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Scot: We had a whole episode about Scot's fatness, and this is an update to the fatness because I decided to take a different route to losing the weight than I had in the past.

So we had Thunder Jalili on, and in order to lose the 15 pounds, I normally would put myself in a calorie deficit. I would figure out what my base metabolic rate is. And this gets a little complicated, but your base metabolic rate is basically the amount of calories your body would burn just to survive. And you eat less than that, and you do some exercising, and that puts you in a deficit, which then would encourage your body theoretically to burn fat.

Thunder told me not to do that, which was totally different. So this is a little update on what's going on.

You're listening to "Who Cares About Men's Health," providing inspiration, information, and a different interpretation on men and men's health. We've got a good crew here today. It's the core crew, as I like to call it. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm part of the core, and I'm proud of it.

Scot: All right. My name is Scot Singpiel, and we've got producer Mitch over here. He brings the microphones and so much more.

Mitch: So much more. Hoo-gah.

Scot: Mitch just got promoted.

Mitch: I know.

Scot: Mitch got a promotion.

Mitch: Love it. Yeah. Core, I'm in the core.

Troy: You're in the core.

Scot: Thunder encouraged me to just stop eating the stuff that got me there, which was Reese's peanut butter cups and probably drinking too much beer, to go back to time-restricted eating, which is this concept that you stop eating for a prolonged period of time. It could be 10, 12 hours, whatever. So you might stop eating at 6:00 at night, not eat until 6:00 the next morning. And get some activity. And remember that I had a fun time and it took me a while to get to where I was, and it might take me a little while to get back.

So I've got a little update. I'm down five pounds. Yeah, I've gotten rid of 5 of the 15.

Troy: That's pretty good.

Scot: Yeah. I mean, I don't know. We'll see if this continues. The win for me was I went on a weeklong vacation and I just didn't eat sweets.

Troy: Wow.

Scot: But you can't necessarily control what you eat as well when you're on vacation. And when I came back, I was at the same spot. So that makes me happy.

Troy: Oh, so that was the win. Okay. I was going to say, "You lost weight on vacation?" But you're just saying you were able to maintain.

Scot: I was able to maintain. I didn't think about it too much and I didn't probably have as much activity as I would.

Mitch: Did you road trip?

Scot: Yeah.

Mitch: Do you not get fun snacks every time you fill up the gas?

Scot: Normally, yes. This trip, no.

Mitch: Okay. Not this time? No?

Scot: No.

Mitch: All right.

Troy: It doesn't sound like a fun road trip.

Scot: No. The snacks . . .

Mitch: That's what I was about to say. That's a part of it.

Scot: Yeah. Well, we did have snacks. I mean, it was Triscuits and cheese, and it was trail mix, but not with chocolate in it. So it was a lot of nuts and some dried fruit. So kind of healthier stuff, I guess.

Mitch: Sure.

Scot: Yeah, Mitch does not look enthusiastic.

Mitch: No. I'm about to go on a road trip myself and highlight, day one, going and filling the tires, topping off at the gas station, and getting a big old sack . . .

Scot: That's right.

Mitch: . . . of every bit of junk food.

Scot: I mean, I guess . . .

Mitch: Maybe I won't do it this time.

Scot: No. I think every once in a while, you might be able to do that, right? I mean, if you're in a position. It just kind of worked out for me that way.

Mitch: Okay. That's good.

Scot: So anyway, down five pounds. I've been doing some reading and I'm a little scared, because I'm afraid that five pounds is just kind of those five easy pounds, right? Like, just maybe some water weight, some salt weight. I don't know.

So I started doing some reading because I was interested in this base metabolic rate and the different exercise levels. So you've got your base metabolic, which is your body. If you just sat around, did nothing, this is how many calories your body needs to function.

And then you've got some of these other levels, right? You've got sedentary. Sedentary, that's how you pronounce it. What is sedentary, do you think? And that bumps you up a couple. You get to eat a couple hundred more calories if you're sedentary. What do you think that is?

Troy: I mean, you're a couch potato. Those are couch potato calories. Those are like just lifting your arm to use the remote and turn on the TV and reach for your soda. Those are your sedentary.

Scot: This is, I think, where some people might run into problems. That's not the case.

Troy: Sedentary?

Scot: Sedentary, according to a couple places I looked, includes activities of daily living. So doing the kinds of things like going out and raking, vacuuming, and even they included walking the dog.

Troy: No. I think of sedentary as . . . Someone who's sedentary in my opinion, in medical terms, in my practice, if I describe someone as sedentary, they're not walking a dog. They're able to take care of themselves, so they're getting up, walking to the kitchen, and walking to the restroom, but they're not doing a whole lot beyond that. I don't see them as out raking leaves and walking dogs. I don't know.

Scot: Yeah. I think that's where this problem is. I think the problem could be as an individual that you're trying to figure out what your activity level is so you can go, "This is how much I should be eating." Well, I'm not sedentary because I go out and I do stuff. I clean the house. I rake leaves. I mow the lawn. In the definitions I've seen, all those things are included in sedentary. The difference is that you do not do 30 minutes of intentional exercise a day.

Troy: So that's the next step up? So to not be sedentary, you have to do 30 minutes of intentional exercise a day?

Scot: Yep, and that's called low active. And low active is daily . . .

Troy: No. Low active is 30 minutes?

Scot: Yeah. Low active is exercise equal to walking 30 minutes at four miles an hour, which burns anywhere from 135 to 165 calories for the average-weight person.

Troy: Four miles an hour is a pretty brisk walk.

Scot: That is an incredibly brisk walk. I have long legs and I can walk fast. I'm probably doing 3.7, 3.8 max. So that seemed a little weird.

Troy: That's fast. I don't know who made the scale up.

Mitch: Let me tell you. It is the FDA and the NCBI. [Crosstalk 00:06:08] this group is the front for public health. It was published back in 2018 when they decided that this is what sedentary meant.

Scot: So this is all going someplace that hopefully will be helpful to listeners and also is going to inform my thinking, and I wanted to throw this out to you guys.

So then the difference between low active to active is it's kind of the same. Your daily activities of living, except for you're doing an hour and 45 minutes of intentional exercise. So that's walking at four miles an hour.

Troy: A day?

Scot: Yeah, a day.

Mitch: A day.

Scot: And then very active is daily exercise walking four hours and 15 minutes at four miles an hour, or you could jog for two hours a day. And that burns anywhere from 1,100 to 1,400 calories.

Troy: This is an interesting scale.

Scot: It is. I mean, think about the individuals we've had on the show in the past who have struggled with losing weight, right? We're saying, "Well, if you get out and get those 30 minutes of activity, that should be pretty good." But I'm starting to kind of wonder if those 30 minutes is good for your cardiovascular health, it's good for your health in general, but if you're trying to lose some weight, you're going to have to go beyond that.

Troy: See, the problem with this scale, though, is there are just so many studies that show if you can just do 30 minutes of activity three times a week, there are very clear health benefits from it, where this scale is implying that those people are just low active, and even they're less than low active.

Scot: I'm going to say there's a differentiation. There's a fine differentiation here.

Troy: Thirty minutes?

Scot: Thirty minutes a day has health benefits for cardiovascular and those other things, but if you're trying to lose body mass, fat, you need to do more.

Troy: But do you think that's sustainable? We're talking 30 minutes of brisk walking at four miles an hour every day. For the average person, it's . . . I feel like you have to have a routine that's sustainable for you. And on the activity side, it sounds like they're recommending high activity, where I'm sure you could balance that with just some decreased caloric intake or adjustment in whatever your dietary intake is, and you're going to accomplish the same thing,

I don't know. I guess I'm trying to figure out where they're going with this, just because that activity level they're putting for active and very active is really active. And maybe I'm kind of taking it a little bit personally here, because I feel like I'm pretty active. I'm pretty active, but I'm not meeting their definition of very active.

I mean, maybe over the course of a week, if you added it all up, I would meet that definition. But over the course of a week, I get about 11 hours, 10 to 11 hours of . . . I don't want to call it jogging because I don't want to be called a jogger.

Scot: I mean, you're running.

Troy: It's running, but still it's . . . Yeah, that's really active what they're getting at there. Two hours a day of what they're describing as jogging.

Mitch: Well, again, this is just how you do your calculations. So when you look up base metabolic rates and things like that and try to get your diet clued in . . .

Scot: Yeah, and you're trying to figure out how many calories you need to sustain. But it could also be used for, "How many calories can I eat, and then what do I have to do to put myself in a bit of a calorie deficit so I can lose that weight?"

Troy: So maybe that's the flip side, just saying, "If you really want to eat this many calories, you're going to have to exercise a ton." Maybe that's what they're trying to say.

Scot: Yeah, I think so.

There was a "Time" magazine article, and I need to send this to you because they quote a lot of research. This is the next part of my thinking, because this was the next thing that I read.

So they cited many studies that exercising at a moderate level for 30 minutes, which is good for health, results according to these studies in little weight loss. So it's good for maintaining, but for losing it's not.

And then they cited some other studies. A combination of diet and exercise generated no greater weight loss than diet alone after six months. At 12 months, the diet and exercise combo showed an advantage, but it was slight, about four pounds on average.

So, in this, the conclusion that they came to based on the research . . . And there was another study. It said exercise results in weight loss when 400 to 500 calories are burned per session at least five times a week.

Troy: So I see what you're getting at here, Scot. What you're saying is if you want to lose weight, don't focus on exercise. Focus on diet. There are clear health benefits from exercise, but it's not going to accomplish the weight loss you need.

Scot: Yeah. Exercise is not going to accomplish the weight loss you need, diet and exercise. But then beyond that, you have to put in a certain amount of exercise, which they're saying is something that can burn 400 to 500 calories per session, 5 times a week, which they equated to 90 minutes of brisk walking or 30 minutes of running 8-minute miles.

Troy: Yeah.

Mitch: Geez.

Scot: I mean, 400 to 500 calories, that's a lot, right? Ninety minutes of brisk walking? Or if you get on a cardio machine and you're not pushing yourself super hard, 90 minutes, that's a lot.

Troy: It is a lot. And how many calories are in just a large soda?

Scot: Right?

Mitch: Too many.

Scot: Too many.

Troy: Yeah, you get a large soda for your road trip and right there you're at 400 calories.

Mitch: This is something that I'm really excited . . . We have a guest coming on in a couple weeks who is part of the weight management program here at The U. And she was talking a lot about in our little pre-interview . . . She was like, "Yeah, losing weight is a lot more than just diet and exercise," and I'm excited to kind of talk to her about all this.

Scot: Yeah. So, for some people, diet and exercise might work, but there are some people that it does not work. And she's going to hopefully tell us some of the things that could happen or some of the things that could be going on that could be preventing somebody from losing.

But I just feel like there's a huge disconnect in the information that I've received. And again, you know what? There are a lot of studies out there. Who knows? But if in order to get some weight loss I have to be doing 400 to 500 calories burned per session, that's a lot more than what I'm currently doing. So maybe that's where my frustration is that in the past I haven't lost weight, or where other people have frustration. So I feel like that needs to get figured out.

Troy: Yeah. I mean, again, it just seems like . . . Like you said, Mitch, maybe we'll have someone on here who talks about all the other factors besides diet and exercise. But my takeaway from this is that you can't just sweat off the calories. You've got to focus on the caloric intake if you really want to lose weight.

Scot: Yeah. You've got to focus on both.

Troy: Yeah. I mean, you've got to do both, but it's going to come down a lot to caloric intake. You can't just say, "I'm going to burn it off by going out and walking the dog," or something. It's a lot of exercise to burn off 400 to 500 calories.

Scot: Yeah. Like you said, what's an average soda have? And if you are doing 30 minutes, according to the scale, which is low active, that burns 135 to 165 calories. So a soda is probably what, 220? I'm guessing.

Mitch: It's 180 per 12 ounces.

Troy: A 12-ounce can.

Mitch: If you get a Big Gulp . . .

Scot: Yeah. So you can either walk for 30 minutes at four miles an hour to burn that or just not drink that, right? So that really kind of shows the importance of watching some of that stuff.

Anyway, here's what I'm thinking. And again, it comes back to sustainability on a couple of levels. One, time. I don't have 90 minutes a day. Two, I'm not in that great of shape anymore.

Troy: Oh, no.

Scot: And I don't know if I could sustain five sessions of 400 to 500 calorie burning and not be completely drained. So I don't know. Part of me wants to try to start to burn some more calories so I can get . . .

Here's the deal on the road trip. This time, instead of the punishment pants, I just sat and played with my fat to remind myself how miserable it is.

Troy: So you were just . . . Is this as you're driving? You're just holding your fat rolls and kind of bouncing them and jiggling them?

Scot: Yeah, exactly.

Troy: What are you doing?

Scot: You drive with one hand and you kind of bounce it and you kind of grab it.

Mitch: For the listeners, he's cupping underneath his lower abdomen and kind of making a flipping, squishing motion. I'm so glad I'm back in studio.

Troy: Yeah, that's wonderful.

Scot: I want not to have to do that anymore.

Troy: So was this what you did just to keep yourself from going in every gas station and getting a large soda and a big thing of candy or something?

Scot: Top of mind, man. Top of mind.

So I don't know what to do with this information other than to say it was kind of eye-opening to me the amount of activity that it kind of takes to burn fat. There are two things. There's the amount of activity that takes to be healthy and reduce the risk of disease. But if you're trying to get rid of body fat, that number has got to go up quite a bit. And then once you get rid of it, maybe your daily exercise goes down again because maintaining is easy. I don't know. But anyway . . .

Troy: I totally get it now. At first, I just thought, "Wow, where is this going?" But I get the point of it, that you have to exercise a lot to burn calories. I mean, that's the simple reality. You've got your basal metabolic rate and that burns quite a few calories, just the thing that keeps you alive. But then beyond that, it's not like you can tell yourself, "Hey, I just went and did a brisk walk with the dog for 30 minutes, and I'm going to reward myself now for that exercise by having a soda or taking in some extra calories." Yeah, you did not burn that many calories.

Scot: Yeah. Even if you don't take in those extra calories, you're probably not going to be losing much fat from just walking the dog.

Troy: Yeah. It takes a lot to burn. Yeah, it really does.

Scot: So that's my update. Those are the things I'm kind of struggling with and I'm trying to figure out. So I'll keep you up to date. Mitch, you have an update too.

Troy: Well, I was going to say, though, Scot, you made progress. I thought that was the best point. I mean, Thunder made a lot of great points, but the one that I think really made sense is it takes you a long time to put that weight on. Think how long it took. It's not going to come off in a month. It's a process. So you're a month out from that discussion with Thunder and you've already lost a third of the weight. That's great.

Scot: Yeah. We'll see if that keeps going down.

Mitch brought up that he felt like he had a different situation, that he has struggled his whole life to try to lose those extra pounds. What's your update?

Mitch: So I was weighing around 230 a little over a month ago, and I am just under 210 pounds as of this morning. So in a month I've lost over 20 pounds.

Troy: Wow. That's crazy. You've lost almost 10% of your body weight in a month.

Scot: Yeah. You want to ask him what he's done, Troy? Do you have any guesses what the difference is? For you, Mitch, this is crazy.

Troy: Let me guess. Did you just stop eating or what?

Mitch: No. I'm eating red meat and sunlight.

Troy: Eating red meat and sunlight. You just go outside and open your mouth.

Scot: Yeah. Any other guesses as to why? Like Mitch said, this is just kind of unheard of that it would be this easy.

Troy: Wow, I'm trying to think what you could have done. I'm guessing you went back to time-restricted eating. I'm sure that was part of it.

Mitch: I was doing that before. I'm still doing it.

Troy: Oh, you were doing it before. That's right. You were doing it before, and you had already really focused on cutting down on sodas and sweets and all that kind of stuff.

Scot: Yeah. He was doing all the right things, remember, and then he was just getting frustrated because it wasn't happening.

Troy: Yeah. I know you were talking more about the carbs. Have you focused more on carbs?

Mitch: I'm eating the same I've always eaten.

Troy: Did you get a different scale? I'm kidding. "This scale makes me look great."

Scot: The best way to lose weight is get that little dial underneath the scale and calibrate it differently.

Troy: Just change the dial. Wow. I really want to figure out how you've done this. Are you exercising more? I know you were trying to . . . You were already doing some exercising.

Scot: I mean, I'm doing it maybe once more a week, once more than I used to, but no, not really.

Troy: Okay. This is huge. You've lost almost 10% of your body weight in a month, and you were struggling before and you were doing everything right. So I don't know the answer. What have you done?

Mitch: So I got my hormones figured out.

Troy: That's right.

Mitch: So I've been working with Dr. John Smith, and he identified that I had really low testosterone. And now that the hormones are . . . I've been three, four weeks on this medication that we'll probably talk about in a future episode that just helps up my testosterone a little bit, and suddenly, I have tons more energy, and I'm losing weight like crazy, and I haven't changed anything.

I've been working out the same I've always been and struggled. I'm eating the same 1,800 to 2,000 calories every day that I've been doing forever and watching the macros and blah, blah, blah, sleeping all the time, etc. But all it took was getting my hormones in check and suddenly I'm starting to get to a healthy weight.

Troy: Wow. That's impressive. Are you putting on muscle mass too?

Mitch: We'll find out when I get in the BOD POD. I don't know if I trust my scale, but maybe. Hopefully. I don't know.

Scot: He just pulled out the guns.

Mitch: Scot, how are my guns?

Troy: He's flexing.

Scot: Does your scale give you a body fat percentage?

Mitch: It does.

Scot: And has that been dropping too?

Mitch: Yes.

Scot: My scale did not match up at all with the BOD POD, so it'll be interesting to see how accurate yours is.

Mitch: That's what I'm curious about too, yeah.

Troy: But it seems like on the scale it was all about relative change. Like, the number itself isn't as meaningful. How much has your body fat percent changed on your scale?

Scot: He's looking that up.

Mitch: It says 4%.

Troy: So you're a 4% body fat change. Like we've talked about before, the actual number maybe isn't super accurate on those home scales, but the relative change is . . . Again, that's significant.

Scot: It is significant. So it was all hormones. How does that make you feel?

Mitch: Well, it's a little strange because I do not want to be the guy that is like, "Testosterone solves everything. It's the magic bullet. You'll lose weight. You'll get your libido back," all the stuff you see on those irritating ads on the internet.

But if you legitimately have a hormonal imbalance, you should go talk to your doctor and you should probably get it fixed, right? It's not the magic bullet for people who are just a little low or something like that. But for me, I was well below the acceptable range when I did my follow-up test with John Smith, and it's night and day for me.

Troy: What was your level?

Mitch: I was in the lower 200s when I got it tested.

Scot: Because the low range is like 180, right?

Mitch: Three hundred.

Troy: He said if you're less than 300, you're low and you were . . . what did you say again? Low 200s?

Mitch: Yeah, 226 I think was the average between the two tests.

Troy: Yeah. So it wasn't like you were going in there and just being like, "Oh, I'm 330 and I need to get on testosterone." You were definitely below the level that he said he really kind of uses as a cutoff. And you'll get your levels rechecked here, it sounds like, in the next couple of weeks.

Mitch: Yeah. And we'll have him back on, and we'll kind of talk about what's going on. Yeah, there was something about, "No, this isn't 'optimizing T levels.'" I had a hormonal deficiency, and it was impacting metabolism, energy levels, etc. And it took some meds to get back to where I needed to be.

Scot: Wow. I think that's awesome.

Troy: It is.

Mitch: I think it's awesome too.

Scot: I keep looking for the thing that's wrong with me, Troy. I keep hoping . . .

Troy: What's yours, Scot?

Scot: I keep looking. Is it testosterone? No. I keep looking for that test that's going to just shine a light on why I have struggled in the past to put on muscle or to lose . . . Even when I was at my lower weight, I still had a good percentage of body fat because I just don't have a lot of lean mass. So I'm still looking for my thing.

Troy: The magic bullet.

Scot: Yeah. It's a magic bullet, right? What's the difference between a magic bullet and what Mitch experienced?

Troy: There's not. That is a magic bullet. That's a dramatic change. You want to talk about a magic bullet? Yeah. I mean, 4% body fat reduction, almost 10% weight loss in a month, that's impressive. And I've known very few people who could ever say they had that sort of experience while really not making any other changes. It sounds like you said you're exercising maybe one more day a week, but . . .

Mitch: Yeah. It's not huge changes. It's tracking a little closer on my calories. I'm working out a little bit more. It's not anything huge. It really is this medical thing that needed to get fixed before anything else could work.

Scot: And I think it's worth, if you are curious about testosterone, going back to our episode on testosterone. I think the thing to really keep in mind for everybody is it is not a magic bullet.

I can't remember what Dr. Smith said that range was. Like much beyond 600? You're not getting much return on that. So if you're around 500 or 600, you're probably fine, right? That's probably not what the problem is. Does that sound familiar to you, Troy?

Troy: I can't remember the exact numbers. I wish I did. Yeah, again, we should probably look at that just to give the exact numbers, but I do remember him saying the 300 number and if you're under that, you definitely need to be on some sort of hormonal therapy.

That episode, I was kind of skeptical throughout it, like, "Really? Do we really need testosterone? Does it really make that big of a difference?" But, Mitch, your experience, and clearly you met the criteria he talked about, and it's made a difference, no doubt.

Mitch: So I was having a conversation with one family member who had been experiencing some hormonal issues themselves. And it was really interesting because from the female perspective, hormones are a huge part of everything from energy levels to how your skin looks, to how much energy you have, how well you sleep, etc. And I think a lot of times as guys we just assume it's a yes or no, like an "Am I low on oil?" kind of approach to your car. Am I low on testosterone? Better put some more in me if it's going to work.

But talking with the doctor and stuff like that, testosterone has everything to do with estradiol levels, with all these other pieces and parts floating in your soup of juices all through your body. And it has a holistic impact on everything.

Troy: Yeah. That's cool.

Scot: Troy, do you have an update for us? Now, you don't have a weight problem. Actually, you'll be gaining about 8 to 10 pounds here in a few months in the form of a new life, a new Madsen.

Troy: I know. I've got a baby carrier that I'm going to be carrying on my . . . I looked at it. So, for the first several months, I carry the baby on my front side and then I can transfer the baby to my backside. I guess my back, not my backside. It's going to be another 8 to 10 pounds I'll be carrying around.

Scot: Are you going to go running with the newborn?

Troy: Oh, you know it. This is so funny. So Laura shared the news with me as I got home from work from a late shift. That next morning, I was reading all about running strollers, reviews, what's the best thing, all that stuff.

Scot: Good for you.

Troy: I know. This is embarrassing. I spent more money on a running stroller than I would ever care to admit. But I asked around. I talked to people. Yeah, I will be taking her running, and this is what some good runners I know recommended and said, "If you really are serious about going on long runs with a child, get this." So yeah, I'll be taking her running.

Scot: That's good. We learned that exercise is super important even for the dads when the child first comes along to counteract any potential . . . I mean, it's a massive lifestyle change, and you're trying to mitigate that as much as possible. Anything else going on? Any other new updates?

Troy: No, things are good. And it's a good point you made too, Scot, because I think it can be a massive lifestyle change. But I was talking to my brother about it. He was just visiting here a week or two ago, and he has three kids and he said that's what people always said to him too. It's a massive lifestyle change, but he said, "Hey, we're just going to do the same things we've always done. We're going to bring our kids." And his kids now are early teens down to about 9 years old. And the kids are crazy active. They love running.

My little 9-year-old niece, we just did a run. She ran a half marathon with me, just went out and busted out a half marathon trail run with me. They're just super active. And so I'm hoping that's how this can be. I'm hoping running can be something that we share as a family and that we're all out doing things together.

So I don't want it to be a massive lifestyle change, because I kind of have had that thought as I'm continuing to run. Not necessarily, "Why am I doing this?" but kind of the back of my mind thinking, "Wow, I'm not going to be able to do this as much in about two months." But then I tell myself, "Well, it doesn't have to change. We can keep doing this, we can stay active, we can keep running and doing all these things." So that's what I'm hoping for, and that's our plan.

Scot: Have to come up with some creative solutions and just have to be dedicated to it, I guess.

Troy: Yeah, I think so. Yeah, you come up with some creative solutions. You have to spend some money on some gear. Like I said, it's a whole lot more money than I ever expected to spend on a stroller, but it should be a stroller that lasts us for many, many years and hopefully running marathons together and doing lots of long runs with her. That's the hope, so we'll see how it all works out. I'll report back in about three months, Scot, and tell you where things are.

Scot: All right. Well, I guess that's that. This is going to be kind of an ongoing thing. We're really excited about some of the upcoming episodes talking about body weight control, losing some body weight, some fat if you have to.

Mitch: And having some people on to talk about testosterone again, and a little bit more about how all that connects and . . .

Scot: Yeah. And I'm just going to keep on keeping on and we'll see if I can catch up to Mitch. He's a Troy Madsen distance ahead of me in the marathon.

Mitch: Oh, no.

Troy: Mitch is smoking you, Scot.

Scot: He really is.

Troy: He's far beyond where I would be right now if this were a marathon. That's impressive.

Scot: I'm going to keep investigating just the amount of activity that you need and keep reading on that. I'll send you some of that information, Troy. You can see what your take is.

Troy: But give yourself credit though, Scot. You didn't lose 10% of your body weight, but you're down 33% of your weight gain. That's great.

Scot: No, I'm cool with it.

Troy: Yeah, you're making progress.

Scot: I just want to get to a point where I'm not playing with it anymore.

Mitch: You've got to quit doing that. I will leave the studio if you keep doing that.

Troy: Well, you can't play with it on a road trip, because you're sitting down. You're kind of hunched down. It's naturally just going to kind of bunch up there. So it's like, "Oh, feel all this fat here." I'm sure it's not as bad as you're saying it is.

Scot: All right. Well, gentlemen, as always, great conversation. Thanks for listening. And if you have any questions, you can reach out to us. It's super easy to do. You can just email us at hello@thescoperadio.com if you have any questions or stories you want to share. Thanks for listening, and thanks for caring about men's health.

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Interviewer: You've decided you want to eat healthier, maybe become more physically active, or quit an unhealthy habit. The next step is to take action.

But Dr. Jennwood Chen says to succeed, don't try to change too much at once.

Dr. Chen: That intention to make a change needs to be realistic. And for some people cutting a whole liter of soda out of their daily routine is not that realistic. So cutting it down to a half liter a day for a while and then weaning yourself off it is a more realistic thing.

Interviewer: Dr. Chen says making even small changes when adopting new health habits can be hard. You will slip up, but strive for progress, not perfection. And be sure to celebrate when you do make progress.

Dr. Chen: You've got to pat yourself on the back and you should, you know, tell your family, you should tell your friends, and you should be proud of yourself really, you know. And that's how we just do . . . that's how we stay on the path.

Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.

We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?

Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.

In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.

Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?

Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.

But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.

Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?

Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.

The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.

Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?

Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.

Interviewer: If shin splints have been bothering you for more than a few weeks, it could be more than shin splints. Athletic trainer Travis Nolan, why do you recommend a professional evaluation of chronic shin splints by a physical therapist or an athletic trainer if it's been something that's been going on for more than a few days?

Travis: You can very easily mix up shin splints with a stress fracture. They give very identical signs and symptoms. They cause the same sort of dysfunction. It's something that, most of the time, athletes can easily push through it and they can sort of tolerate and deal with the pain and it doesn't necessarily take them out of practice. But eventually, when it does take them out of practice, that's when you see them in a clinic. And then at that point, it's like, "Oh, man, you have a full-blown stress fracture. This has progressed, and now we need to hold you out for . . ." whatever it may be, four to six weeks, ". . . in order to let that stress fracture heal up."

So sometimes those situations can be avoided. They can be caught early, implemented restorally, and then you're not missing as much time from athletics if you get those stress fractures checked out sooner rather than later.

Interviewer: And what exactly is a stress fracture and how is that happening? What's going on there?

Travis: So a stress fracture is more so like a stress response from the bones. So it does go through certain stages. That stress response is also almost exactly what shin splints are. It's sort of a stress response in your shin. It's an inflammation and irritation of the periosteum or the covering around your shin bone, your long bone right there in your shin.

And so, basically, it progresses from that sort of first stage of just inflammation, it's bugging you, you only sort of notice it during that practice, and then it can progress to you start noticing it after practice. It doesn't just go away right away after practice like it usually did. And you've noticed it for a good amount of time after practice.

And then it's going to progress to now you're noticing it multiple times throughout the day. It's not just during athletics. It is before, it's during, and it's after. So it never really goes away.

And then it's going to slowly progress even further to that constant pain, sharpshooting almost, along the bone. And that's when you get closer to that stress fracture.

That beginning area is going to be sort of shin splints. So making sure you're treating your shin splints appropriately and doing the right thing so they don't progress and get worse.

Interviewer: So is a stress fracture basically the bone developing cracks in it because of repeated force?

Travis: Yes, exactly. Anything where you're just constantly sort of . . . it's those impact forces on the ground. Also, you have to look at your frequency, intensity, and duration of athletics. And especially pre-season, that's when we're in that sort of stress fracture area and the concern for it. It's more in the pre-season time because that's when your body is getting back used to sort of those impact activities and different things like that. So not just chalking it up to, "Ah, it's not much."

And going to get those things evaluated, making sure they aren't those stress fractures or fractures. Because that's when you're going to miss longer time from athletics. Going and getting an evaluation and sitting out for a week to let your body heal up, get rid of that inflammation process, and then you're back into athletics, instead of letting it get to a full-blown stress fracture where you are eventually missing four to six weeks.

Interviewer: Learn more about the dance clinic and how it can help you if you're a young dancer, or a dancer that's been doing it for a while. We'll talk about that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Trina Bellendir is a physical therapist in the dance clinic at University of Utah Orthopedic Center, and today we're going to learn more about the clinic. It's a resource for you as a dancer that hopefully you'll use before to prevent injuries, and if you do have an injury, it's also a place you can go to have that taken care of. So first of all, who is the dance clinic for? Is it just for amateur, professionals, both?

Trina: It is actually for both. Anyone that has an injury or would like to prevent an injury, or they know that there's some dysfunction, or their dance instructor has told them, "You need to work on this," that's what I'm there for.

Interviewer: Okay. So that's a good trigger word, right? If your instructor says, "This is something you need to work on," and you're not able to do it, that would be something you can help them with. Tell me about a typical visit. Who is that person?

Trina: I've had a few that came in with, "You need to work on your arch supports and lifting up your arch," and them not knowing how to attain that arch. So my job is to teach them which muscles to use, how to show them their points on their feet to get those activated.

Interviewer: Got you. Can you give us some other examples?

Trina: Knees over the second toe. Dancers tend to let their knees fall in, so we'd like to have them knees always in line with their second toe to help prevent some of the chondromalacia patella and knee dysfunctions.

Interviewer: And a lot of those dysfunctions, is this true or false, are caused by some sort of a muscle strength imbalance or a flexibility imbalance that you can help with?

Trina: It is. Most of them are muscle imbalances and we just need to do some minor exercises to help them rearrange those.

Interviewer: Got you. So it's for professional dancers as well as amateurs, young and old?

Trina: Young and old. I've seen them up to 50 or 60 and as young as 8.

Interviewer: Got you. And your typical patient, I would imagine, is somebody that comes in that has hurt themselves at some point, and maybe has ignored it for a while because they're hoping it would get better. You would hope to have fewer of those and more people that are coming in more proactively. Talk me through how somebody might know that they should actually come and visit the clinic.

Trina: Any time you start getting just the basic strains, pains type of thing that doesn't go away after you've iced it and rested it for a day or two, those are the type of people I'd like to see in there, preferably before they are unable to dance and the show is tomorrow.

Interviewer: And then for those that come that actually have some sort of a chronic issue, how do you normally work them through that?

Trina: Well, I treat the chronic issue first mainly by treating, getting their symptoms under control. Then we'll look back and see what caused the issue. Not just the ankle, but does it even arrive at the hip or at the back. We need to make sure the entire body is working well together and those muscle balances are correct.

Interviewer: Do you have any sort of technology or tools that helps you analyze dancers? I've been to a runner's clinic before, and I loved the fact that they filmed me. I learned so much from that.

Trina: So I am in a fairly unique position working at the university, that we have a motion capture system that we have in the clinic. We have a force plate that is actually brand new that we can test their ground reaction forces with. We have isokinetic machines for strengthening and testing, as well as what's called a foot mat. It does the pressure sensitive areas of your foot so they know where they're putting the pressure.

Interviewer: So a lot of kind of cool tools.

Trina: We have lots of fun toys over there, yes.

Interviewer: Yeah, to really help somebody through whatever particular issue they might be facing. So if somebody comes in for a visit and they're in the situation, either I guess. Let's talk through both of these. They're looking to do something that they're not able to at this point, or they have hurt themselves and they're looking to rehabilitate. How often does somebody usually have to come back before they start noticing some results?

Trina: I like to see results after the first visit.

Interviewer: Really?

Trina: That doesn't mean that I've got them completely better, but I want to make some changes day one. So maybe not better, but at least a change, so that way we know we're heading in the right direction.

Interviewer: I see. And does insurance cover this?

Trina: Insurance covers most of it. If we take your insurance at the University Orthopedic Center, then your insurance will cover the dance clinic as well.

Interviewer: So really, I mean, it's just great insurance against hurting yourself or being able to enjoy this thing that you enjoy for a long time.

Trina: It is. It's basically your co-pay versus a new pair of dance shoes, which can run anywhere from $50 to $150, $200. So your co-pays $25, $50 even, and it's worth it. I just would prefer to have people come to me early and have me say, "Well, it's just a little strain." I'd rather have that, give you a couple of exercises, treat some of the mechanics that you're doing early, versus waiting until it's a chronic issue and then it's going to take months to get better.

Interviewer: It's a lot easier to untangle that early on, so.

Trina: It is, and I try not to take you out of dance, because telling a dancer they can't dance is awful. So we try to keep you in your sport as long as you can, unless it's too bad.

Interviewer: So really, pay attention to what your body is telling you, and it's a great resource you can take advantage of that is fairly reasonably priced if you have insurance through the U.

Trina: Absolutely.

Interviewer: What about somebody that doesn't have insurance through the U?

Trina: People that don't have insurance through the U, we do take cash pay. We try to be kind with that, and if you pay upfront, it's a 30% discount.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com, and click "Sign me up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question, on The Scope.

Interviewer: "Where should I start, diet or exercise?" This particular listener wants to get into better shape and wants to know if, you know, it's better to start with fixing your diet first and then moving on exercise, or do you exercise first and then the rest will follow. Certified exercise physiologist Britta Trepp, what do you say? Diet or exercise? What should you start first?

Britta: Both.

Interviewer: All Right. Well, I suppose we should define some terms first. So diet, what does that mean to you?

Britta: Yeah, when we say diet it doesn't mean a one-time diet, but rather a lifetime strategy of healthy eating. So most popular diets should be approached with caution you can talk to a registered dietitian to make sure that it makes sense for you, but healthy diets really aren't low carbohydrate necessarily, extremely low carbohydrate or very high protein. They're well-rounded and myplate.gov is the current recommendations for a healthy diet.

Interviewer: And that's not only healthy in the nutrients you get, but the sustainability of it too. Just being able to maintain that, I mean, it's really hard to do a low carb diet for a long time.

Britta: Right and oftentimes you will see that people will do an extreme diet, and they'll often lose the weight, but then gain it again.

Interviewer: Yeah, is that because they just can't sustain that diet and then all of a sudden, now they're bingeing on carbohydrates?

Britta: Certainly. A lot of the fad diets are low-calorie. They're not surprising when people lose weight if you're actually looking at the diet, but it isn't sustainable long term.

Interviewer: All right, and that resource again for a good diet?

Britta: myplate.gov.

Interviewer: All right. Now, let's talk about exercise. What does that mean? Does that mean I got to go to the gym and be an Olympic power lifter?

Britta: Yeah, exercise really, the American College of Sports Medicine recommends 30 minutes a day of moderate to vigorous activity. Moderate to vigorous means you can hold a conversation, but you might not be able to sing a song, okay? So that's the intensity that we're talking about. Thirty minutes, five days a week.

Interviewer: All right, so when I asked the question, "Where should I start? Diet or exercise?" I would imagine, and I can't speak for this listener, but that's making some assumptions, right? Like diet is going to be super hard so I got to really concentrate, or this exercise part is going to be super hard so I got to really just concentrate on that, but you're saying there's some moderation in there.

Britta: Right, even small tweaks make big changes.

Interviewer: All right, like what for example?

Britta: For example, I worked with a client who is working on changing his body composition, he actually cut out just added sugar for one month and lost 10 pounds of fat. So in addition, to maybe cutting out just one simple thing with a diet to become healthier, you can break up your sedentary time. So these are also small tweaks, if you are able to get up and move every hour, one to five minutes, you are able to accumulate up to 30 minutes a day.

Interviewer: Let's talk a little bit about what the ultimate goal is here. When somebody is asking the question, "Where should I start, diet or exercise?" they're probably trying to change their body composition a little bit.

Britta: Yeah, the ultimate goal is to become a healthier composition. So the numbers on the scale, how much you weigh doesn't tell the whole story. Now, you can weigh quite a bit and actually be composed of mostly muscle which is metabolically active. So we always recommend instead of looking at the scale actually doing Bod Pod body composition test so that you can look at plus or minus 2% what your actual composition ends.

Interviewer: And that's how much fat you have, excess body fat. A certain amount is healthy, but most of us are carrying around probably more than we need to.

Britta: Certainly. Males and females each have separate amounts of body fat that are essential for normal biological processes, but we can track not only where you are now and make small goals and tweaks year after year, but we can also, if you are an athlete, say, "Okay, we're performing really well at this certain body composition and that can be a goal for us moving forward."

Interviewer: Some of the, I think, mistakes that some people make though is they think that losing those numbers on the scale is, like you said, the ultimate goal where they could be really shorting themselves of calories and losing valuable muscle as well. Talk about that a little bit.

Britta: Yeah, so just as with weight loss, diet and exercise are both part of the puzzle. With exercise, cardiovascular activity as well as strengthening activity are essential. So we could act like a gerbil on a treadmill all day long and just zoom, zoom, zoom around. If we are not doing resistance training whether that's body weight exercises or standard lifting in a gym, we will lose some of our muscle mass and that is honestly very metabolically active. It is good to keep.

Interviewer: So an answer to the question, "Where should I start? Diet or exercise?" You should do both.

Britta: Yes. The research says that both are the most beneficial for weight loss.

Interviewer: Got you. And if you need some help who would you recommend somebody get in touch with?

Britta: Yeah, here at the University of Utah we have a clinic called PEAK Health and Fitness. We have registered dietitian as well as certified exercise physiologists, and they can work together to come up with a program for you so that you can get on the right track.

Interviewer: And for those that aren't in this area try to find a similar resource probably in your own community and I think probably one of the most helpful parts of that is you have a plan in front of you then.

Britta: Certainly, yeah. It's often very good to track. It'll keep you honest. So I know on my desk I have a little, it's actually a little black book, that I track my weekly exercise and I see every day, and I open it up and I know that I want to add more to it. So it's very visible in my life.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.

Interviewer: Coming up next we're going to talk about a common hiking hazard and how to make sure it doesn't happen to you. That's next on The Scope.

I want you to think about it. When you go hiking, what problems do you normally run into? Maybe sore feet, tired legs, blisters. Pretty common problems, but today Dr. Emily Harold, a sports medicine specialist at University of Utah Orthopedic Clinic, is here to tell us about one of the more common hiking problems that isn't something that a lot of people really think about, and that's dehydration. And when I heard about this I'm like, "Really? Dehydration? Don't we all drink enough water? It seems like everybody's got a bottle of water."

Dr. Harold: Well, I think we all drink some water. I think that we don't all drink enough water. I mean, I think that we are blessed to live in a great state that has an amazing climate, and it's a very low humidity climate. And because it's a low humidity climate, when you're outside and it's hot outside and the sun's beating down, a lot of times your sweat dries quicker and you don't really realize how much you're sweating. And it can almost be pleasant when it's 80 degrees outside in this environment versus 80 degrees in Houston, Texas, in which case everybody knows they're sweating.

And so a lot of times people are sweating more than they realize and they're losing more water than they realize and they don't replenish enough, and that can lead to headaches, and tiredness, and in extreme forms can even lead to things like heat exhaustion, heatstroke, which can cause a lot of damage over time.

Interviewer: So if I was just going out for like an hour or two hike, do I really need to take water? Is that enough time to start getting symptoms of dehydration?

Dr. Harold: It's enough time. We would recommend at least a quart an hour. So if you're going to go out for a two-hour hike, one, we recommend probably drinking a liter before you go. And then while you're out, at least a quart an hour while you're out. More if you are running, trail running, doing activities that are more than just walking.

Interviewer: You've covered more endurance-based events like marathons and whatnot, and you say that it can really be common in those events. Explain that a little bit.

Dr. Harold: It's a common problem. A lot of times in marathons, people are out on the course for four, five, six hours. On a hot day, they don't drink enough fluid when they're out running and a lot of times when they come in after they cross the finish line, they can have some dangerously high body temperatures, 103, 104, 105. And so we really kind of institute a rapid cooling part and we try to give IV fluids for hydration, but it's very important that you drink enough water, especially when the temperature gets up above 70.

Interviewer: And when that sun's out, is it even worse?

Dr. Harold: Yeah, because the sun dries the sweat off a little quicker, and so you don't get the same cooling effect as you get when it's a little cloudier.

Interviewer: So drinking water, very easily preventable of dehydration. What about extra salt in those situations?

Dr. Harold: It is recommended that if you're out for more than an hour that you do ingest some salt.

Interviewer: Really? And above and beyond what I would normally get in my diet?

Dr. Harold: I think that's why trail mix became so popular. Because people realized if they went walking for a long time, that salt that comes from peanuts and that kind of thing can actually help to retain some of that water that you're drinking, and that helps to replenish their water stores a little easier.

Interviewer: Gotcha. And then also we're talking about kids. If you go out hiking for a couple hours with kids, that has a different effect on a kid than it might an adult.

Dr. Harold: Exactly, and if you're like my kids, you like to run ahead and you're constantly exploring. So you're not drinking water and no matter how much you tell them to drink water, by they time they're to start drinking when they're thirsty, they've already gotten a little bit dehydrated. So it gets really important just to watch your kids' water bottles. I usually recommend bringing a water bottle for each kid and having them drink from it, so you can monitor how much they're consuming.

And if you get somewhere and you realize they haven't really drunk very much water at all, then you can push their fluids a little bit just to keep them from getting dehydrated.

Interviewer: How often does heat exhaustion and heatstroke really lead to things? I mean is that not too common, more common than I might think?

Dr. Harold: I think both. I think we'll see a lot of hyperthermia or high temperatures sometimes in the emergency room. Usually if you catch them early and you cool people quickly, it doesn't lead to bad outcomes. Now if you have someone who is in Canyonlands or Moab and gets lost and wanders, that's something that can lead to heatstroke and it can lead to some, exactly, brain injury.

Interviewer: Just kind of wrap up, then, for myself or for my kids, what would I look for for symptoms to indicate they need to be drinking more water? Or is it just monitor water drinking?

Dr. Harold: I think it's easy enough to monitor water drinking. A lot of the symptoms are kind of difficult. Things like fatigue, they get that when they hike anyway. Headache is a common one. So if your child or you notice that you are starting to get a headache when you're walking, a lot of times that's because you're dehydrated. So that's the earliest one.

Interviewer: So in that instance drink water, get out of the sun for a little bit, rest for how long?

Dr. Harold: Exactly. Find a shady spot.

Interviewer: How long would you want to rest for?

Dr. Harold: Some people find a shady spot, drink some water, you want to rest for probably a good 10, 15 minutes until you start to feel better.

Interviewer: Yeah, and that will start to go away. And then you're fine to go back out again?

Dr. Harold: Absolutely.

Interviewer: I mean, this seems just like one of those topics that I don't think a lot of people think about and a lot of people don't think is really all that serious in their life.

Dr. Harold: Yeah, I think that's my final thought. It's something that I know I could do better at and most of us can do a better job of hydrating, but it is something that can lead to problems and it does make for a much more comfortable walk if you're properly hydrated.

updated: June 16, 2021
originally published: August 24, 2016

Dr. Miller: Anterior cruciate ligament injury or ACL injury, that happens a lot to knees here in Utah with so many skiers and athletes. We're going to talk about this next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here with Dr. Pat Greis. Pat's an orthopedic surgeon, he's professor of orthopedic in the Department of Orthopedics. Pat, what is an ACL injury? How do you get that? I understand it's pretty common. I see a fair percentage of it coming down in sleds off the ski slopes over the ski season.

Dr. Greis: The ACL is one of the main ligaments in the center of the knee. It keeps the knee from sliding forward. Unfortunately, when you tie long boards to the end of your foot

Dr. Miller: With thick boots that weigh 20 pounds?

Dr. Greis: And then go down the ski hill, bad things happen. So, we see a lot of folks who come in had a twisting fall maybe got a toboggan ride down the rest of the ski hill come in with a sore, swollen knee.

Dr. Miller: That happened to a family friend that we took skiing this year. She was, unfortunately, it was last run of the day. Fell. And then pop.

Dr. Greis: First run or last run of the day, it never fails. The knee usually gets twisted. Maybe they feel a pop, tried to get up, tried to ski, a turn or two, the knee feels unstable.

Dr. Miller: Or they can't even stand on it or put weight on it.

Dr. Greis: Certainly those folks who gets put right onto the sled. And then usually managed at the bottom of the hill with a knee mobilizer, maybe got some X-rays, make sure nothing was busted. And then show up in clinic two, three days later to get evaluated.

Dr. Miller: While the ACL is one of the stabilizing ligaments in the knee, but we tend to hear ACL not only in skiing but in other contact sports or even non-contact sports in athletics. So, it's a fairly common injury with the knee?

Dr. Greis: It is one of the higher profile injuries given the level of disability that occurs from it is pretty high. It's difficult for a basketball player, a football player to continue playing after they've torn an ACL because without the ACL in the knee, instability where the knee gives out.

Dr. Miller: So, if you're doing a sport where you pivot a lot - soccer, football, anything with cleats - it's got to be pretty tough to maintain that activity without the ACL.

Dr. Greis: Any jumping, landing, twisting activity is really tough to continue. It's the rare individual who can continue and cope without an ACL. So, we end up rebuilding a lot of these to allow people to get back to these kinds of sports.

Dr. Miller: So, that is to say if you have a complete ACL tear, there's not much in the way of physical therapy that's going to help if you're going to get back into competitive sports. Is that a fair statement?

Dr. Greis: Well, physical therapy alone wouldn't probably get you there. But that is an important part of the overall treatment. ACL injuries, when they happen, result in a pretty sore and swollen knee. And prior to any surgical treatment, physical therapy is a big part of getting ready for surgery. We like to operate and fix knees when they're quiet, when they have full motion, limited swelling. And so therapy, although it's not going to fix the problem, is a big part of treatment.

Dr. Miller: So, this dispels the notion a little bit that when patients have a knee injury, especially the loss of an ACL, they don't need to rush off to the orthopedic surgeon for surgery.

Dr. Greis: Not for surgery but they should see somebody because getting going and doing the right things to get the knee functioning and working again is important.

Dr. Miller: Talk to me about the differences in gender. I understand that women maybe are more prone to ACL ruptures.

Dr. Greis: For sure. Unfortunately, as we've seen more and more young girls and women in cutting sports such as soccer, we've also that their injury rates tend to be four to eight times higher than matched controls with their male counterparts. There's lot of potential reasons for that that's still being worked out. But the fact is, again, young women in soccer are experiencing the same injury quite a bit more often than men.

Dr. Miller: How about the older patient? Do they always need to get their ACL repaired if they're not doing cutting sports?

Dr. Greis: Sure, they don't. Here in the Wasatch Front, given the activity level of many so-called older patients. And I think that that's a question as we all are aging. The activity level is such that many prefer to get their ACL reconstructed so they don't have to modify their activity to fit their knee.

Dr. Miller: So, what do you do? You wait, you do physical therapy, you wait for swelling to subside, you wait for little more motion and then what? I guess there are several techniques that you use top repair the ACL.

Dr. Greis: We usually reconstruct the ACL, so we're replacing it. Actually repairing it, putting sutures in it was something that was done commonly in the '70s and '80s but less so now. So, we're more about replacing the ACL rather than reconstructing it. And the idea there is to put a new ligament where the ACL used to be in the right, anatomic position so that it functions like the native ACL did.

Dr. Miller: And once that's done, I suppose there's a period of fairly enough intense physical therapy to help re-strengthen and reconstruct the knee?

Dr. Greis: For sure. ACL surgery is not something where you wake up from an operation and say, hey . . .

Dr. Miller: Dashing off to the football field.

Dr. Greis: Unfortunately, it's not that quick. There's a period of soreness and swelling just from the surgery. But the rehabilitation occurs in phases. First month might be going to physical therapy, going to the gym, doing simple exercises, spinning on a bike. By two to three months, hiking, playing golf are more reasonable leisure activities.

Dr. Miller: Instead of kick boxing.

Dr. Greis: Kick boxing would not be the first thing you do out of the box. But it's about a 6-month process. And even in six months, many athletes are probably not as good as they're going to be at 9 or 12 months.

Dr. Miller: So physical therapy and follow up is extremely important in coming back with a functional knee that will allow you to participate in high-intensity sports.

Dr. Greis: Without therapy, doing ACL surgery is probably not going to be successful. And it is a big part of that. When you see these athletes who are coming back and six and nine months have to realize that there are probably spending four, five, six days a week in the gym working out. And so, it's a mindset of being injured but then being willing to do the work to get back to where you were.

Dr. Miller: Finally, do you have any tips for the weekend warrior or the visiting vacation skewer handed person who comes out to avoid an ACL injury?

Dr. Greis: Like a lot of sports, keep it upright.

Dr. Miller: Stay on your sticks and don't fall over. I guess, one of my questions was, probably not a good idea to ski until that very of the day when your ligaments and muscles are twitching and not working very well.

Dr. Miller: It's always a little hard to know when to call it. But getting in the back seat, getting behind your skis is certainly one mechanism falls unavoidable. It is what it is. It's a sport that's a lot of fun but comes with certain risks.

Announcer: We're your daily dose of health, science, conversation. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: Olympians are some of the strongest, fastest, hardest-working athletes in the world, pushing their bodies to the limit. But what's it like for a doctor who takes care of them? That's coming up next, on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: I'm here with Dr. Willick, and he is a sports medicine physician at the U. He's worked with the international Olympic and Paralympic medical communities and has worked with some athletes himself. When you're working with an athlete, what kind of considerations do you have to take in when compared to, you know, just someone that hurt their leg when they're hiking, or something like that?

Dr. Willick: One special consideration with any athlete who might get tested for doping is that we have to make absolutely, 100% certain we don't make any mistakes when prescribing medications. So for every single medication that we prescribe with an athlete, we always check, double check, and triple check whether or not it is on the prohibited list to make sure the athlete doesn't inadvertently get into trouble. It turns out that a lot of anti-doping violations are actually mistakes made by healthcare providers unknowingly prescribing a prohibited substance to an athlete when they shouldn't.

Another important consideration when you're taking care of elite athletes is, what is their training and competition and travel schedules. We often have Olympic and Paralympic athletes come to clinic who may only be in town for three days. They may be in between one World Cup event and the world championships, for example. Sometimes you have to prearrange things to get a lot done in a short period of time. You have to know when their next major competition is, because that's going to affect your workup and your rehabilitation protocols. For a recreational athlete, for example a hiker, we often have more time for the workup and rehabilitation.

Interviewer: So, with these extraordinarily driven athletes and things like that, what is it like when, you know, maybe they're injured, or, do you ever come up to a situation where they want to compete, and they're going to compete, and it's against what you want, what's best for them? You're saying, "Hey, I'm your doctor, no, you shouldn't be doing this"? Do you ever run into those types of things, or, how do you deal with those?

Dr. Willick: The short answer to your question is yes, of course. We run into that with recreational athletes as well as the world's best athletes. People want to do their sport, they want to continue being active, they want to compete. Every case is taken individually. There are times when it might be okay for an athlete to compete with a particular injury, knowing that maybe it'll give them a setback, but if they have one chance to compete in the Olympics, sometimes they just have to go for it.

And that's very different than if you have one chance to compete in the next 5K that's being run in town, knowing that there's going to be another 5K a week later and another 5K a week after that or a month after that. But often, there's only one opportunity to actually compete in the Olympic or Paralympic Games and the fact of the matter is, that can be reflected in the medical decision-making. However, if it is truly unsafe or unwise for the athlete to compete, we absolutely have that discussion with the athlete, along with their coach, sometimes with their family and other members of the team.

Interviewer: So coming up, we have all these people sitting down, watching the athletes, right, and cheering for their country, their favorite athletes, watching their favorite sports and stuff like that. What is something you would want the viewers, our American listeners who are sitting and supporting their country, to know about these athletes? What is something that they should appreciate and know about these athletes?

Dr. Willick: The viewer should appreciate the thousands of hours of hard work the athletes have put in to be on TV at the Olympic or Paralympic Games for a few seconds, or a few minutes, or maybe an hour. Thousands of hours of strength training, and flexibility training, and motor skills training, and meeting with a sports nutritionist, trying to regulate their sleep, meeting with a sports psychologist, and the dozens or hundreds of support staff behind every athlete. From all the specialists, to the coaches, to the coaches they had in their earlier days, and yes, even the medical staff supporting that athlete.

Interviewer: So you'll be watching?

Dr. Willick: I will be watching, yes.

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Interviewer: Dr. Travis Maak is a sports medicine expert and the Head Orthopedic Team Physician for the Utah Jazz. He says a majority of ski injuries happen in the late afternoon, and unfortunately it's during that last run, that one more run. How did you find this out?

Dr. Maak: Part of it was from personal experience, to be honest with you. So I actually was a sort of volunteer ski patroller in my high school days here when I was growing up. It's something that is known to all ski patrollers, that basically . . . ski patrol is in large part about 90% boredom, and that happens from the beginning of the day where you literally just go out and ski yourself because you're so bored, because there's nothing else going on, to about 10% of terror.

That always happens at the end of the day, and sometimes right after lunch. But usually it's from about 3:30 to 5:00 is when everything happens. That's where you basically put your gear on and get ready, because you are going out. It's not an 'if', it's a matter of 'when.'

The reason that happens is it most likely it has to do with two things. One is it's starting to cool down so from a temperature perspective the snow is starting to get a bit harder. It loosened up. It warmed up. It was a little bit softer. During the afternoon it starts to cool down, so it gets a little bit rockier, a little bit skied out, so the terrain itself is more difficult. That's the first thing that is most likely contributing.

But the other contributor is a personal and modifiable factor. You can't change the weather, but you can change yourself. We all want to get in as much as we can, the most bang for our buck. We bought that pass. It may seem a little overpriced, but when you do it, it's fantastic and you want to keep going and get the most out of it.

Basically, it has to do with a muscle fatigue. The ligaments are the structures that hold our joints together. The main injury that we see typically is either a broken bone or a ligament tear. In particular in skiing it's the ACL. The ACL seems to be unfortunately the skier's injury. Generally, the reason it happens is the knee joint has two predominant stabilizers, the muscles, the tendons as one unit, and then the ligaments. Those are separate. The ligaments are literally like ropes. They connect the two bones together.

The muscles are the dynamic stabilizers, so they fire when they're working and you make your knee bend and straighten, and it allows you to do those bumps and do those turns in a perfect fashion. But when muscle fatigue happens, then the muscles aren't working correctly. They aren't firing correctly and they start to get weak and tired. As they get weak and tired, your mind may want them to go, but it's not going to happen because, frankly, you just can't put forth the energy.

So where does that energy go? It doesn't disappear. It goes to the ligaments, and so the ligaments end up taking more energy than they're supposed to and they end up failing and tearing. That's most likely why this happens, because the energy which is dissipated by the muscles can't be because they're tired and fatigued, and so it goes to the next step in the chain.

Interviewer: Do you find that people that are a little bit more muscularly in shape are less likely to have this happen, or at that point in the day is pretty much everybody susceptible?

Dr. Maak: Muscularly in shape is a question that a lot of people take to mean the body builder, giant muscles, and frankly that actually has nothing to do with it. In fact, a lot of people who have those fast-twitch, big muscles end up getting tired quicker. If you look at endurance athletes or athletes that are training for a specific sport, the muscles themselves have become accommodated to a long-term type of energy expenditure.

Skiers, for instance, they train in both strength, the quads, the hams, the lower body strength, but also endurance. Ultimately, that's what we're talking about is endurance. It's the fatigue of the muscle, not the ability to jump really high one time or run a sprint. It's the ability to stay and produce that power and energy over a long period of time, hence the last run of the day.

At the end of the day, it's fatigue. It's training. It's the ability to generate that force required to ski throughout the day. When that ability to generate that force disappears, that's when the injuries happen.

Interviewer: So probably your casual skiers don't have that kind of muscular endurance.

Dr. Maak: They don't. Interestingly, here at the University we've actually produced a skier's program to provide people with sort of an ability to produce that type of power and endurance over a period of time pre-ski season, so that by the time they hit the ski season, they are ready. Their quads are ready. Their hams are ready, and it's a completely different muscle set than happens over the summer when you're out running, you're out doing the type of endurance summer activities, rock climbing, etc. It's totally different for skiing. It's a different muscle group, and if you don't [inaudible] and educate your body to those muscles, you're not going to be able to do it.

Interviewer: So what's your final advice? I mean, you've laid it out that the injuries are happening in the late afternoon. Do you just not do that last run? Do you just slow it down a little bit? What would you tell a skier?

Dr. Maak: At the end of the day there's always one last run. That's unavoidable. So the message that we try to get out here is make that one last run a fun one, and not a potentially serious or a safety issue run. The way to do that, let your body be your guide. You can do all of the things that we've talked about already, which is prepare yourself for the run. Prepare yourself for skiing. Get yourself in tip-top shape as best you can. But also listen to your body.

After lunch, you're going to be a little fatigued. You let things set in. You may slow down the runs. Don't go hit the double black run right after lunch. Instead, maybe start on blues, ramp it back up a little bit. But once 2:30, 3:00 starts setting in, look at your watch, listen to your legs, listen to your body, and instead of going and hitting the double black as the last run, maybe take a groomer. Take a nice, little, smooth one down. Enjoy yourself. You don't have to be a hero at the end of the day. At the end of the day, if you do it that way, you'll be able to come back the day after.

updated: December 14, 2022
originally published: February 17, 2016

Interviewer: Exercising outside in winter. I'm here with Dr. Russell Vinik, Internal Medicine at University of Utah Health Care. Dr. Vinik, should we exercise in the winter?

Dr. Vinik: Absolutely. Exercise is good for you, whether it's summer or winter. There's always a fear of going outside in winter. We worry about frostbite, but frostbite is very rare especially if you're dressed appropriately. There is some risk in people with heart conditions. It does create a little bit more work on your heart to exercise in the extremes of temperature, whether it be very hot or very cold. But for most of us, it will do us a lot of good.

And it's certainly not a good reason to stay at home and sit on the couch because you're worried about the temperature. People often dress very, very warmly, and there's actually a risk of overheating in the winter if you dress too warmly. So the most important thing you could do exercising in the winter is to wear layers that way, you can take off layers as you get too hot. But overall, it will do you a lot of good. You'll pump a lot of blood through your body and it'll help your cardiovascular health, as well as your mental health.

Interviewer: I heard you mention, it's probably people with heart conditions shouldn't exercise as much. That surprises me. It seems like people would be more worried about the cold air in their lungs, and the cold and dry air.

Dr. Vinik: Yeah. So even people with heart conditions can and should exercise because there's still benefit in doing that. I would just talk with the doctor before you do that. Now, obviously, we all feel that cold air in our lungs when we're exercising in the outside on cold days. That's not necessarily bad for you. If you have asthma, some people do have asthma that can worsen with cold and that's something to be cautious with, and even have an inhaler if you're going to run. One thing we worry about in Salt Lake City, though, is our inversion.

And when it gets cold outside the inversion settles in the valley, and that increases air pollution. And the two together can actually make things worse on your body than just one or the other. So the times to be very cautious are those days when the ozone is collected in the valley, we see a lot of particulate pollution, and it's cold. Especially if you have heart or lung problems, then you should probably consider staying indoors. But for the most part, getting outside is a good thing. It's hard to get enough exercise indoors. Some of us have the ability to do it easier than others, but it shouldn't be a good reason to sit on the couch.

Interviewer: So if we're middle-aged or younger, and pretty much healthy all the time, even when there's inversion, we shouldn't really worry about it, we should still go for that run?

Dr. Vinik: Absolutely. You could still easily go out for a run. The risk to your body is very, very low. In fact, the benefit to your body is a lot more than the risk associated with going out in cold weather or the inversion.

I think just getting out and working, and it doesn't have to be a huge amount of exercise, 20 minutes, three, four times a week would do a great deal for your heart/lungs, as well as your body, just weight and preventing obesity and all the bad things that come with a sedentary lifestyle

updated: December 29, 2021
originally published: January 7, 2016

Interviewer: So the question is, can you build up a tolerance to heat exhaustion or even getting heat stroke as the summer progresses.

We're with Dr. Scott Youngquist. He's an emergency room doctor at University of Utah Health Care. So the question is, can you build up that tolerance or is it just always the same.

Dr. Youngquist: The short answer, Scot, is yes, you can build up tolerance to heat exposure, and this has been shown for some time now, experimentally, with human volunteer subjects, that you can take them and, typically, under conditions of exercise. So you put one group into an area where they're going to exercise under heat conditions, around 37 degrees Celsius or 98.6 degrees Fahrenheit. You have them exercise for 20 minutes and then have a 10-minute cool-down period, and you do this for 6 days, and they will tolerate passive heat exposure much better than somebody who exercises in the cold. So you can develop this.

When you're exposed to heat, a couple of things happen to try to cool your body and adjust to the heat stress. One of those is, you start to hyperventilate and that will reduce blood flow to your brain. So you start to lose the amount of blood going to your brain. That's why people can get altered mental status with heat stroke. We call it heat stroke, not because they're actually having a stroke, but because, sort of like a stroke, their brain is deprived of essential nutrients and oxygen. So that occurs.

You also have a diversion of blood flow toward the skin, so you sweat and also your skin heats up so you can radiate heat from the body and try to lose heat that way. But that also reduces your circulating blood volume and so you get a drop in your blood pressure, and that can be, in cases of severe heat stroke, that drop in blood pressure can lead to cardiovascular collapse.

And so you have a couple of compensatory mechanisms when you're exposed to heat, and at a cellular level, there are these proteins called heat shock proteins. The heat shock proteins are produced in response to this, and give you this tolerance. So people who are exposed to exercise under conditions of heat build up this tolerance by producing these heat shock proteins. And what you find is that they hyperventilate less, there's increased blood flow to the brain compared to the group that hasn't developed tolerance, and so they're able to compensate much better. They also increase their plasma volume, so they hold onto water a little bit more, anticipating they're going to be sweating and things like that.

Interviewer: So at the beginning of the summer when I feel like, "Oh man, I'm just having a hard time handling the heat," versus the end of the summer, where I'm running and cycling, and it doesn't bother me at all, all those things are happening inside my body.

Dr. Youngquist: Exactly. That's why you feel better as the summer goes along in the same amount of heat.

Interviewer: And I would imagine that everybody's a little bit different. Some people probably have a natural higher tolerance, right?

Dr. Youngquist: Yeah, absolutely. So if you are obese or overweight, it's going to make it harder for you to develop heat tolerance because you've got that extra layer of insulation.

Interviewer: If I'm interested in building up heat tolerance because I want to compete in some sort of an athletic event, is there a systematic way I should go about it, or is it just about getting out for longer and longer periods of time?

Dr. Youngquist: There are several protocols you can look at online. So if you do a Google search, you'll find several proposed heat tolerance regimens that you can adopt. But experimentally it's usually just a small amount of exercise, about 20 minutes a day for 6 days straight, in the heat, being careful to hydrate yourself well and to stop if you're feeling dizzy or excessively tired, and that should do it.

Interviewer: All right. Well, thank you very much. Indeed, you can build up a tolerance to heat exhaustion.

updated: July 16, 2021
originally published: August 6, 2015

Dr. Jones: Personal trainer, athletic trainer, what is the difference and who do I want for me or my daughter? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, fitness and athletic trainers on The Scope.

Recording: Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: We're told we should move more. Women as they age are told they should get some weight training as well as cardio, all these shoulds. But who can be get to help us older ladies push those weights and adolescent girls are performing at increasing levels of athleticism on high school and college teams. Who should be directing their training to make them strong but keep them safe? Today in The Scope studio we're talking with Dr. Amy Powell, a sports medicine specialist at University of Utah Orthopedics Hospital about trainers.
Who trains them, how are they license, and who's the right person for you and your daughter the jock on the college team, or the ski team, or the basketball team, or the track team, maybe not the chess team but maybe? Welcome to The Scope, Dr. Powell.

Dr. Powell: Thank you.

Dr. Jones: So I thought personal trainers were for one person and athletic trainers are for a team but maybe that's too simplistic. So what's the difference between personal trainers and an athletic trainer?

Dr. Powell: I think the biggest difference is that athletic trainers truly are health care professionals and I think a personal trainers are more as coaches, people that can help to make you stronger, make you faster, perform better at your sport or keep you in shape as you age. But athletic trainers are truly health care professionals. They're trained in injury triage, injury management, concussion management, concussion prevention and we use them to help our athletes both stay safe on the courts and the fields and everywhere else and stay healthy.

Dr. Jones: Oh, and how about licensing? Are they licensed differently?

Dr. Powell: They are. The license requirements vary state by state but the state of Utah does have licensed athletic trainers and athletic trainers sit at the end of their four-year undergraduate degree for a board examination that's a national exam, so they're both board certified and licensed by state.

Dr. Jones: I never thought of trainers, well, of personal trainers as being have to triage injury but that's a really big deal for an athletic trainer for a team who should be continuing to get on the court and who should stay off the court.

Dr. Powell: Right. Our athletic trainers here at the University of Utah are really, really important people to help with the initial injury evaluate and we as team physicians fill in for where they need our help.

Dr. Jones: Right. What about practicing jobs? Let's say you've been thinking you're young person and you love sports and you want this to be your career. What are the differences in jobs? Let's say where does the athletic trainer get a job?

Dr. Powell: Yeah. Athletic trainers function at multiple different levels so the classic athletic trainer spot would be with a team at a university, a Division I institution. There are athletic trainers with professional teams. There are athletic trainers with ballet companies and other performing arts like Cirque du Soleil has their own athletic training staff.

Dr. Jones: Oh yeah. How cool is that!

Dr. Powell: We would love to see an athletic trainer at every high school in the state of Utah. That has not happened yet but hopefully it will at some point. Athletic trainers function as a physician extenders in some clinical settings too. So for instance at the University Orthopedic Center we have three or four athletic trainers on staff that help with initial evaluation of injured patients.

Dr. Jones: Oh, oh, maybe one of those are my husband who's kind of a single older athlete with an injury, how cool. So we at Utah are fortunate to have a program in athletic training education here in the College of Health, so how long is it?

Dr. Powell: It is actually a fairly competitive undergraduate program so it's a four-year degree.

Dr. Jones: Whoa.

Dr. Powell: And we also have a graduate program which is a master's degree and a good portion of institutions like ours. Pretty much every athletic trainer that works with our student athletes has a master's level degree.

Dr. Jones: Wow, okay, it's a career.

Dr. Powell: It's a career.

Dr. Jones: Right. So that sports teams for the girls college basketball should have a certified athletic trainer but how about of us older ladies who need help in the gym to show up and push a weight or something, who should we have?

Dr. Powell: I think on that situation a personal trainer will be a really great fit. So personal trainers have different certificates that are given by different governing bodies. One of them are commonly known ones as the American College Sports Medicine and there are different levels of personal trainer’s certifications. You can be a certified strength coach. You can be a certified personal trainer, those don't typically require a four-year degree, some do some don't. And so the level of training is a little bit more variable than the athletic trainers who go through a four-year full degree program and have a very set curriculum regardless of where you train.

Dr. Jones: Great. Now the chess team. There's a growing body of evidence that vigorous exercise makes the brain work better, for science, problem solving, and probably chess and this is true for six-year olds and 60-year olds. So maybe the chess team needs an athletic trainer? Dr. Powell, what are your thoughts on that?

Dr. Powell: Or maybe we should just send the chess team out to run a few laps before their big competitions.

Dr. Jones: Right.

Dr. Powell: That would be my suggestion first.

Dr. Jones: Okay. Stay strong, stay safe, and stay smarter and thanks for joining us on The Scope.

Recording: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.