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Scot: Does it feel like it's a struggle to be healthy? And the Core Four that we talk about here on the show, nutrition, activity, mental health, and sleep, can seem simple, but in practice actually execution can be challenging.

Troy, I've got a question for you. What's your biggest kind of Core Four or other health challenge?

Troy: Sleep, without question.

Scot: I knew you were going to say that.

Troy: You knew I was going to say it. It really is. Sometimes I feel like I'm making progress and I feel like, "This is good," and then I'm just like, "I am just doing miserably with this." I'm waking up at 2:00 in the morning and I'm lying there and I'm just kind of staring at the ceiling for two hours. So sometimes I think I'm doing well. Other times I'm just like, "I have no idea how to sleep."

Scot: Huh.

Troy: Yeah. It's just a crazy thing.

Scot: What's that do to your self-esteem?

Troy: Exactly. As Mitch said before, "Babies do it. Why can't I do it?" Babies do it. My baby sleeps better than I do at this point.

Scot: Mitch, how about you? What's your biggest Core Four challenge or other health challenge?

Mitch: So I think the biggest thing that I've been kind of dealing with lately is getting back up to the activity levels I'd like to be at, but that's mostly because I injured my ankle again. I'm back in physical therapy. Where going for a jog and listening to a murder podcast used to be really fun, these days it's like, "Oh, I've got to make sure I'm going slow. Oh, I've got to make sure I'm babying my ankle, blah, blah, blah."

So it's right back to that situation of having to scale everything back a little bit for where I'm at right now, and that's been kind of a frustrating situation.

Scot: Already, at this point, I love what you both said. It makes me feel so much better that you said at one point things were good, but you're struggling to get back to the way they are, because that's what I constantly struggle with. I constantly struggle with, "I do pretty good, and then all of a sudden I don't do great at all." It's so intermittent. I'm just not very consistent, and both of you kind of brought that up.

For me, it's activity. That's the thing. I cannot seem to be consistent. I will go pretty well for a month, month and a half, do some weights, maybe get out and do some other sorts of things, get my heart rate up, and then all of a sudden it just all comes to a screeching halt, and I'm not exactly sure what's going on.

So here's something you as a listener should know up front. Some of the episodes we have very specific recommendations of things to do, and others, like this one, are just guys talking about their health and health challenges as a way to create some new understanding or knowledge that might help with some insights that could help us and hopefully you on your journey to be eating healthier as well, and maybe even being a little kinder to yourself.

That's one thing I've already picked out of this, is I've got to go back to that. Maybe always being perfect isn't the standard I should be measuring myself to. So that's today's show.

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

Troy: Scot, I think this is a great topic for the middle of winter when everything just seems like you're just getting by. This is a good topic.

Scot: And the hardest working guy that I know of . . .

Mitch: Oh, man.

Scot: . . . when it comes to his health . . . I'm serious, man. I know that you feel like you have your struggles or whatnot, but you're working hard and getting it done. This is Mitch Sears on the show.

Mitch: Well, thank you. Yeah, it is a constant struggle, but yeah, it's something I do try to work hard at. I appreciate that.

Scot: I think for this conversation that's about "Why does it seem like it's a struggle to be healthy?" I think a great place to start is what is healthy even? What is this standard that we aspire towards? Because society has a different definition than perhaps maybe we have or what a more realistic kind of definition is.

So what is healthy from a man's perspective? What is the pursuit of health? How do you define that, Mitch?

Mitch: Well . . . Oh, man.

Scot: I totally understand where you're coming from. That's a good question.

Mitch: That's such a big question, because yeah, it's like . . .

Scot: Here's the thing though. You have to consider that question in order to figure out what are you even comparing yourself to, and is that fair to yourself?

Mitch: For sure. And that's kind of the thing that has been really interesting, having been someone who's started to take interest in their health over the last few years with this podcast and everything.

It seems like men especially, and this is just my kind of experience, are getting all sorts of goalposts and gold standards from a bunch of different places, and very few of those places are actually backed by research or everyday regular people, etc. So much of it is focused on getting ripped, getting tons of muscle mass. "Men's health is sexual health" is one of the mantras that I hear all the time.

I think that it makes it hard, because when you first start to really care about your health, unless you're actively trying to participate and check in and think about what it actually means to you as an individual, it's really easy to look at a cover of a "Men's Health" magazine and be like, "Oh, man, I am not as handsome as Ryan Reynolds, and therefore I am unhealthy." I don't know.

Scot: Or the influencers on social media.

Mitch: Oh, yeah. They're terrible. They're the worst. It's garbage.

Scot: Okay. You kind of talked about your opinion of how the media and society defines health. How do you define it then?

Mitch: Well, it's a constantly changing and shifting idea. And for me, the big central idea is "Am I feeling my best? Am I able to do the things I want to do? Is my health in one way or another limiting me from enjoying my time on this beautiful planet of ours?"

And so that's how I do it these days where it's like, "Eh, do I have 12 abs? No. But can I go for a hike in a pretty trail in the mountains? Yes or no?" That's kind of where I'm at.

Scot: Hey, Troy?

Troy: Yeah.

Scot: Do people have 12 abs?

Troy: Twelve abs? Yeah, good question.

Scot: I thought eight was the . . . Can you have a 12-pack?

Troy: A 12-pack.

Scot: You're the doctor here.

Troy: That's a good question. Yeah, I don't know. We'll have to go back to the cadaver lab, which I dreaded in medical school, and count the abs.

Scot: Troy, how about you? How do you perceive society's kind of definition of health versus how you define health?

Troy: I mean, I think society . . . I think Mitch hit on that already. It's a lot about image and how you appear to other people. I think that's a big piece of health in terms of societal definition, where I like to think of health . . . I think Mitch kind of touched on it already. My definition would be having the physical and emotional capacity to engage in the activities that I find rewarding, and hopefully having that capacity for many years.

And I think for different people, that means different things. Someone in their 60s, they want to engage maybe not in high-intensity activities or endurance activities or things like that, and that's their definition of health. They want to play with their grandkids or they want to spend time with friends and they want to have that capacity. And for them, that's what health is, versus maybe someone who's younger who wants to be more engaged in activities.

So that's how I see it, is having that capacity to do that. And again, I think it just means different things to different people.

Scot: Yeah. I'm sensing, getting back to what Mitch said about it can mean different things at different times, that it's an evolving idea, right?

Troy: Yeah.

Scot: It's not a destination. It's something that you're always kind of pursuing.

Troy: Yeah, for sure.

Scot: And then also I'd like to add to what both of you said. It's an external thing. I think that's huge, right? You look at somebody and you go, "Oh, they're healthy," but really maybe they're not. Maybe inside things aren't that great because of other lifestyle choices they're making, right?

Troy: Yeah, and it's so true. I think one thing, really, I appreciate about my job is that you do meet a lot of people who definitely have very much a public persona being very fit and having a wonderful life, and you gain a lot of insight into what's actually going on in their lives and you realize it's not always that way.

And so I think we often compare ourselves to other people and we compare ourselves to that image and that persona, whether that's the image of health or happiness or whatever it is, but everyone has their struggles.

I meet these people. Sometimes they're local celebrities or whatever it may be, and you realize they have their struggles too. We all do. And they're struggling with personal health issues, or maybe it's substance issues, other things they may bring up, emotional health issues.

And so I certainly don't take any pleasure in the struggles that they're facing, but I think it just puts things in perspective when we do start to compare ourselves to those people who really do seem like their lives are just perfect.

Scot: We're on the same podcast together, so maybe this is why our answers are so similar, because we all kind of have the same bit of thinking. But I'm really surprised because my definition of health is very much the same.

It empowers me to do the things I want to do. It's feeling good, it's functioning well, it's not being tired, it's not hurting or aching more than I really need to do, my brain is working, and I feel happy and finding satisfaction in my work because, from a mental health standpoint, I'm feeling good. I'm doing things that are going to help me with my longevity and ability to function as I age.

So that is my definition of health, but it's also something I feel like I have to manage every day. And this is one thing I think about, is how the modern world almost makes it more difficult to be healthy.

You ready for a soapbox moment? I'm going to go ahead and climb up on my soapbox.

Mitch: Yes.

Troy: Ready or not, I think we're going to get it, so let's hear it.

Scot: So I think about this a lot, and I don't know how much of this is true, right? But for example, activity used to be something that was a part of life. In order to survive, physical activity was involved. Now, there are a lot of people that still do have physically active jobs, but I spend a lot of time at a desk, so I've got to figure out a way to then fit that into my life.

And I feel like eating was a lot more simple, right? But in today's age, I'm constantly bombarded by commercials for food that's been chemically created to be addicting. And billions of dollars are spent on this to get me to eat this food that's convenient and not necessarily great for me.

And then I have a phone with apps on them that seem to suck up more time than I ever want them to, that I could be spending on healthier activities like exercise and sleep. And again, using psychology to making sure that I'm addicted to these apps, right? And I'm watching more and spending more and more time.

And then these daily images and messages about what it is to be a man and a healthy man that doesn't necessarily resemble me at all. I feel bombarded by that. So I feel like I'm constantly thinking about it and constantly having to manage that.

And don't get me wrong, I'm not saying, "Let's go back to the way things were," but I don't think health is something you can take for granted. I think you have to have kind of a plan and be mindful about it. Do you guys buy into any of that or am I just spouting crap?

Troy: No, it makes sense. Sometimes it feels like the cards are stacked against us. Again, you're exactly right. So much has been based on human psychology and addiction and feeding into those patterns, whether it be with diet or with, like you said, apps, or engagement with social media, those sorts of things.

It really has played off a lot of, I think, addictive tendencies that we have as humans to do those things, and so we have to be aware of it, and it's a struggle. I think that alone, the fact that there is so much understanding of our psychology and so much of that plays into our psychology and tendencies toward certain addictive patterns, it's a battle. There's no question.

Scot: And I feel like this can be going on without you even realizing it.

Troy: The simple reality is you can't just go with the flow and be healthy. You just can't, because the flow really pushes you toward those things.

Scot: I love that analogy.

Troy: Yeah, you really can't.

Scot: You're right.

Troy: You figure most Americans are overweight or obese, and that's the flow. That's the majority there. So if you're just going with the flow . . . Yeah, you kind of have to swim upstream in a sense to really be able to get beyond so many of those things that just draw you in. I think it is a huge struggle.

Scot: What are some of the challenges that you guys have experienced with either the Core Four or some other health things, and how did you overcome those?

Troy: Obviously, a big one for me has been sleep, and I can't say I've overcome it, but I think a lot of what we've talked about has been healthy, of trying to have more regular patterns in place and addressing that.

But I think some of the bigger issues for me where I have felt like I've had some success have been definitely activity. And for that, I think it's just been saying, "I'm going to do this and I'm going to try and do it every day and be consistent." And not expect heroic efforts on a daily basis, just to expect a consistent effort and just keep it up. And for whatever reason, that seems to have worked for me so far on the activity side.

But I think it's always a struggle of just saying, "Well, why am I doing this as much as I am? Do I really need to do this to get the results that maybe I want?"

So that, for me, I think is the struggle in other areas where I feel like I'm doing a pretty good job. It's more kind of that temptation to ease up on it or maybe say, "Well, this isn't really necessary," or, "Maybe it's not worth it," or, "Maybe I can get results by not doing what I'm doing and maybe cutting that in half," or something like that. So that's, I think, the challenge I face in some of those areas outside of sleep.

Scot: I want to ask you a question about sleep. I mean, is there really anything you can do? I know you've done some stuff, but part of it is just the job you have, which is, again, a result of the society we live in.

Troy: It is, yeah.

Scot: I mean, then the question is, do you beat yourself up too much about it or . . .

Troy: Yep, I do. And then it's just that spiral. And I think we've talked about that before. I think Mitch has talked about it.

Scot: The shame spiral, he calls it. I love it.

Troy: It's the shame spiral or it's the anxiety spiral. I think we get so anxious about not sleeping that we can't sleep. And that happens to me. And so sometimes I'm just like, "Just don't worry about it. Who cares?"

But you're right. That is very tough to do. And I think, again, there are just certain realities of a 24/7 society that needs people who are available for services or emergencies or whatever it may be at hours when people used to sleep on a regular basis. So I think there's that reality too.

But even that aside, sometimes I feel like I'm in a pretty good sleep pattern and then I might have a week or two without a late shift and I still find that I'm struggling. But again, maybe that's just that cumulative effect of working late and working nights.

Scot: And as far as your activity, what's the difference between you and then Mitch and I? Do you just have more willpower? Do you just have more discipline?

Troy: I was going to say obsessive-compulsive disorder, because that . . . No, I'm saying for me, it's the obsessive compulsive . . . I don't know.

Scot: A lot of times when we talk about health and fitness and the Core Four, it could be easy to go, "Well, you just have to have more willpower. You just have to have more self-control. You have to have more discipline." And maybe that's true to some extent, but are there other things at play that have helped you do that? Or are you just mentally made of sterner stuff than we are?

Troy: I don't know about sterner stuff. Maybe more disordered than you are. Yeah, I don't know. I tend to pride myself, I think, on trying to be very consistent on things, and it's been very good in a lot of ways. I think in terms of just medical school, you do have to have very much a Type A personality and you have to have a certain level of kind of that OCD tendency of very focused and like, "I'm doing this every day."

So I think it's been helpful in some ways in terms of success. It also kind of drives you crazy sometimes, so yeah. And maybe that's part of it for me, honestly. That may be a part of it for me, is just for whatever reason with this routine in particular and just with running in particular, it's been very much . . .

And then you get in a pattern where you've done it every day and it's like, "Well, I can't miss a day." I honestly have not missed a day in almost eight years, so it's been good. I feel like I'm in the best shape of my life, which I love feeling, and I've seen my cholesterol numbers continually improve. So I think there's been great reward there.

But again, I think my point in saying all this is it doesn't come easy. You do get in the habit and you have that habit and that helps you get out the door, but still it's hard. I enjoy it once I'm out there, but often it's hard to get out the door.

Scot: Mitch, what's your take on willpower or discipline being the reason that maybe some of us struggle to maintain these healthy things?

Mitch: That's actually something I have been spending a lot of time thinking about lately with the new diagnosis of ADHD and kind of figuring out what works for me, what doesn't.

A lot of times in the past, I would beat myself up that I was not performing, that I was not able to have enough willpower, that I was unable to do certain things, right? And these days, it's more recognizing that sometimes it's not all willpower. It's just consistency, a general trend towards positivity, a general trend towards doing a little better, the dao of Kaizen, little improvements every day.

It's not necessarily an all or nothing, and if you hold yourself to such a high standard and you don't meet it, it doesn't necessarily mean you don't have the willpower. There are a lot of other things that could be going on too that are preventing you from getting there.

Scot: Mitch, what's kind of your overall challenge then?

Mitch: We've mentioned a couple of times over the last year, my health got a whole lot more complicated than I was expecting. Everything from mental health issues, to physical injuries that I'm back in physical therapy for, to hormonal things that we have figured out and got me on some medications, etc. There's a lot of small progress being made on a lot of different fronts, but it does not feel like I'm actually accomplishing what I want to some days.

Scot: Yeah, I feel you completely. It's like you go on Instagram or TikTok and they've got a Reel, and it's somebody who wanted to get in shape at the beginning of January, and then within that 15-second video you see the before and the after awesomeness. And even though you know better, it just seems like, "Oh, that was an instant transformation."

Mitch: Yes. You get that before and after effect, right?

Scot: Yeah.

Mitch: For me, like we talked on a recent goal episode, it was like, "I want to get back to having X amount of activity all the time. I want to feel better about my mental health. I want to sleep better, etc." I'm doing okay at a bunch of those, but it's so easy to just say, "Well, I don't have enough willpower. Oh, this sucks," when I've got to keep reminding myself that I am not a Instagram influencer, that their whole job is to look happy and look fit, right?

I have a lot going on. I have a lot of stuff on my plate. I've got a job. I'm teaching classes. I am overcoming an injury, mental health stuff, whatever. Oh my god, I am doing okay for where I am right now. And that's kind of some of the stuff that . . .

It's so easy to just be like, "If only I had more willpower, I could be like these other people. If only I had enough willpower, I could be like Troy Madsen." But "right now, I'm doing okay" is where I feel some days.

And so it's just this kind of different approach to it that I've been taking and being a bit more kind to myself. And I find it's easier to do little good things if you're in a good headspace than beating yourself up that you weren't perfect every day.

Troy: Yeah, there's no question. And we've talked about that a bit before too, but I think that being kind to yourself is so essential because it's when we're not kind to ourselves that I think we really do kind of fall off the cliff in terms of our activity. When we do expect perfection or we compare ourselves and just get frustrated, that's when we just kind of throw in the towel and are like, "Ugh, this isn't worth it. Why am I doing this? I'm accomplishing nothing." So I totally agree. We have to be kind to ourselves.

And for me, like I said, in terms of the activity, I feel like I've been very, very consistent there, but then there's the diet piece. That's kind of improved and then it's gotten worse, and sometimes I'm wanting to eat some sweets and I want to drink soda and these kinds of things. But there, sometimes I do kind of feel that tendency. Certainly when we travel, I'm not eating like I should. Then you kind of get frustrated and unhappy with yourself.

But again, I think you just kind of have to look big picture and say, "Overall things are good and I'm not going to be perfect with this, but I'm happy with where I am, and I'm better than where I was 10 years ago. So that's good."

Mitch: Right. So, in that same vein, as someone who deals with a lot of anxiety, someone who deals with the shame spiral, as I've come to call it, this idea of, "Oh, no, I'm not performing as well," and then you feel bad about feeling bad and then it just gets worse and worse, one of the mantras for 2023 that I'm adopting from the younger generation is this idea of if it's worth doing, it's worth doing half-assed.

I don't know how else to say that. We'll have to bleep it because half-butted doesn't sound right, but . . .

Troy: Halfway?

Mitch: Halfway, sure. There you go. Yeah. But it's this concept that perfectionism and the idea that you have to hold yourself to that 100% standard and you have to hustle for it and you've got to push for it can be so detrimental, because what if you don't achieve it? What if you don't hit that 100% mark?

So, as such, the kind of approach is . . . Say you want to work out six days a week, whatever that is. It's better to be consistent, so even if you can't get your butt to the gym three to four times a week like you'd like, going for a walk for 20 minutes is still activity and it's still good for you. Will you see as much of a result as if you were to go in and do whatever? No. But at the very least, you are still doing it, right?

And so, for me, if I can't get my strength training in, if I can't get enough of a jog in or whatever because of my injury that I'm dealing with or whatever, I'll just walk around the block a couple times. Because even doing it just half of what you wanted to do is better than nothing at all, or hating yourself that you didn't hit that.

And it goes to nutrition. If you're not eating healthy every single day, that's okay, right? Just get yourself a chicken sandwich instead of a Baconator. Those kinds of small choices that are like, "Is it the best thing you could be doing right now? No. But it's good enough and it's at least a step in the right direction."

Troy: That's so true. Yeah, I'm a huge believer in that as well and just this idea of . . . I think you're far better off doing something and doing it halfway and doing an okay job of it, but doing it consistently, than you are of doing something extremely well but doing it irregularly. I think you're going to get more results if you just try and stick with it.

Whatever it is, just kind of do whatever you can, and maybe it's not great, rather than having these huge workouts at the gym, but just feeling burned out by it and not wanting to do it more than maybe once or twice a week.

Scot: I'm going to go ahead and throw mine out there. And actually, in homage to Troy, I'm going to recognize what I feel like I do well most of the time. My nutrition, I feel pretty good for the most part, if I'm being honest with myself.

It's easy to beat myself up. Over Christmas break, I ate a lot of salted caramels at 100 calories each, four or five at a time. But I'm off those, right? So that wasn't great. But generally, I feel pretty good about my eating. I don't eat a lot of processed foods or anything like that.

Generally, I feel pretty good about my sleep. Generally, I am feeling better about my mental health, but that activity thing, especially weight training, is always a challenge.

And the thing that I'm trying to do . . . Like I said, I always come up with these little tricks. Sometimes at the end of the day I'm so tired, I just want to do something mindless, and then that's when I go to the phone and I start scrolling, right?

And I saw something that said, "There are these little moments in our day where we make a decision that's going to dictate what happens for the next hour of our life." So I think about that a lot.

I'll pull out my phone when I know I want to exercise and I'm like, "This is that moment. This is that little decision that's going to take the next half hour of my day, or hour, and going to prevent me from doing the thing that I want to do." And then for some reason, it's easier to make the choice of the thing I want to do.

So that's been helpful for me, and I think it could apply to a lot of things. It could apply to eating. It could apply to a lot of stuff in your life. So just that notion that there are these little small moments throughout our day that the next thing we do is going to dictate what we're going to be doing for the next half hour.

Troy: That's true. I think also, though, I like kind of rewarding myself by just mindlessly scrolling on the phone and feeling like I've earned that time because I did exercise and I did the things that I wanted to do. I'm like, "I'm just going to sit here."

And sometimes Laura will make fun of me because I've got a game on the TV, and I've got a game on my iPad that I'm watching, and I'm scrolling through ESPN on iPhone, and I'm like, "I'm going to do this completely shamelessly because who cares? I already ran today." I think there's kind of a trade-off there too.

Scot: But it's a mindful decision. You mindfully made that decision, which took active management again, right?

Mitch: Yeah. Intention versus just defaulting.

Scot: Going with the wave, as Troy said.

Troy: That's true. Yeah, you're right. It is. You're right. You do have those choices you can make, but then at the same time, you can make the choice later and be like, "Hey, I've earned this. I'm just going to enjoy this time. I'm just going to turn my brain off."

Scot: But the worst thing, Troy, is when I reach one of those little moments in my day, and yet I still choose the thing that I shouldn't choose. And I'm willfully doing it and I'm even admitting it to myself at that point. I'm like, "This is that moment and I've chosen to do this instead." It's just almost like waving my fist at authority.

Troy: Yeah. Exactly. But then hopefully you can just kind of forgive yourself and move on from it. That's part of it too, is recognizing, "Hey, I willfully made this choice. It's probably not the choice I should have made, but I'll maybe make a different choice next time."

Scot: All right. Did we get any insight from this conversation? At the top of the show, I mentioned that some shows we have some great solid steps that you can take and things you can do. This one was more of just trying to make some sense out of some things that are going on as we struggle with our own health and our own health issues and the things that give us challenges and trying to explore why that might be. Did we create anything new? Mitch, do you have anything?

Mitch: For me, it's nice to hear that other folks are going through this too, right? It's so easy to get in your own head and only be watching the influencers and thinking you're not doing well enough. I really do appreciate, Troy, to know that you struggle with stuff too. I don't want to say I love that, but it is very appreciated that . . .

Troy: You can love it. Please love it.

Mitch: I love it. Best thing. No, but it's nice to know that, "Hey, there are other people also on their own journey and maybe I need to quit comparing myself to everyone."

Troy: Yeah, I think for me too, hearing about some of your struggles and just talking about some of my struggles. I think that's probably the takeaway for everyone, is I don't think you've ever got it made. I think that's the bottom line. With fitness, you've never got it made. It's never easy. It's always challenging, no matter what habits you've developed.

That pattern can help you to keep that habit going, but I still think there's a mental challenge every day and you're always going to face those decisions, like you talked about, Scot, of "What am I going to do with this moment right now?"

And you're always going to face just the flow and avoiding the flow, which just seems to kind of drag you into a lot of the stuff you just don't want to do in terms of the eating habits and being fully absorbed in social media or whatever it may be. So I think that's my takeaway.

Scot: I feel like my takeaway was something that Mitch said, which is that health to him is something that you're . . . It's a work in progress, right? And sometimes . . .

Mitch: WIP.

Scot: Sometimes in your work in progress, you're in a better position than you are at other times, but it's just always kind of a work in progress.

And I agree with Mitch. It is also good to hear that this feeling that you're constantly managing it is something that goes beyond just me.

Well, we hope this episode was useful to you as we discussed some of the struggles that we have. And a lot of times when you're talking about the Core Four and our health, there are some things that are playing against us that we don't even realize, whether it's society or whether it's our own attitudes.

What is your struggle when it comes to the Core Four and being healthy? And have you figured out how to overcome it yet, or do you still struggle with it? Are you still looking for answers? We would love to hear about your journey. Send that email to hello@thescoperadio.com.

And regardless, whatever your struggle is, good luck and be kind to yourself. Thanks for listening, and thanks for caring about men's health.
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: I have a question for you guys. Do you know the best way to make sure you never fail to achieve your goals?

Mitch: Never set them in the first place.

Scot: Yes.

Troy: Just don't set them, yeah.

Scot: Unfortunately, that's probably not the best plan because goals are useful, right? They can help us achieve the things we want to achieve. But sometimes even when you set goals, you don't achieve them. Just like you never set the things in the first place. And today on the podcast, we're going to talk about goal setting, if you've kind of gotten off track, how you can get back on track. That's what the podcast is going to be about.

I'm curious, do you guys have any sort of goals you've been working on that have gotten off track? Let's start with you, Troy. Anything you'd like to bring up?

Troy: Yeah, without question. It's funny. We talked about this, or we were in touch about this beforehand, and I gave it some thought. My first thought was, "Wow, I'm doing really great. Look at all the stuff I'm doing." And then I thought more about the stuff I had wanted to do over the last couple years where I've just failed miserably, and I thought, "Wow, I've really gotten off track." So, absolutely.

Scot: Could you be specific? You got a couple that you'd like to share?

Troy: Yeah. Oh, for sure. A goal I set like two years ago was I wanted to write more, with the goal of actually writing a book. And I have not even gotten started on that, so that is so far out there. And we can talk about specifics of why I have failed miserably at that, but I haven't even started it. So that one is one where I've really failed.

Another one I set where I did pretty well, but have definitely gotten off track, is trying to keep in touch with friends. And I tried to be more specific on this goal of just being in touch with friends on a weekly basis and trying to get out at least once a month to do things with friends. I'm saying this and I'm embarrassed that I'm saying it because it makes me sound like a total recluse, which at this point in my life I probably am. I tried to set a very achievable goal. Again, to some extent, I was successful, but I am definitely off track on that as well.

Scot: Mitch, do you have any goals that you've been working on, you've kind of gotten off track, or you're not making the progress you want?

Mitch: Oh, do I. So over the last couple of months I've tried really hard to . . . I've been going through some mental health struggles, etc. We're trying to work through it, and I know that I will feel a million times better if I get back into a routine, if I have a reasonable bedtime and I get the same amount of sleep, if I wake up, I do my exercises, my physical therapy, etc.

I set time aside every week to do some meal prep. That was really, really effective for me. I know what I need to do. I write down the things I want to do. And what kind of makes it harder was that I did it really well for a week or two, and it just feels like I'm not doing quite everything I want to in all of those areas right now. So I know that feeling very well.

Scot: Okay. I have some goals too. I would like to read more. I don't feel like I read enough. I want to declutter my office and my garage, get rid of some of the stuff here. That's good for your mental health. And I also want to lose some body fat. So those were kind of some of my goals that I feel like I'm not making the progress on.

And today, we're going to talk about all of our goals and we'd like you to even think about what a goal is you'd like to accomplish and maybe you've stalled out on. We're all together going to try to get a framework so we can all get back on track.

This is "Who Cares About Men's Health" with information, inspiration, and a different interpretation of men's health. I'm Scot Singpiel. I bring the BS, and I also bring a lot of experience to this conversation because I've failed to achieve the same goals for the past 10 years.

Troy: Nice.

Scot: Or I guess we could call it I've practiced the same goals for the past 10 years.

Mitch: There we go.

Scot: The MD to my BS, Dr. Troy Madsen. He's the one that suggested this topic, and although he did say he has some that he hasn't met, I don't know that he's ever failed to achieve a goal.

Troy: I wish that were true.

Scot: And always coming with a unique perspective, welcome to the podcast Mitch Sears.

Mitch: Yep. Always unique. That's me.

Scot: So this show, in a way, as I talk about these things, I feel . . . I don't know. It's just like, "Could you whine more about some of the simplest things in the world to accomplish?" I just feel like there are guys out there that can set a goal and they just laser in on it and they just get it done.

And as I joked in the open, I've kept daily pages and I've looked through my pages in the past, and really it's the same stuff over and over again for me. It's just like, "Come on, Scot. Let's get it done. What's so hard about this?"

So I'm really hoping maybe this show gives me some clarity on some of the things I'm not doing right so I can kind of restructure my thinking a little bit and feel less like a loser and a failure.

Troy: Well, you've got to give yourself credit too, Scot, because you have done a lot of things. And to be successful at achieving these other goals, I think we have to at least recognize where we have been successful and what we've done to be successful in those things. So I think there's no question you've been successful in things.

Like I said, as I thought through it, at first I was patting myself on the back saying, "Oh, wow, I've done this and this," but then I thought more thinking, "Wow, these are some big things I wanted to do and I just haven't done them." So I think you kind of have to look at both things.

Scot: Yeah. That's interesting that you had the positive vibe at first, and I had the negative vibe, like, "Oh, I've still got all these things to do." How about you, Mitch? Where'd you fall in on that whole deal?

Mitch: I just am feeling kind of awkward talking about it, but that's where I'm at. I felt kind of negative, but I felt I had a pretty realistic, like, "You know what? This isn't working, and I'm trying really hard not to feel like a failure." But just in saying it aloud, like, "Yeah, I had these goals and they're not quite working" . . . I don't know. I just feel like that thought that you were talking about, about being a loser, being a whatever, it's just like, "Ugh, I don't like admitting aloud to other people that I made a goal and I am not reaching it right now."

Scot: Well, let's dive into figuring out maybe why we're not achieving these particular goals. I think Troy is right. I think we've all probably set out and have accomplished goals, but I don't know, it sounds like Mitch and I are kind of the same. We tend to focus on the negative.

Mitch: Oh, no.

Scot: Yeah, I don't know. But anyway, I think the first thing that you need to ask yourself is "Did you set yourself up for success in the first place when you made your goal?"

One of the frameworks that I found, and probably we've all heard of . . . and actually, after revisiting it today, I thought, "Wow, this is actually a lot more useful than I gave it credit for in the first place" . . . is setting something called SMART goals. Have you guys heard of this?

Troy: I haven't, no.

Scot: Oh, you haven't? Mitch?

Mitch: No, I haven't.

Scot: You haven't either? Really?

Mitch: No.

Scot: Oh, wow.

Troy: Not specifically. I'm sure I've heard of a lot of the concepts involved in this, but I don't know that I'm familiar exactly with SMART goals.

Scot: Yeah. I'm not talking smart like, "I'm bright and I'm dumb." It's an acronym.

Troy: I knew it.

Scot: A SMART goal . . .

Troy: I figured this was going somewhere.

Scot: SMART goals are these things. The S stands for specific. So is your goal specific enough or is it too vague? Run these against the goals that you have or the goal that you came up with.

Troy: Okay. So my writing goal, already I failed on that.

Scot: M is for measurable. What does success look like and how will you know if you've obtained it?

So within measurable, I've heard them talk about two different types of goals, process goals and outcome goals. So a process goal is "I'm going to exercise every day." That's a process goal. "Every day, I'm going to do something." Now, of course, it doesn't meet the specific in SMART goals, but that's beside the point on this one. Or outcome goal is "I'm going to lose five pounds." That would be an outcome goal.

A is for attainable. So is it something you could attain at this point in your life or is it too much too soon? With fitness goals, I think a lot of us set goals that are unattainable.

Is it relevant? Does it tie back into your objectives, the things you want to accomplish? Or I've seen it talked about as "Does it tie back into your values?" What is your why? Why are you trying to do this? And is this goal actually helping you to accomplish your why?

And T in SMART goals is time-bound. So you're supposed to put a time on it and then reevaluate at that time. Maybe the timeframe is unrealistic.

Troy, with your goals, where do you think the problem was based on this SMART goal framework?

Troy: Well, the writing thing, I think for me, I did have a measurable outcome. I wanted to write a book. So I guess that was measurable. If I had actually written a book, I would've said I achieved it. But in everything else, I really kind of failed. It was not very specific. What kind of book did I want to write, first of all? Did I want to write a novel? Did I want to write a medical education book? I had no specifics.

Mitch: Just a book.

Troy: Yeah, just a book. I mean, who knows?

And then in terms of measurables, I tend to do a lot better with process-oriented things where it's not like, "My measurable is I want to write a book." My measurable in the process thing . . . The thing that would've been a lot more helpful for me would've been to say, "Okay, I'm not concerned about the outcome. I just want to sit down and write for an hour every day." And then ideally, something proceeds from that.

So I think in terms of what I at least thought two years ago I was going to try and do, I just wasn't really set up for success from the beginning.

Scot: I want to dig into this a little bit more because I think this could help people formulate their goals. So specific, is it specific or vague? You want to write a book. That's pretty vague, right?

Troy: That's vague. Super vague, yeah.

Scot: So maybe your objective is to write a book. This is the way I kind of started framing it, and I don't know if this is how it's framed elsewhere. But your objective is to write a book, so what are the steps that you would need to do to write that book? And like you said, you don't even know what kind of book.

And measurable, you kind of got towards that, right? You said, "I want to write for an hour a day."

Troy: Well, I just said that now. Yeah, I should have said that at the time.

Scot: But you're getting closer, right? So is writing for an hour a day attainable though in your schedule realistically, or is a half hour a day better, or 15 . . .?

Troy: You're right. Yeah, probably something that's actually attainable and consistent would be 15 minutes. You're exactly right, if I really said, "What is attainable?"

If I set out to do an hour a day, I would not do that. There's no way I could maintain that. So yeah, 15 minutes a day, you're right. I could do that consistently, and then maybe some days I just keep writing because I have more time or I'm kind of in the groove or whatever. So yeah, in terms of something that's actually attainable, that's what I would need to do.

Scot: And then the relevance part, the R and SMART goal, does writing a book tie back into your objectives or values? I mean, what is your why? Because if your why is not strong enough, you're not going to sit down and do that 15 minutes. I mean, that's a pretty deep question to ask yourself. Why do you want to write a book?

Troy: Yeah, it is a deep question. I think it's something I've always wanted to do, and so that's maybe more the relevance, but I think the relevance would have to relate more to actually what I was writing about. Is it something that just the process brought joy to me? If so, that makes it very relevant.

Does it get at a deeper purpose or something else I'm trying to bring attention to, whether that's a medical topic or health topic or something that entirely has nothing to do with health?

So you're right. I think the relevance would have to . . . Just saying, "I'm going to write a book," that in itself maybe there's some relevance, but I think I'd need a lot more relevance to really stick to it.

Scot: Yeah, and then, too, if the relevance is, "I just want to go through the process of writing a book to say I did that," that would then maybe dictate what kind of book you're going to write. Maybe you want to make that process as easy as possible as opposed to learning a whole bunch of new skills, like writing fiction.

And then time-bound. Did you ever put a time on it as far as, "I'm going to get this part done in this amount of time"?

Troy: No, I never did. It was two years ago and I believe it was a New Year's resolution sort of thing, and I think I envisioned within the next year I would be able to do it. But I can't say I ever put any timeframe on it.

Scot: Mitch, do you have a goal you want to run through the SMART thing?

Mitch: Well, it dawned on me as we're kind of talking through it that my goal was . . . I had little micro ideas that were specific, but the idea of "get into a healthy routine" is way too broad. I'm much better these days. I used to be very much outcome-focused when it came to my health, right? How many pounds I wanted to lose or . . . It was a lot of that kind of stuff.

Scot: How many abs you want to see.

Mitch: I want to see eight abs, whatever it is, right? So I'm getting better about process. It's like, "Hey, I want to work out 30 minutes a day so many times a week."

Scot: Which ties back to the overall objective of healthier habits.

Mitch: Yes. But also I think I'm trying to do a whole lot of things. I've got bedtimes and meal preps and I want to reach out to people more and I want to work through this ADHD CBT workbook that my therapist gave me. I put those all together in the same goal, and I think that might be what's screwing me up.

Troy: Just too big, too much.

Scot: I love that insight, because I think this is something I observed as well, very similar. Sometimes we make a statement like, "I want to live a healthier lifestyle," and we don't think how complicated that really is until you start really breaking it down and trying to do something.

Sometimes seemingly simple things are very, very complicated, and then we get mad at ourselves because we can't achieve this seemingly simple thing that actually has a lot of complicated steps. And each step might take learning some new knowledge or might take overcoming who knows what obstacles.

Troy: Well, I think even just the more specific goal, like you said, Scot, "I want to lose five pounds," even that is very non-specific in a way because it doesn't talk at all about exactly what you are doing with your diet, what you are doing with exercise, all those other things.

So even beyond just the general healthy lifestyle, I think even sometimes some of these specific things we want to achieve are just far too . . . We need more specifics there of how we're going to get there.

Mitch: I think that one of the things with this particular issue I'm having is that, yeah, it's complicated, but also change of any sort can be hard and taxing and it takes effort. And I don't necessarily think that this was overly complicated. You said, "Think through it," and everything. I wrote everything down. I got my little panda planner out and I wrote down when I'm going to do certain things, and what time of the day I'm going to do them, what kinds of blah, blah, blah. I wrote it all out.

But I think for this particular one, you look at at attainability and how reasonable the whole thing is and it's just like, "This is a lot of changes all at once." This isn't a small easing into it. I'm trying to get myself to do four or five big changes, and while I might understand what I need to do, that's still a lot to do all at once.

Scot: Yeah, it is. It can overwhelm you and then it's like, "What's the point? I'm never going to achieve all of this."

Mitch: And then they're all linked together in my case where it's like, "Well, I didn't get to bed on time, so I guess I'll eat McDonald's in the afternoon."

Troy: That's right.

Mitch: Why are those connected?

Troy: And that's a really tough thing too, because I think sometimes when we do set goals that are really tough and we don't achieve them or we fall off the wagon, so to speak, we just kind of give up and just say, "Well, so much for that." And that's the hard thing about it.

I like the attainable piece of this as well, of the SMART goals. I think not just attainable, but something that's . . . We want to set hard goals in a way, but at the same time, I think we want to have steps along the way that we can be very consistent with and that aren't overwhelming.

And I think there's so much more value in just being consistent in something rather than just having a huge effort and just putting that forth and saying, "Wow, I did it," whether that's a workout or whatever it might be. But just consistency every day, something that's relatively easy to do, and if we're consistent at it, I think we see big results.

Scot: I'm going to say overcoming an established routine to do something else in a routine is extraordinarily hard. We have routines for a reason. It's to conserve brain energy. If you had to make all the micro decisions you have to make on a daily basis from "How am I going to get to work?" to whatever, that's why routines are helpful, because they allow us to then turn that brain off to do those things we have to do. So just realize that's a tough thing to overcome.

And in my instance, for example, my "declutter my office and my garage," this is another complicated thing, right? I can get very specific and say, "I'm going to take one thing out of my office or my garage and put it in a box for Goodwill every day." But here are some things that I've struggled with. Well, first of all, I'm a "I might need that someday" kind of guy.

Troy: That's totally me. Trust me, since we did the declutter challenge, I have said to myself so many times, "Why did I do that?" because I need that thing now. And then it keeps you from getting rid of stuff.

Scot: Right. Even if that thing is something I could easily go and buy for a dollar at the hardware store, I get mad at myself because I didn't store it for 20 years, right?

Troy: Yeah, you could have saved a buck because you saved it.

Mitch: Yeah, a buck.

Scot: So I have to overcome that aspect of my personality. And some of the things in this office are tied to my identity. They were things I purchased at a time that, for whatever reason, I identified with, or they were part of who I was at the time.

For example, a picture of me on the cover of a radio magazine when I used to be in radio. That was tied to my identity. I don't necessarily care about it anymore, but it's tough to throw that away or get rid of that.

And some things are stuff my mom saved from my past and I don't have a connection to that anymore, but because my mom saved it and it's from my past, I don't want to get rid of it.

Some things are like, "Hey, I could sell that and make some money," and that slows things down.

So just the simple thing of getting rid of one thing a day can really tie into a lot of complicated issues that we have as people that we have to overcome in order to do that, right? So isn't that crazy? I think that's just completely crazy.

Mitch: Yeah.

Troy: Well, it is. But again, I think if you do have that specific goal, and if you just make it very easy and very attainable . . . I like what you said, just getting one item every day that's going to go to Goodwill, or maybe it's even one item every week if you just need a starting point.

But it seems like once you do that and then you get that item, then there are going to be some days where you say, "Well, I can get rid of this too." Then you kind of get on a roll there with it, and then the next week you just may not be in the mood to get rid of anything, but then you think, "Oh, it's just one item."

So making it a low bar that's achievable and you feel like you've achieved that on a weekly basis, I think, is really key to the larger success.

Scot: The next part is kind of the troubleshooting. So let's say you've got what you believe to be a really solid SMART goal, but you're still not quite accomplishing what's going on. So this is a troubleshooting step that I found in the "Harvard Business Review."

And the process is this. The first thing you do is you think about that goal and you imagine achieving it. I mean, you really picture it. You feel the pride or the excitement or the sense of accomplishment or whatever emotions that you have that accompany that goal.

And then you ask yourself, "What's in the way of achieving that goal? What's it going to take to realistically get there?" And that might be more knowledge. It might be putting together an actual plan, how you're going to make that happen.

For example, if your goal is to eat more vegetables every day, do you have vegetables in the house? Maybe the plan is make sure you pick up a couple of bags of frozen beans.

Then going between the future that you want and the obstacles you have to overcome to get there, according to research, will help develop motivation and the clarity to succeed. And they call this mental contrasting.

They've actually done research on this, that people who do this mental contrasting of thinking what they want, really putting themselves in that position and then thinking, "What are the obstacles between me and that?" are more likely to put more effort into achieving their goals. They're more likely to make them happen.

I took two things out of this. The first thing I took out of it is this process of looking at where you want to go, what it is you want to accomplish, and then troubleshooting it. What's in my way? What is it that I have to do? And that helps you come up with that plan. What is it that I need to do to realistically get there?

And then you can evaluate that along the way and go, "Boy, is this really that important to me? If this is what I realistically have to do, maybe it's not that important to me after all."

But it's a process that you can go through to maybe troubleshoot those SMART goals and figure out, "Is this worth it to me? What do I need to do to get there specifically? How can I break this down into smaller things, into smaller SMART goals, perhaps?"

And then I think the other part that they're talking about is this actual mental imaging of the accomplishment. I think the psychiatrists are saying that that helps motivate people. According to their research, people will put more effort into achieving their goals.

Troy: That's interesting. Sometimes I worry too much though that I try to see the end from the beginning, which is kind of part of that process. I don't know. Like I said, for me it just works just to focus on the process and the achievable goals, and then it seems like that end piece eventually comes.

Sometimes I think when I do focus on the end from the beginning, I get a little overwhelmed. I don't know. I'm interested if that's worked for you, just what they recommend, envisioning that end and how you'll feel and everything associated with it.

Mitch: See, and that's what kind of . . . It's like every so often these things come into my life, whether it's you sharing it on this podcast or whatever. It's like, "I didn't know about SMART goals. When was I supposed to learn about SMART goals? There's a process here."

And it's the same with this "Harvard Business Review" thing. I think, in kind of a similar but different way with Troy, that most of my goals, I don't spend a lot of time thinking about the end. I think about all the steps that I have to do to get there, and that can be overwhelming.

But then on top of that, because I don't take the time to be like, "How will I feel if I accomplish this? How good would it be? What would I appreciate? What will I be able to do?" I don't spend any time thinking about that. So it stays nebulous and it doesn't feel like something I actually want. It doesn't feel relevant.

You have to think about it or else it's not going to be in your brain and it's not going to be real. Why is the "Harvard Business Review" coming into my life right now? Ugh, it's so frustrating.

Troy: So maybe in your case, maybe that's helpful. Like I said, for me, maybe I've focused too much on that, on the end, and not so much on the specifics. But like you said, maybe sometimes, in other cases, you focus so much on the specifics that you find them overwhelming without really focusing on what the reward is going to be. So it's probably something . . .

Mitch: If it's worth it.

Troy: Yeah, exactly.

Mitch: And if it's worth it to you, yeah.

Scot: Yeah, and you can discover that along the way, right? Maybe it was never really worth it to you after some deep analysis.

Troy: Right.

Scot: Some other troubleshooting tips that I came across here. So is it the goal you really want? When somebody says, "I want to get healthier," is that what you really want?

Maybe you said, "All right, I want to get healthier. I'm going to go walk 30 minutes a day for a few months," and then you gave it up because you weren't losing weight. Well, that's a little bit of a different goal, right? The true goal reveals itself. So was that a failure? Well, maybe, maybe not.

But is the goal you really want the goal you're working towards? You've kind of got to ask yourself that question. I think being specific can help with that, the SMART goals.

Did you have a plan in place? It's great to have goals, but what's that plan you're going to do to get there? And I think that's the HBR, the "Harvard Business Review." What are the obstacles? What are the things that are in your way? What is it you need to do to make that goal?

Another piece of advice is getting started again as soon as possible. So if you have set a goal and you've noticed that you're not making steps towards it, don't keep putting it off. Get back into it as quickly as you can.

This is another big one we've talked about on the show. Be compassionate. And we talked about it at the very top of the podcast, right? Don't focus on your failures. Focus on your progress made.

So I wanted to have two kettlebell workouts a week, and I did pretty good for a couple of weeks and then I got off track for a week, and I'm like, "Oh, I failed." Well, no, I can start doing it again. And I did it again last night, right?

And not only that, but I've got my sheet of exercises now. So that was something I accomplished. I went and did the research on the exercises I wanted to do, so it wasn't a failure. I'm starting at a different point, right? If we use the mountain analogy, I'm 20 steps further from my beginning point. I'm not back at the beginning.

Troy: You've taken a nap along the way, but you made 20 steps.

Mitch: Got a breather. You got this.

Troy: You got a breather, yeah.

Scot: So it's not a failure.

Troy: But you're higher up the mountain.

Scot: And then accountability partners was something else I came across. So seek out others who share similar goals or at least will be supportive and help you be accountable. So that might be the missing key for some people.

And then this one really spoke to me. I think we want things to go as smoothly as possible, and when they don't, I think sometimes we're like, "Well, that was not a success." But plan for obstacles. They're going to happen. That's part of the process. They're problems to be solved.

Troy: Yeah. And I think the compassion piece of it is huge because I think the biggest challenge for us, like you said, is just recognizing what we've actually done. We set these goals, we want to be perfect in them, we want to do this every day. Whatever it is, we want to achieve it. And then we just find that we're just not getting there or we're not getting there as quickly as we are and we just are like, "Why am I doing this? What's the point?" And so I think that's probably the biggest piece of it and the biggest challenge.

Mitch: Yeah, that's kind of the thing that I come across a lot, is that it's so easy to fall into a shame spiral. It's so easy to be like, "Ugh, no, I'm terrible. This is bad," or whatever, for me at least. I really like that idea of "I've done something."

For my particular goals, I have a plan. It took me some time to sit down and write down the kinds of things that I wanted to do. Was it maybe a little too much? Sure. But that doesn't mean I need to beat myself up about it. I made some progress. And if we keep focusing on that aspect of it and can forgive ourselves for not being Supermen, I think it might be a little easier to get back on the horse.

Troy: Yeah. And I think if you just do absolutely nothing to achieve your goal, you make zero steps, you can still pat yourself on the back for the fact that you actually set a goal. That's worth something. You envisioned it. You set it. That's a step.

Scot: All right. Are we at a point where we can wrap this up? I think we kind of covered some stuff. Do we want to do some takeaways?

Mitch: Oh, sure.

Troy: Sure.

Scot: Boy, Troy sounds a lot more excited about doing takeaways than Mitch, but that's okay. What's yours, Troy?

Troy: My takeaway is SMART goals. Again, I've heard of certainly pieces of this, but I like the way it breaks it down. I'm not a big fan of acronyms, but in this one I kind of like the acronym.

And then for me, I think getting back to the goal where I've obviously failed, the piece of the SMART goal I need to find . . . there are lots of other pieces, but the big piece I need to find is the relevance. So that's the thing I'm going to take from this. If I'm going to write a book, what is the relevance to me? And maybe rethink this goal and potentially move forward on it if I can find that relevance.

Scot: Maybe a short story would be . . .

Troy: Maybe a short story. Maybe a haiku. Keep it simple. I'm going to start small.

Scot: I do want to throw one thing in. So as I was working through SMART goals, it can be easy to take these acronyms and think that everything has to happen in the order that it is in. I found that that's not the case. I found that I got midway through and then that changed actually what the first thing was. Attainable, that's halfway through. Well, when I started thinking about that realistically, that changed the specificness of the SMART goal, right?

Mitch: Sure.

Scot: So I don't think you necessarily . . . They all are interactive and I think one answer could change previous answers before that, and that's okay.

I think it's a great way to set a goal, and I think it's also a great way then, if you do have a breakdown and it's not working, to analyze your goal a few days later or whenever that breakdown is to see, "Well, maybe where wasn't I quite what I needed to do here?"

Cool. Mitch, your takeaway?

Mitch: I think I'm like Troy, where it's like, "An acronym? That's not going to help me. A listicle? That's not going to . . ." But at the same time, just having a process or a method for being intentional about anything in your life can be really helpful.

And so the two things for me that I really kind of appreciated was the "Harvard Business Review" talking about focusing on the goal, and I think that ties into the relevancy for me. A lot of times, it's really easy for me to let goals come and go. Whether that means I'm afraid of not reaching them or whatever it is, I don't do that step.

Because I don't think about where I'd like to be or what it would feel like to be at that point, it never becomes relevant, and so it's easy to let go of.

And then on top of that, the attainability part, I think that's huge, and being honest with oneself and really understanding, "Where are you at, and what can you actually do in this moment in time?" and not defaulting to, "I am a failure if I am not achieving at 100% effectiveness as an idealized super person would be."

Scot: What is your goal? Did you have a goal that you kind of started out with the first of the year, or a goal like Troy that's a couple years old, and you just really haven't made much progress on it, or not the progress that's making you happy? Think about what that goal is, run it through the SMART goal tenets, use some of the troubleshooting steps, and get back on track. You weren't a failure. You just took a nap, like me.

Troy: You just took a little nap.

Mitch: Just a little nap.

Troy: But you're higher up the mountain.

Scot: That's right.

Troy: It may be later in the day than you thought it would be, but you're doing all right.

Mitch: And you're well rested. You're ready. You're ready to go.

Scot: If you want to share any of your experiences, if you have a different take on any of the things we talked about today, or just need accountability partners, we would love to hear from you. You can send us an email hello@thescoperadio.com.

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

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

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

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

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

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

Troy: Yeah. Right.

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

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

Scot: I'm 15 pounds up since January.

Thunder: Wow. That's impressive.

Troy: That's respectable.

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

Thunder: You're all man.

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

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

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

Scot: No, it's not muscle weight.

Thunder: Focused around your thick, muscular core.

Troy: Exactly. That's right.

Scot: That's spilling out like a muffin.

Troy: Yeah, exactly.

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

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

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

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

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

Mitch: Oh, no.

Thunder: Wow.

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

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

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

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

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

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

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

Thunder: Okay.

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

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

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

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

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

Mitch: Oh my god.

Troy: It's taking on water.

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

Thunder: Defective washing machine.

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

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

Thunder: That's Step 1.

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

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

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

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

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

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

Thunder: Yeah. That's the real world.

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

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

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

Scot: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mitch: Ugh.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Troy: That sounds awesome.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mitch: Sure did. I triple-checked it.

Troy: What's your height?

Mitch: 6'1".

Troy: And your weight is 180?

Mitch: 230.

Troy: 230. Okay.

Thunder: That sounds about right.

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

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

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

Troy: Yeah.

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

Troy: You just don't guess. Yeah.

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

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

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

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

Mitch: Okay.

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

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

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

Mitch: For months.

Troy: For months? Wow.

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

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

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

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

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

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

Mitch: Sure.

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

Mitch: It's super-duper low.

Troy: It's super low? Wow.

Mitch: I make all my foods these days.

Troy: Wow.

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

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

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

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

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

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

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

Scot: And you sound super frustrated.

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

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

Mitch: No, I didn't mean to.

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

Scot: I know. Yeah, exactly.

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

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

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

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

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

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

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

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

Scot: Oh, yeah.

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

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

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

Scot: All right.

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

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

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

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

Mitch: Yeah. We can do this.

Scot: It sounds like we have two different situations.

Mitch: Sure.

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

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

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

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

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

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Scot: So will testosterone solve all my problems as a man? That's today on "Who Cares About Men's Health," providing information, inspiration, and a different interpretation about men in men's health. He brings the MD to the show. Ladies and gentlemen, Dr. Troy Madsen.

Troy: Yeah. Ready to talk about testosterone. I am curious, very curious. Where do we go with this? What do we do?

Scot: Offsetting the MD, I bring the BS. My name is Scot Singpiel. And Mitch, he's responsible for bringing the microphones. Welcome, Mitch.

Mitch: Hello. Hi.

Scot: I think Mitch needs some testosterone. You know how low key he is.

Mitch: It's low T day. I mean, based on everything I see on the internet, that's got to be what's going on.

Scot: Well, yeah. I mean, you go to the internet . . . I'm going to do my impersonation of the internet. You ready for this?

Mitch: I love it.

Scot: All right. You're, like, "You have low energy? You've got to get some T. You putting on a few pounds of fat? You've got to get some T. You having trouble sleeping? You've got to get some T." That's my impersonation of the internet. It's the answer to everything.

Troy: It is. It cures everything.

Scot: Yeah. So we're going to find out if that is actually true or not with Dr. John Smith.

So, Dr. Smith, what is the common complaint you get when somebody comes to you and they're interested in testosterone treatments? What problem are they trying to solve? What are they trying to cure? All the things I talked about? Something else?

Dr. Smith: Absolutely. I mean, I think the thing about testosterone is the symptoms are so wide-reaching -- fatigue, cognition, erectile issues. They've heard on the internet, or they've talked to a friend who's on testosterone, and they're like, "Man, it just changed my life. It fixed everything." Which in some people's cases that may be true, but for most people, it definitely can play a role in helping them out, but I don't think it's the cure-all that you're talking about, that the internet shows. It's not making Frank Thomas who he is today.

Scot: And that's dangerous, right? Because you can get testosterone without even having a face-to-face conversation with a doctor, right? You can essentially just order it online. Is that true or is that overstated?

Dr. Smith: I think some of the newer companies you've got out there that are making things available . . . hopefully you're getting at least a video conferencing going over your medical history with someone who's a medical provider, whether it be a nurse practitioner, a PA. Hopefully you're talking with a physician. If they're not doing it that way, they're doing it wrong.

But testosterone is one of those things where it can be very helpful. I have quite a few patients that are on it, and I think it is one of those things that can definitely benefit people. But the extent that it benefits them kind of varies between patients.

Scot: Testosterone, I get the impression that it's probably not a do-it-yourself sort of a thing. It's not something you want to, as a layperson, just dive into on your own. Why is that?

Dr. Smith: Well, there are certain . . . everything has a risk and a benefit, and testosterone is no different. For people who have low testosterone, replacing it can really make a difference. It can give you that increased boost of energy, help you with weight loss, help you with metabolism, help with sleep. It can help with erections. I mean, it can help with cognition in people who have low testosterone. However, it's not necessarily the thing that's going to fix all those problems.

And oftentimes I'll go through people's history and say, "Hey, man, your testosterone is normal. Adding more to the mix isn't likely to fix things. We should look at other issues." And so I think really just taking that deep dive and seeing if it's something that is right for you is important.

Troy: I guess, John, I've seen all this stuff Scot mentioned, you see all these things on the internet, you see TV ads, etc. Yeah, I think I wonder myself, "Man, is my testosterone low? Should I be worried about this?" At what point do you tell people, "You should get your testosterone level checked"?

Dr. Smith: I think if you've looked at some of the other . . . if you've talked to your primary doctor and kind of gone over things, the usual suspects of a thyroid issue or vitamin deficiencies, things like that that they check a lot, if those are all normal, I think it's completely reasonable to look at it.

Some people say, "Oh, well, my dad had low testosterone and I got it checked in my 30s." But if you look at the facts of the matter, about 40% of people over the age of 45 have a testosterone level of 300 or less. And so that's a decent amount of the population that's out there. And so I think if you have an interest in it, it's okay to ask to have it checked because it's better to know and to at least know what your options are where it may be a benefit to you.

Scot: And how do you do that, then?

Dr. Smith: So your regular doctor can check it. You can make an appointment with a men's health specialist like we have at the University of Utah. We have a men's health group with multiple different providers. We have nurse practitioners, PAs, and multiple MDs and DOs that can take care of your needs as far as checking the hormones. But that's the first thing that we do.

And hormones, ideally, should be checked before 10:30 in the morning because our bodies spike testosterone between the early hours of the morning. Usually people will say between 4:00 a.m. and 10:00 a.m. in the morning. And so we want to check it to see what your body is actually doing.

If you're low in the morning, the odds are that you're high in the afternoon are going to be really slim to zero because your body spikes it in the morning to give you that boost of the hormones that you need to get you through the day.

Scot: And when you take a look at that test, it's a range, right? So a man gets the test done and you've got some numbers and there's a range. And what does that tell you? Let's pretend I'm at the low end of the range, but I'm still considered normal. Is that somebody that you would suggest testosterone therapy for?

Dr. Smith: I think a lot of it is the discussion that you have with the patient. So the range is huge too. If you look at the range, most labs are between 300 and 1,000. Some are a little less, some are a little more, but just for intents and purposes of this discussion, about 300 to 1,000.

So let's say, Scot, you're at 350. Well, what does that mean? Insurance requirements say that we've got to get two tests that show a low value before 10:30 in the morning. So let's say we've done that. You come in, your first one was 350, your second one was 340 or 338. What do we do from there? Well, then we have a discussion.

And I think in a lot of those folks, it is reasonable to discuss therapy. People outside the normal range, it's obviously okay to discuss that as well, but people tend to feel better in a range around 400 to 700. Sometimes, some people will say 600 or higher. There's a lot of different variability out there between who you talk to about it.

But again, if you're feeling the symptoms of fatigue, decreased libido, decreased erectile quality, some of those things are really hitting you hard, and you're like, "I'd love to try testosterone to see if it would help some of those symptoms," I think it's completely reasonable to do that.

Mitch: But insurance won't cover it unless you are beneath that range?

Dr. Smith: Not necessarily. Insurance wants to see that you're in the low. Really, I think it's reasonable for anybody that's 350, 400, and below. You can talk to them about testosterone replacement therapy. And if there's benefit there, insurance usually won't balk at it. And if they do, and it is helping you, cash pay for this stuff is not obscene.

Mitch: I'll just disclose. Now, I had my testosterone levels checked after we did a previous episode, and my number is right around 400. And my primary care provider is like, "Oh, no, you don't need to. We don't need to. There's no need to talk about testosterone therapy." And so I've kind of put it in the back of my mind.

But then at the same time, you have the weird people on the internet that they say you need to be 600 or 1,000 or above to be healthy. And it's just like if I'm right there, I'm at the 400, maybe it would be helpful. What would you say to someone in my situation?

Dr. Smith: I think you've got to look at the whole picture, but I think it's definitely something that you could consider. Again, most primary care doctors don't do a lot of hormone replacement, so they're going to say, "Hey, you're well within normal range. We're not going to touch it. We're not going to do anything," because that's their comfort zone.

This is the thing that I do every single day where I get people sent from their primary care doctor to talk about this stuff. And I think it's an in-depth conversation of, "Hey, let's look at the whole picture. Is there anything else going on that's a problem, or could be seen as a problem? Do you have a thyroid issue? What is your BMI? How does your weight look? What's your exercise routine?" and things like that, because those things can be done before supplementing testosterone.

And there are some interesting numbers out there with diet and exercise. If people will lose weight of 10 pounds or so, you can increase your testosterone by 100 points by losing 25 pounds and getting diet and exercise.

But a lot of times, it's hard to get the motivation to go do diet and exercise when you're overweight and you're really lethargic. And so it's like, "Would testosterone help me get there?" and a lot of those things as well.

And so again, exercise 15 minutes a day for 6 months of moderate intensity exercise will increase your testosterone by 22 points. And then if you're exercising for 30 to 40 minutes a day, you'll increase it by 50 to 60 points. And so again, there are things you can do other than testosterone if you're kind of in that range, and any of those things fit.

Now, Mitch, I know you're super fit, so that doesn't really . . .

Mitch: Yeah, I'm the fittest guy.

Dr. Smith: . . . matter for you. But if those are things that you can do, those are modifiable things you can do in your life to increase your testosterone naturally.

Mitch: Got you.

Troy: You mentioned diet also, John. I mean, it sounded like we're talking more about weight loss here, but are there any kind of dietary changes in terms of foods you're eating or foods you can eat or even supplements that would increase your testosterone levels without actually having to go for any sort of hormone replacement therapy?

Scot: Raw eggs and meat, right?

Dr. Smith: Right. Exactly.

Troy: Well, sure. Yeah.

Dr. Smith: You've seen Gascon in "Beauty and the Beast." That's how he got so huge.

Troy: Exactly.

Dr. Smith: There are no real big things that are out there that are known to necessarily just be super beneficial, other than eating as clean as you can.

Testosterone is a hormone and hormones are built on a backbone of cholesterol, so they're kind of fat. They're built on fat. And so when you have excess fat tissue, sometimes the hormones like to hang out there because they don't love water. And so you'll find that people may have a higher testosterone level when they lose that body weight, because now they don't have as much body fat and that testosterone is able to kind of circulate. Plus, you're in better health and your body is able to just do what it does better.

Troy: Speaking of our concerns . . . obviously, Mitch has thought about it. I've thought about it. I know, Scot, you've told us before you've had your testosterone level checked. I think a lot of men wonder about this, and I think we get concerned and we say, "Hey, maybe I don't have a lot of energy," whatever it might be. Of those who come in to get tested, what percent really have low testosterone?

Dr. Smith: I mean, my practice is kind of skewed, because by the time a lot of these guys get to me, they've already had it checked with their primary doctor who's not going to treat them unless they're outside of the normal range. And then when they are, they get referred to our office. A lot of primary care doctors don't love treating testosterone patients and they know that that's kind of what we do.

And so I get a skewed percentage. Most of the people who come in and are looking for testosterone have already kind of been pre-screened, so they are low. I would say a vast majority, at least three-quarters of the people that I see, already have testosterone levels that come back and are low and they're there to talk about therapy as a referral from their primary doctor.

Troy: Interesting. Yeah, I just wondered if it's one of these things that it's just something else for us to worry about. And if a lot of us are getting tested and it's a small percentage, or maybe it is, like you said, over 45% . . . I think you mentioned 45% of men have levels under 300. So maybe more of us should be getting tested at some point and we're just not getting tested.

Dr. Smith: Yeah. It's around 40% over the age of 45, you'll see low testosterone levels. And again, it's one of those things where you tend to hit that middle age, people tend to not necessarily be as active, and things like that as well. So there are a lot of things that go into it.

But if we're looking at the actual testosterone itself . . . Let's say you come in, you're low or you're low normal, and you want to try testosterone. There are a lot of things you need to have a discussion with the patients about. Are you interested in having children in the future or any more children if you already have children? What are your goals as far as that goes?

There are multiple different ways to treat testosterone these days or to treat low testosterone, I should say. And kind of having that full disclosure discussion with the patient goes a long way, because there are multiple different modalities of treating it from oral medications to topical medications, to injections, to long-term injectables, to subcutaneous pellets. I mean, there's a myriad of different treatment options that we can discuss.

Scot: And of your patients that you start on therapy, you mentioned that the symptoms can be very broad and caused by a lot of different things. Maybe you're not getting enough sleep. Maybe you've got too much stress in your life. That's why you're low energy. Maybe you're not eating the right foods or exercising. That's why you don't feel good. How many after they get testosterone that come in that have low testosterone actually go, "Yeah, that made a difference," versus, "I'm about the same"?

Dr. Smith: Majority of them. But that also varies via the root that they get testosterone. So I'll talk kind of a little bit about each modality. Oral options is . . . there's a medication called Clomid. A lot of people know it as a fertility medication. Women use it for fertility purposes. But what the medication does is it stimulates your body to produce more testosterone and more sperm. This is a very gradual improvement in testosterone. And a lot of times people don't feel that robust boom, that jolt of energy and things, because it's kind of a low-key slow rise of the testosterone back into the normal range. They don't have that big boost.

And most of the time, when people have that boost, it's from the injection because they're injecting a bolus of testosterone that then is being absorbed into the body and they have their levels shoot outside the normal range. So they feel like Superman. It gives them that rush of testosterone, which you don't get with topicals, the lotions, and you don't get with the oral because it's doing what your body normally did before you didn't create enough testosterone. And so you don't get those super highs that you would have before.

So a lot of patients know, "Oh, man, I do have more energy. I do feel good." The ones who do injections tend to come back and have more of a, "Man, that's great. This stuff is great," because they get that boom, that rush, that spike of testosterone very quickly.

Troy: And then how long until that wears off?

Dr. Smith: So usually people inject on a weekly basis, sometimes every other week, depending on their injection tolerance. And I do have a few patients who inject multiple times per week of low doses because they don't like that roller coaster effect. You do really get a high of testosterone and then it kind of fades out over the course until you do your next injection.

And so that's what they notice. They're like, "Man, I just get this high, and I feel it for about two to three days, and then it kind of wears down and I feel pretty good. And then when I do my next injection, I get that high again." I see that a lot more frequently with people who inject testosterone rather than take oral medications or do topical gels.

Scot: And what about side effects or downsides to testosterone therapy?

Dr. Smith: Man, it's almost like you wrote a script for that or something.

Troy: Talked about the good stuff. Let's talk about the bad stuff.

Dr. Smith: I'm going to make you feel like Superman. And now I'm going to tell you the downside.

Scot: Kryptonite is no good for you.

Dr. Smith: Exactly. You really have to monitor things with testosterone. So testosterone can cause an increase in red blood cell mass, and that in and of itself isn't necessarily a bad thing as long as it doesn't get outside of the normal range too far. That puts you at an increased risk of a cardiovascular event, like a heart attack or stroke.

Now, those incidents are rare, but it's something that we definitely keep an eye on. And that's a reason why we follow these folks with labs regardless of the type of replacement that we do.

Other things that we follow is your estrogen levels can rise because testosterone is a precursor to estrogen. There is a molecule called aromatase that actually converts testosterone to estrogen. Their chemical formula is very, very similar.

Your body likes to keep a ratio of about 10-to-1 testosterone to estrogen, and so the higher your testosterone goes, the higher your estrogen level goes.

And some people will develop breast sensitivity, nipple tenderness, or breast growth from elevated estrogen if their bodies are over-converting to estrogen. And so we watch that closely because that can be bothersome to folks.

And then a couple of the other things, we always monitor PSA in folks that are over the age of 40, or at least I do in my practice because . . . There's not an increased risk of prostate cancer, but if you were to develop prostate cancer, testosterone would feed the prostate cancer.

It's kind of like if you have a match and it's lit, nothing happens. But if you have a match and you pour a gasoline on it, you have a problem on your hands. And so the prostate cancer would represent the match and the testosterone would represent the gasoline. It would help it to kind of progress faster in a way.

And those are the things that we really kind of keep an eye on, especially people with family history or people who have had prostate cancer that we're treating with testosterone, which yes, we do that quite frequently.

Troy: So now that we've talked about the risks of taking the testosterone supplement, let's just say someone is like, "Okay, I've had my testosterone level checked. It's low. I don't want to assume those risks." What's the downside of that?

Dr. Smith: So the downside is you can develop osteoporosis with time. There are some studies that . . . initially some studies came out with testosterone that said testosterone supplementation caused cardiovascular issues, and now it's become the opposite. That's been debunked, and there is some literature out there, I don't know that it's super robust, that said low testosterone can increase your risk of cardiovascular events. So those are the big things of not having enough.

Long term, it's really difficult to assess a lot of those risks, but those are the risks. if you were to just have low testosterone.

Scot: Do you have anybody ever come in that you just are like, "No, it's not a good idea for you"?

Dr. Smith: Yeah. I mean, people who come in with a testosterone level of 600 from their primary care doctor. It's a bad idea.

Scot: Yeah. But I mean low testosterone. Is there ever a time where it's just like, "No, probably not. The risks are too big"?

Dr. Smith: So I think the one thing that I didn't get to with the risks is testosterone replacement will cause sterilization. It will stop you from being able to have children. When you supplement testosterone . . . not all methods of supplementation will hurt fertility, but injections will. Anything that's injectable topical or the long-term injectables or pellets all will cause sterility to a point. And so those things are things that you've got to have those conversations.

So if someone comes into my office and they have low testosterone and they don't want to take the pill like Clomid and they're like, "I just want to do injections, but I still want to have kids in six months," I would say, "Let's hold off until you're done having kids or until your wife gets pregnant, or go donate some sperm so that you can have children if that's your goal, before we start therapy."

Scot: Mitch, given the information that you just got today, are you going to go in? You're going to get some T?

Mitch: I don't know. I'm in a place where I think that after this conversation, I would like to go talk to a men's health specialist, especially if there is a hesitation from primary care physicians to just be like, "Oh, you're in the normal range. You're good." There is a curiosity there. There is an interest there, knowing where I'm sitting at on the levels, if they think it would be something that could help with some of the situations that I'm dealing with right now.

Scot: I guess I'm afraid that it just sounds like another pill. I don't mean that as I don't want to take drugs. I just mean we're all looking for the quick fix, right? So yeah, maybe I'm a little tired. Would I like to lose some fat? Sure. Would I like to have a little bit more muscle mass? Yeah. If I'm in that normal range and on the low end, I don't know. It just feels like I'm expecting too much. I'm going in for the wrong reasons. Does that make sense to anybody?

Dr. Smith: And I don't think you can necessarily . . . I mean, again, I'm not trying to sell testosterone here. I just think that . . .

Scot: No, that's not the point of this. We're just trying to get some information, for sure.

Dr. Smith: Right. But I think that if you want to feel your best and be able to do your thing to the healthiest you can be, I don't think it's a bad thing to come in with the desire to be healthier, to feel better, to have more energy. Again, when you start testosterone therapy, you do have a change in lean muscle mass by about five kilograms switch over from body fat to lean muscle.

Scot: Hold on a second. Hey, Siri, convert five kilograms to pounds.

Dr. Smith: Right. Exactly.

Troy: That's a lot of pounds.

Dr. Smith: It's 2.2 pounds per kilogram.

Scot: It's 11 pounds there. All right.

Dr. Smith: Actually, I said that incorrectly. It's five pounds of fat or two and a half kilograms. My apologies.

Troy: That's still a lot.

Dr. Smith: But still, a five-pound change in your body mass, it can be substantial. It can really help. And again, those are just the numbers that we have from the literature that's out there. And so it can be beneficial.

I don't think there's a wrong reason to come in to look for it. Most patients aren't coming in to be like, "Hey, man, I saw this magazine with this guy Schwarzenegger on it and he was pretty big. I kind of want to get there. Can you help me?" Those aren't the patients that I see.

People come in, they're like, "I'm really fatigued. I feel tired at night. My libido is down. I want to feel better. And I want to see if testosterone may be helpful in that regard." And they're not looking necessarily as a magic bullet or trying to use it as a substance of abuse where they can go and just change their whole body composition. But I think it is very beneficial for a lot of people.

Scot: Troy, where do you stand on it?

Troy: As we talk about this, I just feel like there are so many other things I need to address. That's way down the list. We talk about energy and everything there. I feel like, wow, I'm still trying to figure out how to sleep and those kinds of things. So I'm kind of hung up on that still. We've talked about this and if we talk about it today, I am still kind of curious about it, but I don't think I will be getting tested any time soon. I'll say that.

Scot: I noticed a parallel from another show that we did. You're talking about using testosterone treatments to kind of get over that hump, right? Let's say that you would like to exercise more, but you don't have the energy and you do find you do have a low testosterone. That was almost kind of like using medication for mental health. If you're having challenges with your mental health, it can be really hard to become motivated to exercise or eat well, or maybe you don't even sleep well. So you can take medications for a short period of time until you kind of get those things working. We talk about that Core Four, how they all interact with each other. And then possibly come off of it. Am I understanding that correctly?

Dr. Smith: Yeah. And I think if that's your plan, you've got to look at a way to keep the testicles producing while you do that. If you went to an injectable or a topical testosterone that's going to shut down the body's production . . .

So let me nerd out a little bit with the physiology of this. Your body has these precursor hormones called FSH and LH. And those are the two hormones. They are in both men and women. In women, they regulate the menstrual cycle, and in men, they stimulate the testicles to make testosterone and sperm.

And when you give testosterone, it's a negative feedback loop. And so your body sees there's enough testosterone in the bloodstream and stops sending FSH and LH to stimulate the testicles. And so you've got to do something to keep those testicles producing if you're going to be on testosterone in the short term. That's where other drugs come in.

There's an injectable called HCG that we use to help stimulate. It's an LH analog, meaning it's not LH, but it will stimulate the LH receptor on the testicle. And it will continue to have the testicle continue to produce at a lower level, even though you're giving yourself exogenous testosterone.

And then if you decide to come off after six months or a year or whatever, after you've gotten in shape and you've gotten that motivation, then you don't have this complete drop-off of testosterone where your body has to start making it again where it hasn't for the last year.

Scot: But it would. If you're using a topical solution that's telling your body then not to produce more testosterone, does that mean you're dedicated to that for the rest of your life?

Dr. Smith: You can. Now, you can come off of it. And the thing I tell people is if your body was already not producing enough and you haven't done a darn thing to change that, your body is not likely going to go back to producing more than it was before you started the drug. But then there's always that kind of window where your body has to catch up and it's not producing hardly anything at all and you just feel like garbage.

Troy: But it would come back over time?

Dr. Smith: Yes. And that's the part where the HCG comes in to help it, where you don't have as big of a drop-off. Scot: All right. So now I need to ask the question that I think everybody is wondering. I've heard that if you're on testosterone treatments, your testicles get smaller. Is that true?

Dr. Smith: Absolutely.

Scot: Okay. How small are we talking? Yeah.

Troy: What are we talking here? Yeah. Like raisin-size?

Scot: I mean, for running marathons, Troy, that might not be a terrible deal. Right?

Troy: Thanks, Scot. Much less chafing. Yeah.

Dr. Smith: He's looking out for you, Troy. He's looking out for you.

Troy: Exactly. It'd just be nice smooth surface down there.

Dr. Smith: You'll shave minutes off your time.

Troy: Exactly. All that extra weight.

Dr. Smith: Yeah, you won't have the metronome like you've got now, but it'll work out.

Troy: That's right.

Dr. Smith: But they do shrink, and over time you'll notice that testicular size loss happens the longer you're on testosterone. So people who've been on, say, long-term injectable testosterone, they'll shrink down and be very, very small when you get down to it, almost to raisin-like size that you'll see, which is something that I always talk to people about. And again, that's where HCG can come in if you want to preserve testicular size.

And to some people, that's important. And to other people, I say, "If you're not looking to have kids and it doesn't really matter to you . . ." I've never, ever in my experience of having this had someone come in with their spouse and had them saying, "Man, you know what? I just wish Troy's balls were bigger."

So I don't know how much it really matters, but I think a lot of times it is kind of the vanity side of it, of, "This is what I know, this is what I've had my whole life, and I don't want it to change."

Troy: Well, I will tell you, John, hearing that, I'm reassured that your patients are not talking about the size of my testicles.

Dr. Smith: Nor their wives, for that matter.

Troy: That's good.

Scot: John, let's wrap this up. I think we all know your bottom line. I think I've got your bottom line on testosterone treatments. If you're experiencing these symptoms and you get a test and you're in that low range or below, it could be a very good option to help you get some energy back, to help you with your sexual function, with few downsides, really.

Dr. Smith: Yeah. The downsides are minimal. If you're one of those people who overproduces red blood cells or something like that, we keep an eye on it, but yeah, that is the bottom line. If you feel like it's going to make a difference for you, there's a lot of good that can come from it. And it doesn't necessarily have to be a long-term thing. However, most of my patients that are on it are long term.

And I think if you do have questions, go talk to someone that knows what they're talking about. I'm happy to sit down with people. Most of my new hypogonadism patients/low testosterone folks, I like to spend time going over the benefits, the risks, and everything that is involved is involved so that they have a clear picture of what options they have.

And I do have plenty of people who come in and say, "You know what, doc? I think I am going to try to lose 25 pounds and recheck my testosterone." And then I have others who say, "You know what, doc? I just know myself and I'm not going to do that. And so I'm going to take the testosterone and try to do it that way." I think there's merit both ways. Absolutely.

Scot: John, thank you very much for having this conversation with us about testosterone. Hopefully, this will be helpful to a lot of guys. And bottom line, it sounds like perhaps guys who have talked to primary care physicians, haven't gotten a lot of conversation, it sounds like if you do go to a men's health expert, you've got a little bit more time to discuss through some of these issues and really come up with the right choice for each individual guy.

Dr. Smith: Absolutely. I'd be happy to see anybody in our men's health department at The U. I think we do a great job at taking care of folks and making sure that we go over the options and making sure that we help you make the right decision for you.

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

Dr. Smith: Gents, thanks for having me. It's always a pleasure.

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.

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

Scot: Getting up at 5:00 in the morning and then grinding into the night to get things done, that's a badge of honor. "I'm not lazy. I'm getting it done. I'll just get a couple energy drinks and do it again tomorrow." Probably heard the saying, "I'll sleep when I'm dead." That feels pretty manly to say, by the way.

Regardless, if it makes you feel good to tell people how little you sleep, or there are other reasons you're not getting sleep, sleep has proven health benefits and not getting enough can have similar downsides as not getting enough activity or good food.

You could have the other three core four dialed in and if you're not getting enough sleep, it could sabotage at all. That's how important sleep is.

So today, on the "Core Four: Back to Basics" series, we're going to talk about sleep, how good sleep improves your life and how to get better sleep.

My name is Scot Singpiel. I bring the BS to the proceedings here, and the MD to my BS is Dr. Troy Madsen. And before you say hi, I want you to say, "I'm Dr. Troy Madsen, and I'll sleep when I'm dead," in your manliest voice.

Troy: I'm Dr. Troy Madsen, and I'll sleep when I'm dead.

Scot: Also we've got Mitch Sears in the mix. Same thing.

Mitch: I'm Mitch Sears, and I'll sleep when I'm dead.

Troy: Sounded like you were thinking about it. You're like, "I'll sleep tonight."

Scot: We have one opportunity for our manliness to be saved here, and that's Thunder Jalili.

Thunder: I'm Thunder Jalili, and I will sleep when I'm dead.

Scot: There you go. All right. So, today, we are going to talk about the benefits of good sleep. And for some reason, I think society kind of undervalues sleep. What do you guys think of that? When we think about being healthy, it's pretty common to come to nutrition or exercise, but sleep is just as crucial as we're going to learn in a couple of seconds. Is it just me, or does society kind of devalue it? And why do you think that is?

Thunder: I think actually American society maybe does devalue sleep. I think it's part of our work hard work ethic, get it all in and don't be a wimp, and get your stuff done, because other cultures around the world aren't like ours. The Spanish, they value sleep. They have a nap built into the day. We're not like that.

Troy: Yeah, I agree. I think we definitely undervalue it and it certainly is a badge of honor for a lot of people. And as someone who works in the healthcare profession, I can say it is absolutely a badge of honor. If you can talk about how little you sleep or let's say you say, "I just came off a night shift and I didn't go home and sleep, and now I'm here in the office working all day," that's a badge of honor. It's not like, "Wow. That's stupid." Yeah, no question about it.

Mitch: I remember when I was working in broadcast, you would come in and the night shift would be coming off and they would have their pile of energy drinks and they would just be very proud of how much caffeine they were functioning off of and "still getting a good job done." That was always very like, "What are we doing?"

Scot: Dr. Madsen or anybody, do you think that people just don't realize the benefit of sleep? Because a lot of times it's the first thing to get jettisoned, right? When things get tight in your life, that's where you'll cheat, either getting up early or staying up late to get things done. Do you think it's just because people don't realize what that tradeoff is actually costing them?

Troy: Yeah, it may just be that we don't quite realize the magnitude of the effect. I think we recognize, "Yeah, there's some detrimental effect, but those effects are more immediate. I'm tired, but I can use caffeine. I can drink some caffeine or whatever, and that will eliminate that short-term effect." But I do think we definitely undervalue the long-term effects.

Thunder: Yeah, I agree with that. I think cutting sleep is an easy thing to do in the short-term to get things done, and there are ways to get around it, like Troy said, with caffeine. So I agree with him completely.

Scot: All right. I think that's a good segue into talking about the benefits of getting enough sleep and how it can impact your health. Thunder, go ahead and kick us off on that.

Thunder: So there are many benefits to getting good sleep. I'll just share a couple with you. One is sleep is actually tied into maintaining healthy body weight. And I know that's a big focus of what we've talked about on this show in the past. We talk a lot about the exercise and the nutrition component, but getting enough sleep is also a valuable contributor to healthy body weight.

The other thing that's great about sleep is it helps you keep your stress levels low and it helps improve your mood. If you think about it, think about the nights that you haven't gotten a good night's sleep and you wake up the next day and you're just kind of a little grumpy or a little off and things are bothering you. That's something everyone has experienced, and that's really that function of not getting enough sleep.

So having that regular sleep schedule can definitely improve with that. It gives your mind a chance to reset at night and reduce your stress level.

Troy: Yeah. Thanks, Thunder. And the other thing too that I've definitely seen plenty of studies that have shown that sleep lowers your risk for diseases like diabetes and heart disease and cancer as well, like long-term studies.

It's a little scary because I've often seen these studies done with shift workers like myself, which is kind of depressing, but it is one of those things. They do find those who don't sleep well do have higher risk of diabetes, heart disease.

I think the obvious thing we've talked about already is it does help you to think more clearly. But this is something that's been quantified in multiple studies. They've kept people awake for 18 to 24 hours and just noted their ability to perform tasks just declines over time to the point where . . . At 18 to 24 hours, you're at a point where your technical skills, and your focus, and your attention are on par with if you were legally intoxicated. So definitely effects there.

I think we all know we've had those experiences when we don't sleep well, we get sick. Sleeping well helps us to stay healthier, get sick left less often, and helps us look better too. We look better. We look healthier. Our appearance is improved when we sleep well, when we're well-rested. So that's a big thing as well.

Thunder: Don't have those bags under your eyes.

Troy: Exactly. Get rid of the bags.

Scot: I'm noticing the last two episodes that that's been Troy's thing, appearance. So do you want to talk about something?

Troy: I'm feeling self-conscious about my appearance and I need to sleep more. Maybe that's it.

Scot: You look wonderful.

Troy: Thanks, Scot.

Scot: We're going to hit up here some of our sleep struggles and then what we've done to try to work through those or not work through those.

But first, Mitch, let's talk about, like we have in past episodes, the basics. These are kind of the rules that you want to try to incorporate when you're talking about sleep.

Mitch: Yeah. And these are the ones that have been kind of tried and proven from research and studies, etc. So these are kind of the things that have the most evidence behind them.

The first thing that you want to do with your sleep is to prioritize it. And it's important to realize that when you prioritize sleep, it also means that it's not just quality of sleep. It's also quantity of sleep.

So what they're saying is that you need to get at least a minimum of seven hours and that you can't really just make it up. You can't sleep four hours one night and nine the next and expect it to be as healthy as if you were to get seven hours each night.

The other thing is that in order to get a better quality sleep, try to go to bed at about the same time every night and wake up at the same time every morning, which is something that we've kind of talked about before with Kelly Baron on a previous episode about everything from your sleep hygiene to making sure that you're going to bed and waking up at the same time every morning.

Now, the other thing you want to make sure to do is to not underestimate how things you do during the day can impact your sleep. A lot of things you do throughout the day can really impact not only the quality, but the quantity of sleep that you're actually getting. So make sure that exercise, nutrition, and mental health are all big factors that go into your sleep.

Stress, anxiety, depression can all impact how well you sleep every night. Activity, exercise during the day is good, but not less than two hours before bedtime. They've shown that that can kind of interrupt your sleep cycle, if you work out too close to going to bed. And finally, caffeine, alcohol, and nicotine four to six hours before bedtime and big meals before bed can impact your quality of sleep.

So you just want to make sure that you're not working out too close to bed, but you should be working out through the day, and to kind of avoid some of these different chemicals that can really impact the quality of your sleep.

The other thing is that sleep environment needs to be dark, quiet, and a comfortable to temperature. By making sure all of those things are kind of in place, it will really improve the quality of your sleep.

And make sure that you are not doing things that engage your brain like screens, TVs, games, radio, talking on the phone. If you do those things too close to sleep, it can also impact the quality of sleep that you get.

And finally, if you've tried everything else and you are still having trouble with sleep, go talk to a doctor and rule out that you don't have a sleeping disorder.

Scot: Some good basics there. So let's hit the sleep struggles. I want to start with Troy because you work in the ER, you work crazy shifts, you might be working during the day for a few days and then you do an overnight shift. What is one of your sleep struggles?

Troy: My sleep struggles are so plentiful, it's difficult to choose from them. But like you said, Scot, I do shift work, so I end up working nights, evenings. And for me, evening means I get to bed at like 2:00 or 3:00 in the morning. Night means I get to bed at like maybe 9:00 or 10:00 in the morning.

Scot: Wow.

Troy: Yeah. And so I'm trying to do that and then turn around double back and do a 7:00 a.m. shift the next day and do a 10-hour day on that.

So I have no doubt, and I think talking to Kelly Baron, it was very clear I do suffer from shift work sleep disorder. It's not something I really had prior to doing shifts when I started my residency training.

I have plenty of times where I think I don't struggle so much to get to sleep. I generally fall asleep once I get back into my regular routine, but then I will often find that I'm awake four hours later and just lying there and not sleeping. So that's probably the biggest for me.

I feel like I can get to sleep, I can fall asleep, but then I'm often awake a few hours later and not sleeping at that point. So that's definitely a struggle and I think not an uncommon struggle, definitely for people who do shift work, but I think a lot of people I've talked to have that issue as well.

Scot: Yeah. I look forward to hearing if you have some things that you've figured out of work around that. I mean, you can't totally fix it, right? The best you can do is kind of make the best out of a worse situation.

Troy: Yeah.

Scot: Thunder, how about you? Do you have any sleep struggles or you do all right?

Thunder: In general, I do all right. But my sleep struggle that does come up from time to time, believe it or not, is temperature. If it's too warm, I have trouble sleeping. So I have to be aware of that. Most of the time it's fine, especially in my own house, but when I travel, sometimes you're out of your comfort zone and you're someplace where the temperature may not be right.

So I try to do what I can, make sure I'm not putting too many covers on the bed because if it's too warm, it's tough. Hopefully I can adjust the temperature in a room, things like that. But that's my main challenge.

Scot: I'm pretty fortunate that I haven't had a lot of struggles. I have a job that allows me to have a pretty regimented sleep schedule. And for the most part, I fall asleep. For the most part, I sleep through the night. And then for the most part, I'm able to wake up in the morning when I need to. So I am pretty fortunate.

I think my biggest challenge, though, is I'm always thinking. My brain is always going, and sometimes I'll just lay in bed and I can't quite shut it all off. And part of it might be my fault. Maybe I was doing something too close to bedtime, but that's kind of mainly the struggle that I have.

How about you, Mitch?

Mitch: So I guess I have a slightly different story here. I have always struggled with waking up feeling refreshed. Every single night, it just feels like I haven't gotten any sleep the night prior and it's day after day after day, month after month.

I've been working with my doctor for the last year to try to figure out what I should be doing. And from stuff that we've talked about on the show, I've made sure that I go to bed at the same time every night. I'm waking up at the same time in the morning. I've played around with using a little bit of melatonin sometimes before bed. I've tried making sure not to look at screens or anything beforehand, and it doesn't seem to help.

And it was just recently after trying all of these things, my doctor had me do an at-home sleep study and they think they have found that I have sleep apnea. So I am waiting to go to do a formal sleep study in the next month or so and kind of figure out what's going on.

The struggle I've been having is I try everything and I still feel so tired. And when it comes to the Core Four, I'm working on my nutrition, I'm working out, I'm doing all the mental health things I can, but sleep has been one that's been really troublesome. And it eventually led me to talk to the doctor and we might be able to actually fix it now that we can find what's going on.

Troy: That's great you did that, though, Mitch. You talked to them and you went and looked for help. Yeah, that's a common story I hear from people where they say exactly that. They feel like they're getting plenty of hours of sleep, but they are just awake and they are not refreshed.

And I'm guessing they talked to you about in your sleep study, or in the sleep study you'll do, if they do see that, you wake up so many times at night due the sleep apnea that you're really not sleeping a whole lot, or at least good, deep REM sleep.

Mitch: Yeah. And that's kind of what they've explained. It's like, "Hey, if you have a sleep disorder, whether it be apnea or . . ." They talked about some restless leg syndrome. They talked about all these different kinds of things that can keep you up through the night. It doesn't matter what you're doing. It doesn't matter how often you're going to bed. It doesn't matter how healthy you are with your sleep hygiene and your hours and everything. If your body has something a little messed up that is waking you up all night, it doesn't matter. So that's where I'm at.

Troy: You're going the right direction. That's good. That's good to hear.

Scot: Mitch, do you find that impacts you, any of your other Core Four, like your nutrition, your . . .

Mitch: Oh, yeah.

Scot: How so?

Mitch: So I find that on days where I have not had any restful sleep and it's been day, after day, after day, when your energy level is so low, the idea of cooking a meal goes right out the window, right? In my sleep deprived state, all I want is a Big Mac. You go straight to the fast food whenever you can.

When I'm tired, I find that I can't work out the way I'm supposed to. When I go out for a jog or something like that, I can't go nearly as far as I think I need to. The whole process is really kind of frustrating and your heart rate gets up higher than it's supposed to, etc.

And mental health-wise, things . . . We're living in a very stressful time right now and I find that on the days where I don't get enough sleep or I'm not able to sneak off and take a nap in the middle of the day, I get really stressed and my anxiety gets high and I'm quicker to be frustrated and all sorts of things.

And it's been really surprising, ever since starting working on this podcast, that I'm focusing so much on all aspects of my health, but sleep was the last one. Sleep was the one that was like, "Eh, that one will figure itself out." But here I am learning that maybe I have something else going on. And hopefully, by working with my doctor and finding out a treatment plan, maybe in the next little while I can start seeing better results elsewhere.

Scot: That's a great point about how "maybe it'll just work itself out," right? This notion of "something might fix itself," I think that can be kind of dangerous, and I think a lot of us guys have that.

Mitch: And that was kind of the thing that was interesting when I first started speaking with my doctor. He was like, "Well, yeah, if you're having trouble sleeping, you might be having mental health stuff. Why don't you go talk to someone about that?" and, "Oh, when you start getting more activity, I'm sure you'll feel tired by the end of the day," and, "Oh, if you improve your nutrition and drink less caffeine, I'm sure your sleep will kind of fall into place."

And so, for the last year, I've really been working under that assumption that sleep is easy, sleep is going to just happen if I do all these right things. But if you're out there and you've been trying everything, maybe it's time to talk to a doctor.

Scot: All right. Let's go ahead and talk about maybe three struggles or three things that we've learned and what we've done to overcome those. And again, the hope is that if somebody else is struggling with something similar, this might be a new, fresh idea for them.

So I'm going to kick things off with this notion of a dedicated bedtime, being sure that you get to bed at the time that you've decided to get to bed. For me, it was 10:00. And it was challenging because if it was 9:15 or 9:30 and my wife and I were up and we were hanging out and she wanted to start a show, I'm like, "Well, it's going to be 52 minutes. I can't do that. That's going to put me past my bedtime."

Or sometimes I feel like I don't have enough time in the day to get things done. And I'm sure that's something that a lot of men deal with. And so, as a result, you push into the night, or what I've learned is you kind of have to prioritize what's important or ask for help to get all the things done that you need to get done. You can let go of some of those things.

So a dedicated bedtime has really, really helped me, and it helps me wake up a lot more refreshed, but it is challenging for those reasons and other reasons as well.

Troy: Scot, I'm going to jump right on that, and I'm going to say also a dedicated wake-up time. That's been big for me. We talked about that also with Kelly and just saying, "I'm going to get up every day." For me, it's, "I'm going to get up every day by 7:00 a.m. regardless."

And certainly, I have shifts where I have to get up early. I don't care if it's the weekend, whatever. Granted, I did mention there those times I'm getting to bed at like 3:00 or 4:00 in the morning, so I might sleep in a little after that. But once I'm in my regular routine, I'm up at 7:00, and I know I'm going to get up at 7:00.

Just knowing that, it kind of helps mentally, because before, I would kind of give myself this nebulous wake-up time. If I didn't have a shift or if I didn't have something going on early, I'd be like, "Well, I'll just get up when I wake up, because I have to make up for my missed sleep."

And then during my night sleeping, I would just lie there and I wouldn't really fall back asleep and I would just be like, "Well, I don't really have to get up. Okay. Maybe 9:00. Maybe it'll be 10:00." Kind of this mental thing where I just kept putting it off in my mind.

But I think knowing, "Hey, I'm going to be up at 7:00," something about that mentally just lets me know, "This is my sleep time, and I'm going to take advantage of it and I'm not going to sleep past that, so don't think I'm going to be able to make up what I'm missing now by sleeping in until 9:00."

Thunder: So I'm going to jump on the regular schedule bandwagon as well. I'm also all about that, going to bed about the same time and waking up about the same time.

I will add one thing about the waking. I usually wake up around 6:30, give or take a little bit, and I never have to set an alarm because I'm used to waking up at 6:30. So all the things that you have to do in life that you have to wake up early for and you need to set an alarm for, I never do that, and I find it cuts down on my stress level the night before. You're not thinking, "Oh, I've got to wake up extra early," or, "My alarm is going to go off," or something. You just wake up at your normal time.

The new thing I'll add to that is I have a bit of a relaxation routine that I engage in almost every night, and that is I read a little bit before bed. And for me, that works. I'm talking reading out of an actual book, or a magazine, or sometimes I'll read on my Kindle with a black screen.

So that kind of helps my mind disconnect from whatever was going on during the day and get lost in something else for a little bit. And I don't last too long reading. Maybe I can do like 10 minutes to 30 minutes, depending on what it is. So that's part of my routine, that little relaxation moment.

Scot: All right. Mitch, you're up.

Mitch: So the thing that it really helped me out is I'm the worst millennial. I am on my phone up until . . . I used to be, at least. I was on my phone up until the moment of my bedtime. What I have found is that regardless of your phone, most modern phones, whether it be an iPhone or an Android, they have digital wellbeing settings. And if you can go into there and turn them on and respect them, it has really helped me make sure that I'm not doing too much screen time before bed.

On my phone, at least, I set in my bedtime. I'm like, "Hey, I want to start winding down. I want to stop using my screen for an hour before bed. Here's when I want it." And when the phone hits that time period, it turns off all my notifications, it turns super-duper dim, and black and white.

And it seems kind of dumb because it's like, "Well, I can still use the phone." But for some reason, the lack of color, the fact it's super dim, the fact that you can't hear anything, it really helps just kind of disconnect and set it aside before I go to bed.

Scot: That was a big thing for me too. Up until recently, I would go to bed and I'd get out my iPad and I'd scroll social media, and then I'd find something that enraged me and then I couldn't stop thinking. Somebody would make some comment and then I would spend the next hour coming up with what my comment would be back to them, right? So, for me, getting rid of that social media has been absolutely crucial.

And the other thing that I struggled with too, and, Mitch, tell me if you did this, are the Instagram Reels, which are like TikTok videos, right?

Mitch: Oh, yeah.

Scot: I'd watch those. And even if I'd quit an hour before bedtime, then I'd have one of those stupid songs playing in my head and I couldn't get it out and fall asleep.

Mitch: Well, it's so easy to just get sucked into that hole too. You're just scrolling, and swiping, and swiping, and swiping and the next thing you know, it's like, "Oh, man, I've been doing this for two hours."

Troy: And how much of our life do we waste just thinking about snarky replies to other people's snarky replies?

Scot: Right?

Troy: I totally hear you on that. It's like, "What am I going to say to this?"

Scot: That I would never ever actually enter in, but I'll spend a lot of time thinking about what it's going to be.

Troy: Yep. I'm going to think about it, and it's going to be good. It's going to keep me up all night.

Scot: All right. Number two for me. Now, I don't know if this is a type of meditation or what, but it's a little exercise I do. It could be considered maybe a form accounting sheep or whatever. But if I'm struggling falling asleep, I will pick a color. That kind of tends to be my go-to. So I'll pick the color green, for example, and then I'll just let my mind go and think about things in my life that are green or in my past that have been green.

Troy: Oh, wow.

Scot: It takes me down this kind of memory lane. My parents' first car that I remember was this big green Plymouth from the 1970s. And then I'll think, "Oh, I had a toy box. It was a frog, and it was green." I just kind of let my mind go where it wants to with whatever color I've picked, and I find that after a few minutes of that, I feel kind of tired or I might just fall right asleep. So it's a little weird, but it's worked for me.

Thunder: So it's so boring that it puts you to sleep?

Troy: I guess so. I just feel like that would be too engaging. You would really be thinking way back into your childhood and trying to come up with all different things. I don't know. That's interesting. You just kind of let your mind wander and somehow that puts you to . . . I've never heard of people doing that, but whatever works.

Scot: Yeah. I mean, I get the engaging part because I have caught myself in the trap where I'm engaging and thinking about it too much. I think, for me, the trick really is just to let your mind wander through your past and just those things that were green. So anyway, that's mine.

Thunder: It almost sounds like a type of meditation. You pick one thing and you just kind of reflect on it and just let your mind go on it.

Scot: I don't know why it works, but it works. Who's next?

Thunder: Another thing that works to me for me is related to . . . We talked a little bit about temperature of the room is important. So we have this Nest thermostat in our home and it's programmed to start reducing temperature around 9:00. And it's great in a winter because by the time I want to go to bed around 10-ish, the temperature of the bedroom is probably like around 65 degrees, which for me is a good temperature.

So it's kind of good. It's automated, so I don't have to do it. It just happens every evening, and that is part of what helps with my sleep schedule.

Troy: Well, kind of along the lines of making sure you're addressing external factors, for me, it's about white noise and sleep mask.

Six years ago, I reached a point where I said, "I'm going to do everything I can to try and optimize my sleep and do what I can to optimize it and control what I can in terms of environment." For me, that meant white noise.

And for me, white noise means I actually have earbuds I sleep with that are made for sleeping. They're comfortable. They're soft. And then I just have a white noise thing I play that I listen to there, just kind of a sound of a fan or something. And I wear a sleep mask.

For me, that's made a big difference just being able to have that, control what I can, trying to eliminate the light, and noise, and all those sorts of things.

Mitch: And even for people who aren't doing shift work where you might be trying to sleep during the daytime, there are a lot of little itty bitty lights that are turned on in every room, in my house at least, whether it be a little power indicator light, or whether it be the light on a fan, whatever. And it has been night and day since I've gotten my sleep mask how quickly I'm able to fall asleep and stay asleep.

Scot: Tell me more about these earbuds that you have in because I've seen Bose advertise these sleep-only earbuds, but they're super expensive, right?

Troy: Yeah, crazy expensive.

Scot: Yeah. So did you find a cheaper alternative, and how do they work?

Scot: Mine are super, super cheap. It's like $10. They're designed to be ergonomic flat. They're noise-blocking. So they're just earbuds. They're soft. It did take about a couple weeks to get really used to them and comfortable with them.

Thunder: Hey, Troy, have you ever tried just foam earplugs?

Troy: Yes, I have.

Thunder: I've done that on occasion when I'm somewhere where there's a lot of ambient noise.

Troy: Trust me, Thunder, I've tried everything. And once again, I'm probably going to admit things here that are very embarrassing, but I not only have tried foam earplugs, I've tried foam earplugs with construction-type . . . like those noise blockers, those big headphone things that construction workers wear.

Mitch: Oh, my.

Troy: I'm a side sleeper, so I actually took an old pillow and I actually hollowed out a little spot in the pillow.

Scot: Oh, my.

Mitch: Oh, wow.

Troy: I was that desperate to try and block noise that I tried it. And I actually used that for a couple months. I took a lot of heat from Laura, from my wife, making fun of me, that I was that desperate that I tried that.

Finally, just these ergonomic things, these earbuds with just white noise going through it, that's what worked for me. So trust me, I've tried it.

Scot: Mitch, what do you have?

Mitch: So one of the things that is a constant struggle for me is I'm a list maker, like, "What is my to-do list? What am I doing next?" And when I try to fall asleep, for the longest time, it would just be, "Okay. What do I have to do tomorrow? I'm waking up, I'm doing this, I'm doing this, I'm doing this."

And what I found is that I keep my day planner . . . When I'm going to bed, as part of my ritual, I take the day planner, I climb into bed, I take my little pen out, and I write everything down that I'm going to be doing the next day. And for me, at least, that has really helped cut down the anxious thinking about the next day that typically happens when I try to fall asleep.

Troy: Yeah. I've heard of people doing that. And just doing a notepad, not typing it on your phone because you don't want the blue eye to mess you up. You just have a notepad, something is on your mind, write it down, deal with it later. That's a great idea.

Scot: My last one is another weird one. It works for me. I don't know if it'd work for anybody else. But sometimes when I have a hard time falling asleep . . . I'm a side sleeper, but I will lay on my back with my knees bent. Can you kind of picture what that looks like? What? Why are you laughing?

Mitch: You're just curled up and thinking about colors, and that's . . .

Troy: That's called a fetal position, Scot. You're doing it on your back.

Scot: No, I'm not on my side in the fetal position. I'm on my back and I've bent my knees, right? So if you were to come in the room, you would see this big bump of where my knees are in the comforter, right?

Troy: Yeah.

Scot: So I will lay on my back with my knees up. I mean, 99% of the time, if I can't fall asleep within five minutes, if I do that, I will fall asleep.

Troy: Wow.

Scot: I don't necessarily fall asleep on my back, but I get so tired from that position that I will turn over to my side and I can fall asleep. I don't know why it works. I don't know how I discovered it, but there it is.

Troy: I just want to be a fly on the wall in your house, Scot, and just see this, just see you lying there and sleeping with your knees brought up to your chest.

Mitch: And then talking about snakes and cars.

Scot: No, it's not all way up to my chest. I'm not that flexible. It's just like a 45 . . . Yeah, it's like a 45- or 90-degree of your knees.

Troy: I'm trying to think of the physiology of this, how this might work. I will tell you there are certain things called vagal maneuvers that basically increase the blood flow to the head and slow the heart down.

If someone comes in with a very rapid heart rate in the ER and something called super ventricular tachycardia, we will do a procedure where we lay the head of their bed down and lift their legs up at the same time to increase that blood flow. And that sort of has a calming effect on the heart rate.

So I'm trying to think of this physiologically, Scot. I don't know if there's anything to that, but it's interesting you do that and you found that works. Maybe there's something to it.

Scot: Thunder, you're up next.

Thunder: Well, this last one may be kind of old fashioned, and it doesn't actually pertain to me exactly. But I think having a television in the bedroom, a lot of people have that. I think that could actually interfere with sleep. I've never done that, but similar to being on the phone, being on a tablet, laptop, whatever, I think having a TV on when you're in bed trying to go to sleep . . . Again, it's something to engage your mind and keep you active. So that's something I think we should consider.

Scot: And Kelly Baron, when she was on the show, talked about the bedroom is for two things. It's not to watch TV. It's to sleep and to . . . I guess we're going to go to Troy next.

Troy: And to make sweet love. Is that what you want me to say, Scot? Anyway, Scot, moving on from that, this third thing I'm going to say is something I am going to try. And I will tell you I recently celebrated a birthday. For this birthday, I received a gift, and my sister was so excited to send me this gift. She said, "This is something I heard about on the podcast." The gift I received was a toilet light. So Mitch suggested this. This is one of the gifts Mitch suggested getting.

Mitch: Yes.

Troy: And I have now been using it for about a week. It's awesome. It's got a motion sensor, Mitch. It's everything you described. You come in . . .

Mitch: I told you.

Troy: Yeah, it's so cool. It's like a joke kind of gift, but I've used it and I'm like, "I love it." You come in and it just . . . I've got it on this very dim, purple light. It just hangs over into the toilet. It just lights up the bowl like this little beacon in the night, like, "Oh, there it is." I don't have to flip on lights. I'm not struggling to find the toilet. It's great.

I think it definitely helps you to avoid those interruptions in your REM sleep where you're flipping on lights and you're too focused on the task at hand, so to speak. Instead, you've got the toilet light, great, in and out, go back to sleep.

Mitch: I love that. A couple of my friends also purchased. So I don't know how much reach we have in this podcast, but some toilet lights were bought this Christmas season because of what we were saying. And I cannot be more delighted because everyone has been saying, "This is ridiculous. I can't believe I spent $10 on this." And then the next day they're like, "It's wonderful. This is the best thing. I don't have to wake up. I don't have to turn on the lights."

Thunder: Yeah. Add me to the list. I also have a toilet light.

Scot: What?

Mitch: Yes!

Thunder: Yeah. And it is, it's awesome. The only thing that I don't like about the toilet light is it . . . or maybe it's just the one we have. When the batteries start to go low, it flashes red like a police siren.

Troy: Oh, no.

Mitch: Yeah.

Thunder: So that's the one thing. You walk in there and batteries are always like, "Flash, flash, flash." It's like, "Oh, my gosh." It's very bright red. But love it.

Mitch: It's interesting you thought police siren. I thought poltergeist the first time I woke up in the middle of the night and there was a flashing light in my bathroom. I was like, "My house is haunted. I've got to go figure this out."

Troy: Your toilet. Something is going to emerge from the toilet.

Mitch: Yeah.

Thunder: But all in all, it is really a great invention.

Troy: Well, we've got three believers here, Scot. I think you're next.

Scot: Yeah, I guess.

Troy: Now I know what I'm going to get you for your graduation.

Scot: Oh. Yeah.

Troy: Because we know that's coming up soon.

Scot: Oh. Mitch, you're taking us out with number three.

Mitch: So the last one is actually a tip for my partner, Jonathan, and it's kind of this same thing. If you have difficulty sleeping and it has something to do with not being able to turn your brain off or not being able to just let go of the anxieties of the day, the thing that he does every night as part of his sleeper team that he's come up with is he has a series of positive affirmations and mantras that he tells himself.

At the start, again, I think there's a touch of toxic masculinity where I'm just like, "You're doing what? You're positive self-talking before bed?" I don't know. I need to be better about that. But he has seen a significant . . .

Scot: Go ahead and incorporate that into your self-talking.

Mitch: Right. I've got to bring that in to me, right? But he's found a lot of real benefit from it. And I've been trying it out recently where it's just . . . If you are someone who's struggling with any sort of negative self-talk or any sort of . . . if you go to bed and you replay the bad moments that happened through the day, if that's you, this has been really helpful.

And it sounds cheesy and it feels ridiculous. You're looking in the mirror telling yourself something, but it works for him. And since I've been doing it, I've been finding myself able to go to sleep faster.

Thunder: Mitch, I think that's awesome because I think we're good at being hard on ourselves about different things and replaying those in our mind, but we're not good at the opposite, patting ourselves on the back when we need to.

Scot: This turned out to be a far more entertaining show than I could have expected.

Mitch: Not the snooze fest?

Scot: Yeah, not the snooze fest I thought it was going to be. I was like, "What are we going to talk about?" But I think we've learned a lot about each other.

Troy: And I'm so glad you shared, Scot. I'm so intrigued by your sleep techniques. Anyway, it's definitely been entertaining.

Scot: Yes. It's been a good show. So I think the takeaway is that the Core Four . . . Sleep is one of them. And a lot of times, if you get your activity, and your nutrition, and your mental health right, the sleep will take care of itself. But sometimes it doesn't. Sometimes maybe the sleep is the first thing that you need to tackle.

The Core Four don't live in isolation. They all impact each other. And like Mitch explained to us, how sleep impacts those other three for him is absolutely huge.

So hopefully you got some good tips here. Hopefully you have a better understanding of the importance of sleep, and thanks for listening.

We are going to talk about next week, in our "Back to Basics: Core Four" series, mental health. So that'll be next.

If you have a technique that you would like to share, you can get a hold of us. It's so easy.

Troy: Yeah. You can reach out to us, hello@thescoperadio.com. We're on Facebook, facebook.com/whocaresmenshealth. Call our listener line, 601-55SCOPE. I would love to hear who is going to try Scot's elevation of the knee technique tonight when they can't sleep and tell us if it worked. I'm going to try it, Scot. If I can't sleep, I'm trying it, and I'm going to give feedback.

Scot: All right. I look forward to that.

Thunder: I'm going to try the color technique.

Mitch: Oh, yeah.

Troy: The color technique. I'm going to start with color and then I'm going to move on to knees. That's my strategy.

Scot: I'm glad I had an influence on you guys today.

Troy: You did.

Scot: As always, it's awesome. Thanks for listening and thanks for caring about men's health.