time.

We talk about health turning points on this show, that moment when you knew something wasn't right, and as a result, things needed to change. And listener Neil contacted us about a couple of other questions he had, but as he was doing that, he told us a little bit about his health transformation. We were so intrigued by it, we wanted to find out more.

So this is what Neil had told us in an email. He's 50 years old. He's in better than average shape for a 50-year-old. Works out five to six times a week, runs mud races, takes deliberate walks every day, eats healthy, drinks alcohol only occasionally.

Raised his testosterone from 300 to 450, which puts you right in the zone there, man. That's awesome. And that was done by changing his exercise. He said that he ended workouts that thrashed him, like CrossFit, and instead is doing more lifting. And then started eating healthier based off the show as well.

So we wanted to find out about your story. Before, what was it that molded kind of your opinion or your ideas of health, exercise, nutrition, and sleep that caused you to live the life that was the life before, this kind of extreme life it almost sounds like?

Neil: Yeah, I think that's exactly right, Scot. I was doing way too much. I was doing CrossFit in the morning. It would be nothing for me to get up, do CrossFit 5:00 a.m., 6:00 a.m. in the morning, finish that at 2:00, 3:00, go for a four- or five-mile run, and then maybe even do something at night. That happened as well in preparing for different mud races and things of that nature.

And as I age, which is one of the things I learned from you all, I wasn't losing weight, I wasn't gaining muscle. In fact, I was gaining weight and I was gaining it around my belly, which I knew was bad for my heart. So I kind of knew a change needed to occur.

Troy: So it sounds like your change was really kind of the opposite of a lot of changes we hear about. Your change was definitely not ramping up the exercise, but reassessing the exercise you were doing and just saying, "Maybe I'm doing too much or I'm doing the wrong things."

Neil: Exactly. So what I noticed was, and I think I wrote this to you guys, I felt like I was living the bad commercial that I think all men hate. Your testosterone is low, you're gaining belly fat, you're agitated, and you can't concentrate.

Scot: Don't want to be that guy, do you?

Neil: No. None of us want to be that guy. And as I approached 50, I thought to myself, "I've got to do something different. I'm pushing myself so hard." And so I started doing research, and what I realized is that the stress workouts that I was doing were causing what I believe to be a major increase in cortisol.

And so I learned from one of your previous guests that the only way to naturally raise testosterone was to lift weights. And I had stopped lifting weights because I was taught lifting weights makes you gain weight, and I wanted to lose weight. So I had the completely wrong concepts on what I was trying to accomplish.

Scot: Yeah. You wanted to lose body fat. So what was your diet like? Was your diet kind of the same?

Neil: Yeah. My diet was pretty rigid. It was paleo and I ate a lot of meat, which I don't do anymore. I feel so much healthier eating the way I'm eating.

I want to explore the Mediterranean diet that you guys recommend. But I eat really high quality carbs, split grain bread, quinoa, those types of things, vegetables, and I eat small portions of meat. And I feel way healthier than I used to feel eating paleo, which was high meat, high fat, that type of diet.

Troy: And a couple of things you mentioned I'm curious about. You said you weren't doing any weightlifting. Were you doing any resistance training at all, like push-ups, pull-ups, sit-ups?

Neil: I was doing some push-ups, pull-ups, sit-ups, but not enough. Those were add-ons, if that makes sense.

Troy: Okay. But you were doing quite a bit of CrossFit though, you said, so I imagine you were getting some resistance training there.

Neil: Yes, some there. What I learned from CrossFit is you would do the resistance training and then you would go and do the AMRAP or the EMOM or whatever the next part of it was. And for me, I don't know, maybe I pushed too hard, but I would be completely thrashed by the time it was over. And I would feel awful. I'd crash on the ground.

Then what I noticed is I was falling into the trend of overeating afterwards. That's when I started realizing I need to make a change.

Troy: And was there one thing specifically? You mentioned you noticed increased belly fat, increased weight rather than losing weight. Was there one specific moment? Was it your testosterone check that really triggered this reassessment, or was it more of a process as you just noticed things were going the wrong direction?

Neil: I think it was more of a process. And actually, I was talking to my doctor, who's my best friend, but I don't go and see him, and we were just BSing at a bar having a beer and dinner together.

Scot: That's my kind of doctor visit. That's good.

Neil: Right? And I said to him, "Man, I'm doing all these events." And I told him what was going on. And he said, "There's a lot of evidence that that can actually do the reverse."

And so I didn't really follow up with him, but I decided to do some research on my own, and that's when the cortisol discovery came up. And I kept reading, "Take Ashwagandha. It fights cortisol." And then I realized cortisol is caused by stress. And so I thought, "Maybe I should stop stressing my body to this extreme." That was the process that I went through.

Troy: And it sounds like realistically you were doing, at least just from what I heard, two to three hours of pretty high intensity exercise every day.

Neil: Yes.

Mitch: Wow.

Troy: Yeah, that's a lot.

Scot: Yeah. It could be super frustrating too, I bet. You're exercising, you're eating what you think is healthy, and you're putting on body fat. That must have been really super frustrating.

Neil: It was super frustrating.

Troy: Were you monitoring your body fat percent during that time, or was it more just you noticed the increased body fat around your waist and on your belly?

Neil: No, I was not. I don't have percentages, but yes, my pants were getting tight. The usual.

Troy: Yeah, that's incredibly frustrating.

Neil: Yeah.

Scot: So where did you get your ideas about fitness? What brought you to be doing three hours of exercise a day and eating paleo? Where did these ideas come from?

Neil: Yeah, that's a good question. I'm not totally sure. I played sports in high school and in college, and I think it just came from media. I just thought that's what you're supposed to do.

And the American way is . . . which I love America, I don't mean to sound negative, but it's "push harder," right? Everything is "push harder, push harder, push harder." So that's what I did.

And I've taken more of a . . . Well, I've adopted your four pillars of health or whatever, four foundations of health. And I meditate now and just do some things quite a bit different.

Troy: But I think it's not at all uncommon. We always think if we're not getting results, you've got to do more of it. It makes sense, I think, for most of us to say, "Well, if I'm not losing weight exercising two hours a day, I should probably exercise three hours a day."

Mitch: And not just that. I mean, I'm really empathetic and resonating with the story, even though I think I come from a very different background. It's just this idea that whenever I was struggling with either my weight or feeling healthy enough or liking how I looked in the mirror or whatever, the thing that I tried to do was work harder, right? I'm not lifting heavy enough or I'm not doing the right program or whatever.

And I'd find something on Reddit and I'd commit to it for a week or two. I'd choke down 12 giant chicken breasts every couple of days or whatever, and I just felt like garbage. I felt tired. I didn't see any real results.

It's so interesting to hear that someone who was very active and who was doing these other things was kind of experiencing the same thing. If you are pushing yourself far too much, it's not going to get . . . I mean, it's not sustainable. It's not good for your body.

Scot: It's counterproductive.

Mitch: Yeah.

Scot: I'd like to share my experience. I wanted to put on some muscle, so at one point, as more of an adult closer to my age now than my age a while ago, I was lifting really, really heavy and doing heavy squats and that sort of stuff.

And I'm sure I was not doing them in good form. I'm sure I was trying to put too much weight on too fast because I had a bit of an ego going and I had this goal that I wanted to lift more weight, so you just put more weight on, right? You don't think about those things.

And then I'd come home and the next day, not from muscle soreness, but just . . . I don't know. It was just muscle fatigue. I could barely squat down and pick something off the floor. And I'm like, "What good is this kind of exercise routine if I can't live my daily life?"

The other thing that would happen is when I would start exercising, even where I wouldn't consider it pushing myself super far . . . it's almost embarrassing the little amount of weight I would do . . . I would notice I would start getting sick every time I started exercising again.

And I think possibly what I was doing is I was just doing too much for what my body could handle at that moment. You've got this built-in recovery system, and if you stress it too much, not great things start to happen. You start to get sick. You start to experience some of the things that Neil experiences.

Neil was going a lot harder than I was, which I'm a little nervous to say. I mean, that's been my observation. So that's really changed my opinion on what is fitness. It's about getting that dosage to be healthy, to have a healthy heart, to have healthy lungs, to have healthy bones and muscles, and to do the things I want, not to take over my life or make it so I can't do the things that I want. So that was a big reframing for me.

Neil, do you have any thoughts on that? Any additional thoughts?

Neil: Yeah, it's been great for me because I actually have more time to do other things that I want to do, like spend time with my family. So that's been great.

And I'll tell you, I probably will do another mud run because I'm curious to see if I can still go as fast as I used to. I have a feeling I can. In fact, I think I can go even faster because I think I'm a lot healthier, and that's what's exciting to me.

So I get up, I lift, I go for at least a one-mile walk every day, and that's about it. And I lift for about a half hour. Then about every fourth day, I do some type of HIIT workout that's about 20 minutes. And then about the 10th day of my routine, I do a big stressor, but I take the next day off. I feel way better. I'm actually excited to give it another shot at that.

Troy: So you said you're now doing 30 minutes of weights a day, a one-mile walk. How much cardio are you getting? Are you getting a decent amount just with the weightlifting or how's that looking?

Neil: Yeah, the cardio . . . so I get the HIIT. I think I get enough with the walking. My resting heart rate is about 57. So I feel really good about my cardio. My run times have all been . . . I run at 5,000-feet elevation, and my run times have all been sub-9-minute miles, which is good for me. I feel like my cardio is doing great. I mean, if you have another suggestion, Troy, I'd love to hear from you.

Troy: No, I think you just find what works for you. I was curious just how you perceive the cardio and if you feel like it's dropped off too much, because it sounds like before you were doing a lot of cardio. So I'm curious if you feel like you found a good balance there and exactly where things are.

But just the fact that you're getting your heart rate up and you're doing it every day, that sounds like that's what you need and it's working well for you.

Neil: Yeah, I think it is. Thank you.

Mitch: And one of the things that kind of . . . a thought that just kind of entered my head is that's the same approach that a former guest and listener Robb experienced. His approach to fitness and his own health was work out 30 minutes a day, run a couple of times a week, whatever.

But that's not what we hear when we talk about health and fitness, right? We hear, "You've got to push yourself harder. Oh, you've got to do whatever." It's not just a consistent, livable, reasonable kind of approach to your health. That's not what we hear.

Scot: Hey, Neil, it sounded like a lot of your thought of health . . . We do talk about the Core Four, exercise, nutrition, sleep, and emotional health. It sounded like before it kind of really focused around exercise and nutrition more and sleep and emotional health weren't quite at the forefront, and you've kind of brought those to the forefront. Is that accurate?

Neil: Absolutely.

Scot: Yeah. Tell us about that.

Neil: Well, if you remember, Scot, I originally emailed you about sleep apnea. I was diagnosed with moderate sleep apnea. My doctor friend recommended a CPAP. I don't really want to do that, so I'm still working on it. But I do know that I've lost about 16, 18 pounds doing what I'm doing. I have been sleeping way better, and my girlfriend says I do not seem to have the apnea like I did when I was heavier. So that's good.

I meditate every day in the morning, and I do a gratitude/grateful journal every night. And it's funny because I started the grateful journal literally the same week you guys did your show. I was like, "Oh, these guys. I'm their number one fan."

Scot: It didn’t freak you out a little bit, like, "Where's the camera, guys?"

Neil: It did freak me out actually. And actually, some of Mitch's stories freaked me out too because I was like, "Man, yeah, I know what he's talking about there."

Troy: Wow.

Neil: So anyway, that's really helped. I really feel very healthy. I feel better now at 50 than I did at 45 when I was doing all that stuff.

Troy: And it sounds like a lot of . . . The theme of this is just more balance. And it sounds like you're finding a lot more balance. Scot mentioned you were very focused on diet, but it sounds like it was not so much a balanced diet. It was just more of an extreme paleo diet where, again, that theme of balance has come more into your diet approach while also focusing on these other things as well.

Scot: Did the Neil before think the paleo diet was considered eating healthy? And what does the Neil of today think of the paleo diet?

Neil: Yes, to answer your question. Yes, I thought it was healthy and I was . . . When you go to the supermarket, you see all the magazines and everything else, "Eat paleo." So that's what I did.

And yeah, I did think it was healthy. The Neil now says no way. I just feel way too good or way too well to ever eat that way again. I actually like carbs. I have avocado toast every morning and I love it.

Troy: Nice.

Scot: All humans love carbs. That's what has sustained humanity.

Neil: Yeah.

Scot: It's interesting how the media and how popular culture can take things that aren't healthy and make them seem healthy? There was a period of time you believed the paleo diet was a healthy diet. And if somebody is on paleo . . . I might get pushback for this, but I think, Troy, you could speak that that's kind of an extreme diet and probably not the healthiest choice.

Troy: Yeah, it is. I absolutely believe it's an extreme diet. And the big thing I look at are the long-term outcomes. Cardiac outcomes. What's it doing to your cardiac health? What's it doing to your risk of colon cancers and other cancers? If you're eating that much red meat, those risks are all going to increase.

And again, we always come back to the Mediterranean diet. And the big reason I come back to it is because there's great research on it looking at those same outcomes of health in terms of just your . . . You're going to feel better, but just health in terms of your heart health, your cancer risk. All those things have been shown to improve with the Mediterranean diet.

The Mediterranean diet to me is pretty simple. It's just whole grains, nuts, legumes, vegetables, fruits. It's pretty simple, and it's very balanced. Any extreme diet, I think, may show some short-term results. Paleo, obviously, you're not eating carbs.

Scot: Short-term results, and this is interesting, I think, in weight loss. So much of our idea of health revolves around, "What is our weight? What do we physically look like?" We don't even consider "What's this doing inside of me?"

Mitch: "How do you feel?"

Troy: Yeah, exactly. "What is this doing inside of me? What's this doing to my heart health, to future risk 10, 15 years down the road? What's it doing to my cancer risk?" and those kinds of things. So, yeah, we do often focus very much on the short-term. Paleo, I have no doubt people can see some short-term results in terms of weight loss.

Again, Neil, it sounds like that wasn't so much your case. Maybe you did. Maybe initially you did see some results in terms of some weight loss, but I think it eventually catches up with you where your body equilibrates and you're not having that water weight loss that initially you get with all that ketone production from just not taking in carbs.

But yeah, again, long-term outcomes, I think it's that balanced diet. And I think, really, the Mediterranean diet is the one that again and again shows the benefits.

Neil: Yeah, I did have initial weight loss and I thought, "Oh, this is the greatest thing in the world." And that didn't stick.

Troy: Interesting. Yeah. That's my experience in terms of what I've heard from other people and just based on the physiology. Again, Thunder could speak to that a whole lot better than I could. But yeah, it's interesting that was your experience.

Scot: As you started focusing more on your emotional health, how have things in your life changed? How has that aspect of your health changed?

Neil: I definitely have the ability to stay in the moment better. With modern society and phones buzzing every second and computers beeping every other second, the ability to kind of just stay in the moment and concentrate has definitely improved through the meditation. I really enjoy that.

I also feel more at peace. I did share with you guys I'm working on being agitated. My job is somewhat of an agitating job, being a lawyer. But I still feel a little bit better at it. So I'm working on it.

But I do feel definitely more at peace. For me, it's a better connection with my family, because when I'm with them, I'm present, which is nice.

Scot: And then just even from an emotional or mental health standpoint, what would happen at work, Neil, before meditation and gratitude versus now? What might be something that would happen? Did you express anger? Was it frustration? Was it just overwhelm? What was it that's kind of gotten better?

Neil: Frustration. Frustration and allowing things that are out of my control to control me. You guys know this, and I think you guys just were talking about this, but when you meditate, you have the ability to realize what's in and out of your control.

And that's been a big asset, especially in my job, because as lawyers, we constantly or oftentimes have conflict with others. So you can control what you can control. You can't control what the other guy is doing. And so that makes life a lot better, a lot healthier.

Troy: Yeah, I couldn't agree more with you, Neil. I think that's just such a huge, huge thing to be able to meditate on and certainly to approach things with just accepting what we can control and accepting we can control our response, but we cannot control what others do. So, yeah, that's great to hear that's been a big part of this as well.

Neil: I know we're probably going to wrap up here soon. I want to thank you guys because you've really led me down this path. I found you on accident. And the University of Utah, thanks that they keep you guys on. I think it's fantastic what you do.

Men hate talking about this stuff. And when I got asked to do it, I've got to be honest, I was a little nervous. I really appreciate everything you guys have taught me and you guys are super open.

Mitch has shared so many different things, as you, Scot, and Troy have as well, but Mitch I know has led us on quite a path over the last few episodes. And then Troy had his dad episode, and I just listened to it all. I mean, I have two grown kids and I still listened to the episode about being a new dad.

There's always something to learn, and it's entertaining. You're very funny and I get a chuckle out of it, so it's good. Mitch, are you laughing at me?

Mitch: I'm so delighted because this is . . .

Neil: It was like a giggle of delight.

Mitch: Oh my god.

Troy: It was like he's on a merry-go-round.

Mitch: No, it's just that's part of it, is there are times that I think, "I am sharing a lot. I am giving a lot out there." And the hope was that . . . In the same way that just being able to talk to other guys about their health has completely changed my life, if I could just talk about my own health that way, maybe someone out there could hear it and do the same, or have at least even an ounce of the same sort of change I've had.

And so I'm just tickled pink to hear that there's someone else out in the world who is like, "No, we don't have to be super intense, and if guys just start talking to one another, we can help figure this out together."

Scot: You mentioned that you were a little nervous coming on the podcast, right? You listen to the podcast "Who Cares About Men's Health." We talk about guys don't talk about their health. We try to model behavior where you do talk about it because it can make a difference as we're seeing, but yet you were still a little nervous to come on. Where do you think that came from?

Neil: Ego. In a word, just ego. I mean, you can embarrass yourself, right? So I'm sure somebody I know listens and they haven't told me yet and they're going to hear this and they're going to be like, "Dude, I heard you on that show."

Scot: Well, hopefully it goes, "Dude, I heard you on that show and I've struggled with something like that too."

Mitch: Yeah, that's what we need, right?

Neil: Yeah, I hope so. That's why I was willing to do it. If you guys were willing to do it and you need other people to help out, why not?

Scot: So would you have a conversation with any of your men friends, other than this doctor friend that you get your doctor appointments at the bar? I've still got to figure out how to do that, which I think would get guys more interested in health and going and getting their checkups.

Troy: Yeah, sporting events. Let's take this to the arena. I agree.

Scot: Anyway, would you now be more likely to talk to another person in your life, doctor friend aside, about health? Is that something you do, or are you still a little close to the vest? I mean, I'll admit I'm still a little close to the vest.

Neil: I have a core four of friends, let's just say, that I would. And then outside of that, unless I'm asked, I probably wouldn't to be honest.

Scot: Sure. Got it.

Neil: Yeah, I wish I could. It's just not . . .

Troy: Yeah, it's tough. It is. It's tough. I think this podcast definitely gives me more of a forum where I feel like I can be more open about my health. But you're right, I think beyond that. I think it's helped me in a lot of ways to talk to some of my friends about mental health stuff and they've opened up to me, which I think has been really good. But it is. It's still tough stuff that most guys just kind of don't want to talk about, so I get it.

Scot: Wrapping up here, what have you learned from this journey that you have gone on this transformation? What have you learned from this experience?

Neil: If I can steal from Troy, I think balance. I was way out of balance. I was over-fit to the . . . Actually, I didn't even share this with you guys, but to the point where I had an EKG that was kind of wonky and they said, "Oh, you've got a runner's heart." It was really . . .

Scot: Wow.

Neil: Yeah, it was really odd circumstance. Anyway, what I've learned is just balance. My eating is better. I have some discipline as part of my eating. I have some discipline as part of my working out. I have some discipline as part of my meditation and my sleep. But I'm not over-the-top disciplined like I was before, where if I ate a piece of pizza and fell off my paleo diet, I needed to go run 10 miles. So I just I feel great. It's all about balance. That's what I learned.

Scot: And enjoying life, right? A piece of pizza has never derailed somebody's health, right?

Mitch: Right.

Scot: It's when that piece of pizza gets together with 18 of its friends every week. Then you've got a problem.

Neil: Right.

Troy: That's right.

Neil: Yes. Well, I've reintroduced pasta into my life and I love it. I just don't do it a lot. That's all.

Scot: Right? And I would contend that's just as much of a mental health thing as anything else. You've got to enjoy life. Why are we doing all these health things to these extremes at the expense of enjoying our lives?

Neil: Absolutely.

Scot: Well, Neil, thank you so much for coming on the show, sharing your story. I'm just so excited that you are finding success in what you're doing. A little of an unusual story, as Troy pointed out. Most of us are coming at it we need to exercise more maybe as opposed to less. But I think it's fascinating to know that you can take things too far, and when you dial that back, good things happen.

I bet you will run that mud race faster, because I've heard stories of runners that end up hurting themselves or getting sick and they take three or four weeks off, and those first runs back, they do better because they were just over-training.

It comes back to what Mitch says. You think, "If I want to get better, I've got to do more," but you've got to remember that recovery and all that other stuff as well.

Troy: And I've got to say this, Scot. I always say I'm not going to talk about running, but since we're doing this, I've got to say one of the big things that really hit me.

Several years ago, I talked to a runner who had broken the three-hour barrier in marathons, which is kind of a big deal when you can get sub-three hours.

And I said, "Well, how did you do it?" And he said, "Well, I just started running slower. I just didn't run as fast on my long runs. I just slowed down on my long runs and I saw the results."

So he went from kind of the same thing where he was just pushing himself way too hard. He said, "I just slowed down on my long runs and my races got faster."

So it's kind of cool to hear that. And it sounds, again, Neil, like you're kind of seeing the same things, where you've taken a step back from the really high intensity stuff. Again, you may see results as you start to do more mud races. It'd be interesting to see what happens.

Scot: And I think if there's another lesson to take away, it's what we believe, what society might have us believe, what the media, what advertisements might have us believe might not necessarily always be the right way, right? The paleo diet or you've got to push yourself if you want to be super healthy.

That's why, Neil, I love that you did some research and you're looking at science and you're looking, "Well, what does that actually say? What is the truth versus what truth are we kind of being fed about health?" So that's one of the lessons I'm going to take away.

Mitch, do you have a lesson?

Mitch: Just talking about it. Willing to be a little bit vulnerable and saying what you are concerned about with your health or whatever, how much it can help one another, right? Talk to your other guy friends. Just talk about health, please.

Scot: Neil, great story. Thank you for being on the podcast, and thank you for caring about men's health.
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Hey, this is Scot from "Who Cares About Men's Health." The episode you're about to listen to developed into two different themes. It was a very organic conversation, but I think it applies to a lot of men. And I want to be sure that you hang out long enough in case you are the second situation that we talk about today.

So this is about two different guys who are trying to lose some body fat. One has made some poor decisions over the past six months, had some stress in his life, that would be me, and had some questions for nutritionist Thunder Jalili, who we have on the show, and also Dr. Troy Madsen.

And then Mitch, who is producer of the podcast, has a different situation. He's been doing the right things lately, but he is struggling to lose his body fat and he's getting very frustrated and wants to know what he should do.

So we talk about both of those things in this episode. Without further ado, here is this episode of "Who Cares About Men's Health," and I hope you find it useful.

You're listening to "Who Cares About Men's Health," bringing information, inspiration, and a different interpretation of men and men's health. Got a good crew here today. My name is Scot. I bring the BS. The MD to my BS is Dr. Troy Madsen. We've got Mitch, and then we also have nutritionist Thunder Jalili. Thanks for coming together today, guys.

This show is about my fatness. I've gotten to a point . . . I don't know if this has ever happened to you guys, ever. Not Troy. It never happens to Troy. It seems like Troy has always got . . .

Troy: Yeah. Right.

Scot: But I don't know. I was a really good weight and then the last semester of my master's came in January and my exercise, my diet fell apart. I was stress eating Reese's Peanut Butter Cups and just anything hand over fist. I got the minis. I don't know if you've ever done this. I got the minis because I thought it's not as much Reese's Peanut Butter Cup as if I get the full-size one, except for then eat the whole bag of minis, which is more than . . . Yeah.

Troy: So how much weight are we talking here, Scot?

Scot: I'm 15 pounds up since January.

Thunder: Wow. That's impressive.

Troy: That's respectable.

Scot: Well, this is how guys are supposed to talk about it. Not like, "Oh, that's concerning, Scot." It's like, "Whoa."

Thunder: You're all man.

Scot: "Good for you." And this is another weird thing about it too. I knew that my weight was creeping up, but then all of a sudden one day, it just slaps you in the face with how bad it's become. And it could be different things. For me, it was putting on a particular pair of pants that I apparently hadn't worn in a while. I'm like, "What's going on here?" I got stuff hanging out.

Troy, do you have something like that that's . . . Have you had an experience like that where all of a sudden you're like, "Wow, this has gotten out of control"?

Troy: Yeah, I have. I've talked about it before. I had a stretch where I did put on a decent amount of weight. From where I am now, it was about 15 pounds more. And it was that kind of thing too, where the pants started feeling tighter. And you just start to realize . . . I was convinced that it was muscle weight, but then it became very clear that it was not muscle weight.

Scot: No, it's not muscle weight.

Thunder: Focused around your thick, muscular core.

Troy: Exactly. That's right.

Scot: That's spilling out like a muffin.

Troy: Yeah, exactly.

Scot: For me, I noticed it was coming on, but all of a sudden, one day, it almost, and I hate to say this, snuck up on me. It didn't, but it did. Can anybody relate to that? Mitch? Thunder?

Thunder: Yeah, absolutely. I went through something like that a few years ago too. Not quite 15 pounds, but I probably put about 5 pounds on and I'm not a big person. I'm somewhat lean, so five pounds was very apparent. And it did sneak up on me. It's the same experience, shorts and pants fitting tighter. And I did the eye test in the mirror and I thought, "Yep, it's not muscle."

Scot: What's the eye test in the mirror? Looking at yourself?

Thunder: When my stomach is starting to come over my belt in different places.

Scot: Yeah. So I just got back from a road trip too, and that was another kind of indicator. I put on this pair of jeans to go on this road trip, and they were just tight and things were hanging over and I was uncomfortable just standing. I'm like, "You know what? I'm punishing myself. These are my punishment pants. You're going to wear this on this 600-mile drive today."

Mitch: Oh, no.

Thunder: Wow.

Scot: "And you're going to live with it. You put yourself here. You're going to live with it." So I drove 1,200 miles total with my punishment pants on.

Troy: Wow. You should have just worn a corset or something. Just go all in. Just pull everything in and just hurt.

Scot: Yeah. Anyway, I'm putting together a plan to get rid of this and I thought, "You know what? I've learned a lot over the couple years we've done this podcast." This has happened to me before. I've yo-yoed in my weight before. It's kind of an ongoing thing.

Thunder: Hey, can I ask a question, Scot?

Scot: Yeah, absolutely. Ask as many as you want. It probably could make it more entertaining.

Thunder: So you mentioned your weight has yo-yoed in the past. Is the 15 pounds within the realm of previous yo-yoing, or is it new territory?

Scot: I am not the heaviest I've ever been. I'm still 10 pounds shy of that.

Thunder: Okay.

Scot: There was one point where I was . . . I'm 6'1". I was 190. I'm a skinny fat guy, so people don't notice it, but I have a disproportionate amount of body fat. And I worked really hard to get that down, and I was down to 165, and it snuck up again on me.

For the most part, if I put on some weight or lose some weight, it's a little less of a swing, but I'm constantly exercising and then not exercising, paying attention to what I'm eating and then not paying attention to what I'm eating. This has been a recurring thing in my life.

Thunder: Well, I would say right off the bat that you're not alone. This is something everybody deals with from time to time. So I don't think there's any stigma against it. It's just that it happens and then you deal with it. So I think you're doing the right thing.

Mitch: Scot, I am so glad that you're bringing this up because I am in a very similar boat and . . .

Scot: Hopefully we're not in that boat together because it ain't floating long.

Mitch: Oh my god.

Troy: It's taking on water.

Mitch: I know. Yeah, I am at this moment in time heavier than I've been in maybe four years, and it's not great. It's not great. And I think it's interesting that everyone assumed it was putting on muscle. I just assumed my dryer wasn't working or overheating my clothes.

Thunder: Defective washing machine.

Mitch: Yeah. Go make sure that the heat settings were correct and that's not . . . Anyway. But it's interesting because the struggle I had was very similar where I've been having a lot of fatigue issues and been going to the doctor's for the last year, working on all this stuff. And we got it under control. But during the rough times, both mentally, physically, etc., I've been putting on the pounds. I eat pretty healthy, but I need to get it off. So I'm excited to hear what your plan is.

Scot: Yeah. Well, I haven't eaten healthy, so that's going to be part of the plan.

Thunder: That's Step 1.

Scot: Yeah. I've maintained some of my healthy habits. My breakfast that I eat has a ton of vegetables. I still eat fruits. My problem, I think, truly was beer, sweets, Reese's Peanut Butter Cups, and everything else. I think I was using it to get myself through that difficult time of doing my master's project. Exercise completely fell by the wayside. So that's where I'm at.

Now, the first thing, Thunder, is during this podcast and just some of the readings that I've done, eating is really the key to this, right? Exercise can play a component, but really, losing 15 pounds of fat, it's diet. Am I correct on that? That's where my focus should be?

Thunder: I'm going to say just partially correct, because exercise is still very important. One of the things you want to do . . . Most people, to lose weight, if they're just looking at the food side of things, are going to try some way of cutting calories. And that's great, but if you cut calories without really exercising, you run the risk of losing some lean body mass. So to avoid that, it's good to exercise and focus on the diet side at the same time.

Scot: Okay. And when you say exercise, you mean some sort of resistance or strength training?

Thunder: I would say all of the above. Obviously, whatever you can do in the context of your work and life balance and all that, and what you enjoy, but all the above. Walking, running, strength training, mixing and matching.

Scot: All right. So this is a mix of what I've learned on the podcast and what I've seen out in the real world. I should come up with a better term than that. I should say on the internet, right?

Thunder: Yeah. That's the real world.

Scot: Instagram, Facebook. That's as far from the real world as it gets. So I've seen this. I've seen that you cannot gain muscle mass when you're in a caloric deficit. My first step to losing some of this body mass is to go into a caloric deficit, right? Below my base metabolic rate. Would you agree with that or not?

Thunder: Well, I would say below what you've been eating, because I would think you're probably eating more calories than you've needed for the last five, six months. And that's one reason why you have some of the weight gain. So first let's target what are your caloric needs and eat to that. And then adding the exercise just to make sure you're preserving lean body mass.

And then there's probably a third component I would add to that. I remember you were a proponent of time-restricted feeding to a certain degree, right?

Scot: Yeah.

Thunder: Have you been doing that the last five, six months, or did that go out the window as well?

Scot: That went out the window. Yep, absolutely.

Thunder: Okay. So I would say bring that back as well. I think with the combination of the three you're going to see some pretty rapid changes, because your body knows what it's like to be leaner as well.

Scot: Okay. So there's a memory thing going on there?

Thunder: Yeah. And you're used to it. Psychologically you're used to it. We're not asking you to do something that's brand new. You know what it is to eat healthy. You've done it before. Psychologically you're comfortable with it. You're comfortable with exercise and you're comfortable with time-restricted feeding. Those are all things you've done in the past. So I think that makes your job easier. It's maybe a little harder if someone has not done any of those things and we're asking them to totally turn their lifestyle upside down.

Troy: And the good thing, Scot, it seems like you've got some pretty easy targets here. Like you said, you've identified you've been eating more sweets than you should. And the time-restricted eating has gone out the window. So yeah, I agree. I don't think you'd want to go below your caloric needs, but it seems like you could definitely cut some calories down to those needs.

Scot: Sure. So let me clarify. I had a BOD POD done one time, which is that thing that they put you in and they check your body fat. And one of the numbers you get back with that is your base metabolic rate. So mine is about 1,700 calories a day, according to that.

My interpretation of what to do with that information is that is the amount of calories my body burns if I did absolutely nothing. That's just to survive if I sat in a chair for 24 hours a day. If I start adding some activity in, then that calorie level goes up.

It was always my impression that to lose weight, what you want to do is you want to have a little bit less than that base metabolic rate. You want to consume fewer calories than that. Thunder, is that true or not? Or really, truly for what I've done, it's just eliminate what I've been doing that's got me here?

Thunder: Yeah. I wouldn't go below your basal metabolic rate or your resting metabolic rate recommendation of calories. I would first focus on reducing the beer intake and the Reese's Peanut Butter Cup intake and things like that that are easy targets. That's low-hanging fruit.

Scot: All right. And why would you not want to go below a base metabolic rate? Is there some reason for that?

Thunder: Yeah, there is. There's actually a good metabolic reason for that. If you cut your calories too much, your body can also defend against that calorie loss and it can reduce your metabolic rate even further, which would make it more difficult to lose weight. So, to avoid that, you don't want to cut your calories too much. You just want to cut out the offending things.

And if you cut out the offending things, you are going to be reducing your calorie intake. It's just not going to go to a level that's low enough that we would worry about it interfering with resetting your BMR, your basal metabolic rate.

Scot: And as a nutritionist, would you also not recommend taking that base metabolic rate, figuring out . . . Because also, on that BOD POD, it tells you, "If you're moderately active, this is probably how many calories you're burning." And that number might go up from my 1,700 to 2,000 or 2,100 calories a day.

Thunder: Right. It all depends on your activity level.

Scot: Would you recommend trying to find that level and eating just below it or . . .

Thunder: That's a good place to start, but again, I guess what I would just focus on if I were you is I wouldn't go out of my way to cut out calories. I'd just cut out the things that I know are bad. Again, doing that in itself may cut 1,000 calories a week out of your diet.

Let's say you have five beers a week. That's like 1,000 calories right there. Let's say you have a bag of Reese's Peanut Butter Cups a week. A week. I'm not saying in a day, right? I'm giving you credit.

Scot: Yeah, you are. A day would probably be closer to accurate, but . . .

Thunder: Do you know what I mean? If you do the math, maybe that's another 2,000 calories. So if in a week's time you're reducing your caloric intake by 2,000 or 3,000 calories because you're not eating the bad stuff, that's calorie reduction.

And then you add to that the time-restricted feeding part of it . . . Maybe let's try to get all the calories in, in a 10-hour period or 11-hour period, and then start off on an exercise program. Give that a couple of weeks, give it two or three weeks, and see how things work out, because that may already get the weight loss going and you don't have to make any additional sacrifices. And I know you won't be messing with your metabolic rate either.

What I think is worse is to say, "Slam on the dietary breaks. I'm eating 1,200 calories a day, and I'm going to hit the gym," and blah, blah, blah. It's like, "Well, how hard do you think you can hit the gym if you're in a semi-starvation state?" And what's that going to do to your metabolic rate?

Scot: Is that a common mistake that people make, what we just outlined there, what I was heading towards?

Thunder: Yeah. I think that crash, aggressive-type, rapid diet is a common mistake. People do it either on their own by just deciding to cut calories like crazy, or maybe they get sucked into some sort of diet plan from a book they read or a website they came across or something that advocates restriction of what you can eat and how much you can eat and things like that. So yeah, that's been for decades or centuries, people have been doing that.

Troy: Yeah. And it seems too, Scot, like Thunder said, if it's so difficult . . . I can't imagine just trying to drop down calories, just a low caloric intake like that. And again, you could maybe do it short-term and then see some dramatic results, but certainly, it's not sustainable. Again, we've talked a lot about sustainability and it seems like it would just make sense just to say, "Hey, this is what I can do. I feel good doing this. I can keep doing it." And I'm sure you'll see results.

Scot: Yeah. I think part of the danger, too, could be if you go a little too drastic, that might only last a couple of weeks. It might be just like, "I can't do this anymore." So you don't get that consistency, which is so important that we've talked about on the show, whether that's what you eat or your exercise. That consistency is super important.

I have another question. So this is a thing I see on Instagram a lot, Thunder, and it comes back to this notion that you cannot lose body fat and gain muscle mass at the same time. And it says that, however, that is possible if you up your protein intake during a caloric deficit.

I think we've already decided I'm not going into a caloric deficit, but I'm curious about that logic. What I read was if you up your protein intake to 0.8 grams per pound, then you can eat less calories than you're burning and you would not lose and you could actually gain muscle mass. Have you ever heard that before?

Thunder: Yeah, I have heard that. There is some truth to it because to gain muscle mass involves resistance training or exercise. And if you're going to do resistance training, you do need a higher protein intake. That's known. So there is an element of truth to that.

So most of the time for people who do resistance training, depending on the intensity and the frequency and all that, we'll recommend maybe they increase their protein intake by 50% or something.

The other part of it, though, is it's hard to reduce your calorie intake that much and still gain muscle mass because you do need energy, you need calories to fuel the muscle, to fuel the process of muscle protein synthesis. So there's definitely a balance of all that. You need insulin to stimulate muscle protein synthesis.

So I would say, going back to your situation, attacking that healthy diet by definition would also make sure that you're getting enough protein. And if you want to increase it a little bit, that's totally fine. That's going to address making sure you're getting quality protein, but at the same time, you're cutting out the crap, the sugar, and stuff, but you're still getting enough calories to allow your body to build muscle in response to that resistance exercise. So cutting too much would probably get in the way of that.

Scot: So we've talked in the past what the average person needs for protein. Refresh my memory what that was.

Thunder: Yeah. So, in terms of kilograms . . . and 1 kilogram is 2.2 pounds, so you can figure out the math . . . 0.8 grams of protein for a kilogram of body weight is the general recommendation for an average adult who has an average activity level, a lower activity level.

And if you add exercise into the mix, then that recommendation progressively increases. So, for example, for resistance training, maybe 1.2 grams of protein per kilogram of body weight is a good goal.

So there's no specific hard and fast rule, but it would be looking at your own personal exercise situation and then picking a target accordingly.

Scot: For me, the downside, though, is trying to get in that amount of protein. It requires you to eat a lot of food that's just like, "How many chicken breasts can I eat?"

Mitch: Ugh.

Scot: And then as a result, if you're eating more protein, you can't eat as many fruits and vegetables or carbohydrates as easily. So that there is a downside for me. I don't necessarily always think about optimizing, but I'd like to optimize that because it's hard consuming large amounts of protein.

Troy: Scot, I've struggled with this as well. Obviously, being a vegetarian, I don't get meat sources of protein, but it seems . . . Thunder, you can help us out here too. There are a lot of other sources you can get. For me, I do eat a protein bar every day and I do have a protein drink, so I'm getting some protein there. But I eat eggs and there's a decent amount of protein there.

I'm taking you up, Thunder, on the smoothie thing. I am a convert to the smoothie now, man. And using the non-fat Greek yogurt in that, that's a great source. So that's where I'm getting my protein now, and I find that provides a decent amount of variety. Yeah, it seems to work.

Thunder: Troy, you hit on so many good suggestions for Scot. Yeah, you can eat chicken breast Scot. Actually, chicken breast has a lot of protein. It has, depending on the size of your chicken breasts, maybe 40 to 55 grams of protein. So that's a lot. If you weigh 80 kilos and you're shooting for 1.5 grams of protein per kilo of body weight, you're looking at 120 grams of protein a day. You may get 50 out of that 120 grams from just a chicken breast, right? So it's not always as much as you think.

And then Troy had so many great suggestions of other ways to incorporate it. And I would, again, harp on the smoothie. You can put a scoop of your favorite protein powder and some Greek yogurt in a smoothie, and that would probably give you 30 grams of protein right there.

Scot: So I hear it's 0.8 per pound, right? That's what I hear on the internet. Not per kilogram. And that's a huge difference because 0.8 per pound is 144 grams of protein, and that is hard to achieve.

Thunder: Yeah, that's hard to achieve. But the 1.2, which is about 100 grams of protein, that's really not that tough.

Scot: Yeah. When you do the kilograms, it makes all the difference in the world. Now I can consider doing a vegetarian diet. I don't have to eat chicken breast all the time. That's an achievable number.

Thunder: Yeah. And also, if you can spread out your protein intake across your meals, that's also beneficial. So that's something to keep in mind. If we're going to shoot for . . . if 25 grams of protein is the amount we're going for in each meal, that would mean if you're looking to gain muscle mass and you want to do that through exercise, you want to have four meals in a day with 25 grams in each meal.

Now, for your purposes, if you're trying to lose weight and you're not maybe necessarily looking for maximal muscle building, you just want to preserve what you have, then maybe you don't have to worry about it as much.

So I would say in the context of time-restricted feeding, shoot for 10 hours of eating, shoot for three meals, try to get around 30 or so grams of protein in each meal, and incorporate your exercise routine.

And I'm assuming, saying that, your exercise routine is not going to be hammering in the gym for three hours a day six days a week lifting weights.

Scot: I think that's another mistake people can make too. And I'm not making that mistake because I don't want to work out three hours a day.

Plus, also, we go in the gym and we're like, "Oh, I've got to lose this weight, so I've got to really pound the weights." And then that's not sustainable because it's not fun for me. I've tried to lift the heavy weight and then I feel terrible and I actually start getting weaker, and I just decided that's not what I'm after anymore. I'm just after doing this to stay healthy, right? I'm not after it to look like Arnold anymore.

Troy: Well, we've got to hear from Mitch. Mitch, you said you're in the same boat. Is any of this hitting home? Is this just stuff relevant to Scot? Scot, I know you love numbers. I know you love counting calories. I'm curious, Mitch.

Mitch: As someone who has consistently struggled with their weight his entire life . . . I was a little chunkier when I was younger. I thinned out when I got tall and then got fat again when I was in a relationship where breakfast in bed was going to Dunkin' Donuts, Starbucks, and a Beto's burrito. Who knew that you could go to multiple fast food chains if you wanted the perfect breakfast?

Troy: That sounds awesome.

Mitch: I know it sounds awesome. But no, it was a bad habit. I'm glad I'm out of that relationship.

But when I hear that kind of stuff, it's weird to me because I have been doing a lot of big changes to my diet. I have counted calories in the past. I do meal prep. I do everything I possibly can and I still can't lose the weight.

The question I wanted to ask earlier, Thunder, was when you said as someone who has been there before, you're telling Scot one piece of advice. For someone like me, who's never really . . . I have been trying to get down to 180 my entire life, right? And it's still a struggle. If someone is doing okay with most of everything, but still not losing weight, what do you tell to them?

Thunder: Well, I would try to look at the bigger picture for one thing, because the main reason why health professionals like Troy and others would say, "You have to control your body weight. Don't get too fat," the main reason is to prevent chronic disease.

Now, from a societal psychological standpoint, we have other reasons we like to be skinny. We think it looks good and it's attractive and all that. But the main biological reason is avoiding chronic disease.

Now, having said that, there is a weight range that's associated with reduced risk of chronic disease. And you can actually find this in different height and weight tables and charts and things like that.

So it's a long-winded way of getting back to your question and saying if your body weight falls within that realm of reduced risk of chronic disease, I would say that the main box is checked. You're in a lower risk category for diabetes and other obesity-related diseases.

What you're really looking for is more that societal acceptance of body weight, and that's tougher, but it's not medically harmful. Do you understand where I'm going with that, Mitch?

Mitch: Yes. But I guess that's the thing. Let me do the math real quick.

Thunder: And you probably don't want to hear that, but . . .

Mitch: I hear all of that, Thunder, but that's my question. I get all of these tests done. I really interact with my health more than I ever have in my entire life. I'm getting my cholesterol checked. I'm getting everything checked, but . . . But, but, but. My current BMI is 30.3.

Thunder: Okay. So you're in the range where it's a health thing potentially.

Mitch: Yes. And that is what is very . . .

Troy: Are you sure you calculated that correctly, Mitch?

Mitch: Sure did. I triple-checked it.

Troy: What's your height?

Mitch: 6'1".

Troy: And your weight is 180?

Mitch: 230.

Troy: 230. Okay.

Thunder: That sounds about right.

Scot: Troy just committed the number one sin. He tried to guess somebody's weight. "Your weight is 180?" "230."

Troy: I heard 180, but you're trying to get down to 180. I'm sorry.

Mitch: I'm trying to get down to 180.

Troy: Yeah.

Scot: "How old is she? Sixty-eight? Forty-two."

Troy: You just don't guess. Yeah.

Mitch: So I guess that's the thing. All the tests are saying that my cholesterol levels and everything are just fine, but every single doctor visit I go to, the little system automatically lets the doctor know to remind me, "You should probably lose some weight."

But I'm eating, I haven't been exercising as much as I did in the past, but I am getting back into it. Am I really unhealthy or am I just fat?

Thunder: So right now, you're a fairly young man. As you get older, the weight will be more of an issue when it comes to those numbers. You're talking about cholesterol, sugar, and so forth. So, yeah, I guess it is best to get ahead of it and try to lose the weight now.

Some things I would point you towards we also talked about with Scot. Have you tried the time-restricted feeding approach? That would be one thing.

Mitch: Okay.

Thunder: And if you haven't tried that, I would try that. And then I guess I would also look at . . . it'd be nice to do a dietary analysis on you to see exactly what your average intake is. How many calories are you eating? What is your nutrient status? How many grams of carbs and so forth are you eating? That would be the place to start.

Mitch: I'll just send you my last four weeks of calorie counting that I've been doing. And we can explore as to why I'm still putting weight on.

Troy: So you've been keeping a journal, a calorie journal on what you've been eating?

Mitch: For months.

Troy: For months? Wow.

Thunder: Well, what I would actually say, Mitch, have you ever done a dietary analysis, like using software to analyze your diet?

Mitch: No, I haven't. Just the calorie counting and the macro factoring.

Thunder: So since you're already into keeping a log of what you eat in calories, doing an analysis is actually pretty simple. What you do is you just keep a journal of all the food and beverages you consume, and you have to make sure you get your portions correct. And then, say, keep a four-day dietary record or something or a five-day dietary record.

Then use diet analysis software. You enter in all those foods and the amounts, and it'll spit out your average daily calorie intake, the amount of all the different nutrients you're eating, the grams of fat, grams of carb, grams of protein, grams of added sugar, etc. Very detailed analysis.

We do these in some of the classes I teach, but I think there's also online diet analysis software as well that you could access.

So I would say that would be a great starting point. Let's really see what your intake is instead of just guessing that it's good or that it's bad.

Mitch: Sure.

Troy: Do you have an idea of your sugar intake per day, added sugars?

Mitch: It's super-duper low.

Troy: It's super low? Wow.

Mitch: I make all my foods these days.

Troy: Wow.

Mitch: Yeah, I know. I don't know. It's one of the things that I have trouble with when I see things online and sometimes when we have these types of discussions and stuff. It's like I guess I'm obese. I don't think I look obese. Is BMI real or whatever? And then it's like I'm . . .

Maybe the analysis is what I need to do, but I've weighed my food to make sure my portions are right. I've switched to different lower versions of one thing or another. I'm trying and I don't seem to be making much progress.

Thunder: Mitch, have you ever done a body composition test?

Mitch: No. I keep putting off getting in one of those BOD PODs.

Thunder: I think you need to do that as well. The BMI is a reflection of body weight for your height, for your stature. It doesn't really discriminate if that extra body weight is muscle or fat.

And it goes back to what we were joking about. "You mean it's not muscle?" But joking aside, there are some people that just naturally are more muscular for their stature. So why don't we do a body composition to see where you're at with that as part of the overall assessment?

Mitch: Okay. I can do that. I think it would be important to know. I think I need to . . . Something is not working.

Scot: And you sound super frustrated.

Mitch: Well, yeah, and I feel like I'm now taking over the episode. It's, "Scot is feeling fat," and then it's like, "No."

Scot: Yeah, you did. It was supposed to be about me today, but Mitch made it about himself.

Mitch: No, I didn't mean to.

Troy: Well, Scot, yours sounds like you've got some low-hanging fruit. You've got some easy stuff. Hearing Mitch's story, I'm frustrated too. I'm just like, "Wow. What do you do?"

Scot: I know. Yeah, exactly.

Troy: But the dietary analysis, something with a dietician, like Thunder said, the BOD POD, those all sound like great ways to go next. And I think we probably have people listening who are in both boats, who are like, "Yeah, I'm eating too much sugar. I could cut that." And then people maybe who are in your situation, Mitch, where it's just like, "Hey, I'm doing it. I'm doing time-restricted eating. I'm not taking in extra sugars," and they're still just not losing the weight. So it's nice to know where to go from there.

Scot: And is there a troubleshooting kind of . . . It's not called troubleshooting, I don't think, but is there a process, Thunder, that you would then go through for somebody who's in a situation like Mitch? The next step does sound like to do a nutrition analysis and get a BOD POD. With that information, where would you go from there?

Thunder: Yeah, there's definitely a process. A good dietician could take you through that. At the University of Utah, we have Peak Health and Fitness that also does fitness testing and BOD POD, and they can recommend you do a dietician. They help people get this sort of data so a plan can be crafted to let them meet their goals.

So, yeah, there's a process, but you find out what's your nutrient intake, what's your requirements, what's your basal metabolic rate, what's your body composition, and then you go from there.

Scot: I have one last question for you, Thunder. And this is for people like me that have an idea of how many carbs they might be consuming or fat. Is there a percentage of my calories that you would recommend be carbs? Or just eat the number of grams of protein I need and then fill in the rest with good fats and carbohydrates? What should that breakdown look like?

Thunder: I'm just going to give you some super general carbohydrate windows, and there are a lot of customizations that can be built into it depending on your exercise and your preferences and all that.

If half of your calories come from carbs, that's plenty. The others you can fill in from fats and proteins. If less than half come from carbs, 40%, 45% is totally fine also.

And I will add . . . I wanted to give one other thought just to keep in mind, for you, especially, Scot, because you're in a situation where you've had this gradual weight gain and now you're all ready to lose it.

Scot: Oh, yeah.

Thunder: Gaining weight took a while, right? It didn't happen in three or four weeks. It took five, six months, right?

Scot: I'm not falling for your Jedi mind trick. I know where this is going.

Thunder: Yes. I'm saying patience, young Jedi. You're not going to lose all the weight you want in three weeks, right?

Scot: All right.

Thunder: It was fun to gain weight. You took your time with it. Everyone had a great time. Now you've got to be patient with the weight loss. It may take a couple or three months.

Scot: All right. I'll be patient. Do you have any final questions, Mitch? Any final thoughts, reflections?

Mitch: Maybe, just maybe the general approach and advice is not working for me, and I need to go talk to someone who knows stuff and get tested and figure it out. I need to get over the idea that I can just fix it myself, and maybe I need a little bit of help.

Scot: All right. Well, we'll follow up, Mitch, you and I.

Mitch: Yeah. We can do this.

Scot: It sounds like we have two different situations.

Mitch: Sure.

Scot: In a few weeks, I'll report back and let you know how things went. I'm going to take the balanced approach that Thunder suggested. I'm not going to go into some sort of caloric deficit, which I think is the natural reaction any time people want to lose weight. I'm going to admit that it takes some time.

I'm also being kind that I ate a lot of Reese's, as you like to say, Thunder. I think that's cute that you call them Reese's instead of Reese's. I ate a lot of those, and sometimes coming off sugar can be really hard, right? So the first couple weeks, eat generally healthy and if I have a couple of those, that's fine. Some people might not work that way. They might have to just cut it out completely. But I'll take that balanced approach. I'll try to exercise every day and we'll see where I end up.

Thunder: Yeah. And if you have any extra beer in the house you want to get rid of, just send it to me.

Scot: Okay. Well. Thank you so much for listening, and Thunder especially, you're just such a big-hearted guy to help me out like that. Thanks for caring about men's health.

Thunder: Great talking to you guys. Thanks for talking about men's health too.

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Scot: Oh, it's the big 100th episode. And everybody has been asking, "Guys, what are you going to do?" Mitch and Troy keep nagging me. They're like, "Come on, Scot. What are we going to do? We've got to do something special for the 100th episode."

Troy: That's a pretty good impersonation of me right there.

Mitch: I don't know about nagging.

Scot: And we have something special today. So this is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation of men and men's health. He brings the MD to the podcast, Dr. Troy Madsen.

Troy: Scot, I can't believe it's 100. And I can't believe we're actually still talking to each other after 100 episodes.

Scot: The BS, that is my job. I bring the BS to the show. My name is Scot Singpiel. Mitch, he brings the mics. Welcome to the show, Mitch.

Mitch: I bring the mics. A hundred episodes and I finally get a little intro. I love it.

Scot: Yep. And our guest today is Dr. John Pohl. He's a gastroenterologist. Welcome to "Who Cares About Men's Health."

Dr. Pohl: It's great to be here.

Scot: All right. So before we get to the main show, I have a question for you, Dr. Pohl. Can I call you John?

Dr. Pohl: Please do.

Scot: All right. I have a question for you, John. How do you know if somebody runs marathons?

Dr. Pohl: They talk about it.

Scot: Yeah, that's right.

Troy: I was going to say there is no way of not knowing because everyone has a way of slipping it into a conversation in some way or another, like, "The weather is great out today. This is the exact weather I had when I ran the San Francisco Marathon. I felt just like this."

Scot: Yep. They'll tell you, all right.

Troy: They'll tell you.

Scot:Don't worry about that. Yeah. One of the things we're going to celebrate on our 100th episode is the fact that Troy had a personal best time in his most recent marathon. And I just find this amazing. He broke the three-hour mark. Congratulations, Troy.

Mitch:Nice.

Troy: Thank you. Thanks, Scot. Thanks. Yeah, it was a great race. I loved it. It was a cool experience. I did not go into it expecting to do that, but I figured it was kind of a fast course. It was a downhill course. I didn't really think I was going to do it until I had a mile left. And then I thought, "Wow, I'm going to do this." And coming around that corner, it was a cool feeling, like, "Wow, I broke three hours."

It's kind of one of those things you think about as a marathoner. I was thinking about Boston. I had the chance to do that. And then to do this, yeah, it was a cool experience.

Scot: So you beat your previous personal best by like 10 minutes?

Troy: Yeah. Ten minutes.

Scot: That's also just insane. Congratulations.

Mitch:Wow.

Troy: Thanks, Scot.

Scot: How many miles an hour are you running on average to do that? John, do you have any idea how fast you have to go to break three hours in a marathon? Twenty-four miles? Twenty-six miles? Twenty-six miles.

Dr. Pohl: You were going like 4.5 miles per hour, right?

Troy: Yeah.

Scot: Were you doing 4.5 miles an hour?

Troy: Well, it's a 6:48 mile. I know that. I don't know exactly the miles per hour. So it'd be a little more than 4.5. Yeah, it'd be more like probably eight and . . .

Scot: For 26 miles.

Troy: Yeah. Because you figure it's just under 3, so 8 times 3 is 24.

Dr. Pohl: Oh, that's right. It's 26 miles.

Troy: Yeah. So it'd be like . . .

Dr. Pohl:That's like 8.5. Yeah.

Troy: Yeah. So maybe 8.5 or so. A little over 8.5.

Scot: Hey, Mitch. When was the last time you ran 8.5 miles an hour ever?

Mitch: Never in my life whole.

Scot: For any period of time.

Mitch: Zero. Zero time.

Scot: Zero time. All right. So let's get to the show. For our 100th episode, guys, I've kept it a little bit of a secret. You wanted something big, you wanted something special, and I thought for a long, long time about, "What is the most appropriate way for us to celebrate our 100th episode of this podcast 'Who Cares About Men's Health'?" Having Dr. Pohl on, who's a gastroenterologist, to talk about poop.

Mitch: For real?

Scot: The 100th episode of "Who Cares About Men's Health," we are giving you the poop on poop.

Mitch:Oh my god.

Troy: That's right. That's what we do.

Scot: Do you think that's appropriate, Troy? Mitch does not think it's appropriate. He's very disappointed.

Troy: Mitch does not think it's appropriate.

Mitch: I don't know why. Of all the health things to talk about, of all the true crime things that I read and listen to and whatever, there's something about poop that I just can't get over.

I'm excited. A hundred episodes. Let's do this.

Scot: All right. The first thing I want to know is can our poop tell us something about our health? And what would we be looking at? To me, I think it would come down to three things, right? Well, two things: how it looks and how it smells. Are there other considerations?

Troy: Maybe how firm it is, the consistency.

Scot: All right.

Dr. Pohl: Yeah. I think that things you would think about would be how hard or soft it is, how frequent you're having it. And then, of course, you're asking about smell, and that can be a little difficult because when people tell me their poop really stinks, I'm sometimes stuck because I kind of go back to the baseline belief that all poop stinks. So maybe I'm missing something. But there are some situations where it does stink.

No, but seriously, you're exactly right. I mean, your fecal matter is loaded with just billions of bacteria, and there is a huge correlation between that and health. A lot of it we've only realized probably in the past 20 years, that there's such a correlation. And not just with intestinal health, but overall body health, which is really fascinating.

Troy: I will tell you, John, as you're talking about this, I've had more than once . . . Number one, people come in and show me pictures of their poop.

Dr. Pohl: I promise you I've outdone you.

Troy: This one is even better. I had a patient come to the ER, who came on a bus, and had multiple mason jars filled with his poop samples suspended in water. Was carrying this in a bag. I can just imagine these things rattling around on the bus and then had them all displayed in the room for me to look at, because there was something to it and I had to see it. I don't know if you've outdone that one, though. You probably have.

Dr. Pohl: Yeah. I mean, I've had people bring in several pounds' worth of diapers for me to look through.

Scot: Wow.

Mitch:No.

Scot: Well, I mean, if you think there's an issue, what else do you do?

Troy: Yeah, a doctor has got to see it. Has got to see it firsthand. I usually tell people, "Just describe it. I think that's adequate." But some people kind of take it to the next level.

Scot: Is that true, Dr. Pohl? I mean, if I went to a gastroenterologist because I thought I had an issue . . .

Dr. Pohl: You don't need to bring me your poop, Scot.

Scot: Okay. Just describing it would be enough?

Dr. Pohl: Yes, that's fine.

Scot: All right. So our poop can tell us something about our health. Let's talk about what it looks like first. I've heard a lot of times if you take a look in the bowl, that could tell you generally how you're doing.

Dr. Pohl: So you want me to tell you what poop looks like?

Scot: I want to know if . . .

Dr. Pohl: Because we can start really basic here.

Scot: Yeah. Actually, hold on.

Dr. Pohl: Guys, you just may need to help me here. It sounds like Scot is having an issue.

Troy: Yeah, Scot. Let's hear what's going on.

Scot: All right. Mitch and Troy, I'm going to send you an email. Okay?

Troy: I know what you're going to send me, by the way, but . . .

Scot: Oh, what am I going to send you?

Troy: It's going to be the . . . I'm blanking on the name of the scale, but it's the scale that shows the various types of consistency of poop.

Scot: And what's that scale called, Dr. Pohl?

Dr. Pohl: It's the Bristol Stool Chart.

Troy: That's right. Bristol.

Scot: And it's from England, right?

Dr. Pohl: Yes. And as a friend of mine once said, "What was going on in Bristol to make them come up with this chart?"

In actuality, there's the funny side of this and the serious side of this. The serious side is it's very helpful telling if someone's having diarrhea. So it's 1 through 7 and it's been kind of used clinically to . . . I mean, it has things like constipation and stuff, but to really help people determine if someone really is having diarrhea, that's what it's been clinically modified for. I think it does a pretty good job of 1, 2, 3, 4, 5, 6, and 7.

Scot: Yeah. So number 1 is severe constipation, which looks like deer droppings. And then 2 is mild constipation described as lumpy and sausage-like.

Dr. Pohl: Kind of like Oktoberfest.

Scot: Number 3 is normal. So there are two types of normals. I guess I didn't know this. A sausage shape with cracks in the surface, that's normal, and so is a smooth soft sausage or snake.

Dr. Pohl: It's like M&Ms or peanut M&Ms.

Scot: Number 5 is lacking fiber. That's soft blobs with clear-cut edges. So unlike the deer poop, it . . . How does that differ actually? I don't understand what they mean by clear-cut edges.

Dr. Pohl: That's the one thing that I always find somewhat humorous about this stool chart. It has a very, to my opinion, English description of the poop. And I'm not exactly sure. I would assume that soft blobs is all you need to do, but obviously soft blobs with clear-cut edges. I'm not exactly sure what that means.

Scot: All right. And then mild diarrhea is mushy consistency with ragged edges. And then severe diarrhea is liquid, no solid pieces at all.

Dr. Pohl: Right. And again, I don't know what ragged edges . . . I mean, that's terrifying. But yes, we'd use that.

Troy: So it sounds like, though, you don't want the ragged edges, the fluffy pieces, and you don't want the watery.

Dr. Pohl: Right.

Troy: And you don't want the severe hard lumps or the sausage shape, but lumpy. Kind of that middle ground is where you want to be.

Dr. Pohl: That's exactly right. So if you're wanting to have a normal bowel movement, just from a simple medical perspective, you really want a 3 or a 4. And so my rule is you should be pooping once a day. And if you're having too much constipation, we can talk about that in terms of safe laxative therapy. And if you're having diarrhea, make sure it's not an infection or something more serious.

And then in the adult world, obviously, you want to pay attention. If you aren't having issues with colon cancer, which you can see with persistent rectal bleeding. Sometimes it can be a very pencil and small-shaped stool as you're trying to go through a cancer area. Sometimes if people are having a hard time and they're pooping Type 1s, often it's constipation, but if it's soft and it looks like little, tiny, hard lumps, you should worry about rectal cancer as an example.

So we should take it . . . I mean, we joke about poop, and as a gastroenterologist probably my entire life is joking about it, but you do want to pay attention to what you're seeing.

Mitch: I guess when we're talking about the consistency, is this on a day-to-day? How consistent, how frequently should we see things that, say, jump between the chart?

Dr. Pohl: You should have a notepad and a calendar every day.

Scot: And you always have your phone on you so you can always take a picture.

Mitch: I'll take a bunch of pictures for you guys.

Dr. Pohl: Yeah, honestly, my rule is a normal bowel movement is a soft, not diarrhea-type stool once or twice a day. When people ask me how often, you should try to shoot for once a day. Some people really don't. But yeah, you want to do that.

And then just kind of pay attention. The biggest issue that we would have in this country, just because of dietary issues, is problems with constipation, which may affect as many as one in every eight Americans. And that's actually the biggest thing that we often see and probably you see in the emergency room setting. Number one reason I see kids in my clinic. So these are things to keep in mind.

And then did you know . . . I think a sloth, by the way, poops every eight weeks.

Mitch: What?

Troy:Wow, every eight weeks?

Scot:Wow. Imagine the kind of money you'd save on toilet paper.

Troy: Seriously.

Scot: That would be amazing.

Dr. Pohl: Yeah. It's actually the animal model that's often used for constipation because they just poop so rarely.

Scot: Wow. All right. So as far as shape goes and consistency, I'm looking at this chart. It looks like it's either something is causing some constipation, which I'd want to eat more fiber at that point. I mean, is that what's causing that? Or are there illnesses that would cause that constipation?

Dr. Pohl: Well, the vast majority of the time, it's just constipation, which is an issue with both the movement of your colon from the top of your colon to your bottom and just also how much water and fiber you have in your stool. So that's the most common reason. When you live in a dry climate, that's something you have to kind of pay attention to. So in states like Utah, that's a problem.

And of course, fiber does help quite a bit in that setting. We are Americans. Americans are not the best about fiber, and sometimes just working on things like taking a very safe over-the-counter stool softener is very effective in most settings.

Troy: And do you recommend fiber supplements as well?

Dr. Pohl: I think fiber supplements are never a problem, but there are very, very safe over-the-counter stool softeners. I typically don't use stimulants. I try to use more like what they call stool softeners or osmotic laxatives. Osmotic means it just brings water in from your body into the colon to make it softer. Things like Milk of Magnesia, MiraLAX, there are lots of different things that are out there. Very, very safe. And those tend to be extremely effective.

Scot: So if I'm dealing with constipation, more water, perhaps more fiber in the diet. I would imagine people that are on the Atkins diet probably experience constipation, people that might . . .

Dr. Pohl: They do have a lot of problems. Yeah. That's exactly right.

Scot: Or fast food. If you eat a lot of fast food, you're not getting a lot of fiber a lot of times.

Dr. Pohl: Right. Oh, absolutely. Diet is a big part of it. And then also exercise really helps quite a bit as well. And I'm not talking that you have to be a marathon runner. Troy, as you probably know, people who are long-distance runners can have some problems with diarrhea, which we can talk about.

Troy: I know all too well.

Dr. Pohl: Yeah. But just getting some good walking exercise in. I'm not talking about weight lifting, that doesn't really do it, but cardio really can help regulate your bowel movements.

Scot: All right. And then on the other end of the scale, the other end normal, we've got the looser, which is soft blobs or mushy consistency or diarrhea. Are those generally reasons to be concerned, or are there dietary things that could impact that just temporarily, and if you stop eating those things, everything is good again?

Dr. Pohl: Yeah. I mean, as a pediatric gastroenterologist, I worry quite a bit more about diarrhea because I want to make sure I'm not missing a malabsorption syndrome or an infection or something inflammatory like Crohn's disease.

Now, honestly, the most common things I see is what you would see in the setting of irritable bowel syndrome. So irritable bowel syndrome, let's say you get anxious about something and your stomach hurts. Very common. Some people get constipation with their abdominal pain and irritable bowel syndrome. We call that constipation-type. But some people get diarrhea-type and they get anxious and their stomach hurts and they have some diarrhea.

If you know there's nothing else going on, you can offer over-the-counter medicines that decrease diarrhea, such as Imodium type products.

But you do need to pay attention. So the times I get very worried if it's diarrhea associated with weight loss, diarrhea with blood in it, especially what we call nocturnal stooling. If you have to get up in the middle night and poop and have diarrhea, that's extremely concerning for something else going on.

Food products can do it. What I see quite a bit in children is if they drink a lot of juice or eat a lot of fruit, they get what's called nonspecific diarrhea of childhood, or it's also called toddler's diarrhea. And they basically just have too much carbs and they just have a very foul-smelling stool that actually is fairly acidic and can cause a diaper rash. So that's really not something we see as much in adults, although you can see that sometimes with people who drink too much alcohol as an example.

Scot: I was going to say sometimes after maybe having a few more beers than I should, like the next day, I might notice things are a little softer than normal. That is being caused by the alcohol? Or sometimes if I eat too much junk food.

Dr. Pohl: Oh, absolutely.

Scot: Like the week leading up to Halloween when you got the junk food in the house because you're going to give it to the trick-or-treaters, and then you end up eating it all before Halloween and have to go to the grocery store and buy more.

Dr. Pohl: Yeah. The thing that I'll see is teenagers who eat a large amount of chips with a large simple carb load, they'll do the same thing. Are you familiar with the things called Takis? Are you familiar with Takis at all?

Troy: Like taquitos?

Mitch: No. They're gas station food.

Troy: I was going to say Mitch is familiar with taquitos.

Mitch: I do know taquitos.

Dr. Pohl: So they're a type of chip and they have a lot of spicy stuff in them. They have one called Fuego, which I think is fire, and one called blue heat. And besides getting all the carbohydrates, all the chemical stuff in there to make it burn, you can get the diarrhea and then you can get, how should I put it, a secondary after taste, if you know what I mean. So your bottom hurts.

Troy: It's coming out.

Dr. Pohl: Yeah. So sometimes I'll have teenagers and they get diarrhea and their bottom is hurting, and they're eating like 8 or 10 bags of Takis a day. Just stay away from Takis. So these are things that . . .

Scot: Yeah, sure.

Dr. Pohl: You guys may see this in the emergency room as well, but this is something that I deal with.

Troy: Yeah. Probably, like you said, you see a lot of constipation. I see a lot of people with constipation as well. And it's funny because people say, "Wow, what's the most common thing you see in the ER?" thinking it's trauma or heart attacks. No, it's abdominal pain. And a large number of patients with abdominal pain are just really constipated.

And speaking of constipation, people listening may think, "Well, I'm not having a bowel movement every day, but maybe it's every third day or something." At what point do you get concerned about constipation? At what point does it really become dangerous? If someone comes in and says, "I haven't had a bowel movement in a week," is that concerning?

Dr. Pohl: Well, that is concerning.

Scot: Divide that up into the two different questions that Dr. Madsen asked, actually. What if it's every two or three days? Is that something that somebody should worry about?

Dr. Pohl: My rule, again, is I tell people, "You really should be having a bowel movement once a day." A soft bowel movement once a day. If you're going every three days, I'm going to assume you probably have significant problems with constipation. It's probably general, just primary constipation, nothing else causing it. So at that point, you should consider being on a stool softener.

Now, if you're on a stool softener and nothing is getting better, you should see your physician about that just to make sure there's nothing else going on. In the adult world, you'd worry about things like colon cancers as you get older and things like that.

Troy: Yeah. But it sounds like if you're going, like you said, every third day or so, not great, maybe not an issue or a sign of something worse, but once you get beyond that, if someone is just having bowel movements once a week, then it sounds like that would . . .

Dr. Pohl: That needs to be checked out.

Troy: . . . raise your concern a bit. Yeah, that's a bigger deal. Honestly, I just feel like there's this epidemic of constipation in our country and it's this thing we just don't talk about.

Scot: The untalked about epidemic of constipation.

Troy: I see it so often. Like I said, the most common thing I see is abdominal pain. Quite often, the abdominal pain is caused by just chronic constipation. And people have been to multiple ERs. But it's one of those things if you really get in, "How often are you having bowel movement?" in some cases, they're telling me, "Yeah, it's not often." I've had people tell me, "I haven't had a bowel movement in two weeks."

Mitch: Oh my god.

Troy: That doesn't seem healthy.

Dr. Pohl: Exactly. It's not healthy. Now, I do wonder sometimes when I hear that is . . . Sometimes I wonder if people really haven't had a bowel movement in two weeks, because that would make me feel incredibly sick, or they may be having something and not realizing it.

Troy:Exactly. That's what I wonder too.

Dr. Pohl: But I think you're right. It's a huge part of emergency room settings. It's a huge part of primary care settings.

One thing that we had been worried about for a long time was unnecessary hospital admissions. And it was really interesting, again, basing somewhat on the PDF that we made and the video that we made, we got together with the hospital service and the pediatric ER service about when these kids come in, how to keep them out of the hospital. We found that there were just unnecessary treatments going on where you can just simply give someone a prescription for a safe laxative, talk to them about scheduled toilet sitting times, and when you should be worried about it.

And we looked at it as a quality improvement study and we got it published in a British medical journal. It was actually really interesting. Just doing some simple interventions, we kept these kiddos out of the hospital, which I think correlates very well with adults. Sometimes do we actually really need to admit these patients? There's some stuff we can do at home.

Troy: That's great to hear. Do you ever just recommend straight up essentially what would come down to a bowel cleanse, like a colonoscopy prep essentially, where they're just taking all sorts of MiraLAX in and just clean everything out?

Dr. Pohl: Yes. If they definitely are very constipated, I recommend . . . What we've done with this PDF that we've made is that it has a recipe based on age. And so all of our GI doctors at Primary Children's, we all say the same thing, so you're not hearing different things from different doctors.

If they're very backed up, I'll recommend following that recipe on that worksheet for one day a week for two weeks, or one time, and then start up on a daily regimen such as Lactulose 15 milliliters a day, or MiraLAX one capful a day. I usually write that down for the families.

We try to avoid enemas for a multitude of reasons. One thing that we don't ever recommend are what I call milk and molasses enemas because they are associated with death, both in adults and children.

Scot: Well, that's an unfortunate side effect of the treatment.

Mitch:That's what I was going to say.

Dr. Pohl: Right. So if someone came in simply for constipation and you're doing milk and molasses . . . And people may be asking what that is. Basically, you take some milk and you take some molasses and you kind of warm it up until it gets into a solution, let it cool obviously, put it in an enema bag, and squirt it up into the anus and the rectum.

But the problem is you're doing nothing more than feeding the bacteria that are in there. It produces a large amount of gas, and it can lead to perforation and death. So we are very anti-enema unless we absolutely need to do it. And when we do it, we do normal saline. That's the only enemas we use.

Troy: Do you ever do soap suds enemas or just normal saline?

Dr. Pohl: Nope. Just normal saline. It works very well.

Troy: That's good to know.

Dr. Pohl: Very safe. And you do it like you would do an IV bolus for someone. So in children, 10 or 20 cc's per kilo. I use it like a bolus for a child, and it works very effectively.

Scot: We've talked about how our poop appears could indicate if there's a health issue or when to be concerned or not. What about the smell? Now, you had mentioned that all poop smells. Don't think your poop doesn't stink, as the old saying goes, because it does. Some is just stinkier than others.

For example, when I go into the bathroom at the Health Library sometimes, I smell a smell that is just . . . I'm wondering what's wrong with these people. Is there something wrong with these people, or what's causing it when it gets that smelly?

Dr. Pohl: These are all med students, Scot. You're talking about all these students who have irritable bowel syndrome. I'm going to tell you right now that's . . .

Mitch: They're eating Takis like crazy.

Dr. Pohl: Eating horrible food, free food that they get for showing up for some journal club or lecture, and then combine that with irritable . . . Anyway, that's my thought.

Scot: I mean, the other place that you might smell really bad poop is in the gym bathroom. Sometimes that is just terrible. Are there health concerns if your poop is smelling bad, or is it more a result of just the kinds of things you're eating like Troy is saying?

Dr. Pohl: It's really concerning to me that you have been going to bathrooms and sniffing around, Scot.

Scot: Well, you can't help it. That's how bad it is. It's not like I'm going in there like a dog and . . .

Dr. Pohl: I'm sorry you can't help it. I'm just joking. For example, people who are lactose intolerant or have lactase deficiency because they can't break down the sugar in milk, they will have very foul-smelling stool. Food that has a lot of sulfur in it, like Brussels sprouts, sometimes will do that. And then, again, just the biggest issue that I have seen with people is eating a large amount of carbohydrates in their diet. It's just fermented very quickly. It's just very foul smelling, typically diarrhea.

Scot: Okay. So your junk food and that sort of thing, or anything with lots of sugar in it?

Dr. Pohl: Right. It's like they say: Eat less, exercise more. I mean, if you're eating healthy, this should not be an issue.

Scot: Okay. Protein powders, is that why I'm smelling things in the gym?

Dr. Pohl: Probably. Yeah.

Scot: Do protein powders make it stinky?

Dr. Pohl: Yeah, from the amines. Yeah, probably.

Scot: Okay. All right. And then alcohol too, right?

Dr. Pohl: Right. And there are several issues there. A lot of people probably do have experience with having too much alcohol and then they can get diarrhea afterwards.

Of course, you have to be really careful of that because, first of all, you don't want to drink too much alcohol because of the risk of alcoholism. But if you're doing excessive alcohol, especially in the setting of getting liver disease, the alcohol will basically kill a lot of your good bacteria in your gut and cause the bad bacteria then to overgrow and you can have a release of some of the toxins of those bad bacteria, which will get into the bloodstream and affect your liver.

So there's always the joke about drinking too much alcohol and having diarrhea, but there are a lot of issues in general with drinking too much alcohol. And if this occurs on a chronic basis, you're getting yourself sicker over time.

Oh, and one more thing. Often, and you guys may have seen this, when someone comes in the ER and they say they're having like purple poop or blue poop, ask them what they've eaten. In kids, it's Play-Doh or icing on cake. You can actually buy sparkles. They come in little capsules and you can eat them. And so you can have sparkly poop if you want that too.

Troy:Oh, that's too cool.

Mitch: Oh, no.

Troy:That's pretty cool.

Mitch: Why? Why would we do this?

Scot: Your reaction at first, Mitch, I thought you were excited about it.

Mitch: No.

Troy: I'm fascinated.

Mitch: I'm just so upset with this whole episode, 100th episode.

Scot: This was not the 100th you'd hoped for, huh?

Mitch: No.

Troy: This is not it? This is not the capstone of excellence we wanted to achieve here?

Mitch: No, it's perfect.

Troy: Exactly. That's what I love, though. We're talking about poop. You've already cited a British medical journal article. This is not low-brow stuff. We're talking about high-level research here. So this is good.

Scot: Well, thank you, Dr. Pohl, for giving us the poop on poop. My takeaway anyway is if it's not every day, if it's happening less than every three or four days, that is a problem. It sounds like that, if you have constipation, there are some pretty decent over-the-counter solutions to help you with that, in addition to eating more fiber and drinking more water. And then if it smells, check what you ate first. Is there anything else we need to know?

Dr. Pohl: No, I think that's it. Just to remind listeners that constipation is extremely common. It's one out of every eight Americans. And there are some very safe, non-addictive stool softeners that are over the counter that you can try and always talk to your provider about.

The other thing just to keep in mind is that certain types of difficulty pooping in adults can be associated with colon cancer. And as we get older, you just need to pay attention to that.

And then diarrhea, like I talked about, can be just dietary related or due to a recent infection. But if it's chronic, if you're losing weight, if you're getting up at night with diarrhea, if there's blood in it, you need to talk to your provider right away to make sure nothing else is going on.

Scot: Dr. Pohl, thank you for being on the podcast and thank you for caring about men's health.

Dr. Pohl: I appreciate it.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Back in January, we talked about the Project 50 Challenge. Mitch decided he was going to take the challenge, and we're to a point now where 50 days has gone by. So we're going to find out how Mitch did.

This is the Sideshow edition of "Who Cares About Men's Health." My name is Scot Singpiel. I bring the BS to the festivities. The MD to counter my BS, Dr. Troy Madsen.

Troy: Hey, Scot. And I didn't tell you, I took on the 50 challenge too, the 50-day challenge, Project 50 Challenge, whatever we're calling it. Not to the extent that Mitch had discussed, but with some modifications.

Mitch: Oh, that's great.

Scot: And also on the show, of course, the guy we're going to be talking to about the Project 50 Challenge, Mitch.

Mitch: Hey.

Scot: I think the first thing we should do is just give a brief, 45-second summary of what this Project 50 Challenge was and why you decided you want to do it.

Mitch: So Project 50 was a challenge that was going around the internet in end of December, start of January. And it was seven habits that you committed to do for 50 straight days. And the idea was if you did these seven things, you would end up being a completely different person in 50 days and a healthier one as well.

Scot: All right. And what were the seven things? Can you summarize those?

Mitch: Yep. Seven things. One, wake up before 8 a.m. Two, create and do a morning routine. Three, exercise for one hour a day. Four, read 10 pages a day of something non-fiction. Number five, dedicate one hour towards a new skill. Six, follow a healthy diet for all 50 days. And seven, track your daily progress in a journal.

Scot: Okay. And we had an extensive conversation about each one of these things, the viability, would this be hard or easy, is this something that could happen. If you want to listen to that episode, it is the "Project 50 Challenge." It was out on January 11th. I believe it was Episode 93. So you can check that out. We'll be here when you come back and we can find out is Mitch a different person after 50 days?

Troy, can you give me a drumroll, please?

Troy: "Brr." That's the best I've got.

Scot: Mitch, are you a different person 50 days later?

Mitch: No. But I've learned a lot about myself.

Troy: Good or bad things?

Scot: I would contend you are a different person, but maybe not because of the Project 50 Challenge.

Mitch: Sure.

Scot: All right. So you started it. You were pretty gung ho. Tell us what happened.

Mitch: So I was going along, and like we talked about in the previous episode, I was finding new ways to condense these things down and really integrate as much of these habits into my daily routine as possible. While it was difficult, it was not quite as difficult as I was expecting. It's a lot to manage, but you can fit it in here or there.

But about, I'd say, three weeks into the process, I got COVID. I got extraordinarily sick for about a week and a half. And not only that, I've had some lingering fatigue symptoms afterwards. And that kind of put a kibosh on the entire effort. Not only is momentum and motivation hard to do when you're sick, I was really sick and it was really hard to get back into it. So I kind of failed at the Project 50 Challenge.

Troy: I was going to say you did it at least part of that time, didn't you, Mitch?

Mitch: Yeah, about three weeks.

Troy: Three weeks. Project 21.

Scot: Yeah. I think we should have a discussion. Is Mitch a failure? I think that should be the . . .

Troy: No.

Scot: That should be the first topic of conversation.

Troy: He did it for 21 days. When I heard about the Project 50 Challenge, I thought, "This sounds incredibly difficult." So I think just to even have done that for 21 days or whatever exactly he did is quite an accomplishment in itself.

Mitch: Yes. And I did learn a lot, I think, about myself and my approach to the kinds of things that it was trying to accomplish.

Scot: So when you started out the Project 50 Challenge, you had the energy to do it. But then when you got better again, what was it that kept you from wanting to start it again after you had recovered from COVID? Or have you really not recovered all the way from COVID?

Mitch: Well, I am dealing with some fatigue symptoms afterwards. And it's something I'm going to my doctor for, but there are days that I am still completely wiped out. Whether it's long COVID or just lingering whatever, it's taken me quite a while to get back to being able to even work out 30 minutes a day.

And so that's been my trouble. Jumping from 30 minutes of exercise a day to an hour is a big step anyway, but getting all the way down to zero and trying to get back up to one hour when you're dealing with these lingering symptoms, it's been hard.

Troy: I can imagine. Yeah. That's a big setback. But again, I'm impressed. Number one, I was impressed that you wanted to do it. When you told us about it, I thought, "Wow, that's a lot to take on." And then number two that you did it for as long as you did, and it sounds like even now you're still at least bringing some of those things back into your routine. So I think that's great.

Scot: All right. Mitch, what lessons did you learn about yourself through the Project 50 Challenge even though you didn't make it to Day 50?

Mitch: Yeah. So one of the things that I've been really trying to focus on lately with my own health in relation to all of the Core Four is to stay curious about your health, and try things out, and not be angry with yourself if they don't work for you, finding that individual approach to things.

Now, while the seven steps that they were trying to do were pretty intense, I did find a couple of things that really were helpful to me and my mental health, my physical health, and they're things that I continue to do to this day.

Scot: All right. This is like panning for gold, Troy, right now. That's what we're doing. We were panning for gold nuggets that Mitch has to offer us.

Troy: Let's see what we can find here.

Scot: Yeah. I'm looking forward to this.

Mitch: So the big thing for me that I have adopted and absolutely love, especially in these weird trying times of unprecedented event after unprecedented event is the morning routine.

Now, I also found out that I am more of a night owl than a morning person and getting up super early and working out and trying to be creative was not for me. I'm just a drag. I just drag in the morning. I'm one of those people that I need that morning cup of coffee before I can be creative. And it's not until the evening that I actually get my most work done.

But the morning routine of not using your phone for that first hour, even if I'm not journaling, even if I'm not making a master list of what to do, but just not reading the news for an hour, not seeing what emails I have or pressing projects or drama from friends or text messages or anything, just an hour to start the day all to yourself has been really life-changing in the last couple of months.

It gives me an opportunity to talk with my partner and really have a connection there. It allows me to focus on . . . start the day with a big chunk of time that is not stressful in any way, shape, or form. And I found that it has completely changed the way I feel throughout the rest of the day.

Troy: And are you doing that . . . because you mentioned before also you were rolling out of bed right before you had to start work and that kind of thing. Are you finding that you're getting up fairly early, and then you've got that hour and a nice way to ease into the day?

Mitch: Yeah. And it gives me a little time to eat breakfast and get my mind straight. And especially when you don't have all the beeps and boops and the notifications and then doom scrolling or whatever, when none of that is happening and you can just have a breakfast and you can just get ready for the day and shower, even though I'm working from home, all those basic things, it's really, really nice. It's really, really good to start the day that way.

Scot: All right. What else did you learn from the experience?

Mitch: Well, the other one was a little surprising to me, and it's one that we don't necessarily talk too much here about here on "Who Cares About Men's Health." But it was actually Rules 4 and 5. It was read 10 pages a day and dedicate an hour towards a new skill.

And while doing that every single day can be really difficult and really time-consuming, I found myself filling my day with things that I really enjoyed doing and learning.

So there was an intellectual stimulation that came from reading something that was non-fiction. I found some really cool old history books that have been giving me some new perspective on world events these days. Read a couple of self-help books. Even just 10 pages a day, you can get through some of these shorter books in a week.

And when it comes to learning a new skill, finding even half an hour to unplug from everything else and play the guitar. I downloaded Rosetta Stone and tried to learn a bit of a new language. And I'm not going to say I'm fluent in any way, shape, or form, but that intellectual stimulation is exciting and it is something that I look forward to.

And especially after so much time during COVID that got "blah" and the days ran into one another, it's been really, really enjoyable to get curious about things that relax me and things that intellectually stimulate me through the day.

Troy: So what language have you been learning?

Mitch: I've been refreshing my old German skills.

Troy: That's great. So your new skills. Because that was a part of this that really intrigued me, was this idea of spending an hour a day on a new skill, which seems amazing, but that's a lot of time.

Mitch: I've been really surprised at how much . . . I was rusty at guitar and any time I'd pick it up, I'd be like, "Ugh, I'm not good anymore," and I would feel really defeated. But just this blocking out even a half hour to just noodle or learn a couple of chords of a song or something like that, just how much enjoyment I got out of that after years of not playing, it's been really, really cool.

And then the last one that I really found surprisingly helpful and surprisingly motivating was tracking your daily progress. Now, in the past when I've tried to lose weight in the past, it's been 100% on the scale. I step on the scale every day and I'm like, "Well, crap." I'm not losing as much weight as I would like or whatever. And that can be really discouraging.

But by tracking everything from "How many reps did I do? How many was I able to do before failure? How much weight did I do exercise to exercise?" journaling my thoughts, and things that I accomplished through the day, and new ideas that came from the reading, and just seeing every day the small, incremental changes that are happening in the positive way and being able to make a habit out of acknowledging those and writing them down and being able to look back at your progress is extraordinarily meaningful for me at least. And it really helped me stay motivated.

And even though I didn't complete the full 50 days, and even though I'm not doing all seven challenges every single day, and even though I'm not riggedy ripped like some of these Instagrammers who did it for 50 days and swear that that's all they did, I know that I made some progress in those three weeks and the week sets. I'm able to look at it and say, "You know what? That did work for me," or "You know what? That didn't work for me and I have this log of why."

And in the effort to stay curious, it's really, really helpful. It's that gold panning type thing that you were talking about, Scot. It's like unless you are taking the time to really track that kind of stuff, how do you know if you're actually succeeding or not? If you're just focusing on what you look like in the mirror or just focusing on your general feeling rather than the actual things that you're doing, how do you stay motivated? So it's been great. It's been absolutely great.

Troy: See, Mitch, I feel like you did Project 50 the way that seems a little more realistic for all of us. You gave it a good shot and you had a big setback, but you're still incorporating things. It may not be every aspect of it, but I think the way you've done it is a success.

You gave it a fair shot, and you've got a lot of things that you're continuing to do, and you found value in it. And in a lot of ways, it hasn't just changed your life because you said, "Oh, I did it." It's changed your life because you're now doing some of those things and carrying those forward into your routine.

Mitch: Yeah. Thank you.

Scot: All right. Well, we've concluded that Mitch is not a failure. So that's good.

Mitch: Yes.

Troy: You're not a failure, Mitch.

Scot: Go ahead and put that in your progress journal.

Mitch: Not a failure.

Troy: Not a failure according to Scot and Troy.

Scot: All right. So was there anything else that you wanted to hit about the Project 50 Challenge before we move over to Troy?

Mitch: No. I think we hit . . . Those were the three big things that I've been doing.

Scot: All right. I love your overall attitude about just being curious. Being curious, trying some stuff out, not judging it before you try it for a few days. Who knows? It might be something that really works for you.

Troy, how did you integrate Project 50 into your life?

Troy: Scot, again, like I said, when I heard about it from Mitch, I said, "This seems like a whole lot to take on." But I also was thinking very much about, "How can I consolidate this into one hour a day?" which I wasn't successful in doing, but trying to multitask.

But again, I think some of the things I really appreciate . . . I did focus more on that morning routine. And again, social media hasn't been such a big deal for me. Scrolling on my phone, not such a big deal, but just being a little more aware of that in my morning routine has been . . . I think just became a little more focused on, "Don't get on your phone, don't read the news, have that time to yourself." And then part of that morning routine has been going out for a run with my dog, which I always enjoy.

The one piece of it that was very intimidating to me is this idea, and we talked about it originally, of spending an hour a day on a new skill. And from the start, I just said, "I am not going to do that. I just can't find the time for that." So my modification for that was very similar to Mitch's. It's so cool to hear what you did, Mitch. I used to play the piano a lot, and I really enjoyed playing the piano. And I've got a piano in my house, an electric piano that was a gift from my grandmother and my parents when I was in medical school. I used to play it all the time, and I really enjoyed it.

It just sat there, and I'll sit down here and there and play it, but I said, "You know what? I'm going to sit down every day and play at least one song. And if it's just one song, that's all I'm going to play." But then I found as I sat down, I would play a song and I'm like, "Ah, just having a good time." And I would open up a book of piano music and maybe play two or three songs or maybe more.

And that, to me, was I think the most rewarding thing to come out of this, to say, "I'm going to do it. I'm going to try to relearn a skill I had that's gotten kind of rusty." And I've just really enjoyed playing the piano every day. So I appreciate you for posing this to us and that's what I took from it.

Mitch: Oh, that's so cool because that was just it. For me, it was like the new skills were a little intimidating. I did work on a cookbook or whatever, but shifting to, "I know some of this. Let's get the rust off. I know I enjoyed this at one time. Let's try this out," it's been great. And I'm so glad to hear that you were doing it too.

Troy: Yeah, that's cool to hear you did it too, because I thought about it . . . I was going to learn breakdancing or relearn it from what I knew in my youth, but I decided I was never that good at breakdancing, but I was pretty good at the piano. So I picked it up again. It's been fun. It's been good.

Scot: I told you that I probably was not going to participate because I'm still in my graduate school. This will be my last semester and I just didn't think I'd be able to take additional things on, which I did not. However, what it did do is it did make me refocus some things that I had done before.

So I've had a morning routine for a long time and I'd gotten away from it. So I got back into my morning routine and I incorporated some physical therapy stretches in the morning.

Mitch, I'm like you. I need that cup of coffee to get going. But a lot of times if I just start my day with the stretches even before the coffee, if I do it while the water is heating up, that wakes me up. Just those gentle stretches and movements really wake me up. So I enjoy that because it makes me more alert.

And the other thing I just refocused was some basic stuff like making sure that I'm getting to bed at the time that I want to get to bed, making sure that I'm getting out of bed at the time I want to get out of bed. Not hitting the snooze.

So I didn't really add anything new, but I just refocused some stuff and it has paid dividends. So I have appreciated that. And I look forward to the chance to maybe learn a new hobby. I don't know what that would be, but anyway.

Troy: That's great. We can start to propose hobbies to you if you'd like, Scot. I was thinking magic. We talked a little bit about magic already. You could learn some magic.

Mitch: We're a drummer or a bassist away from having a band. The "Who Cares" band.

Troy: Any takers here, Scot? The "Who Cares" band.

Scot: "Who Cares About Men's Health" band. Is there anything else to talk about with the Project 50 Challenge, the recap, the conclusion?

Mitch: Well, one of the things I wanted to do is if you are stumbling upon this episode because you tried the Project 50 or you typed it in and you were like, "Oh, hey, there's someone who has tried it," maybe approach it in a way that isn't a succeed or a failure. And don't judge yourself compared to all the guys and gals who were on the internet showing all of their progress the whole time for social accolades and thumbs ups and likes and everything. Just try some things out for yourself and see what does and doesn't work.

Troy: So now, given that we've done this, does this make us influencers? I don't know.

Mitch: Yes, 100%

Troy: Cool. Putting it on my résumé.

Scot: Right now.

Troy: Right now. Internet influencer.

Scot: Well, Mitch, thank you very much for sharing your story about the Project 50 Challenge. That was fun. I enjoyed that.

If you have any comments or would like to contribute to the episode, if you did the Project 50 Challenge, would like to share your experience, you can do so. A lot of different ways you can get a hold of us, and Troy is going to fill you in as to what those are.

Troy: Yeah. You can find us on Facebook, facebook.com/whocaresmenshealth. You can email us, hello@thescoperadio.com. Website is whocaresmenshealth.com. Call our listener line, 601-55SCOPE.

We'd love to hear what you've done with the Project 50 Challenge if you've done it or if you're doing it now. And please tell us about that new skill because we're looking for recommendations for what Scot can now do. So let us know.

Scot: All right. Thanks for listening and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Troy: You've got to say something like, "Troy puts the stud in studies," or something like that. Something good. I'm just kidding.

Scot: I will never say that.

Troy: I was just trying to think of something better than "Troy's articles" or whatever you called it.

Scot: That's us. It's a "Sideshow" episode. That's what we like to call a soft start. You caught us in the middle of a little prepping trying to decide what we're calling this segment, where Troy scans the medical journals so you don't have to and then shares an article that hopefully is of some interest.

Troy: Hopefully.

Scot: Yeah, this is "Who Cares About Men's Health," a "Sideshow" episode. My name is Scot. With me, as always, the MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: And Producer Mitch.

Mitch: Hey there.

Scot: All right, Troy. Let's take a look at your articles, hear what you've got. Go ahead and put those articles on display.

Troy: Look at the articles.

Scot: Yeah. Go ahead and put those articles out on display for us. We're going to pick one.

Troy: Oh, we're picking?

Scot: Oh, yeah. I mean, unless you just decided you had one that you . . .

Troy: I decided.

Scot: Oh, okay.

Troy: This title is so good that I knew even if I gave you my list of five, including the one on green urine that I keep trying to get you to pick, I know you'd pick this one.

Scot: All right.

Troy: And I'm just going to read it to you and if you don't like it, if you're just like, "No, we would not have picked that one," let me know and I'll pull up some other ones.

Scot: Okay.

Troy: The title of this article from the "Journal of Emergency Medicine," the title is "Battlefield Acupuncture Versus Standard Pharmacologic Treatment of Low Back Pain in the Emergency Department: A Randomized Controlled Trial."

Mitch: Oh, Troy, I did a bunch of interviews about this. Keep going.

Troy: Yeah. Tell me I have not piqued your interest.

Scot: So when you say battlefield, you mean like a war battlefield?

Troy: That's a good question.

Scot: Oh, okay. Well, I guess, Troy . . .

Troy: I'm hoping I piqued your interest enough that I can . . . I'll explain what battlefield acupuncture is. I didn't know before this article.

Scot: Move forward with this one. Go for it.

Troy: Okay, we got it. So battlefield acupuncture, to your question, is a technique using acupuncture. So you're familiar with acupuncture? You use these little needles in different spots. Ideally, the way this is designed, it's supposed to then relieve pain or lead to different effects.

Acupuncture, of course, is considered an alternative therapy, and it's one of those things where it has gained more mainstream acceptance as these types of studies have come out. But it's been considered a traditional therapy, an alternative therapy. It is not something I have ever done or have ever practiced. I did spend a day shadowing, spending time with an acupuncturist during med school, which was really cool, to kind of see what she did and hear her philosophy and see her approach and see the patient's response.

But battlefield acupuncture is a technique where there are certain little needles that look more like little tiny darts that are placed in specific places in either one or both ears.

The idea behind this is that these spots are said to influence the central nervous system pain response. And by putting these little needles in these different spots in the ear, they then decrease pain that is coming from other sites in the body. I mean, that's the theory. Again, I'm not a traditional practitioner, but I'm just kind of reading what I found on it.

Scot: Time out. In the ear, or in the part around the ear, or the earlobe?

Troy: In various parts. So yeah, let me clarify that. Not in the tympanic membrane. You're not going in the ear hole. These are different spots . . .

Scot: Okay.

Troy: Yeah, these are different spots on the auricle of the ear. You do not want to puncture the eardrum. These are spots . . .

If you just do a Google search for this, you can see photos of where these spots are. They're basically at the very top of the auricle of the ear, so the very top of the ear, and then kind of maybe half an inch down from there. And there's another spot half an inch down from there. There's a spot on the earlobe. There's a spot just on the very front part of the earlobe.

So they're like little tiny darts, and they actually have a tool that you use to place these. They just stay in place until they fall out. So it's usually three or four days. You put these in there, you leave them in, and you just send people home with these in place.

Scot: Wow.

Troy: Yeah, it's fascinating. Again, I have never done this. I've never been trained on this. This is the first article I've seen looking at treatment of low back pain.

And then you might ask, "Why would I even care about this? Because surely I have some great treatment for low back pain." I can tell you that when you see a patient come to the ER, the first thing you'll see is their name and a chief complaint and that's what shows up. And when the chief complaint is low back pain, that to me is one of the most frustrating things to go and see because there is so little that I can offer.

It used to be these patients would come in and everyone would just get opioids, like, "Okay, here's your script for Norco or Lortab." That's a horrible way to approach it and that's what's led to the current opioid epidemic.

So now when people come in, I say, "Well, you can try ibuprofen or Tylenol." "Well, I've already been trying that."

"Well, you could try some lidocaine, some numbing cream on there." "Well, I've tried that."

"Well, you could try physical therapy." And we actually had a physical therapy in our emergency department and did a study on it, and that was great. But that person was only there 30 hours a week and the emergency department is open 24/7, so that's not something I can offer that often.

So if there was something I could actually do and say, "There's evidence behind this and this is going to help you," and people actually did it and said, "Wow, it helped me," that would be really cool.

So this study, essentially what they did is they took patients who came into the emergency department . . . It's a fairly small study, more of a pilot study we would call it, where it's kind of like, "Hey, let's try to see if it works. If it works, let's do a bigger study."

So they only had 52 patients. Twenty-six of these were randomized either to getting this battlefield acupuncture done or to just standard treatment, which would be the stuff I talked about where it's just like, "Hey, do whatever you normally do."

The patients with the battlefield acupuncture had a significant decrease in their pain score when compared to the patients who just had standard treatment.

And they then contacted these patients two to three days after they were there and found that the patients who had the battlefield acupuncture continued to have a significant improvement in their pain scores compared to those who were sent home either with a prescription or with just standard stuff we would do for low back pain.

Of course, there were no difference in any adverse effects. It's not like these patients were getting a lot of infections, they were complaining of a lot of pain or bleeding, or anything like that.

So their conclusion was that this potentially shows some promise. I can tell you please don't come to the ER right now and ask for battlefield acupuncture, because we don't have the tools there. It is not something we're doing. But maybe a study like this and some subsequent studies, if they continue to show this works, maybe it's something we're going to learn to do. I would love to be able to offer something better than what I can realistically offer in the ER.

So kind of a cool study. A pretty simple thing, it looks like, to do. It's just something we're not doing now, but maybe we'll see more of this in the future.

Mitch: I have to chime in because I've done it.

Troy: So when you say you've done it, have you performed this on people?

Mitch: Yes, I have.

Troy: Wow. This is cool.

Mitch: Okay, so 2011, it was my old life as a documentary filmmaker. We were working on a project called "The Painful Truth," and we were traveling all over the country investigating chronic pain patients and how they are treating their different conditions and how it impacts their family. And I got to actually go to this big medical conference. And one of the rooms where they were doing a breakout session was all about battlefield acupuncture.

You go in there and up on front, there's like this cute small woman who's been studying it and she published the paper. And then there are these military guys in full uniform with all their awards and medals and everything, talking about how they were using acupuncture in the ears and the tragus and all these different parts to stop people from going into shock on the battlefield.

Troy: Wow. So that's where it got the name then. I had no idea before this.

Mitch: So I was actually able to get one of them to be interviewed with us. And when we were talking about the interview, he pulls out first an orange and he's like, "Here's the tool. I want to show you how easy it is here. Here, why don't you go ahead and put some of these little brads in." And it's like a little gun and it's just, "Pew, pew, pew." So I bedazzled an orange.

And then he's like, "Do you want to see what it feels like?" And I'm like, "Absolutely, yes, a thousand times." And so he clips my ear. I'm trying to find some photos of it right now. But he clips my ears, and I didn't feel anything because I wasn't going into shock. But I'm like, "Wow."

And then he asked if I would feel comfortable doing it with my cameraman, and I said, "For real?" And the guy was not sure, but I'm like, "Oh, come on. It'll be fun." So yeah, I got to basically bedazzle my cameraman's ear with this tool. And it was just . . .

Troy: Did they draw the spots on there for you to shoot this little gun into, or did you just see it and you're just like, "Okay, there, there, there"?

Mitch: So they had a little printout and they were like, "Here's where you're going to do it." And then when I was doing it, he took his little Sharpie and did little dots on the guy's ear to be like, "Here's where you're going to shoot it."

Troy: Make sure you hit the right spots, yeah.

Mitch: And so the big part of it is that this for them at that time was . . . This was not necessarily something that a battlefield medic would need to have special training for. They can train anyone to do it, right?

Troy: Yeah. It's sounds so simple.

Mitch: So it was really kind of cool to . . . And especially for him, the guy who was giving me the interview and everything, he was like, "These for so long have been treated as 'alternative medicine.'" Big quotation fingers there. But they're starting to find real applications. And so it's kind of exciting to hear that you also found a study about it.

Troy: Yeah, that is fascinating. Again, it's not something I've ever been trained on. And there probably are other emergency-department-based studies that have done this kind of thing, but there are not a lot. And maybe there are some others with low back pain, but this is the first time I've seen this.

I would love to be able to do this. Again, I would love to also maybe see some larger studies just saying, "Yeah, this panned out and we are seeing an improvement and this works."

Again, Mitch, like you said, it sounds super simple to do. As I've looked at pictures of it, it's like, "Okay, just hit these five spots." It's not rocket science, and you just need that tool, the same tool you had, which we don't have. But that's so cool you were doing that.

So if we can do this, I'm going to bring you in to teach us all how to do it, Mitch. Apparently, you're the expert now. You have more experience with this probably than any physician in our emergency department. So you're coming in.

Mitch: Okay. All right.

Troy: I love it.

Scot: Can we get you one of these guns on eBay?

Mitch: I don't know.

Troy: They have them on eBay?

Scot: What do they cost? What does one of these things cost?

Troy: I don't know. I've never looked into it.

Mitch: It was like a handheld staple gun. It was between a hole-punch, like one of those single handheld hold-punches. It was kind of like that plus a staple gun. It didn't feel too technical.

Troy: Yeah. We should probably clarify. Don't do this at home with a staple gun. It would be unwise and unsterile. But yeah, it seems like if you have the proper tools and a sterile device that's designed for this, it doesn't sound difficult.

Scot: Troy is a physician, right? Mitch mentioned something that resonated with me. Alternative medicines, right? There's a lot of stuff out there that people swear by. But as a physician, or at least many physicians I've talked to, until they can see some hard evidence that it actually makes a difference, they don't really accept it as a treatment. But it sounds like you would be in all the way on this because of this study?

Troy: I would like to see at least a couple more studies that replicate the results. At the same time, I don't want to just do something just to do it. It would be nice to see something that helps. I would be open to doing this if a patient . . . if I talk to them about options and I said, "Hey, there's been a small study. It seems to make a difference."

The big thing for me is, "Is there a big downside to this? Am I going to be causing harm?" And if I'm not going to be causing harm, and they did not report significant adverse effects with this, if I'm not going to be causing infections in their ear, or a lot of bleeding or things like that, and there's reasonable evidence to support it, I would offer it to a patient specifically that way. I would say, "This is something . . . there's been a small study." I'd say, "We can try it if you're interested."

Scot: And if this really did work, that sounds like it would change your life. It would make you go from seeing name and back pain to name and I can help this person. Name and back pain, going, "Oh, geez," to name and back pain and, "I have something I could probably do."

Troy: I would love to have that. If anyone asks me, "What is the most frustrating thing you deal with in the emergency department?" it is back pain, because people come there wanting answers and wanting a quick fix and it's a 15-minute discussion often of saying, "Hey, this is what you need to do. It's going to be a long process. You're going to have to do physical therapy. I'm not going to prescribe opioids for this. I do not want to do that. I do not want to create potential for addiction." And then I'll offer them the Lidocaine, things like that, and say, "Well, maybe this will help."

But yeah, to be able to just be like, "Yeah, I can try this. We can do this and there's evidence to support it," would be wonderful.

So we'll see what happens. Again, it's one of those articles where you see it like, "Oh, that's really cool." I can't say it changes my practice right now where I'm going to start doing this. Obviously, I don't have the tools to do it right now or the training. But it's one of those that maybe we're going to see more on this. It takes a while for these things to come into practice, but maybe in five years, this will be a standard approach in the emergency department. Who knows?

Scot: All right. You made it to the end. Good for you. Be sure to check out some of our other "Who Cares About Men's Health" episodes.

What you just heard is what we call a "Sideshow." It's where sometimes we talk about health topics that aren't necessarily directly related to what we normally would talk about, which is the core four plus one more. That is to be healthy now and in the future, you should concentrate on your nutrition, your activity, your sleep, your emotional health, and you've got to know your genetics.

Plus, we also have episodes that are dedicated just to men's health issues. So check out some of those episodes as well.

And if you know somebody that would find any of them useful, please go ahead and let them know about the podcast. It's the best way that you can help us grow the podcast.

If you want to reach out, lots of ways to do that. You can call us at 601-55SCOPE and leave a voicemail, you can email us at hello@thescoperadio.com, or you can check out our Facebook page. That's facebook.com/whocaresmenshealth.

Thanks for listening, and thanks for caring about men's health.

This week's recipe is easy Thai red curry. If you make it, tell us how it was and post your pictures on our Facebook page.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Hey, guys. It's Scot from "Who Cares About Men's Health." Before we get to the episode, I would love it if you would make some of these meals with us and let us know what you think. Were they easy? Were they hard? Were they tasty? If you'd like to participate and get the recipe from this week, you can go to facebook.com/whocaresmenshealth. Check out the recipe and if you do make it, post on the Facebook page what you thought and any pictures you take. And now, the episode.

Today, we're going to learn about easy-to-make-all-at-one-time man meals that you can eat all week, and maybe we'll even learn a thing or two about nutrition along the way.

This is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation about men's health. Today's crew, we've got a big crew here today. With me, the man who brings the MD, my co-host, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: I'm Scot Singpiel. I bring the BS and ask the dumb questions so you don't have to. We've got Producer Mitch in the mix.

Mitch: Hey there.

Scot: All right. Our guest today, we're really excited about this, from University of Utah's College of Health Department of Nutrition and Integrative Physiology . . . did I say that right? I said that right. That was the Olympics for my mouth right there. Registered dietri- . . .

Troy: See?

Theresa: Fail. You stumbled on the podium.

Troy: Yeah. You just tripped at the finish line, Scot.

Scot: Registered dietitian, Theresa Dvorak, she's got a stack of tasty recipes for us today. How are you doing?

Theresa: I'm well. Thanks for having me.

Scot: All right. And also, we've got our all-around baller, shot caller. He's got a PhD in eatology. His name is Thunder Jalili.

Thunder: Hi, Scot and everyone. Glad to be here.

Scot: All right. Hey, Troy, I got a question for you. So we're talking about these kind of meals that you can make on a Sunday and then eat for the rest of the week that are going to be nutritious and easy to make. I don't know what to call them, so I just went with easy-to-make-all-at-one-time man meals.

Troy: Yeah. That's a good, long name.

Scot: If you come up with something better, I'm more than willing to hear it. No problem.

Troy, I have a question for you. When do you make bad eating decisions? Is there kind of a time you make bad eating decisions?

Troy: I make horrible eating decisions after night shifts, no doubt about it. So when I'm tired, I always make bad eating decisions. I make bad eating decisions if I get home at like 2:00 in the morning from a shift. So I think sleep deprivation is the theme there for me.

Scot: Yeah. How about you, Mitch? Bad eating decisions, when do they happen?

Mitch: I make them a lot when I'm driving around. For some reason or another, I cannot . . . just old habits, whatever, I always like to go to the Maverick, get myself a drink. And then there's always a weird candy or there's . . . I have a soft spot for roller food as terrible as that sounds. That's when I make the worst decisions, is when I'm getting gas or stopping by somewhere.

Troy: So just to clarify, roller food, we're talking the stuff that's been on the rollers for a day or two, right?

Scot: Oh, that's what he's talking about.

Troy: That's what I assume he means by roller food, like the hotdog . . .

Theresa: Yeah, the hotdogs, the corn dogs.

Troy: The taquito that's caramelized from . . .

Mitch: Oh, man, get a pair of those taquitos.

Theresa: I think it's past caramelized.

Thunder: Been rolling for several weeks.

Mitch: I know. I'm feeling a lot of shade right now and I . . .

Theresa: Sorry. No shade.

Troy: Mitch, we've all been there, but it's . . .

Scot: Hey, Thunder. When do you make bad eating decisions?

Thunder: My bad eating decisions are made during times of desperation. When I'm coming home from work, there's nothing prepared for dinner, and I'm just desperate, and I just need something.

Scot: Yeah, boom. That's exactly me too. I will make a good eating decision if I can go to the fridge and pull something out regardless of what it is. So that is kind of the whole premise of today, is to have these meals that are just ready to go.

How often is it that maybe there's nothing in the fridge or when lunch rolls around, if you're working from home, you're just kind of too lazy to make something, so you just grab the easy stuff, the chips, whatever? Or you don't have anything to pack when you go to work, so you hit a fast food joint for lunch. Those are all those situations where if you could have something that's nutritious and easy, then you make better decisions.

So Theresa Dvorak, she's a registered dietitian, and we're going to be doing a series for the next few episodes where she is going to bring us some of these great man meals. We're all going to make them. You all in for that?

Thunder: Yeah.

Mitch: Absolutely.

Troy: I'm up for it, yeah. Let's do it.

Scot: We're going to make them on a Sunday. And then the following week, we will review them and we'll let her know what we think of her recipes.

Thunder: It's a lot of pressure.

Scot: Yeah.

Troy: This is pressure, yeah.

Scot: Before we get going, Theresa, you had some questions you kind of wanted to ask us to determine maybe what recipes you might offer up.

Theresa: Yeah. Thanks. So this is really great and this is very common, the stuff that we hear, "I'm tired," "I'm driving," "I need quick, convenient," "I want something yummy and I don't really want to have to work for it." So this is awesome and not unusual. So all of you are very, in this regard at least, normal. I can't speak to everything, but regarding your food choice it's normal.

Troy: The one thing we do check the normal box.

Theresa: Right. I guess what I also wanted to know as we're kind of picking recipes . . . yes, I have a recipe for today, but as we're looking at the next several weeks, what do you guys want to try to make or learn to make? Is there a cuisine that you're really interested in? What intimidates you in the kitchen?

Troy: I'm just going to start here and just say the kitchen itself intimidates me.

Scot: Really?

Troy: My idea of cooking is opening a box of pancake mix. It requires nothing but water, and that is what I cook, and that is about the only thing I cook. So you're starting pretty . . . I'm setting the bar pretty low here in terms of anything that requires mixing together and cooking it is a stretch for me.

Thunder: think the bar is actually on the floor, Troy.

Troy: It's in the basement. Yeah, it is.

Theresa: All right.

Mitch: So, for me, the big thing is that, in our household, we eat pretty healthy. Jonathan makes all these delicious salads, but I'm not a salad person. And I think when I was first thinking about this idea, it was like, "I'm terrible. I love my junk food. I love my salty stuff. I love my tacos."

And so, especially when I'm trying to eat healthier, when I'm trying to lose a little bit of weight, which I'm trying to lose a bit of the COVID right now, it's hard because it seems like it's always, "Ugh, another salad. Ugh, another salad." I don't know what to do, right? I feel pretty confident in the kitchen, but I don't have the imagination, I guess, to make something tasty, fun, and healthy, and have it not be a pile of vegetables.

Thunder: What intimidates me, if you want to know, is actually things that require a lot chopping and cutting and processing because I always feel like I'm pressed for time. So that's the big hump that I have to try to get over when I want to sit down and cook.

Scot: Theresa, I'll tell you I have had a habit of making meals in advance, but I have a very small kind of group of meals, like beans, rice, and chicken. I ate that every day for lunch for years. Kind of gotten tired of it. I really didn't spice it up or anything like that.

I like spaghetti a lot, so I'd make that in bulk and eat it a lot. I'm not too intimidated in the kitchen, but I think time is kind of a thing. I'm willing to invest some time, but I'd like to be able to make it and then pop it in the fridge and have it for the rest of the week, or pop a couple in the freezer, have it later in the week. So that's what I'm looking for. I'm looking for stuff with flavor too.

Theresa: Awesome. That's something that . . . I love the flavor piece and the junk food that Mitch is talking about and late night opening the fridge of Troy. You want something quick and easy, but it also has to taste good, right? It can't just be this what we often think as pile of vegetables that's good for you, that is just kind of bland and doesn't have a lot of flavor. That's hopefully what I'm bringing to the recipes and to this, is that it can be healthy, but it can be super yummy and really tasty too, and we shouldn't have to sacrifice deliciousness for health.

Scot: And easy to make too.

Theresa: And easy to make, yes, indeed. So I get the time and I think when we're thinking about these big batch meals, we're kind of paying it forward, that we're putting in some time on the weekend or a day during the week where you've got some extra time, and then you've got it in the fridge. You've got extra portions that you can repurpose different ways, or just pull out and either eat cold or pop it in the microwave for 30 seconds, a minute, something like that.

So that all sounds awesome. Are there any significant either dislikes or allergies that I need to be aware of with these? My husband hates mushrooms and olives for that matter. I don't remember what it was. It was something. It literally makes him gag. So I try not to make lots of those kinds of things at home. Are there foods that you guys are like, "Anything but that, please"?

Thunder: Organ meats.

Theresa: Organ meat. Got it. No liver. Done.

Troy: Heart, liver, intestines, stomach, brain, tongue.

Theresa: No problem.

Troy: I don't want to make our listeners be vegetarians, but I am vegetarian, so that's kind of my one limitation on foods. I'm pretty open, otherwise.

Mitch: It's iceberg lettuce. It's that super crunchy head of lettuce, that terrible whatever. I get a weird sensation in my mouth. I cannot do it. It feels like my jaw is cold. I cannot do iceberg lettuce.

Theresa: And you love tacos. Where do you get your . . . you take it off?

Mitch: I'll do shredded spinach. I will do cabbage. I will do anything but that iceberg lettuce.

Scot: I'm no culinary expert. I'm no Guy Fieri over here, but I have a pretty good feeling that iceberg lettuce wasn't going to come up in any of these recipes.

Mitch: I just had to make sure.

Theresa: r organ meat.

Scot: I don't have any limitations. I'm fine with anything. I'll eat meat. I'll go all vegetarian. It doesn't matter.

Theresa: Thunder?

Thunder: And I'll pretty much eat anything, but I do prefer vegetarian.

Theresa: All right. And that brings in some of the health stuff that we'll talk about throughout this series as well. You'll notice that most of these recipes . . . well, all of the recipes are what I call plant-forward. So you may have heard plant-based. That can be kind of different depending on the circle that you're running in. Plant-forward is that it's mostly plants on your plate, whole grains, fruits, and vegetables. There might be a little bit of meat or maybe there's an alternative or a substitution that you could make.

And they're all going to be recipes that you can easily explode or contract if you want to, meaning if you wanted to half the recipe, you could do half the recipe if you just wanted it for one night. If you wanted to make three batches of it at once and literally feed you for the entire week, you sure could. So they're going to be easy that way.

Something that I've realized, too, as working with patients in different community groups through our culinary medicine program and through my personal practice is looking at what works for the individual, because it's different for everybody, right?

And so my goal is that we're here for four weeks. We're going to have four recipes. I would view success if you guys all find one or two of the four that you actually like and make again. So that's my low bar success rate.

But yeah, we'll have lots of these recipes and then kind of where we're . . . maybe one of the weeks, we can also talk about where we find good recipes, because I find that's sometimes hard as well. If you don't know where to look, where do you look? And we can explore some of those things.

Thunder: Theresa, I think that's a great point, actually, because that's one of my personal issues that I run into. I know I want to try to make something different, but I don't have the imagination to try to figure out new places to look or even where to look.

Theresa: And then is the recipe even tested? I mean, I've tried countless recipes that it doesn't taste good or it didn't taste right when I made it per the recipe. So I have personally tasted and tested all of the recipes myself, my husband, teachers, students, my children. If a 4-year-old and a 2-year old can eat it, and a 45-year-old can eat it, let's hope that you guys can too.

Scot: So what you're saying is if I don't like it, you're going to take it really personal?

Theresa: No. Remember, my bar was low, one or two.

Thunder: You're the outlier.

Troy: One or two.

Theresa: You've got to at least like one of them. Otherwise, I failed.

Troy: We're going for 25% here.

Scot: All right, Theresa. Well, we're very excited to go ahead and kick off the series for the next month. What is recipe number one? What's it called? What are we going to be feasting upon?

Theresa: Easy red Thai curry.

Troy: Oh, I like this. I like it already.

Scot: I'm into that, yeah.

Theresa: Have you guys ever made curry before?

Thunder: Yes.

Troy: Never.

Scot: Nope.

Mitch: No.

Theresa: Okay. We got one yes, all right. So we'll see how this recipe stacks up. The big thing that I like about this recipe not only is it easy, as the title implies, but it's kind of a fridge cleanout. So I often find as well I get to a certain point of the week, depending on when I grocery shopped or not, and I've got veggies that are starting to not look the best, right? The zucchini is starting to look a little wrinkly. There are a couple of spots on the cauliflower or whatever. This is a recipe that's great for using up and putting in whatever is in the fridge.

And all of the ingredients, maybe the hardest thing to find at the grocery store could be the Thai curry, but that's usually with your Asian cooking spices and sauces and whatnot.

Also, you can choose whatever kind of additional protein if you want to into it. There's an option for tofu. There's an option for fish, shrimp, white fish, ideally, or chicken breast if you wanted. So there are those options in there for you as well.

And then either rice or rice noodles, depending on your preference there.

So how does that sound? How does some Thai curry sound?

Troy: It sounds delicious.

Thunder: It sounds great.

Theresa: I guess this brings to another question. What about spice? How are you guys on spice? Do you like things spicy?

Mitch: All of the spice. Bring it on.

Theresa: All about the spice?

Thunder: Actually, I had two questions. One of them was about spice, but the other was also, since you mentioned tofu, are you going to tell us how to prepare the tofu so it actually tastes good?

Theresa: That's the great thing about this recipe. Honestly, you just chuck in the tofu and it takes on all of that awesome curry flavor. If I was doing something where I was maybe putting it on top, like a Buddha bowl or something like that, yes, I would tell you. And we might get there, just a little foreshadow there, so hold that thought.

Thunder: Does the type of curry we select going to affect the spice? I mean, how should be go about that choice? Are you going to talk about that?

Theresa: There's a red, a green, and a yellow curry paste. The red will be the spiciest. Yellow and green tend to be more mild. This recipe, for the whole lot, calls for about two tablespoons. If you're okay with spice, this is going to have some good flavor to you. And then you can also know by playing with it in the future, "Okay, did I want a little bit more spice, or was it too much, and was I sweating profusely throughout the meal?" Then you just add less of the spice, or then try a yellow or green curry paste. But that's a great question because there are variations.

Mitch: So, Theresa, one of the things I was kind of wondering is . . . We've talked about it in the past, but I've had a weird kind of relationship with food in what I deem healthy and not healthy. It's been everything from "if it fits your macros" to "stay away from all the carbs, stay away from all the rice," etc.

Theresa: So rice is kind of like bread, right? And carbs, in general, I think they get a bad rep. Thank you, Dr. Atkins. We need carbohydrates. It's just what kind of carbohydrates are we choosing and how are we preparing them.

So I would probably do a brown rice on this, but at the same time, this recipe is loaded with a lot of vegetables and some healthful fats. And so it's going to help keep us satiated and satisfied while also, if you're looking at your macros, meeting your macros. It's got a good source of carbohydrates, fats, and proteins.

Thunder: Mitch, I wanted to add one other thing on that carb story. Just piggybacking on what Theresa was saying, don't be afraid of the rice. Carbs, in isolation, when it's the only thing that you're eating and it's a simple carbohydrate, can potentially be bad. But this is such a mixed meal that she is describing and you're having carbs in combination of many other things. So, metabolically, it's going to take you a while to digest it and absorb it. So all those negative things we associate with carbohydrates, I don't think, are much of a facture in this type of meal.

Scot: And we also have an episode where we had Thunder on and we talked all about carbs. So it might be time to go back and listen to that one.

Thunder: Were you sleeping during that one, Mitch?

Mitch: I edited it. But still, to this day, when someone's like, "Oh, do you want a big cup of white rice?" I'm like, "Hmm." It's still in there.

Scot: I know. Mitch . . .

Theresa: It takes a long time.

Scot: Yeah. You and I are on the same page because I avoided that and potatoes and that sort of stuff for a long time. And then it came to the point where I realized that grains are good for you. Potato is good for you. And if you have the fats and you have other vegetables, it all mixes together and you don't get that . . . Thunder could speak to this, but you don't get that jolt of . . . what is that? Insulin response quite as much, right?

Thunder: Right. That's where the carb effect that everyone is down on is. If you have a simple carbohydrate, like a Coke, like some sort of candy bar or something, the blood sugar response to that is really rapid, really high, and then it crashes afterwards. When you have rice in this type of meal that Theresa is talking about, the blood sugar response is just different.

Scot: And then the portion size too. She's just talking about a small portion size of rice. I think we have distorted views of what a portion is as consumers, because you go to a restaurant or whatever and they bring out just this big, huge plate of food. So maybe that will help as well. But rice is your friend, my friend.

Mitch: All right.

Troy: Yeah. Everything Thunder has ever said, my takeaway is just don't eat a bunch of sugar, and otherwise, you're going to be okay.

Thunder: Whole foods.

Troy: That's my lesson from Thunder. Eat whole foods. Don't eat a bunch of sugar.

Theresa: Right. Mitch, I give you permission to eat the rice.

Mitch: That's amazing. Thank you. That's all I needed to hear, is a professional to tell me to have permission to have it. I will play this forever. Thank you.

Scot: The first couple of times, you might cry afterwards, but you'll get better.

Theresa: Yeah, but you'll be crying out of enjoyment and pure pleasure. So we'll get back and let me know how this recipe pans, but this has been a lot of great information to help me build the next weeks of recipes.

Scot: How long is it going to take to kind of prepare this?

Theresa: From start to finish, you're getting the stuff out of the refrigerator to sitting down at the table, probably 45 minutes to an hour, depending on how particular you're being. They're all going in the pot. You don't need to be too precise.

When you are chopping your veg and that kind of thing, my one word of advice is make sure that everything is about the same size so that they cook fairly evenly. Otherwise, you're going to have super hard carrots and really soggy zucchini, or whatever your choices are, so . . .

Scot: And that 45 minutes or an hour, I mean, you're not constantly over the stove, right? There are times where you could step away . . .

Theresa: There's simmer time, exactly.

Scot: Yeah. You can step away and work on another project or whatever, and then come back and check on it. And then if you've got a week's worth of meals out of it, that 45 minutes was really well invested.

Theresa: Right.

Scot: Does anybody else have any other questions about the recipe, Troy or Mitch or Thunder? We're all good?

Mitch: Yeah, we're good.

Troy: I'm excited to try it, yeah. It sounds delicious and it sounds like prep time isn't bad at all, so I'm ready to do it.

Scot: All right. When are you going to cook it up, Troy?

Troy: It's probably going to be on Sunday. I think your plan sounds good. Then you've got your stuff for the week. Maybe you have some that night and then have a couple more meals over the week, so I think that's my plan. I will be ready to report back next week on this.

Scot: All right. Mitch and Thunder? Mitch?

Mitch: I'll probably be doing it either Sunday or Monday night.

Scot: Okay.

Thunder: Yeah, I think Sunday sounds like a good day for me. That's when I'm going to do it.

Scot: All right. So thanks for all of the advice, the extra cooking advice. It sounds like a simple one. I guess we'll find out. I wish that we could all get together and taste test each other's recipes, but I guess it doesn't matter if anybody else likes it as long as you like it, right?

Troy: Right.

Scot: All right, Theresa. We'll put a link to that recipe on the post along with this podcast. We'll also put it out on our social media channel, which you can find at facebook.com/whocaresmenshealth.

And we encourage you to try it as well and report back what your findings were, questions, or what you thought just in the comment section, or you could also email us at hello@thescoperadio.com, or call us at 601-55SCOPE and leave a voicemail message.

Theresa, thank you so much. I look forward to the next four weeks to get some better recipes in my repertoire, and thanks for caring about men's health.

Theresa: Excellent. Thanks. Stay cool. It's hot.

Mitch: It is so hot.

Scot: Cool like temperature or cool like, "Hey"?

Troy: "You guys are so cool."

Theresa: However you want to read it.

Scot: Hey, check you out. You made it all the way to the end. It's Scot from "Who Cares About Men's Health." If you found this episode entertaining, useful, or you know somebody that might find it entertaining or useful, please share it with them. It's one of the ways that we can help grow this podcast and be very much appreciated.

And don't forget, for the next few weeks, we're going to be doing these recipes and would love your participation. I know I said it earlier, but I'm just going to just reiterate it. If you want to try out these recipes, you can find the link to them right here in the episode show notes. We'll have them at facebook.com/whocaresmenshealth.

If you want to post your comments there, post pictures of you cooking or the final product, or whatever it is that you thought, or if you have a request for a type of recipe, get us any of that information at facebook.com/whocaresmenshealth.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: "Who Cares About Men's Health?" And we just wanted to kind of give you one final gift of 2020 because that's the kind of giving guys we are. I mean, I know Troy's a lot more giving than I am generally. And Troy, this was his idea really.

Troy: This was my gift to all of our listeners. You know, Scot, we wrapped it up last week, but we said we can't end 2020 like that. We've got to have one final thing we say here. So we're giving you this.

Scot: All right. So before we get to our final thing here, this is going to be just a short "Who Cares About Men's Health?" We wanted to let you know some of the episodes coming up next season that we're pretty excited about. We've got some familiar faces back on. Thunder Jalili is going to talk about obesity and why is that a big deal when it comes to your health, and you might be surprised . . .

Troy: Great way to ring in the new year.

Scot: Yes.

Troy: Because I'll feel guilty on January 3rd or whenever it's going to air.

Scot: We're also going to bring back John Smith, he's our urologist, with another episode of ask a urologist. One of Troy's acquaintances is going to come on, tell us about, [Roshago 00:00:58].

Troy: Yeah, Roshago is someone I've known for over a year now. And he is a bodybuilder, not a professional bodybuilder, but just below a professional level, fascinating guy in terms of what he goes through for these bodybuilding competitions. Like talking to him, I hear him talk about body fat and how low he goes and what that does to him, how he diets for this, his whole process. Really, it's going to be fun to hear from him and his experience and then how that translates to the average guy. You know, like Scot, you know, a completely different world, but how do we incorporate some of what he does to try and, you know, put on a little more muscle mass and take off some of that fat.

Scot: And then also our very first episode back will be on a topic called cognitive load, which is fascinating and how COVID-19 and the pandemic has maybe impacted your ability to concentrate and even solve difficult problems. And there's actually a psychological explanation for that, which we'll talk about and we'll have some tips on how to overcome that as you head into 2021. But here is your Christmas present, if you will, your gift, your final gift, whatever holiday you celebrate, this is our little thing that we are giving to you. Our final, just going to leave this here. I'm just going to leave this here. So I wanted to let you know, Troy, that I have started puzzling. I've started doing a puzzle.

I know I'm a little late to this party. I know that this is so beginning of the pandemic, you do puzzles.

Troy: Yeah.

Scot: But my wife got a puzzle for me of Bryce Canyon for my birthday, 500 piece puzzle. I finally dumped it out on our big table, and I've really enjoyed it. You know, we talk about finding those things that can kind of take our minds off of what's going on or distract us or use a different part of our brain, and puzzling really is kind of filling that for me. So what I've enjoyed about it is getting intimately kind of familiar with an image and just knowing every little, small detail. It forces you to look at these little, small details you may have overlooked before. And then you look at all the pieces on the table, so you're looking at the cover, right, and you get the overall image. And then you look into the pieces on the table and then starting to recognize those patterns, those little intimate details that you might not have noticed before. And just the kind of even searching for the different pieces that go there. I've really started to enjoy that, and I find myself in a Zen state. I was up till midnight last night because I lost track of time.

Troy: Wow.

Scot: Putting together this puzzle. And, you know, so anyway, I just was really excited to share that that is something that I found has really kind of helped distract me. It's kind of like that hobby that we talk about. So it's not all on exercises back to, you know, reduce that stress and that sort of thing. You're laughing, what do you got?

Troy: But I can't help it, Scot. You're talking about puzzling. My only association with puzzling is Christmas Eve at my in-law's house, and every year, my mother-in-law has this gigantic, super-involved Christmas puzzle. And she wants us all to get involved and do it. And I do as much as I can. And usually, the other family members who are there find some excuse to get away from there. And so one year it seemed like it was just me and her doing this puzzle all evening. And I was just like, "Please, please make it stop." Nothing against my mother-in-law, but it was just trying to find these pieces. What you were finding to be a Zen-like experience, I think with my difficulty with concentrating for a long period of time, I really struggled with, so maybe I need to do more puzzling, but I'm glad you found that satisfaction.

Scot: Well, and I think the context . . . Yeah. The context for you isn't that great either because that's not what you're looking to do over your holiday.

Troy: It is really not.

Scot: Like, for me, it's like I go down to have my lunch and instead of taking my electronic device and just scrolling, I'll eat my lunch and I'll just kind of look at the pieces and look at the picture and, you know, I might find two or three pieces that help me with it and that's fine. I'm not breaking any records solving this thing, but, you know, it's something different other than, you know, mindlessly scrolling.

Troy: No, it's good. It sounds more productive than sitting down and watching "The Office" for the 40th time on Netflix, which is usually how I spend my evenings. So, yeah, definitely, a better activity than that.

So, Scot, I'm just going to leave this here. I now have gotten the COVID vaccine and I got it last week. As you probably know, it came to the U.S., rolled out last week. The first person to get it was in New York City. I think it was a MICU nurse in New York on Monday. And then I think you were involved in the news conference at the university on Tuesday where our first person in Utah to get it was also an ICU nurse at the University of Utah, and then I was fortunate enough to get it later that day.

So they told me I was one of the first 50 people. It was just dumb luck. I was leaving my shift in the respiratory unit after taking care of COVID patients all day, very sick patients, and one of our nursing administrators said, "Hey, do you want to get your COVID vaccine right now?" And I said, "Absolutely." I went upstairs up to the medical intensive care unit. We had several other frontline healthcare workers there from the MICU, from the emergency department, some from the trauma service, and I got the vaccine.

And it was a really cool experience. It was like a very bonding experience with everyone there. Like people were all getting pictures of each other and pictures of themselves doing this, probably all sorts of HIPAA violations with that, but we didn't care. You know, it's like, "Hey, this is amazing." And I had a lot of emotions. I think, like, I didn't think a ton about it at the time, but afterwards I got home and went for a run and kind of thought about it and, you know, kind of had a few different emotions. I mean, one was a very deep sense of gratitude that I was able to get this. And, you know, just kind of this feeling like, "Hey, here's the light." This is the light at the end of this very dark tunnel that we've been traveling through, and this is how we get out of it.

And I felt so grateful that I could get that vaccine, and I also felt a little bit of guilt. I mean, I got to be honest. It's almost kind of that survivor guilt. I kind of thought about people I've cared for over the last nine months who haven't made it and how I wish they had that vaccine and they could have prevented this and they could have gotten through this and guilt too that I was getting this when I know so many other people both in my life and then patients I know, and other people who I would rather have this than I have it. You know, I'd rather that they get it before I get it. So a little bit of guilt too.

So kind of an interesting range of emotions there. But my biggest feeling was I am so grateful to have this. You know, I guess it's kind of like feeling like you're on a ship that's wrecked and you're the first one ashore and you want to get everyone else to shore. And my thought was I want everyone else to have this right now. I want it right now for everyone. I know that is not logistically possible, but it was kind of like that opening of the door to say this vaccine is here. We're rolling it out. People are getting it. And I'm so grateful to have this. And I want as many people to have this as soon as possible.

So what I can tell you, in terms of reaction, the shot, the vaccine did not hurt going in. It's sore. You know, it was sore afterward, just an ache for a day or two after in my left deltoid, on my left shoulder where I got the injection. Maybe a little bit more of an ache than a flu shot, kind of like a tetanus shot if you remember how you feel with the tetanus shot. But otherwise, I felt fine. You know, everything's good. I've been running consistently since then. Everything's been great. So I would absolutely encourage you whenever you have the opportunity to get the vaccine, when that opportunity comes to get it.

Scot: I'm excited for you. That makes me feel better. I know that you've got, you know, all the safety precautions in place in the ER, and you're very diligent about that, but this is just that added level of protection and security. Now, does this mean that you can go after your immunity builds in two weeks, you can go visit your parents again because you won't be carrying it or no?

Troy: It's tough. The guidance that we have received and that others have received and given as well is to continue to practice everything you had practiced prior to getting the vaccine, which means I'm going to be wearing the same PPE at work, you know, the same mask, the same PAPR helmet, all that kind of stuff I'm wearing. The reality is still I need a booster in 21 days. From what I understand, two weeks after I got the injection, I should have built up maybe to 50% to 80% in terms of that immune response, and then that booster at 21 days gets you up to the full response. So we're really . . .

Scot: Which is like 95%?

Troy: Yeah. I mean, 95% reduction in risk, 100% in terms of just the response you'll receive from it, but a 95% reduction in terms of risk of catching the virus. But you can still catch it. That's a little of the challenge. You can still catch it, but it reduces that risk significantly. I mean, the efficacy of this vaccine is mind-blowing for me. Like this is better than anything I think any of us ever hoped for. So, hopefully, that plays out in the long term. Again, I don't know what the implications are for family, but I've been visiting my parents, meaning that I'll go down and see them, we'll hang out outside, you know, social distance, that kind of stuff. So when I do them, that's how we do things, and I don't think that's going to change anytime soon.

Scot: Time to say the things that you say at the end of podcast, because we are at the end of our podcast. All right. So if you want to reach out . . . wow, this is the last podcast episode of the year, Troy.

Troy: Wow, this is it. Yeah.

Scot: We're heading into 2021 after this one. All right. So if you want to reach out, you can do that, we've got a lot of ways. You can email us at hello@thescoperadio.com, you can go to facebook.com/WhoCaresMensHealth, or you can go to the website whocaresmenshealth.com.

Troy: We also have our listener line, it is 601-55SCOPE. We'd love to hear from you. Subscribe anywhere you get your podcasts, Apple, Google Play, Spotify. Please rate us five stars if you like us. Thanks for listening. And thanks for caring about men's health.

Scot: Have a good holiday, my friend.

Troy: You too, Scot.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Here we go. Did I maintain? Troy, are you still there?

Troy: I'm here.

Scot: Dr. John Smith, you there?

Dr. Smith: I am here.

Scot: Did you hear John, Troy?

Troy: What?

Scot: Did you hear John, Troy?

Troy: Yes.

Scot: Troy, did you hear John? John, did you hear Troy?

Dr. Smith: I hear everything.

Troy: I think we're good, Scot.

Scot: Okay. Here we go. The podcast is called "Who Cares About Men's Health," providing information, inspiration, and motivation to understand and engage in your health so you feel better today and in the future. My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Smith: And I'm Dr. John Smith, a non-surgical urologist at the University of Utah, and I care about men's health.

Scot: Second time we've had Dr. Smith on the show. The first time, Troy, it took a little warming up to Dr. Smith, but finally at the end of the episode, gave him some applause. So we've become fast friends. It's great to have you back on the show, Dr. Smith. Sure do appreciate you coming on and talking about some urology, urological sort of issues.

Dr. Smith: Thanks for having me back.

Scot: Quick question before we get to the topic, and today we're going to talk about erectile dysfunction because Dr. Smith was telling me that that's a reason, one of the reasons, one of the big things that he sees on a daily basis is guys coming in with some sort of an issue. So we're going to talk about that. We're going to give you the real information. So it's not like you're getting it from the friends on the playground. That's the internet, by the way, in case you're not catching my reference there. You're going to get it actually from the doctor's mouth. So that's going to be awesome.

Troy, I have a question for you. So at one point, you talked about how in the ER, you call urologists sometimes to do some procedures.

Troy: We do.

Scot: What are some of the reasons that you have urologists come to the ER? One time you said that if you're having difficulty inserting a catheter, you might have to have a urologist come and then do that for you. What other reasons?

Troy: Sometimes we call them for kidney stones. That's probably one of the more common reasons. If it's a very large stone that's just likely not going to pass on its own or an infected stone where the patient has a big kidney stone, or even a smaller kidney stone and a bladder infection, kidney infection, along with it. We do call them for trauma-related injuries, whether that's a tear of the urethra or sometimes even a penile fracture. Scot, you may hear that and say, "Wait, is there a bone in the penis that gets fractured?"

Scot: There's not.

Troy: Was that your thought?

Scot: I mean, I know there's not though. I mean, sixth grade Scot would have thought that.

Troy: Sixth grade Scot.

Dr. Smith: Seventh grade Scot knew better.

Troy: He wised up quickly.

Scot: He did.

Troy: It's referred to as a penile fracture. It's a tear in . . . John can describe it in more detail, but a tear in the . . .

Scot: Or not.

Troy: It's an incredibly painful thing. I will say that. Having seen men with penile fractures, it looks incredibly painful. So we will call them for that as well.

I will say along the lines of erectile dysfunction, I was working a night shift once and a man came in at 6 a.m. and he said, "My woman said, 'You leave the house and you go to the ER and you don't come back until you get that fixed.'" We did not call urology for that. We didn't do that to them. But I have seen "erectile dysfunction" emergencies, at least in the mind of the individual in the ER, as well. So again, I did not call urology and push that on them, but it would have been funny.

Scot: Dr. Smith, you would actually handle some of that stuff though, even though you don't necessarily go into the ER. But don't they use . . . for kidney stones, don't they use sound waves now for a lot of that sort of thing?

Dr. Smith: So they can. There are multiple different ways to treat kidney stones. We could probably do a show on that, but . . .

Scot: Well, let's do that.

Dr. Smith: Fair enough. I'll come back.

Scot: Not right now, but yeah, someday. We've got more pressing topics to get to.

Dr. Smith: That's fair. But yeah, there is something called a lithotripsy. and they use a machine where they put a little bag of . . . it feels like a bag of water, like a gel bag, against your back and they find the stone with an X-ray and then they send shockwaves in to break it up.

Scot: Wow. That's pretty cool. Technology is awesome. So let's talk about erectile dysfunction, one of the main reasons guys come and see you. Just want to break it on down. So help us kind of understand what's going on, what you as a urologist do to help men solve their problem, and I think, in general, makes men that are struggling with this feel that it's okay because it is okay.

Dr. Smith: It is okay.

Scot: Yeah, so where should we even start this conversation? I'm not good with sensitive conversations.

Dr. Smith: You just start by digging in. There's no way to just waltz around this thing and hope that it comes to you. I would say a lot of men come in with erectile dysfunction. It can be a . . . well, there are multiple different reasons, but overall erectile dysfunction, the definition of it is the inability to achieve or maintain an erection that's adequate for sexual function.

And so it's estimated that about 18 million men in the United States have erectile dysfunction. So guys, you're not alone. That's a pretty sizable number. Some of them seek treatment, some don't. This condition can affect people in a lot of different ways in their relationships. So it's one of those things where you might as well come in and have a conversation.

Scot: So it's not just about erectile dysfunction. It can cause psychological issues. Are there other health issues that men should be aware of?

Dr. Smith: Sure. So it can be a harbinger of cardiovascular problems, other things like that. Folks with longstanding diabetes often have erectile issues. There are multiple health problems that can cause or precipitate erectile dysfunction. And so those are good reasons to come in as well.

Scot: So my ability to not get or maintain an erection is not because I've become less of a man. It could actually be a medical symptom to a bigger problem, or it could just be mental. What are some of the other causes?

Dr. Smith: Absolutely. So it could be psychogenic, which means that . . . guys like to think if it doesn't work once, it's never going to work again. And so that brings in some gentlemen. Again, diabetes can be a problem, people with known vascular problems, people who've had prostate cancer and had surgery or radiation oftentimes have a decreased quality of erections.

And then sometimes we don't know. We call it idiopathic. There's not a reason for you to have erectile dysfunction but you do. It's not necessarily an age thing, but as men age, generally, the quality of their erection declines some.

But those are kind of the things that we kind of overview with folks when they come in to have a chitchat.

Troy: John, it sounds like there are a lot of different things that maybe could cause it. But how do you really determine if someone has erectile dysfunction? What do you use just to say, "Yeah, it sounds like this is definitely an erectile dysfunction," versus, "Maybe you don't have a problem"?

Dr. Smith: So, generally, I ask a few questions. "Do you have a decreased ability to attain or maintain an erection?" Oftentimes, it's not one or the other. It's both for folks. I ask them how rigid their erection is compared to an erection that they had when they were having quality erections. And one of the big ones for most people is, "Is it adequate for sexual function?" And so if it's not, that's a good indication that it's erectile dysfunction. That's true erectile dysfunction.

Scot: And when a guy comes in and you ask him the questions, how often is the next word out of his mouth or the first word actually when he even walks into your office, "Yeah, I have a problem and I need some pills"? I mean, is that kind of the first thing that you get asked?

Dr. Smith: Not always. Some men come in and that's kind of what they want, and in a way, that's not a bad way to look at it because the pills generally work for all comers of erectile dysfunction. It doesn't matter why you have it. Seventy percent to 80% of patients with erectile dysfunction are treated adequately with medication. So again, that's not a bad way to go, but it does warrant a little bit of investigation at times.

Scot: So there are two different types, it sounds like, getting and maintaining, and then maybe even a third, having the quality of an erection that is adequate enough for sex. You give the man the pills, and then you send him on his way. Is that that, or are there other potential treatments that you might have to look at?

Dr. Smith: If you're going to come to me, I'll generally do a workup for you. The American Urologic Association has guidelines that they put out for everything, and I tend to try to follow those guidelines. One of them is to make sure that there's not a hormonal issue. I'll check a hypogonadism panel, make sure that everything's working as far as testosterone, hormones, things like that.

If I feel like after getting a history from you that there's maybe a cardiac issue, or you're a diabetic that may struggle with controlling your diabetes, I may refer you back to other folks before we get you started on medications, things like that.

But generally, looking at all those reasons, it's not just as simple as saying, "Here are some pills. Go and let me know how it works out." But in certain cases where we do the workup and we don't really find a reason and they do well with pills, it's not a bad way to treat them as long as we work it up and look at it the right way.

Troy: Speaking of pills, John, and the workup you mentioned, I'm sure we've all seen the ads on TV. You're seeing them more and more now, especially if you watch sports, for some of these online things where you basically, it sounds like, probably chat online with someone and then get medication for erectile dysfunction. What's your thought on that? Is that a reasonable route to go for someone who's maybe embarrassed to go into see a physician or any insight into that?

Dr. Smith: I think those companies have a place. One of the companies, I think one of the guys that started it actually had a cardiac issue and that's why he had erectile dysfunction. So they kind of mention that in some of their advertising where it makes sense to maybe talk to your primary doctor as well.

The big thing for me is making sure that people are taken care of the right way. If you were my dad or my brother, how would I want you treated? And I think that sometimes those guys may miss some steps. I've never used them to know a 100%, but I think looking at everything as a whole and making sure that there's not some underlying problem is important.

However, if it's impacting your relationship or there are different reasons, I could see a reason why you would utilize those services. No question.

Scot: You said the pills take care of a majority of men's problems. In the instance that pills don't work, what do you start looking at, at that point?

Dr. Smith: So in general, the algorithm that I use is if oral medication isn't effective, I'll generally refer you to have an ultrasound done, a penile Doppler ultrasound where I'll look for a possible cause of your erectile dysfunction at that point.

And the reason that I don't do that first is it requires us . . . we usually do it with a medication called Trimix, which is three medications that will produce an artificial erection. And most men aren't jumping to get a needle put into their penis. Granted it's a small needle, it's like a diabetic needle that you would use, but most men aren't interested in trying that first.

So I'll generally look at that next and see if I can come up with the actual reason that they may have an issue, and see if there's a blood flow problem and different things like that. And then after that, the options that we have for treatment are, again, if that medication works well to give an artificial erection, you can continue to use that. And then there are other surgical options that are out there as well.

Troy: John, I guess getting back at treatment, obviously medication, injections, surgical options, what if someone comes to you and just says, "Hey, I just don't like taking medications. Is there anything else I can do?" Is there anything you recommend in that situation, or do you just say, "Probably want to try some pills first"?

Dr. Smith: So there are always things you can do. Diet and exercise has been shown to be effective in helping mild erectile dysfunction, to improve the quality of an erection. It's not as effective as medication, as the Viagra/Cialis/Levitra medications, but it has been shown to provide some benefit to improving the quality of erection.

And I think the whole purpose of this podcast is "Who Cares About Men's Health" and you guys often speak about taking care of yourself. And I think if we're all smart about that and we take care of ourselves and take care of our diet, different things like that, make sure that we're healthy, it does improve the quality of your sexual function.

Scot: Does the pill also help in the instances of maintaining or can that be other things?

Dr. Smith: Absolutely. So for some folks who have difficulty maintaining, sometimes a constriction band . . . the layman's term that everyone uses is a cock ring. You can utilize that to help maintain an erection if you have a venous leak where more outflow of blood is coming out of the penis than the inflow can support. And that can be very effective for men with that issue. I would say that's a lower percentage of the patients that you see with erectile dysfunction, but when it works, it works really well for folks.

Troy: Too many stories from the ER with the cock ring, too many. We won't go there. Like things gone wrong, but we won't go there.

Dr. Smith: I'll give you a two-second story that you can edit out.

Troy: Or not.

Dr. Smith: We took a family vacation when I was in residency, out to Hersheypark. I was in New York, so it was a close drive. And we stayed in a hotel, went to Hersheypark the next day. We were going for two days, which if you ever go, don't go for two days. You only need one.

Troy: Been there.

Dr. Smith: But I wake up in the morning, we're getting ready to go to the park, and my kid comes over and she goes, "Dad, look at this ring I found in the drawer." And it's this silicone, spiky little ring. And my wife's jaw just drops. I look over and I go, "Drop it and go wash your hands immediately, child."

Troy: Our department chair in residency was doing teaching rounds. And they had a patient whose complaint was he had a cock ring on, he couldn't get it off, and the department chair did not know what a cock ring was. All the residents there were just totally silent, did not say a word to try and tell him, "This is what it is." He says, "So we'll just look this up," and goes over to the computer and types in and all these images just start coming up. And it's like, "Oh, okay. Let's shut this down." Anyway, yeah, we've seen some crazy things.

Scot: I feel a little left out. I'm the only one without a story.

Troy: Scot, you can make one up. You could just tell one.

Scot: I haven't lived apparently because I don't have a story to share. Both of you sound like you've got even more of them and I have none.

Troy: Unfortunately, yes. But we won't go there.

Scot: Troy, actually I do want to ask you, do you have any advice if somebody is using one, based on what you've seen in the ER, that you want to avoid?

Troy: My advice . . .

Scot: Are we going to get into some argument here with Dr. Smith about you don't think they're safe and he says they are?

Troy: I don't think Dr. Smith will argue with this. My one piece of advice is if you use a cock ring, don't leave it on for three days. It's a bad idea.

Dr. Smith: That's a fact.

Troy: It's a bad idea. I think we're all on the same page there.

Dr. Smith: A hundred percent. Follow the directions.

Scot: Oh, they come with directions?

Troy: Read the directions.

Dr. Smith: Well, they should come with directions. If they don't, you should probably get one that does.

Scot: Have we covered the topic well enough? I mean, I don't know for sure. It seems like we've covered the important points that somebody might have. Did we leave anything out, Dr. Smith?

Dr. Smith: I talk about this all day, every day, so there's always plenty more to talk about, but I think that gets the ball rolling. If you haven't seen a urologist by that point, you probably should.

Scot: Sounds good. And if you have further specific questions, of course, you can reach out to us here at the "Who Cares About Men's Health" podcast. A lot of different ways to do it, which we will put in the links to the show notes, including hello@thescoperadio.com. You can call our scope line 601-55SCOPE. You can do Facebook direct messages, and you can use the name John Smith and just asking for a friend if you feel a little shy about the whole thing.

You know what? I'm proud of us. We really more or less got through this without making a lot of jokes. We've kept the jokes to a minimum, so that's good. Or is that bad? It could be bad.

Dr. Smith: I mean, it depends on the viewership, what they think. If they wanted more jokes, they should probably ask for them.

Scot: Do you find when a man comes in to talk to you about erectile dysfunction that they tend to have a little bit of a different personality? Do they tend to deal with it by joking a lot more than you think they might normally in real life? I mean, what's the demeanor of your average patient?

Dr. Smith: Average patient I would say comes in a little bit gun-shy. Most of them don't want to come in and talk about it, especially the older generation of men that I see in the office. The ones that are just "throw caution to the wind" don't care are generally the guys who've had prostate cancer, where they were told before they had their treatment that this is likely going to cause erectile dysfunction. So they come in and they're like, "Hey, I just had surgery. I have erectile dysfunction. What are you going to do?"

Scot: And it makes sense, because they've got a medical reason now. Getting back to this whole stigma about "Are you less of a man if you can't get it up?" and those sorts of things, there's not a stigma there anymore, right?

Dr. Smith: Right.

Scot: There was a medical procedure that was done beyond their control that caused this to happen.

Dr. Smith: Right. They've already been through a wild roller coaster of being diagnosed with cancer and the unknown there. And so a lot of times they're coming in and they're just like, "Hey, is there anything we can do? I hope so." But they're very happy to kind of be through that mental roller coaster.

Troy: John, along those lines, you mentioned our listenership. A large number of our listeners are women. How often do you have where people are coming in with their significant other, or they say they've been encouraged to come in? Is that something you see often?

Dr. Smith: Prior to the pandemic, yes. A lot of couples would come in together. And oftentimes, the spouse/partner is very supportive of the individual coming in because that intimacy is an important part of their relationship that they've kind of lost and they want it back. And so I did see quite a bit of that.

Now, with the visitor policies and things being different after the pandemic, I've even had a couple of patients say, "Hey, can we FaceTime or can we WhatsApp or whatever with my partner so that we can have this conversation together?" so they're all on the same page, which is great.

Scot: Dr. Smith, as we wrap this up, just kind of give us your final thought. I think you've given the men that listen to this show that might be suffering from this problem hopefully some good information to go seek help and know what to expect. But any kind of final thoughts on this for a guy that's on the fence?

Dr. Smith: There's just no reason to feel bad in any way about it. This is a normal thing. Like I said earlier, 18 million men in the United States have this issue, so you're one of a big group. And there's no reason to wait to feel better and improve your relationships and your confidence in that area.

Scot: Fine work. Thank you so much for being on the podcast, Dr. Smith, and thank you for caring about men's health.

Time for "Odds and Ends" on "Who Cares About Men's Health." We just have one item, and that is in reference to last week's episode about kettlebells. Possibly something you might want to do. A lot of people, their gyms are closed, or you don't want to go to the gym. That was certainly the situation I found myself in. I also used to do just traditional weight training, and I wanted to see if I can get more of a full body, natural movement sort of exercise routine going. So I wanted to do kettlebells, and Caleb helped get me started.

Troy, I'm happy to report that those kettlebells that I bought in that parking lot at the Walgreens in Bountiful, Utah, looked like some sort of a drug deal going down, but no, it was for kettlebells. I have started sniffing around them kind of like a dog sniffs around stuff. So I have started using them. I've started implementing some of the swings and the squats and the deadlifts that Caleb recommended.

And I'll tell you, I really like them. Now, I'm moving really slowly because it's a different type of exercise than I've done before. So I'm watching how heavy of a weight I'm using. I'm also just really not trying to do too many reps.

I've got a really light one up in my office. So I take little breaks while I'm working. I stand up, because you can sit for so long, and I'll do some exercises with that little light, 10-pound one. I've got an 18-pound one in the office. And then the big boys, those are out in the garage and I go outside and I do the swings and the cleans . . .

Troy: Your 35-pounders?

Scot: Yeah, and my full pood as they call it in Kettlebells. The 35 pounds is called a pood.

Troy: That's when you swing the pood in the garage.

Scot: Well, I do it out in the backyard. But I am really enjoying it, and I just wanted to update you that I'm really digging kettlebells. So if you haven't been doing some sort of strength training routine, and they say you should do 30 minutes at least three times a week of strength training, go back and listen to the last episode about kettlebells. Get some do's and don'ts, get a basic little routine, and check out that episode.

Troy: Well, I have not bought my kettlebells yet, but it was very convincing. I'm thinking about it. Like you said, supply and demand right now. Supply is not in our favor. Demand is definitely high. So it's a challenge getting kettlebells right now, but I would like to try them out.

Scot: I highly recommend it.

Troy: I would sing it, but I . . .

Scot: Na-na-na-na-na-na-na-na.

Troy: Thunder!

Scot: Troy, do the honors of singing, "You've been Thunder debunked!"

Troy: I can't do that, Scot. Come on.

Scot: Thunder debunked!

Troy: I kind of have to maintain some sense of dignity.

Scot: Thunder debunked!

Troy: I'm sorry. I can't. I think you already did it.

Scot: Eat this. Don't eat that. It can be really confusing out there when it comes to nutrition, and there's a lot of stuff on the internet. Is it true or is it false? Well, we're going to try to find out again with Thunder Jalili. He's our nutrition expert here on the "Who Cares About Men's Health" podcast. And this is a segment we call "Truth or Thunder Debunked?" So I'm going to give Thunder a statement here and I want him to tell us if it's truth or if he is going to Thunder Debunk it.

Frozen fruits and vegetables are less nutritious than fresh ones. Truth or Thunder Debunked?

Dr. Jalili: I'm going to have to go with Thunder Debunked on that one.

Troy: That surprises me.

Dr. Jalili: Depending on the context, it could be somewhat similar. Let me just give you a really quick background. So if we think about fresh fruits and vegetables that you buy in your grocery store, you've got to remember that product is not as fresh as you think. It was probably picked days or weeks before it found its way to the grocery store, and it was probably picked before it was ripe and it ripened during transit and delivery. So that means you're probably not getting the optimal nutrients in that in the first place.

Now, frozen fruits and vegetables, they're picked when they're actually ripe and then they're subjected to the freezing process. And so they may have a little better nutrient content. But of course, the process of freezing them and blanching them, that may degrade some of the nutrients.

So at the end of the day, when you look at both, they're about the same.

Now, the one exception for fresh is if you have a farmer's market close to you and you go there to buy fruits and vegetables, chances are you're buying something that was just picked in the last couple of days. In that case, that is the most nutritious version of the fruit or vegetable you can get because a ripe fruit has the peak nutrient content. And those were picked when they were ripe before they came to the farmer's market.

Scot: So the statement as it stands, frozen fruits and vegetables are less nutritious than fresh ones, again, Thunder Modified.

Troy: Thunder Modified. It sounds like if you've got the fruit tree in your backyard and you're picking it off the fruit tree and eating it, that's the best you can get. But otherwise . . .

Dr. Jalili: That's the best you can get. Or farmer's market. You've got to make a pitch for farmer's markets, especially when stuff is in season. That's really the highest quality produce you're going to find anywhere.

Scot: Fascinating, though, that frozen fruits and vegetables and fresh ones that you perhaps might get at the grocery store because they were picked and ripened on transit are essentially equal though.

Thunder, as always, thank you very much. We appreciate your participation on the "Who Cares About Men's Health" podcast with "Truth or Thunder Debunked?"

Time for "Just Going To Leave This Here" on "Who Cares About Men's Health." Could be something to do with health, might be something random. I'm going to start.

Just going to leave this here. I am going to encourage you, Troy and our listeners, to unleash your inner puppy. I want you to unleash your inner puppy.

So we have a brand-new puppy. His name is Murphy. I say puppy. He's in the body of an adult dog at this point. He's six months old. You look at him and it's hard to remember this is still a puppy. He behaves like an adult dog, but every once in a while you see the puppy in him. And the moment you see the puppy in him is like when we're outside and he will find a leaf and pick it up and throw it around and chase it and bite it and try to keep it away from you.

There are other little moments where he does puppy things, and that made me think back to times that we've talked about that for your own sanity and mental health, you should play.

And whether that's a hobby that you get into that flow state because you enjoy it so much, whether that's a sport that you like to play either by yourself or with other individuals, I think we forget to play. And we forget the benefits of playing on our mental health and our emotional health.

I've talked to psychiatrists who say that this can actually recharge you. We always talk about taking days off or vacations to recharge you, but it's also about what you do. So I'm encouraging you to release that inner puppy because it can help you unwind and be ready to take on what's going to happen the next day or the next week.

I can speak from personal experience that I find myself recharged after doing that. And maybe if you have kids, maybe that just means when you play with them, just get totally lost in it. Just get totally lost as a kid in it. And it can be hard because our adult brains kick in and we go, "Oh, I'm being silly. I'm being stupid." But just try it. Unleash your inner puppy.

Troy: Great advice. Well, since you have a new puppy, Scot, I'm going to share my puppy advice with you. We have Charlotte who you know. She's a pretty young dog. We guess she was probably maybe eight or nine months old when we got her. She had puppies herself, but we joked that she was like a teenage mom. She wanted nothing to do with her puppies. She'd feed them and then she would come up and play. She was a very young dog.

And Charlotte had a habit, and still has a habit, of eating our remote control for our TV. So what I do now is I keep a spare remote. The original remote I was trying to buy . . . I bought this stupid magic remote a couple of times that cost $50 after she ate it. And then I just said, "Forget it," and found some cheap $8 remote on Amazon.

So each time she eats the remote, I buy a new remote, and I then have a spare remote for when she eats the next remote. So then it takes us a week to get the next remote.

The good news is, I just looked, we've gone through three months now without her eating a remote. So I hope your puppy does not eat your remotes, but if you do, I can share my advice on stocking on remotes and making sure you have a steady supply so you can continue to watch your TV with your puppy.

Scot: Our dog does have a little bit of a chewing thing, but we've kept just chew toys around, and so far that has satiated his need to chew. So we'll see.

Troy: Good. That's great.

Scot: We'll see. But good advice on the remote.

Time to say the things that you say at the end of podcasts, because we are at the end of our podcast. Troy, kick it off with the how you can hear us. Of course, that's kind of redundant because somebody is hearing us right now. They already know.

Troy: Well, you can subscribe. Please subscribe anywhere you get your podcasts, whether it's Google Play, iTunes, Spotify, Stitcher, Pocket Casts. I'm going to mention Pocket Casts, Scot, because you don't like them but my sister uses Pocket Casts.

Scot: So does Producer Mitch.

Troy: So does Producer Mitch.

Scot: They're like the four people that . . . or two people. They're two of the four.

Troy: Two of the four who are still using . . . they probably still have Hotmail accounts as well. Actually, Hotmail doesn't even exist anymore I found out.

Scot: AOL accounts, they probably have.

Troy: Yeah, they have AOL accounts.

Scot: All right. And also then if you want to get in contact with us, there's a couple of ways to do that. And that entails if you have a question you want to ask about a health topic, a suggestion, anything of that nature, hello@thescoperadio.com. That's the email. The Facebook page is facebook.com/WhoCaresMensHealth. And there's also a phone number you can leave a recorded message, and that's 601-55SCOPE. That's 601-55SCOPE. Whatever you're comfortable with, we would love it if you'd reach out and say hi.

Thanks for listening and thanks for caring about men's health.